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Insider Arthritis Tips December 2013
December 15, 2013

“Don't cry because it's over, smile because it happened.” ― Dr. Seuss

December Arthritis News

Less fetal risk due to immunosuppressive therapy than previously thought

Nancy Walsh writing in Medpage Today reported on a study from Vanderbilt University. Researchers found the use of immunosuppressive medications during the first trimester of pregnancy didn't significantly increase the rates of adverse fetal outcomes, analysis of three large databases found. The risk ratio for any event, such as major congenital malformation or fetal death, was 1.39 for women treated with methotrexate and 0.98 for those receiving tumor necrosis factor (TNF) inhibitors. In addition, the risk ratio was 1.33 for those with first-trimester exposure to hydroxychloroquine and 0.98 for exposure to other immunosuppressives such as sulfasalazine and azathioprine, the researchers reported. None of those differences were statistically significant, they noted.

Comment: Good news for a change.

Knee Brace Reduces Damage, Pain in Osteoarthritis

Alice Goodman writing for Medscape reported on a study from Boston University presented at the American College of Rheumatology meeting that showed a simple slip-on knee brace reduces bone marrow lesions and pain associated with osteoarthritis. It is thought that bone marrow lesions represent areas of bone trauma caused by increased focal stress across the knee. One of the goals of this study was to demonstrate that bone marrow lesions can be a viable treatment target; the other was to determine whether a knee brace can reduce pain. The 126 patients with painful knee osteoarthritis were randomized to wear a knee brace for a median of 7.35 hours per day for 6 weeks, or to not wear a brace. None of the patients participated in any exercise program over the course of the study. Pain score during activity declined about 18 points in patients wearing the brace, but there was almost no change in patients not wearing the brace. In addition bone marrow changes were significantly less in the brace group.

Comment: Simple but effective.

Intestinal Bacteria Linked to Rheumatoid Arthritis

A news release from NYU School of Medicine provided more insight into why RA may develop. Researchers have linked a species of intestinal bacteria known as Prevotella copri to the onset of rheumatoid arthritis, the first demonstration in humans that the chronic inflammatory joint disease may be mediated in part by specific intestinal bacteria. The new findings by add to the growing evidence that the trillions of microbes in our body play an important role in regulating our health. Using sophisticated DNA analysis to compare gut bacteria from fecal samples of patients with rheumatoid arthritis and healthy individuals, the researchers found that P. copri was more abundant in patients newly diagnosed with rheumatoid arthritis than in healthy individuals or patients with chronic, treated rheumatoid arthritis.

Comment: You are what you eat.

Researchers Discover Specific Inhibitor for Rheumatoid Arthritis Treatment

Collaborating with researchers from the Northwestern University School of Medicine in Chicago, a research team at Wayne State University’s School of Medicine led by Kezhong Zhang, Ph.D., discovered the key inflammatory stress response that drives the development of rheumatoid arthritis. Their studies revealed that inflammation triggers receptors on macrophages, the white blood cells that activate a protein that promotes arthritis. They then identified a specific inhibitor of that process that can prevent arthritis in animal models.

Comment: Another possible breakthrough that might lead to better treatments, I hope.

Altered Brain Circuitry May Contribute to Pain in Fibromyalgia

Reported in Healthday, patients with fibromyalgia have disrupted brain responses to pain-related reward and punishment, according to research published in Arthritis & Rheumatism. Marco L. Loggia, PhD, of Harvard Medical School in Boston, and colleagues performed functional magnetic resonance imaging (fMRI) on 31 fibromyalgia patients and 14 controls to assess neural responses to anticipation, onset, and offset of painful stimuli. The researchers found that activation of brain regions involved in pain processing was less robust in fibromyalgia patients. Compared with controls, fibromyalgia patients had decreased or absent activity in the ventral tegmental area during painful stimuli and anticipation of pain or relief from pain. "Our findings suggest that fibromyalgia patients exhibit altered brain responses to punishing and rewarding events, such as expectancy of pain and relief of pain," Loggia said in a statement. "These observations may contribute to explain the heightened sensitivity to pain, as well as the lack of effectiveness of pain medications such as opioids, observed in these patients."

Comment: Another indicator of central nervous system processing abnormalities in patients with fibromyalgia.

