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Insider Arthritis Tips September 2014
September 15, 2014

I'm sorry, if you were right, I'd agree with you.

Robin Williams

Note: A fantastic talent who will be missed.

Here’s another reason to lose weight if you have RA…

Patients With Early RA Who Are Overweight May Be Less Likely To Achieve Rapid Disease Control

Nancy Walsh writing in MedPage Today reported that research published in Annals of the Rheumatic Diseases suggests that individuals “diagnosed with early rheumatoid arthritis who were overweight were less likely to achieve rapid disease control.” Investigators found that “those whose body mass index (BMI) was 25 kg/m2 or higher at the time of diagnosis had a 33% lower likelihood of reaching low disease activity by 3 months than those of normal weight.” The data indicated that “by 6 months, they had a 51% lower chance of achieving this state.”

Comment: Yes I know I sound like a broken record but obesity aggravates everything.

Do you take statins? Do your muscles ache? You’re not alone

Muscle pain not well defined in most statin studies

Shereen Jegtvig writing for Reuters reported that studies evaluating cholesterol-lowering drugs might find more muscle problems if they did a better job of defining and asking about muscle pain, suggests a new review. Researchers say 10 to 25 percent of real-world patients on statins report having muscle problems, but clinical trials consider these side effects to be rare. “A lot of patients complain about . . . muscle aching while they’re on statins,” Dr. Paul D. Thompson told Reuters Health. Thompson, who worked on the study, is chief of cardiology at Hartford Hospital in Connecticut.

Comment: I see at least one patient a day who complains of muscle aches while on statins.

RA patients live longer than they used to … here is one reason

Mortality reduced in RA patients who maintained methotrexate therapy

Reported in Helio, an article published in Clinical and experimental rheumatology, researchers in Germany analyzed data on 271 patients with rheumatoid arthritis who had started methotrexate treatment between 1980 and 1987. Modified American College of Rheumatology 20 (ACR20) response was used to measure response to MTX treatment 1 year after baseline. Follow-up data were available for 250 patients up to 18 years. Of those patients, 66% had a ≥20% response rate at 1 year (responders), 20% were considered nonresponders, and 14% had stopped MTX treatment because of lack of efficacy or adverse events including nausea, vomiting or mouth sores. Sixty-one percent of patients maintained MTX treatment at 10 years after baseline. Responders had a 1.6 mortality ratio compared with a 3.2 ratio among non-responders after 18 years.

Comment: By reducing systemic inflammation, there is a lower incidence of cardiovascular mortality.

Disturbing news for men on statins… next

Older Men on Statins Found Less Physically Active

Reported in Healthday, this item…Among older, community-dwelling men, use of statins is associated with modestly lower levels of physical activity, according to research published in JAMA Internal Medicine. David S.H. Lee, Pharm.D., Ph.D., of the Oregon State University in Portland, and colleagues assessed the association between statin use and physical activity among men, aged 65 years and older, who were participating in the Osteoporotic Fractures in Men Study. Among 3,071 men (half of whom were statin users), statin users versus statin nonusers expended fewer metabolic equivalents and engaged in less moderate physical activity, less vigorous physical activity, and more sedentary behavior.

Comment: This study poses serious questions as to the cost benefit of using statins.

Another serious risk of low vitamin D… next

Low vitamin D levels increase risk of premature death

Reported in Science World Report, a recent study conducted by researchers at the University of California, San Diego School of Medicine, found that inadequate levels of vitamin D can increase the risk of premature death. According to the study, published in the American Journal of Public Health, researchers found that participants with lower levels of vitamin D in their blood were up to two times more likely to die prematurely compared to those who had higher levels of the vitamin.

Comment: It is no secret that certain vitamins and minerals can play a critical role in our everyday health. This is a good look again at vitamin D.

A huge problem associated with Sjogren’s disease… next

Heart Attack Risk Increased in Sjogrens’ Patients

Nancy Walsh writing for Medpage Today reported patients with Sjogren's syndrome, an autoimmune condition characterized by inflammation of the tear ducts and salivary glands, had more than double the heart attack risk seen in the general population, a researcher reported here. Compared with matched controls, patients with Sjogren's syndrome had an incident rate ratio for myocardial infarction (MI) of 2.19, according to Antonio Avina-Zubieta, MD ,PhD, of the University of British Columbia in Vancouver. Avina-Zubieta and colleagues also found a nonsignificant trend toward increased stroke risk among patients with the condition, he reported at the annual European Congress of Rheumatology meeting.

