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Insider Arthritis Tips March 2014
March 16, 2014
When you are courting a nice girl an hour seems like a second. When you sit on a red-hot cinder a second seems like an hour. That's relativity.
March Arthritis NewsAnxiety and depression were linked to poorer recovery outcomes after hip replacement
The Daily Rx News reported that although total hip replacement is often an effective treatment option for osteoarthritis, some factors may affect how well patients recover from the surgery. A recent study looked at the physical and mental health factors that influenced total hip replacement recovery in osteoarthritis patients. The researchers found that higher levels of anxiety, depression and pain before surgery were linked to poorer outcomes in the year after the hip replacement. These researchers suggested that these patients may need more support after surgery to help ensure a successful recovery.
Comment: Certainly not surprising.
Exercise May Delay or Prevent Hip Surgery
Alice Goodman writing in Arthritis Today reported the findings of a Norwegian study. People with mild to
moderate hip osteoarthritis (OA) may be able to avoid hip surgery if they exercise, according to a study published recently online in Annals of the Rheumatic Diseases. The study showed that people who participated in an exercise program for one hour at least twice a week for 12 weeks were 44 percent less likely to need hip replacement surgery six years later compared with a similar group of people who did not exercise. Also, those who exercised reported improved flexibility and ability to perform physical activities compared with those who did not exercise.
Comment: Good news.
Camels to the Rescue for Arthritis?
Dr. Sanjay Gupta writing for Medpage Today reported a novel antibody derived from alpacas -- significantly reduced cartilage erosion and inflammatory cell infiltration in two mouse models of rheumatoid arthritis, Chinese researchers reported on Arthritis Research & Therapy.
targets a specific protein, which has been implicated in the pathogenesis of rheumatoid arthritis through its recruitment of destructive cells and enzymes into the joint. Camelids produce a unique type of antibody can be easily and inexpensively produced, unlike most conventional antibodies.
Comment: There was an old commercial for Camel cigarettes. The catchphrase was, I’d walk a mile for a camel.
Stress management in RA patients helped to reduce IL-8 levels
Patients with rheumatoid arthritis who participated in stress management training had lower levels of stress-induced interleukin-8 levels at follow-up compared with a control cohort, according to recent study results.
Researchers in the Netherlands randomly assigned 74 patients with rheumatoid arthritis (RA) to a control group or to receive a short stress management training course. Blood samples were collected during
the stress tests, and assessment was made of stress-induced changes in levels of cytokines involved in stress and inflammatory processes, including interleukin (IL)-6 and IL-8, as well as tumor necrosis factor-alpha.
At 1 week after treatment, the intervention and control groups did not display significantly different levels of basal and stress-induced cytokine levels. Patients in the stress management group, however, had lower levels of stress-induced IL-8 than controls at follow-up.
“This is the first study to explore the response of circulating cytokines to a psychosocial stress test after stress management training in patients with RA,” the researchers concluded. “Stress management training might prove to be beneficial as adjunct to standard therapy to control arthritis symptoms.”
Comment: They needed a study to show that stress makes RA worse?
Anti-TNF-naive RA patients with periodontitis
history likely to discontinue Enbrel
Reported in Healio, a study from Taiwan disclosed a fascinating finding. Patients with rheumatoid arthritis who were anti-tumor necrosis factor drug -naive and had a history of periodontitis within 5 years of beginning Enbrel therapy had an increased risk for treatment discontinuation, according to recent study results. The findings were published in the Journal of Clinical Rheumatology.
New compound reduces joint inflammation in arthritis
Researchers have developed an oral compound that can significantly reduce joint inflammation in animal models of rheumatoid arthritis.
Scientists from The Scripps Research Institute (TSRI) in Florida developed the compound, SR2211, that blocked development of virtually all symptoms of rheumatoid arthritis in mice within the first eight to ten days of treatment.
The mice also showed significantly reduced bone and cartilage erosion compared to animals that did not receive treatment.
The experimental compound targets the nuclear receptor RORy, a key regulator of TH17 cells, one of a family of white blood cells that play a role in the immune system.
Gout Risk Has Genetic Component
Jennifer Davis writing in Arthritis Today reported on a new study that showed for the first time on a large scale that gout does indeed run in families. The study, published in the journal Annals of the Rheumatic Diseases, also shows gender differences in gout risk from the impact of genetic and environmental factors.