Patient Beliefs About Back Pain Shaped by Clinicians

Reported in Healthday, health care professionals have a substantial and lasting effect on patient attitudes and beliefs about back pain, according to research published in the the Annals of Family Medicine. Ben Darlow, of the University of Otago in Wellington, New Zealand, and colleagues analyzed data from interviews with 12 patients with acute (<6 weeks) back pain and 11 patients with chronic (>3 months) back pain to assess their attitudes and beliefs about back pain. The researchers found that health care professionals had the strongest influence on patient attitudes and beliefs about back pain, whereas the Internet, family, and friends had a lesser impact. Many messages from clinicians were interpreted as meaning the back needed to be protected and could contribute to increased vigilance, worry, guilt, or frustration for the patient. Clinician reassurance and advice were associated with increased confidence and positive effects on movement and activity, respectively. "Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain," the authors write. "It is important that this opportunity is used to positively influence attitudes and beliefs."

Comment: Much like the healers of old, physicians can influence how patients feel.

G block for knee osteoarthritis?

Although surgery is generally effective for patients with advanced osteoarthritis of the knee, individuals with multiple medical conditions may not be appropriate surgical candidates. In patients who have failed traditional therapies, radiofrequency (RF) neurotomy might be a minimally invasive treatment with low risk of complications. This procedure is based on a theory that blocking the nerve supply to a painful area may alleviate pain and restore function. Several nerves can be approached with a needle under fluoroscopic guidance. Patients can get a diagnostic nerve block to determine if this will provide adequate relief. Since the purpose is to block the genicular nerves, it is called a G block. Not a G spot or G string… a G block.

Comment: This seem to be a safe, effective, and minimally invasive procedure for chronic knee OA patients. The procedure can also be repeated if necessary when nerves regenerate. Unfortunately, it does nothing to regrow cartilage.

Joint Replacement May Help the Heart Marianne Wait writing for the Arthritis Foundation reported that people who undergo total hip or knee replacement appear to have reduced risks of heart attack, stroke and other cardiovascular events according to a study published in the journal BMJ. “Our study suggested that in persons with moderate to severe osteoarthritis of hip or knee, joint replacement was associated with a greater than 40 percent reduction in the risk for serious cardiovascular events such as heart attack and stroke,” compared with similar patients who didn’t have surgery, says study author Bheeshma Ravi, MD, resident physician in the division of orthopaedic surgery at University of Toronto. For the study, researchers in Ontario, Canada, looked at adults with moderate to severe hip or knee osteoarthritis. They matched 153 patients who went on to receive a joint replacement with 153 who did not, pairing people who had similar health profiles in terms of age, weight, smoking status, arthritis severity, etc. Then they looked at the rate of serious cardiac events, including heart attack, heart failure and stroke, in both groups over a period of seven years. They found knee replacements were associated with a 54 percent reduction in heart risk, and hip replacements with a 39 percent reduction, says Dr. Ravi.

Comment: Interesting and provocative.

Gum disease bacteria linked to rheumatoid arthritis

In an article published in PLOS Pathogens, University of Louisville School of Dentistry Oral Health and Systemic Diseases group researcher Jan Potempa, and an international team of scientists from the European Union’s Gums and Joints project have uncovered how the bacterium responsible for periodontal disease, Porphyromonas gingivalis worsens RA by leading to earlier onset, faster progression and greater severity of the disease, including increased bone and cartilage destruction. The scientists found that P. gingivalis produces a unique enzyme PAD. PAD changes residues of certain proteins leading to an immune attack. In RA patients, the subsequent result is chronic inflammation responsible for bone and cartilage destruction within the joints.

Comment: Perhaps a clue that will lead to better treatment?

Metabolic syndrome associated with osteoarthritis of the knee, but not the hip

An article presented by Anita Wluka from MONASH University in Melbourne showed that people who have metabolic syndrome which consists of elevated blood lipids, hypertension, elevated blood sugar, and obesity is a major risk factor for knee osteoarthritis. Interestingly, it was not predictive for hip osteoarthritis.

Comment: Not very surprising but important to recognize.

Skin abnormalities source of fibromyalgia

A study from the Albany Medical College published in Pain Medicine provided an interesting set of findings. The investigators biopsied the palms of patients with fibromyalgia and found an excessive number of nerve fibers involved in temperature regulation. This may contribute to pain in the hands, altered blood flow to the muscles and abnormalities in circadian blood flow leading to fatigue, pain, and sleep disturbances.