Comment: Very disturbing news and prompts the need for more aggressive treatment.

An unexpected complication of gout… next

ED May Be Common In Men Suffering From Gout

Alice Goodman writing for Medscape reported that according to research presented at the European League Against Rheumatism Congress 2014, “erectile dysfunction (ED) is common and often severe in men suffering from gout.” The study “included 201 men aged 18 to 89 years who presented at a rheumatology clinic between August 2010 and May 2013,” 83 of whom suffered from gout. Researchers found that “the presence of ED was significantly more frequent in gout patients aged 65 years or older, compared with men of the same age without gout, and was significantly more likely to be severe.

Comment: If you’re a man with gout, you might want to pay attention to those ED commercials on TV.

Osteoporosis fractures and diabetes… what’s the connection? next...

Research Suggests TZDs And Sulfonylureas Both Increase Risk For Fractures Compared With Metformin

Miriam writing in Medscape reported that research suggests that “the oral diabetes drug classes of thiazolidinediones (TZDs) and sulfonylureas both boost the risk for fractures compared with metformin.” This research “confirms previous findings of increased fracture risk with TZDs but is the first to compare multiple classes of glucose-lowering agents and the first to suggest a possible increased fracture risk for sulfonylureas, Sandhya Mehta, PhD...told the American Diabetes Association (ADA) 2014 Scientific Sessions.”

Comment: Makes you almost afraid to take any medicine, huh

You are what you eat unless you have psoriatic arthritis… next

Gut Inflammation Tied To Worsening SpA

Mitchell Zoler writing for Rheumatology News reported that according to the results of a 63-patient study presented at the annual European Congress of Rheumatology, “among patients with newly diagnosed spondyloarthritis [SpA], microscopic gut inflammation at baseline was linked to a two-fold higher rate of anti-TNF treatment initiation.” The study found that “SpA patients with microscopic gut inflammation initiated anti–tumor necrosis factor (TNF) therapy roughly twice as quickly as those without gut inflammation at each time period examined – at six, 12, and 18 months after their initial diagnosis.” After the 18-month point, “56% of patients with inflammation were on treatment with an anti-TNF agent, compared with almost 29% of the followed patients without microscopic gut inflammation.”

Comment: Gut inflammation due to microbes is linked to rheumatoid arthritis… and maybe now another form of arthritis.

So… are steroids being used more or less in rheumatoid arthritis nowadays…

Steroid Use in RA More Common

Nancy Walsh writing in Medpage Today reported that more patients with rheumatoid arthritis today are initiating treatment with glucocorticoids (GCs) early in the course of disease than was the case 20 years ago, a retrospective study found. During the first year of disease, 68% of patients diagnosed with rheumatoid arthritis between 1995 and 2007 started GCs compared with 36% of those diagnosed between 1980 and 1994 (P<0.001), according to Ashima Makol, MD, and colleagues from the Mayo Clinic in Rochester, Minn. However, the doses have remained similar, with mean starting doses of 8.7 mg/day and 10.3 mg/day in the later and earlier cohorts, respectively. These findings may reflect shifting patterns of rheumatoid arthritis treatment, away from a "step-up" approach toward an early, aggressive, treat-to-target approach.

Comment: Personally, I think low dose prednisone is a good bridge to use.

What effect do arthritis drugs have on fertility? Coming up next…

RA Meds Can Lower Fertility

Nancy Walsh writing in Medpage Today reported the use of prednisone and nonsteroidal anti-inflammatory drugs (NSAIDs) may contribute to the subfertility common among women with rheumatoid arthritis, Dutch researchers found. In a multivariate analysis, preconception use of prednisone was associated with a 39% reduction in the likelihood of pregnancy, according to Jenny Brouwer, a PhD candidate, and her colleagues at Erasmus Medical Center in Rotterdam. And NSAID use preconception was associated with a 34% decreased chance of pregnancy, the researchers reported online in Annals of the Rheumatic Diseases. Retrospective studies and registries have demonstrated that women with rheumatoid arthritis typically have a harder time conceiving than healthy women.

Comment: Another risk and benefit to consider.