“The composition of risk is different in men and women, but both genders are at higher risk if they
have family history [of the disease],” explains the study’s lead author Chang-Fu Kuo, a PhD candidate at the University of Nottingham in the United Kingdom and a practicing rheumatologist in Taiwan. “And genes determine part of the risk but environmental factors shared by families – like diet habits – determine much more.”
Comment: Another thing to blame your parents for…
Age, rheumatoid factor among risks for metabolic syndrome in RA patients
Reported in Healio was a study from Argentina that evaluated the risk of metabolic syndrome occurrence in patients with rheumatoid arthritis. Metabolic syndrome consists of the combination of obesity, hypertension, diabetes, and elevated blood lipids. Patients with rheumatoid arthritis did not experience a greater prevalence of metabolic syndrome compared with controls, although the patients’ age and rheumatoid factor positivity were risk
factors, according to study results.
Comment: Sort of interesting I guess but not the greatest study.
Pores in cell membranes trigger RA.
Reported in the Almagest, Experiments by scientists at Johns Hopkins and in Boston have
Discovered that pore-forming pathways in cell membranes are associated with a process called “abnormal citrullination” in rheumatoid joints. The pathways are normally used by the immune system to fight pathogens.
Researchers say such disruptions in cell membranes by these pores leads to enzyme-activating imbalances of calcium ions and set off the inflammatory immune response that is rheumatoid arthritis’ hallmark.
Comment: Isn’t that what those acne treatments are supposed to fight… abnormal pores… oh well…
An inexpensive high BP pill can treat arthritis
An inexpensive pill that treats
high blood pressure and heart failure could also help ease pain in people with arthritis without causing any side-effects, scientists say.
Recent research suggests the drug called spironolactone could provide a breakthrough in the treatment of osteoarthritis for people with aching, ageing joints.
It is believed spironolactone suppresses a hormone called aldosterone, which has also been linked to inflammation in the joints, Daily Express reported.
It is also thought that the drug boosts cortisol, a hormone which reduces the body’s sensitivity to pain.
Scientists at Dundee University turned to spironolactone, in their hunt for a safer, cheaper painkiller, the report said. After an initial study highlighted the drug’s painkilling powers, scientists are now setting up a larger trial to assess its full potential.
Comment: This is the first time I’ve heard about this. I’m eager to hear more.
Gout increases 7 fold in
the last 50 years
Bruce Jancin writing in Rheumatology News reported on a study presented by Dr. Eswar Krishnan at the Amercan College of Rheumatology meeting. According to data compiled by the National Health and Nutrition Examination Survey or NHANES as it is referred to, the number of Americans with gout has climbed sevenfold during the last 50 years. The increase was most striking in men older than 65 years.
Low serum uric acid slows kidney disease
Doug Brunk writing in Rheumatology News reported on a study presented by Dr. Gerald Levy at the American College of Rheumatology meeting. Data showed that patients who achieve a serum uric acid less than 6 mg/dl showed a 37% reduction in kidney disease progression.
Soft drinks increase RA risk
Bruce Jancin writing in Rheumatology News reported on a study compiled from data in the Nurses Health Study. The numbers showed that women who regularly drink one or more sugar-sweetened soft drinks per day are at increased risk of developing rheumatoid arthritis.
Comment: Soft drinks and cigarettes… risk factors that can be modified.
TNF therapy reduces heart attack risk
Bruce Jancin writing in Rheumatology News reported on a Swedish study involving more than 7,000 rheumatoid arthritis patients. While those patients with no response or only a moderate response had the expected increase in incidence of coronary events seen in rheumatoid arthritis, those with a good response had an incidence similar to age matched controls.
Comment: This study confirms that patients who
respond to anti-TNF therapy also benefit from fewer heart attacks as well.
Psoriasis linked to fatty liver
A Dutch study from Erasmus University in Rotterdam, the Netherlands, showed that the prevalence of psoriasis was significantly greater in patients with nonalcoholic liver disease by a margin of 7% to 4.2%. The study involved more than 4,000 individuals.
Comment: An unexpected finding worth noting.