Comment: Interesting and provocative.

MR-Guided Focused Ultrasound for the Management of Osteoarthritic Knee Pain

A Japanese study published in BMC Musculoskeletal Disorders and reported in Medscape showed that local bone denervation by MR-guided focused ultrasound has been demonstrated as a promising tool for pain relief of bone metastases. Eight patients with medial knee pain and eligible for total knee replacement were included. MR-guided focused sonication treatments were applied the target sites. The pain intensity during walking was assessed on a 100 mm visual analog scale (VAS) before and after treatment. Six patients showed immediate pain alleviation after treatment, and four of them demonstrated long-lasting effect at 6-month follow up. There were no adverse side effects or complications during and after treatment.

Comment: This therapy is promising and innovative. It’s a pretty small sample size though.

New Hips More Troublesome in RA Than OA

Nancy Walsh writing in Medpage Today reported that patients with rheumatoid arthritis were at higher risk than those with osteoarthritis for adverse outcomes following joint replacement surgery, a Canadian study found. After adjustment for potential confounders, having a diagnosis of rheumatoid arthritis was a significant and independent predictor of dislocation following total hip arthroplasty, with a risk almost double that for osteoarthritis, according to Bheeshma Ravi, MD, of the University of Toronto, and colleagues. Patients with rheumatoid arthritis also were at greater risk for developing an infection after total knee arthroplasty, the researchers reported in Arthritis and Rheumatism.

Comment: A disturbing finding for sure.

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 Arthritis Pain Relief for Winter Weather


Dress warmly, work out inside, and get enough vitamin D. These are some of the ways you can get arthritis pain relief despite the bone-chilling cold of winter weather.


By Madeline Vann, MPH

 Medically reviewed by Lindsey Marcellin, MD, MPH


Though there’s not much scientific data to support the joint pain and weather connection, you can still use these arthritis pain relief tips when your aching joints act up in winter:

Dress warmly. If it’s cold outside, keep yourself warm with gloves over hands that ache and added layers over knees and legs.

Exercise inside. A study published in the Journal of Physical Activity and Health that measured physical activity in 241 adults with arthritis living in Chicago (a city known for its bitterly cold winters) found that the amount of sedentary time increased by over three hours between November and June. But while it's understandable to want to avoid winter chill, people with joint pain should still stay active — and the best way is with an indoor exercise plan.

Enjoy warm water. Swimming in a heated pool is both great exercise and soothing to joints. You can also get relief from warm baths. Just don’t go right out into the cold after your soak. Let your body temperature normalize a bit first.

Supplement vitamin D. Being deficient in vitamin D might make osteoarthritis worse.  You are less likely to get enough vitamin D in the winter, so this is a good time to take a supplement or make sure your diet is vitamin D-rich.


How to Be Supplement Savvy


Stay safe. Particularly when the weather turns icy, people with arthritis need to protect their joints from further damage. If you’re going outside, pick solid, supportive shoes with good treads and try to walk on a surface that doesn’t look icy.

Try a glucosamine-chondroitin supplement. Although there are no herbal supplements that have been proven to provide arthritis pain relief in clinical studies, some patients do report relief from these supplements.

Add fish oil. Omega-3 fatty acids do have some benefit because they seem to reduce the level of inflammation. You need about 2,000 to 3,000 milligrams a day to get benefits.  Make sure to let your doctor know if you try omega-3s, as they can increase the risk of bruising or bleeding.

Take NSAIDs. Even if you prefer to treat your joint pain with lifestyle changes rather than medication, it’s okay to take an over-the-counter pain reliever when your joint pain is worse due to the weather.

Get a massage. Yes, you have permission to indulge yourself.  Massage can help ease those cramped muscles.

Go under the needle. Acupuncture is another option for those willing to consider non-traditional treatments. You may need several sessions to get the joint pain relief you seek.


 The Magic of Massage


So when your joints start to warn you of miserable weather ahead, plan a toasty warm schedule of indoor exercise, cozy clothing, and treats such as massage to get through the oncoming cold spell.