Are some people predisposed to hurt? The answer next…

Innate immune response cause of chronic multisite musculoskeletal pain

Lucy Piper writing in medwireNews reported that an enhanced innate immune response may be an indicator of the onset of chronic, multisite musculoskeletal pain, cross-sectional study findings suggest. The study researchers found that 307 patients with chronic, multisite musculoskeletal pain had significantly higher levels of a number of lipopolysaccharide (LPS)-stimulated pro-inflammatory cytokines than 400 individuals without such pain after taking into account lifestyle and disease variables. What this means is that there is an exaggerated response to a trigger that causes inflammatory proteins to go haywire. This finding indicates an enhanced innate immune response, which the researchers say may “reflect a disposition to respond with pro-inflammatory cytokines that may induce central sensitization and contribute to pain hypersensitivity.”

Comment: Whew. A lot of big words but what it means is that there are some people predisposed to getting pain.

Natural arthritis treatment from Malaysia next…

Traditional anti-inflammatory developed in Malaysia

A GROUP of researchers from Universiti Sains Malaysia here has developed an anti-inflammatory agent specifically to control arthritis. Known as eusinorthec, the anti-inflammatory supplement is able to suppress the expression of inflammatory genes as well as the production of its mediators. It is made from Orthosiphon Stamineus (locally known as "misai kucing") which has been traditionally used to relieve inflammation. Team leader Dr Yam Mun Fei said the product was an alternative to the contemporary non-steroidal anti-inflammatory drugs, which could have side effects.

Comment: A natural supplement with few side effects. Looks promising.

Are you feeling sluggish?

Do you have trouble finding energy just to do everyday tasks?   

Do you wish you had just a little more energy to accomplish more in your day?


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  • Boosts stamina, energy and vitality

  • Promotes endurance and positive mood

  • Works to combat exhaustion due to adrenal gland health

  • Eases feelings of being overwhelmed

  • Helps fight stress

  • Promotes healthy adrenal hormones

  • Fosters healthy immune system function

  • Lifts that "run-down" feeling

  • Contributes to the metabolism of carbohydrates and fatty acids

  • Enhances quality of life and well being


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Now instead of dragging your "half dead" body through the day, you can keep going strong from sun up to sun down with Arthritis Natural Energy Boost. Unlike other formulas, this breakthrough actually works at the cellular level to deliver more energy to your very "core" so you feel alive and full of vitality whatever comes your way!!


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Untitled 1

Kale Frittata With Tomato And Basil

Courtesy of the American Institute for Cancer Research.

  • 1 Tbsp. olive oil

  • 1 cup chopped kale

  • 1/2 cup finely chopped onion

  • 9 large eggs

  • ½ tsp salt

  • ¼ tsp black pepper

  • ½ cup halved cherry tomatoes

  • 2 Tbsp. chopped fresh basil or 1/2 tsp. dried basil, or to taste

  • 1/3 cup grated Parmesan or Romano cheese, divided


9-inch or 10-inch iron, nonstick or regular, ovenproof skillet heat oil over medium-high heat. (If using a regular or cast iron skillet, make sure the sides are coated with oil.) Sauté kale and onion until wilted, about 3 minutes.


In large bowl, whisk together eggs, half of cheese, salt and pepper.


Stir kale and onion into egg mixture and then return egg mixture to skillet. Sprinkle in tomatoes, basil and remaining cheese. Turn heat down to medium to medium-low and cook uncovered for 10-12 minutes or until frittata is just about set. While cooking, pre-heat broiler.


Remove skillet from burner and place under oven broiler until frittata top turns light golden brown, about 1 minute. Remove from broiler and let frittata rest a minute before cutting into wedges. Serve hot, cold or at room temperature.


Makes 6 servings.  Nutritional values per serving: 168 calories, 11 g total fat, 4 g saturated fat, 289 mg sodium, 4 g carbohydrate 12 g protein 

