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Insider Arthritis Tips, September 2008-Supplements and
September 15, 2008

Hope your summer has gone well...

This month's issue has a couple of interesting articles and I really hope you get alot out of it.

As many of my patients, but none of the readers of this newsletter know, our third child, Benji, has arthritis. He was 10 years old when he was diagnosed. Fortunately, he sees an excellent pediatric rheumatologist in New York and now, at age 17, is in complete remission. Benji, who has always loved soccer, has played for and been cut from a couple of club soccer teams.

Once, it was related to his arthritis- he wasnít able to keep up anymore. Another time, he simply didnít make it. The competition was too good. Benji doesnít take failure well. His self esteem really takes a hit. As a dad, I know I push himÖ but I do it knowing that the price of succeeding is to fail first. Hereís the paradox of life: in order to succeed, you first must fail.

Failure is important because it teaches you what you need to do to eventually succeed. In my life, I have failed many more times than I have succeeded. Did failure feel good? Of course not! Was it necessary? Absolutely! Because, in looking back, I see that it was failure that eventually allowed me to become successful. The important lesson I try to transmit to my kidsÖ and to my patients is this: donít be afraid to try something because youíre worried you might fail. The only way to succeed is to fail, get yourself back up on your feet, and try again using the lessons youíve learned.

Table of contents


Dietary supplement labels... what do they mean?

My doctor wants to give me a cortisone shot... what are the side-effects?


This month I'll discuss two important situations patients with arthritis may encounter... how to decipher those labels on supplements and cortisone shots.

If you have any questions just shoot me an email...

How to read a dietary supplement label if you have arthritis

Today, more than ever, dietary supplements are being sold and being consumed by patients with arthritis. Unfortunately, many people don't know how to read a dietary supplement label. This article that is part one of a three part series discusses how to do that.

All dietary supplements sold in this country must contain certain information.

Supplement facts: This is a heading that should be on any label.

Serving size: How much to take. The amount of each dietary ingredient in each serving is listed here. Either the per cent of daily value (for example, "percent of FDSA recommended daily intake from all food sources of vitamin C in each tablet of a multivitamin") or if there is no recognized daily value, by weight in each serving (for example, "50 milligrams standardized buckwheat extract").

Statement of identity: What the product is (for example, pure buckwheat).

Name and place of business of manufacturer, packer, or distributor.

Other information to look for include:

Warnings and cautions: Who should not take the product, or who should be careful when taking it (for example, pregnant women).

Interactions and side effects: Any possible reactions that it might have with prescription and over-the-counter medicines, as well as foods and other dietary supplements.

Expiration date: If necessary, the date after which the product should no longer be used.

My doctor wants to give me a cortisone shot... what are the side-effects?

Cortisone injections are an accepted part of care for certain types of arthritis. This article discusses some of the things you should know about them.

"Cortisone" is a term commonly used to describe an anti-inflammatory steroid medicine. These medicines - given by injection directly into a pain, inflamed joint- are often used to treat arthritis. The types of arthritis where these injections are used most often are rheumatoid arthritis (RA), osteoarthritis, gout, pseudogout, psoriatic arthritis, and ankylosing spondylitis.

If a patient has one or two... or even three inflamed joints, steroid injection can be useful. However, if a patient has many swollen joints, as can occur with rheumatoid arthritis, then steroid injection for all the swollen joints is not practical. In an inflamed joint though, removal of joint fluid and injection of steroid medication can alleviate pain and swelling almost miraculously!

Depending on the size of the joint, needle size will vary. For small joints, small needles; for larger joints, larger needles. Larger joints will also be the ones that will have joint fluid. A larger bore needle is needed so that fluid can be withdrawn.

Caution should be exercised. An inflamed joint should have the fluid withdrawn and cultured to ensure the joint is not infected. Injections of steroid too frequently (more than 3 times a year into the same joint), can cause side effects such as weakening of cartilage leading to osteoarthritis, and thinning of the skin.

In addition, too much steroid given over an extended period of time can lead to osteoporosis. An injection, as with any invasive procedure, has the potential to cause infection so sterile technique must be observed.

If a patient with rheumatoid arthritis requires frequent steroid injection, then this is an indication that the background medication therapies are not doing their job. In patients with rheumatoid arthritis this may mean the need for higher doses of methotrexate or the institution of biologic therapy. In other words, steroid injections- at least in RA- are not the primary mode of treatment for the disease. Steroid injections are adjunctive therapies.

These injections should be administered by an experience rheumatologist or orthopedic surgeon. Ultrasound or fluoroscopy are imaging techniques that should be used to ensure accurate placement of the needle into the joint.

Informed consent is an important part of the injection process. The procedure should be explained to the patient. The patient should be provided with the alternatives to injection as well as a list of potential side effects.

Arthritis tip of the month:

If you have hand or wrist problems, do this the next time you go to the supermarket...

Ask for groceries in a paper bag. You can carry paper bags between your forearms and hips, which reduces the strain on the hands and wrists you experience if using plastic bags.

Not only does this protect your hands and wrists, but it is good for the environment!

Thatís it for this month. Hope itís been helpful.

I'll be back next month with more news.

Nathan Wei, MD, FACP, FACR

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Insider Arthritis Tips A monthly ezine on arthritis written by a board-certified rheumatologist with tons of excellent and useful information for anyone interested in arthritis

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