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Insider Arthritis Tips June 2013
June 15, 2013

In the end, it's not going to matter how many breaths you took, but how many moments took your breath away - Shing Xiong

June Arthritis News

Bacteria Cause Of Chronic Lower Back Pain?

Andrea Gerlin writing in Bloomberg News reported , "As many as four in 10 cases of chronic lower back pain are probably caused by bacteria, and treatment with antibiotics may cure them," according to a 162-patient study published in the European Spine Journal. The study found that "as many as 80 percent of the participants with persistent back pain following a herniated disc and swelling in the spine reported an improvement after taking antibiotics three times daily for 100 days." The back "pain is caused by an infection of Proprione acne bacteria inside the affected spinal disc, study author Hanne B.Albert said."

Comment: Very intriguing. Reminds me of the initial reports that Helobacter was the cause of gastrointestinal ulcers.

Anti-TNF drugs don’t increase risk of gut perforations

Zavada and colleagues from the University of Manchester published a study in the Annals of the Rheumatic diseases which allayed some fears. One of the concerns has been whether anti-TND drugs used for the treatment of diseases such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis might increase the risk of bowel perforation. The group looked at more than 15, 000 patients, most of whom were treated with anti-TNF drugs and compared them with a group of patients not taking the drugs. They found there was no increased risk associated with anti-TNF drugs.

Comment: Reassuring for both physicians as well as patients.

Are you at risk for the complications due to ankylosing spondylitis? Discover what they are…

Ankylosing spondylitis (AS) is an inflammatory form of arthritis that preferentially attacks the spine. Many people are under the impression it’s one of the less serious forms of arthritis. Uh-uh. Unfortunately, it has a number of potential complications associated with it. These include:

1. Acute eye inflammation, termed “uveitis”, in one-third of patients. Symptoms include pain, redness, blurred vision, light sensitivity, and if left untreated, blindness.
2. Osteoporosis occurring in a significant number of patients. This is a condition where the bones become brittle and more likely to fracture.
3. Approximately 10-15% of patients have inflammatory bowel disease such as Crohn’s or ulcerative colitis.
4. Skin involvement occurs in as many as a quarter of patients. The most common skin condition is psoriasis.
5. AS can lead to conduction abnormalities in the heart as well as inflammation of the aorta. 6. Fibrosis of the lungs can cause restrictive lung disease.
7. Neurologic complications are due to compression of the spinal cord and can be life-threatening. 8. Long term ankylosing spondylitis can cause a condition called amyloidosis of the kidneys leading to kidney failure.

Comment: Not such a benign condition is it?

Inflammation In Patients With Chronic Pain

Ed Sussman writing in MedPage Today reported, "Even after long-term treatment with opioids, inflammation persists in many chronic pain patients as evidenced by C-reactive protein levels and erythrocyte sedimentation rate," according to research presented at the annual meeting of the American Pain Society. Among "the 40 patients taking high dose opioids, over 100-mg equivalents of morphine a day, eight individuals (20%) were found to have high levels of the inflammatory markers, said Forest Tennant, MD." Dr. Tennant said, "The elevated inflammatory markers suggest that the underlying cause of pain is still active or there may be on-going neuroinflammation related to centralized pain."

Comment: Very difficult situation and makes the treatment of chronic pain that much more difficult.

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.

Sleep important in rheumatoid arthritis

A study presented at the American College of Rheumatology highlighted the importance of sleep in rheumatoid arthritis. The study from the Diakonhjemmer Hospital in Oslo showed that patients with rheumatoid arthritis had sleep disturbance related to their disease and this sleep disturbance was more common in women and had a negative impact on disease activity, pain, fatigue, and physical function.

Comment: No question that rheumatoid arthritis adversely affects sleep and this study proves it.

Huge variability in knee replacement recommendations

According to data presented at the American College of Rheumatology meeting, there is a great variability of recommendations made to patients regarding joint replacement surgery. For example, the recommendation for knee replacement is increased by gender (men more than women), academic institution setting (academics more likely to recommend than private practice), and country (America more than Europe).

Comment: Interesting, huh?

Forteo plus Prolia May Lead To Increases In BMD

Nancy Walsh writing in MedPage Today reported, "Treatment with a combination of teriparatide (Forteo) plus denosumab (Prolia) led to greater increases in bone mineral density (BMD) in postmenopausal women with osteoporosis than either agent alone," according to research published online in the Lancet.

Comment: Sometimes combinations work and other times they don’t. In this case it looks like it does.

MRI May Detect Early Synovitis In Metal-On-Metal Hip Implants

Forrest writing in Aunt Minnie, a radiology publication reported that researchers at the Hospital for Special Surgery "found that MRI can detect inflammation of the joint lining, known as synovitis, in patients with metal-on-metal hip implants long before symptoms appear, allowing for a more conclusive diagnosis and effective planning for follow-up care," according to research published in the Journal of Bone & Joint Surgery.

Comment: While detecting it early may help, the ultimate outcome will still be the patient will have to undergo another surgery to remove the implant.

Will Elderly Be Cared For By Robots

Nick Bilton writing in the New York Times reported that “as the baby boomer generation grows old and if the number of elderly care workers fails to grow with it, many people might end up being cared for by robots.” The piece noted that “the technology is nearly there. But some researchers worry that we are not asking a fundamental question: Should we entrust the care of people in their 70s and older to artificial assistants rather than doing it ourselves? ...That’s the catch. Leaving the questions of ethics aside for a moment, building robots is not simply about creating smart machines; it is about making something that is not human still appear, somehow, trustworthy.”

Comment: What a scenario to consider. As a Baby Boomer myself, I’m concerned… maybe a bit scared too. Being a physician was, at one time, considered an honorable profession. Now… I’m not so sure.

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Wei’s World June 2013

Some of you may know that I'm the rheumatology blogger at Medscape. Today's Wei's World is from one of my blog posts entitled...

"A little girl from Mississippi" reveals the one thing technology will never replace!

On a sultry May morning in Harvard Yard, Oprah Winfrey presented the 2013 commencement address to the graduating class of 2013. As she usually does, she mentioned her well known travails growing up in Mississippi. She also acknowledged the difficulties encountered with her most recent project, the Oprah Winfrey Network.

However, what was most interesting to me was her revelation that after conducting more than 33,000 interviews... the people, no matter their station in life, always whispered to her after their interview, "Did I do all right?"

... the implication of course is that all people need to know they've been understood. People crave validation. And that is the crucial ingredient that technology can never deliver.

As rheumatologists, we can provide this validation. We owe it to our patients to do so.

Technology is important and has its place. However, the temptation by many is often to follow the "next bright shiny object." This sometimes can interfere with what is important.

I believe we need to remember the example set by "the little girl from Mississippi."

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