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Chocolate Bread Pudding
Michael Paul

Makes 8 servings, with leftovers| Hands-On Time: 15m| Total Time: 2hr 00m


  • 4 cups milk
  • 4 eggs
  • 1/2 cup sugar
  • 8 tablespoons butter or margarine
  • 12 ounces semisweet chocolate chips
  • 1 tablespoon vanilla extract
  • 1 loaf white bread, crusts trimmed
  • 1 pint heavy cream, whipped


  1. Whisk the milk, eggs, and sugar in a medium saucepan. Add the butter and chocolate and heat over low heat, stirring only until the butter and chocolate melt. Stir in the vanilla.
  2. Lightly coat a 13-by-9-inch baking dish with cooking spray. Arrange the bread slices in 3 layers. Pour the chocolate sauce over the bread.
  3. Cover with plastic wrap and place another baking dish on top to weigh down the bread. Set aside for 1 hour to allow the bread to absorb the sauce. (Can be made to this point up to 1 day ahead. Refrigerate.) Heat oven to 325° F.
  4. Remove the top baking dish and plastic. Bake uncovered 35 to 40 minutes or until set. Serve warm with whipped cream.
  5. To fake It...and save 1 hour, 10 minutes: Thaw two 13-ounce packages frozen French toast and cut into 1 ½-inch cubes.
  6. Heat oven to 325° F.
  7. Lightly coat a 13-by 9-inch baking dish with cooking spray.
  8. Place the toast in the dish. Beat 4 cups milk, one 12-ounce can chocolate syrup, and 2 eggs; pour over the toast.
  9. Cover with foil and bake 10 minutes. Remove foil and stir.
  10. Bake, uncovered, 20 to 25 minutes longer or until set. Serve warm with canned whipped cream. Total time: 50 minutes.

Joint Food

Joint Food is the purest preparation of glucosamine and chondroitin available. Studies show that people who take pure forms of glucosamine and chondroitin experience pain relief and improvement in joint function.

Joint Food is based on the German formula and is available in Europe today—only by prescription.

The effectiveness of glucosamine and chondroitin products, used as a treatment for osteoarthritis, is proven. You may need to take the supplements for at least two months before noticing marked improvement.

There are no side effects… no drug interactions… and you may even be able to reduce your dose of NSAIDs.

Glucosamine supplements do not interfere with any NSAIDs, aspirin, Tylenol, or other anti-inflammatory or analgesic medicines and continued use of the supplements will not lead to progressive joint destruction, GI upset or bleeding, or strain on the liver and kidneys.>

Experience improved joint function and pain relief by taking Joint Food.

PPurchase a two month supply for $71.

Save $20

You can join the auto-ship club and save even more money! Plus, it’s delivered right to your door with no additional shipping fees./p>

Call our product specialist at 301-694-5800 for more information.

Wei’s World December 2013

It was about four days after Labor Day when I noticed. I guess it had been up even before but this was the first time I really saw it. A Christmas decoration.

Don’t get me wrong. I have wonderful memories of Christmas from when I was a child. My early years were spent growing up in central New York State and we usually had a lot of snow by then.

My siblings and I so looked forward to Christmas. The trees (I can remember Xmas trees costing three dollars then), Santa, the Nativity, the wreaths and other decorations, the time off from school… We didn’t even mind going to church because we knew all the hymns would be Christmas carols. We had Christmas pageants and we all had a chance to play the Wise Men, or other characters. The baby Jesus was usually someone’s doll.

I always spent the week before Christmas reading A Christmas Carol.

But I don’t remember all this emphasis on Christmas occurring until … well… until near Christmas.

Now it seems Christmas stuff goes up when school starts in September. And not only has the emphasis shifted from this being a religious holiday but even Santa has been lost in the shuffle.

How a fat guy with eight reindeer and a troop full of elves gets lost in the shuffle is beyond me.

Now Christmas has morphed into an opportunity for people to spend money they don’t have on things they don’t need so they can go into a lot more debt.

I understand businesses see this as an opportunity to make a profit. And this time of year is when they have a chance to make up for all the other dead times of the year. But give me a break!

I’m sure Walmart wasn’t around 2,000 years ago.

I guess I’m irritated because the meaning of Christmas appears to have been lost amidst the flurry of Black Friday, Cyber Monday, and whatever. It’s sort of like where I live in the suburbs of Washington. The area between Washington and Baltimore appears to be coalescing into one big metropolitan area.

Maybe that‘s what’s happening with the holidays. Labor Day seems to be melding into New Years. Eventually we’ll just have this one holiday… imagine that!

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