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Insider Arthritis Tips July 2013
July 15, 2013

"A happy family is but an earlier heaven." -- George Bernard Shaw, Playwright

July Arthritis News

Relationship between gout and kidney disease strong

Chronic kidney disease is associated with gout. Many uric acid lowering drugs used to treat gout require lower doses in patients with poorly functioning kidneys and they may have toxic effects on the kidneys. Based on the National Health and Nutrition Examination Surveys between 1988 and 1994 and published in Seminars in Arthritis and Rheumatism, investigators came to two conclusions. There is an increased incidence of gout in patients with chronic kidney disease and protein in the urine suggests a higher prevalence of gout.

Comment: Not really new news to those of us who see these kinds of patients.

Serious infections occur in elderly RA patients

Rosemary Frei writing in Value-Based Care in Rheumatology reported on a recent study which showed that severe respiratory infections occurred at a rate of more than 2 per 100 patients with rheumatoid arthritis followed for 1 year. The greatest increases in infection were associated with medications. Predictors of infection included living in rural areas, having past infections, and other serious medical conditions. Having a past infection increased risk of developing a serious infection in 51 per cent of patients.

Comment: Worrisome problem, no doubt.

Sugar Injections May Improve Symptoms In Patients With Knee OA

Nancy Walsh writing in MedPage Today reported, “Injection of a sugar solution into the joint significantly improved quality of life among patients with osteoarthritis in the knee,” according to a study published in the Annals of Family Medicine. Investigators found that “in patients who underwent the dextrose injections – a treatment known as prolotherapy – scores on a knee-specific quality of life scale at 1 year had risen by 15.32 points, which represented a 24% improvement.” Comparatively, those who received “saline injections had increases of 7.59 points and those who followed an exercise program showed increases of 8.24 points.”

Comment: Prolotherapy has been around for more than one hundred years. It’s roots actually date back to the time of Hippocrates. It is worth a try.

New Technologies Help Patients Stick to Pill-Taking Schedule

Hay writing in the Wall Street Journal reported on new technologies that companies are developing that will encourage people to take their prescription medication as directed. Health insurers and companies such as CVS have used robo-calls, mailers and even face-to-face meetings with pharmacists to keep patients on track. Now, CVS is testing analytics technology from RxAnte that detects what patients have poor record of adherence, according to CEO Josh Benner. Other ideas include an app that rewards users with Target gift cards or donations to charity for following the schedule. Other ideas include a digital pills containing digestible sensors and an automated pill bottle that glows different colors when a dosage is needed or missed.

Comment: My wife and I use a weekly pill container to keep track… I still occasionally forget though.

Common Foot Disorders Inherited

The Huffington Post reported on a study published in the journal Arthritis Care & Research, that showed that many common foot disorders, including hammer toe, claw toe and bunions, seem to be inherited, particularly among white men and women of European descent.” For the “study, researchers looked at foot bunions, lesser toe deformities and plantar soft tissue atrophy among 1,370 study participants with an average age of 66 who were part of the Framingham Foot Study.”

Comment: Another thing to blame your parents for.

RA Patients: Higher Risk For Blood Clots

Lynda Williams writing in Medwire reported that individuals “with rheumatoid arthritis have a significantly elevated risk for venous thromboembolism- blood clots, suggest study findings published in Arthritis Care and Research.” Researchers found that individuals with RA “were 2.4 times more likely to develop VTE than age-, gender-, and index date-matched patients without RA.”

Comment: Another systemic complication of rheumatoid arthritis to be aware of.

Chronic Pain Associated With Higher Risk Of Suicide

Andrew Seaman writing in Reuters reported that, according to research published in JAMA Psychiatry, certain types of chronic pain may be linked to a higher risk of suicide. Investigators came to this conclusion after analyzing data on approximately five million individuals. The researchers found that migraine, back pain, and psychogenic pain were associated with an increased risk of suicide.

Comment: A serious problem that needs more investigation.

Increased cardiovascular risk with osteoarthritis?

Patrice Wendling writing in Rheumatology News reported on a British study which showed an increase in premature death from all causes among patients with hip or knee osteoarthritis. In particular, cardiovascular-related deaths were increased in incidence. Osteoarthritis patients were twice as likely to die if they had a walking disability.

Comment: First rheumatoid arthritis was associated with premature death. Now osteoarthritis as well. Not benign conditions.

Special brace helps kneecap OA

Patricia Wendling writing in Rheumatology News reported on the outcome of the BRACE trial, the largest kneecap bracing study to date. After 6 weeks, pain fell 16.87 points during activity among brace wearers versus wearing no brace at all during activities designed to bring out pain. A 12 point reduction was deemed statistically and clinically significant.

Comment: Comment: This is a particularly difficult form of knee osteoarthritis to treat successfully so the results of this study are welcome.

