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Insider Arthritis Tips April 2012
April 15, 2012

"Obstacles cannot crush me. Every obstacle yields to stern resolve." -- Leonardo da Vinci, Artist

Aspirin Cuts Cancer Risk

Simeon Bennett writing in Bloomberg News reported that individuals "who took a daily dose of aspirin had a 24 percent lower rate of developing cancer after three years and were 37 percent less likely to die from the disease after five years than those who didn't, according to a study in The Lancet." This "rate was similar for men and women." Two additional "studies published in The Lancet and The Lancet Oncology... showed that aspirin reduced the risk of any cancer spreading to other organs by 36 percent and certain types of tumors by 46 percent."

Comment: Aspirin… the wonder drug!

Foods Interact With Drugs

Judy Hevrdejs writing in the Chicago Tribune reported certain "foods and beverages... as well as dietary supplements (vitamins, herbals, etc.) and over-the-counter (OTC) drugs can interact with prescription drugs when they land in your gut" possibly affecting "the ability of the drug to work as it should" or producing "unwanted side effects." As the number of drugs a patient takes increases, interactions with food become more important. " A survey published in the Journal of the American Medical Association that found in the population 57 and older in the US, 'at least 80 percent use at least one prescription drug. Half of them use OTC drugs. And some use dietary supplements.'"

Comment: Always discuss your diet and Any supplements you take with your physician.

Demyelination Risk During Treatment With TNF Antagonists

Helen Albert writing in Medwire reported, "Central nervous system (CNS) demyelination risk may be higher than previously believed in psoriasis and other inflammatory disease patients taking tumor necrosis factor α (TNF) antagonists," according to a study published in the Journal of Dermatological Treatment. In the study, researchers "report data on 65 patients who experienced CNS demyelination following treatment with TNF antagonists for arthritis (rheumatoid or psoriatic), psoriasis, Crohn's disease and other inflammatory disorders." Notably, "symptoms of demyelination occurred between two and six months from TNF antagonist commencement in 42% of patients and within one year of commencement in 92% of patients."

Comment: Always a risk – maybe a small one-with TNF drugs.

Statins Hurt Ability To Exercise

Gretchen Reynolds writing in the New York Times reported "For years, physicians and scientists have been aware that statins, the most widely prescribed drugs in the world, can cause muscle aches and fatigue in some patients," but "many people don't know...that these side effects are especially pronounced in people who exercise." Reynolds points to one study in rats that found that "over all, the study data showed that working out while taking statins 'exacerbated metabolic perturbations' in muscles."

Comment: Statins can cause significant Problems so beware.

Pycnogenol Studies Too Flawed To Prove Efficacy

Anahad O’Connor writing in the New York Times reported on research into pycnogenol, which is an extract from "French pine bark" that can be made into a supplement that users claim "strengthens cardiovascular systems and eases symptoms of chronic disorders like asthma, osteoarthritis and chronic venous insufficiency." However, an overview of research on the substance published in the Cochrane Database of Systematic Reviews "found that most of the studies on the supplement were too flawed to prove its efficacy."

Comment: This is a popular supplement for arthritis. Does it work? Jury is still out.

Increasing Interest In Massage Therapy

Andrea Petersen writing in the Wall Street Journal reported on an increase of scientific interest in massage therapy. For instance, the National Center for Complementary and Alternative Medicine is spending $2.7 million on research into massage, compared with $1.5 million in 2002. According to the Journal, research has suggested that massage may improve immune function in breast cancer patients, asthma in children, and osteoarthritis. Researchers are currently studying massage as therapy for generalized anxiety disorder.

Comment: Massage is an overlooked but valuable mode of relief for arthritis.