Did you know…

  1. It takes 17 muscles to smile and 43 to frown!

  2. You are about a half inch taller in the morning than you are before you go to bed!

  3. The strongest muscle in your body is your tongue!

  4. The smallest muscle in your body is the stapedius, deep inside the ear!

  5. Your body has 650 muscles. They make up nearly half of your total body weight!

  6. Your body has about 60,000 miles of blood vessels, which is enough to stretch more than two times around the earth!

  7. When you sneeze, you produce wind that travels more than 100 miles per hour!

  8. During your lifetime, your mouth will make enough saliva to fill two swimming pools!

  9. Your body gives off enough heat in 30 minutes to boil a half gallon of water!

  10. It is not possible to tickle yourself!

  11. The purpose of eyebrows is to keep sweat from running into your eyes!

  12. Around 20% of the oxygen you breathe goes to your brain!

  13. During your lifetime, your kidneys will clean over 1 million gallons of blood!

  14. The aorta is the largest artery in the body. It's about as wide as a garden hose!

  15. Your body releases about a half liter of water every day through breathing!

  16. Nerve signals to and from your brain can travel as fast as 170 miles per hour!

  17. 80% of your brain is water!

  18. Your heart creates enough pressure to squirt blood 30 feet!

  19. The average person breathes about 76 millions gallons of air in their lifetime!

  20. It takes about 1 minute for a red blood cell to circulate around the whole body!


Stop Fatigue Before it Starts

The Arthritis Foundation


Because fatigue can be caused by multiple sources, relieving that run-down feeling involves treating the main underlying issue.  For example, managing your arthritis pain or treating depression, anemia or thyroid disease can, in turn, alleviate fatigue.  While you should always talk to your doctor about appropriate treatment, there are some simple things you can do on your own.


Understand your triggers - Knowing what makes you feel tired can help you avoid fatigue.  Try keeping a fatigue diary to see if you can identify a pattern.


Get Active - Exercise can help you feel better.  When you get moving, your body releases endorphins, which improve energy levels and can help improve nighttime sleep.


Pace yourself - Allow time for rest between activities throughout the day, and plan strenuous or stressful tasks for times when you have the most energy.


Seek assistance – Do not try to do everything on your own.  Get family members to help around the house or hire a housecleaner, and use assistive devices such as canes and reachers.


Adjust your lifestyle - Exercising, maintaining a healthy weight, getting enough sleep and eating a healthy diet can help maintain your energy level.

Wei's World, September 2014

In July, I visited the Big Island of Hawaii. “Hawaii” is actually a chain of islands with the Big Island being, of course… the biggest. The reason I was there was because I was invited to give a talk about a new treatment for osteoarthritis of the knee we had done research on. The presentation was given to orthopedic surgeons attending the Western Orthopedic Association annual meeting.

While I had been to Hawaii before, both my visits had been to the island of Maui. My wife and youngest child came along on the trip.

I didn’t know what to expect from the Big Island. It was a very pleasant surprise. It has eleven different climates with two soaring mountains (one is actually an active volcano) in the middle of the island. The east coast of the island is lush, green, with majestic waterfalls, and gets a lot of rain. The west coast, where we stayed, gets more than 350 days of sunshine a year. The island is basically a big lava field and continues to grow since the one volcano remains active with frequent lava flows.

We decided to forego most of the touristy things and wanted to explore the “real” Hawaii. We had the opportunity to visit a coffee plantation and a chocolate farm. Our daughter was able to go horseback riding at one of the horse ranches. What was interesting was that the ranch was in and above the clouds. So we encountered a fine mist as we drove around the ranch.

And we got to snorkel. The coral reefs near the hotel were teeming with tropical fish and enormous turtles so it was convenient just to snorkel right from the beach. The food was delicious. As you might imagine, Hawaii has fresh fish. So that’s what we ate… and a lot of it!

The highlight of our trip was a helicopter tour of the island. We got to see the smoking lava fields up close and also saw the highlands where the cattle and horse ranches are located. Also, we had a bird’s eye view of the east coast of the island which we didn’t get to visit while on land.

But another highlight was my hat. I saw a hat in a store that I really liked. Both my wife as well as my older daughter via cell phone expressed their displeasure vehemently. (“ Daaaaad…..” ) But I liked it and I got it. And I’m wearing it no matter what. They teased me that Crocodile Dundee had called and wanted his hat back. I didn’t care.

Everyone we met was friendly and helpful. The people of Hawaii are a mix of many different cultures. And we found the history of Hawaii to be fascinating. In a previous Wei’s World, I commented about the lack of Asians in the musical theater industry. Well… just the opposite is true in Hawaii where Asians are the majority.

So what did I think of the trip? When people describe Hawaii as a paradise, I agree… particularly when it comes to the Big Island.

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