Osteoporosis drugs increase survival of knee, hip implants

Sara Freeman writing in Rheumatology News reported that long term use of bisphophonate drugs, typically used for osteoporosis was associated with a reduced risk for joint implant failure and subsequent need for revision surgery in 40 % of patients in a large 10,000 patient study. Revision rates were 1.88% in bisphosphonate users versus 4.36% in non-users.

Comment: A drug with two uses. Nice.

Walking, Running Offer Different Health Benefits

The New York Times “Well” blog reported on the benefits of walking and running, and discussed which is better depending on which health goals one is hoping to achieve. “If, for instance, you are looking to control your weight...running wins, going away.” However, “on other measures of health, new science shows that walking can be at least as valuable as running — and in some instances, more so.” The blog points to several studies showing the benefits of each activity.

Comment: Exercise is the key to a long and healthy life… and it doesn’t cost you anything.

Many RA Patients Don’t Take Oral Meds As Prescribed

Nancy Walsh writing in MedPage Today reported “Many patients with rheumatoid arthritis (RA) don’t take their oral medications as prescribed, which can have clinical consequences,” according to a study published in the journal Arthritis & Rheumatism. “Adherence to the prescribed regimen for the most common disease-modifying anti-rheumatic drug (DMARD), methotrexate, was only 63% over two years, and just 21% of patients took their DMARDs correctly at least 80% of the time,” the study found. In addition, “adherence to the prescribed regimen correlated significantly with the Disease Activity Score in 28 joints (DAS28), with adherent patients having lower scores, the researchers reported.”

Comment: Compliance with medicine taking can be a real problem.

Statins Associated With Strains, Sprains

Chris Kaiser reporting in MedPage Today stated, “Muscle pain has been associated with statin use, but” a study published in JAMA Internal Medicine “suggests a link with skeletal adverse events as well.” Researchers found that “the chances for any musculoskeletal disease diagnosis in those taking statins was significantly higher when compared with nonusers.” In addition, “statin users had a higher chance of being diagnosed with musculoskeletal adverse events in two out of three musculoskeletal subgroups of conditions including dislocations, sprains, and pain.

Comment: I see a lot of statin induced musculoskeletal problems. Sometimes these can be very serious.

Autoimmune Disease May Increase Depression Risk

Crystal Phend writing in Medpage Today reported, “Autoimmune disease may increase risk of developing depression and other mood disorders,” according to a study published in JAMA Psychiatry. The study, which included some 3.56 million Danes, found that “any contact with a hospital for autoimmune disease was associated with an independent and significant 45% higher risk of a subsequent mood disorder diagnosis,” and that “hospitalization for any infection was associated with a significant 62% elevated risk of later mood disorders.

Comment: Not a surprising finding. Possible contributors include the disease, social circumstances, and medicines used to treat the illnesses.

Big Toe Not Be The Biggest Culprit In Gout Flares

Robert Preidt writing in Healthday reported that research scheduled to be presented at the European League Against Rheumatism meeting suggests that “the big toe is not the biggest culprit in gout flare-ups, contrary to popular belief.” Investigators “found that people with the highest risk of repeated cases of gout are those whose gout first appears in other joints, such as the knee or elbow, rather than in the joints of the big toe.” The study included 46 patients with gout who were followed for approximately 13 years.

Comment: Another myth bites the dust.

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Wei’s World July 2013

My wife and I have four children. The two older children graduated from college and are supporting themselves. Our oldest works in the president’s office at Harvard, and our second child is making a living as a musical theater performer.

I don’t need to tell you that it is a very competitive industry.

Our third just graduated from Bowdoin College and is looking for work in the financial arena… Note to those readers who are in the finance field –he’s a good worker and smart kid so offer him a job.

Our fourth child is still in high school and this summer will be assisting camp counselors at a camp in Maine and is also volunteering at a shelter for elderly dogs.

The point of this month’s Wei’s World is that my family means an awful lot to me. Somehow I lucked out with having a great wife and kids.

One problem is that as the children have grown older and have lives of their own, it is becoming exceedingly more difficult to get together as a family. This past week we did just that on the Outer Banks of North Carolina.

It was special and the children got along very well. I mention that because so often in the past when they would come home, they would revert back to their childhood roles and we had our share of battles.

When you have a family and the kids are growing, it sometimes feels like they’re sucking the life out of you. And when those tuition bills come along, you really wonder, “Is this all going to be worth it?”

Well… I’m still not sure about that last point but I do know that we had a very enjoyable time last week.

Plus… we had other visitors as well so it was a nice time away. The older I get the more I value my time away from the office.

It’s not that I don’t like what I do. It’s that… well… I like my time away from medicine too.

None of my children elected to go to medical school. Am I disappointed? Not really. I’m not sure what the future of medicine holds and I would hate for them to do something just because I did it.

Right now, they seem to be doing just fine.

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