RA Drugs Hold Promise for MS

Greg Williams writing in the UAB News reported that UAB researchers feel that a new class of drugs for rheumatoid arthritis may be useful for treating multiple sclerosis. The findings are timely because STATs are part of the JAK-STAT pathway targeted by a new class of JAK inhibitors, the first of which are expected to finish clinical trials for the treatment of rheumatoid arthritis and seek regulatory approval this year. Such drugs should be considered for the treatment of MS, say the authors, who already are conducting pre-clinical studies. STAT3-signaling is known to activate microglia and monocytes, the immune cells of the brain and macrophage scavengers that collect and dispose of damaged tissue or invading bacteria. They can promote either injury or repair in the central nervous system, depending on the signals they get.

Comment: You’ll be hearing a lot about this RA treatment in the coming months.

FDA OKs Nerve Growth Factor Studies

Emily Walker writing in MedPage Today explained that the drug makers "all agree there is a signal linking the use of anti-NGF drugs and deterioration of the joints, but they say it's caused by patients using anti-NGF drugs along with nonsteroidal anti-inflammatory drugs (NSAIDs) and have recommended that if the drugs are marketed patients not use them alongside NSAIDs." Panel "members agreed that the class of drugs is linked to joint destruction but said the evidence is not well-understood on whether anti-NGF drugs cause osteonecrosis and how they interact with other drugs."

Comment: These drugs worked too well for OA. I’m glad they’re going back into clinical trials.

Low Vitamin D Levels Increase Death In Elderly Women

Crystal Phend writing in MedPage Today reported that "low vitamin D levels, common among women in nursing homes, may raise their risk of dying within a few years, Austrian researchers found." According to the story, "women with the worst deficiency, at 14 nmol/L serum vitamin D or less, were 49% more likely to die over a period of about two years than those with the highest levels."

Comment: Vitamin D deficiency uis an epidemic in nursing homes.

Rheumatoid Arthritis Causes Increased Risk Of Atrial Fibrillation

Robert Preidt writing for Healthday commented on a study appearing in the BMJ Investigators found that people with RA had a nearly 40 percent increased risk of atrial fibrillation compared to those in the general population – - 8.2 events per 1,000 person years for those with RA and six events per 1,000 person years for the general population." In addition, participants "with RA had a more than 30 percent higher risk of stroke than those in the general population -- 7.6 events per 1,000 person years for those with RA and 5.7 events per 1,000 person years for the general population."

Comment: Sobering

Long-Term Info On Knee Replacement Outcomes Comes Up Short

John Gever writing in Medpage Today "Long-term data on total knee replacement surgery is largely limited to revision, leaving clinicians and patients in the dark about outcomes such as residual pain and disability," according to an article published in The Lancet. Researchers "outlined four directions for the future of knee replacement surgery," those being "more consistent patient selection for knee replacement, long-term monitoring with patient-oriented outcomes, as well as revision, as endpoints, approval of new designs only after large randomized trials that demonstrate cost-effectiveness as well as clinical efficacy," and "better management of young people with early arthritis to avoid need for replacement surgery." Researchers also proposed that "new treatment strategies for osteoarthritis that avoid the need for surgical joint replacement should be a 'major emphasis' for research."

Comment: We still don’t know everything we should know about joint replacement surgery.

J&J knew about Hip replacement failures

Barry Meier writing for the New York Times reported that A year before recalling an artificial hip, an executive at Johnson & Johnson reported in an internal e-mail that the FDA had refused to approve the device, after reviewing company studies that showed it had failed prematurely in “significant” numbers, requiring repeat surgeries for patients. Meier said, “The statements in that e-mail contrast with those made by the company in recent years about the all-metal hip. Before recalling the device amid rising failure rates in 2010, Johnson & Johnson insisted it was safe and maintained that its internal studies refuted complaints by surgeons and regulators abroad that the device was flawed.

Comment: Shame on J&J!! Think twice about joint replacement!

Vitamin E Can Cause Bone Loss

Mary Elizabesth Dallas reporting In Healthday wrote that according to a study published in the journal Nature Medicine, "vitamin E may stimulate cells that result in bone loss." Researchers found that "mice deficient in vitamin E actually have higher bone mass because there is less bone breakdown. Meanwhile, healthy mice that were fed a diet with the amount of vitamin E found in typical human supplements lost bone mass." Researchers emphasized that "these results are in mice and more studies are needed to see the risks and benefits in humans."