Surgical Infection Rate Higher with RA Drugs
Marianne Wait writing in Arthritis Today reported that people with inflammatory forms of arthritis, such as rheumatoid arthritis who take more than one traditional disease modifying antirheumatic drug (DMARD), or a type of biologic drug known as a TNF inhibitor, have an increased risk of infection following orthopaedic surgery, according to a new study published in Arthritis Care & Research in
It is not a new theory that drugs taken for inflammatory arthritis conditions, which in many cases work by suppressing the immune system, might increase post-surgical infections. Over the years, a host of studies has looked at which drugs might elevate the risk and by how much. The results have not been clear.
But this study “is one of the best out there regarding this topic,” says Tim Bongartz, MD, associate professor of rheumatology at Mayo Clinic in Rochester, Minn. Dr. Bongartz was not involved in the study.
Based on their results, senior study author Inès A. Kramers-de Quervain, MD, of the department of rheumatology at the Schulthess Clinic in Zurich, Switzerland, suggests “it may be advisable to consider stopping TNF inhibitors more than one administration interval before surgery, since the risk of postoperative infection appears to be higher if the operation occurs within this period.” An administration interval is the length of time between one injection
and the next.
Comment: Not anything I didn’t suspect sooner.
Side Effects of Methotrexate Experienced Even Before Treatment Starts
Intestinal bugs to blame for RA?
Flu shots a must for arthritis patients
Foot osteoarthritis affects one in six over 50s
20 Things You Don’t Need To Know
Arthritis Research Institute
7th Arthritis Symposium
Thursday, May 15, 2014
The Arthritis Research Institute has assembled a brilliant team of elite arthritis experts. The advice and information they provide is bullet-proof. These “Navy Seals” of arthritis are among the most respected names in the field. As an attendee you will be privy to inside information. You will discover:
Throughout the day you will receive a steady flow of unexpected, bottom-line, advice to help you manage your arthritis. If you suffer from arthritis, this will be the most valuable experience you will ever have.
This full day event will be held at the Ceresville Mansion, a historic 1888 mansion, surrounded by beautiful grounds with idyllic mountain views. Lunch will be served on the garden terrace (weather permitting).
John A. Goldman, MD
Recipe from Family Circle
Bake this moist cake for a potluck and it will be the talk of the party. Servings: 16 ~ Prep Time: 15 mins
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Wei’s World March 2014One time a patient asked me if I’m happy. The question surprised me because no one had ever asked that question of me before. I had to think about it. I have had moments of happiness in my life. In fact, quite a few moments. But they were just moments. Do I go through a day every day with a silly grin on my face. Not exactly...
I think I’m probably more unhappy than I am happy. And that’s okay. I used to think I was weird. But I realized that because of the type of person I am, it’s not easy to be happy a lot. And here’s the reason why:
First, I didn’t grow up in a happy household. I guess nowadays you would call our family dysfunctional. But from what I gather, many households have their share of dysfunction. But I think ours had even more than the norm.
Second, I have four children. If you have children, you know you’re only as happy as your least happy child. And that means you’re generally unhappy.
Third, I’m a physician. I expect a lot of myself and my staff. I work hard, not only in the office, but after office hours too. I’m constantly trying to get better at what I do. I’m studying constantly. I’m learning about new techniques, new procedures… what can I do to improve outcomes? And here I am in my mid-60’s!
I realize that medicine is also undergoing a lot of changes. Insurance companies, the government, etc… they all want their pound of flesh from me. That doesn’t make for a lot of happiness.
Still, I do have those happy moments… when a patient appreciates what I do for them… when a patient has a good outcome… when my children seem to appreciate what it is that their parents have done for them… when I finish a day and feel happy that I’ve done not only my best but even a little more.
So that may be a reason why I’m not as happy as I probably should be. I don’t really feel happiness if I’ve done an adequate or even a good job. I only feel happy when I’ve extended myself and raised the bar to a new level. Set another record for bettering my best. Whether it’s a procedure or helping a difficult patient through a hard time. Whatever. So imagine a baseball player who hits 300. And doesn’t feel happy until he hits 310… and so on. Or a quarterback who completes 60 per cent of his passes, but doesn’t feel happy until he competes 65%. And then doesn’t feel happy until he completes 70%.
I think you get my drift. It’s a burden. But the way I’m wired I’m not sure I could do it any other way. In a sense, and don’t take this the wrong way, but I feel that those who just settle… who are content with what they’ve accomplished… who feel happy at the end of the day because it’s the end of the day and they’ve made it through… I feel sorry for them. Because in those moments, when I’ve climbed the mountaintop and know I’ve really really excelled, I feel ecstasy.
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