Comment: Thank you mice!

RFA For Patients With Low Back Pain?

Christina Fiore writing for MedPage Today reported On a study presented at the American Academy of Pain Medicine's annual meeting suggesting that "patients with low back pain who don't respond robustly to intra-articular steroid injections may still be candidates for treatment with radiofrequency ablation (RFA)." Investigators "conducted a retrospective study of 80 patients who underwent pre-operative intra-articular steroid injections RFA" and found that 75% of the "patients had at least 50% pain relief from the injections, while the rest had a response of 25% to 49%." Patients who reach this point usually have a poor prognosis no matter what is done.

Comment: RFA worth trying if pain is still an issue.

New safety warnings for statins

Gardiner Harris writing for the New York Times reported the Food and Drug Administration "added new safety alerts to statins," adding that it "is the first time that the" agency "has officially linked statin use with cognitive problems like forgetfulness and confusion, although some patients have reported such problems for years." The medications include "Lipitor, Zocor, Crestor and Vytorin."

Comment: First muscle problems and now this!

Knee Replacement Surgery …Less Heart Failure, Mortality

Tara Parker-Pope writing in the New York Times reported, "New research suggests that for some patients, knee replacement surgery can actually save their lives." Researchers "examined the effects of joint replacement among nearly 135,000" Medicare patients and found that "three years after diagnosis, the knee replacement patients had an 11 percent lower risk of heart failure. And after seven years, their risk of dying for any reason was 50 percent lower." Researchers cautioned, however, that the "data...are not randomized and controlled" and point out that "not every patient with knee arthritis is a candidate for joint replacement surgery."

Comment: Surprising but very encouraging!

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Thank You

I want to thank the many many people who expressed their condolences regarding my dad’s death. The outpouring of calls, words, flowers, and cards was very touching. Many of you shared your experiences and I found that extremely comforting. It’s very difficult to lose a parent…

Wei’s World April 2012

Two of our children were home from school for spring break. The other two older ones are working and didn’t have time off. It was a bit strange having the kids home. The routine my wife and I had settled into was disrupted.

Don’t get me wrong. We love our children. But Judy and I had gotten used to buying and cooking for two. And we had grown accustomed to not having to wonder how to work their routines into ours and vice versa. There’s also a certain noise level that comes with having other people in the house. The television is on more frequently, the computers are going, and so on.

But by the same token, it was nice to have them home for other reasons. Like making popcorn to munch on while watching a pay-per-view movie. Or going out to a restaurant and just talking. Or getting to know more about their lives at school, details that don’t always come out over the phone. (Certain details, I’m sure, we’ll never know… and that’s just fine).

Our son, Benji, in particular, is always helpful when it comes to running errands. So that was definitely nice to have the extra help. And our daughter Emily is a reader and is usually eager to share her thoughts on new books. Mei-Mei, our dog, also seemed to appreciate the company, particularly when it came to walk and play time.

I have to admit that when I look at our pictures of the children when they were little, I get a bit sad. While they are growing up, it’s so hectic and tiring. But when they grow up and begin leaving the house, even if it’s only to go away to school, the realization sets in that they’ll never be little again.

That time goes by so quickly. I often wish I could get those times back, to correct the mistakes I made, maybe act differently, be more patient and understanding. But that time will never come back. It’s gone forever.

That’s the thing. There is no learning manual for parents. There’s no final exam. And there are no make-ups… no do-overs. You’re left with what you did- good or bad. Our second child, Jeffrey is a performer and is constantly rehearsing before a show. But as a parent, there are no rehearsals. Everything is a final performance. No audience. But critics… yes. Our children have been especially good at that, particularly during their teen years.

Going through college, medical school, residency, fellowship, and the years of practice as a doctor is not easy. But it pales in comparison to the task of raising children.

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