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Insider Arthritis Tips May 2013
May 16, 2013

"The fundamental cause of trouble in the world is that the stupid are cocksure while the intelligent are full of doubt." - Bertrand Russell (1872-1970)

May Arthritis News

Stubby hands, square wrists can lead to carpal tunnel syndrome

Ann Lukits writing in the Wall Street Journal reported that a study in Archives of Physical Medicine and Rehabilitation found that individuals with short, wide hands and square-shaped wrists may be more likely to develop carpal tunnel syndrome. Greek researchers examined the hand and wrist characteristics of 50 CTS patients and 50 people without CTS, and researchers concluded the limited free space around the median nerve in patients with square-shaped wrists and the increased pressure places on the nerve could further hurt it, causing CTS.

Comment: Well… doesn’t that beat all!

Gout drug helps the heart

Bruce Jancin writing in Rheumatology News reported on a study involving 603 patients with heart disease including heart failure. 103 patients were taking allopurinol while 500 were not. In retrospectively evaluating data, it was clear that allopurinol reduced the risk of atrial fibrillation in the setting of heart failure and also reduced the risk of left ventricular hypertrophy- an enlarged heart- in patients with Type 2 diabetes. The study was conducted at the Miami VA and presented at the meeting of the American College of Cardiology.

Comment: A old drug with new tricks.

Weight Gain Common In Patients Who Have Total Knee Replacement

Nancy Walsh writing in MedPage Today reported, "Patients who undergo total knee replacement are at substantial risk for weight gain during the 5 years after the surgery," according to a study published in Arthritis Care & Research. Investigators found recipients of knee arthroplasty were 60% more likely to gain 5% or more of their baseline body weight than matched controls who did not have the procedure. The researchers also found that "the chance of that 'clinically important' weight gain doubled for individuals who had a second arthroplasty during the subsequent 5 years.

Comment: This is disturbing since not only does it place more stress on the replacement but also shows that overall health might be adversely affected.

CDC Says Only 1 In 5 US Adults Gets Enough Exercise

Nanci Helmich writing in USA Today reported according to data published in the Morbidity and Mortality Weekly Report, a journal of the Centers for Disease Control and Prevention, most adults in the US don't meet "the Federal physical activity recommendations for both aerobic exercise and muscle-strengthening activity." The research reveals approximately 79 percent of adults don't get "at least 2½ hours a week of moderate-intensity aerobic activity such as brisk walking, or one hour and 15 minutes a week of vigorous-intensity aerobic activity, such as jogging." The Federal guidelines also recommend adults "do muscle-strengthening activities, such as push-ups, sit-ups or exercise using resistance bands or weights" at least twice a week. Research has shown that regular physical activity can reduce weight, prevent heart disease, stroke, type 2 diabetes, and stave off depression and some forms of cancer.

Comment: This is dreadful news since it is a fact that regular exercise can stave off the degenerative processes associated with aging.

New joint lubricant shows promise

Jo Willey writing in the UK Express, reported, “Scientists have created an “oil” for joints hailed as a breakthrough for millions of arthritis sufferers. The synthetic substance stops the destruction of the joint and also appears to protect against further damage. Professor Mark Grinstaff, of Boston University, described the new biopolymer as “like oil for joints”.The new discovery – the first synthetic synovial fluid – mimics some of the natural chemicals in the body. Prof Grinstaff said: “You put it between your fingers, and it is ¬slippery. Once we made it, we ¬wondered if we could use it as a lubricant and where it would be useful. That is how we thought of using it as a potential treatment for osteoarthritis.” The best current treatment only offers temporary relief and does not provide enough lubrication to prevent the cartilage wearing away. The findings were published in the Journal of the American Chemical Society.

Comment: This substance appears to work better than the current viscosupplements. Obviously, it needs to go through clinical trials to determine safety and efficacy.

Creatine Helps Fibromyalgia Symptoms: Improves Strength

Trevor Stokes writing for Reuters reported that creatine supplements may be a good non-drug alternative to fibromyalgia medications, suggests a study published in the journal Arthritis Care & Research. In the double-blind, randomized, placebo-controlled trial, the researchers at the University of São Paulo School of Physical Education and Sports in Brazil gave 23 patients with fibromyalgia daily doses of either creatine supplements or placebo tablets for 16 weeks. They found that the 15 trial participants in the creatine arm had a significant improvement in pain levels, moods, sleep quality and muscle strength compared to the 13-person placebo group, which reported no changes in the aforementioned qualifiers.

Comment: Interesting. This compound is used by body builders and weightlifters.

What’s a safe dose of prednisone? Is there such a thing?

A spirited debate was published in the Rheumatologist, a magazine I get. The topic was the use of prednisone in rheumatoid arthritis. Recent guidelines produced by the American College of Rheumatology regarding treatment of rheumatoid arthritis omitted the use of prednisone. Dr. John Kirwan, a professor at the University of Bristol, who wrote several papers showing that prednisone had disease-modifying effects and held back the destructive processes of rheumatoid arthritis (RA) made his pitch. He advocated the use of prednisone in combination therapy for this condition. Dr. Theodore Pincus, a professor at NYU, advocated the use of low dose prednisone (less than or equal to 5 mgs a day). He provided evidence that it was safe and effective at that dose. Dr. Anthony S. Russell, a professor at the University of Alberta issued the counterpoint. He provided historical data showing that prednisone had long term toxicity without significant benefit (in his opinion.) With all due respect to Dr. Russell, much of the data he cited was old data when higher doses of prednisone were used. He also contended that primary care doctors would be tempted to use prednisone if they saw rheumatologists using it.

Comment: My opinion is this. I use low dose prednisone a lot in my practice. By low dose, I mean 5 mgs or less. I think it is effective as an add- on therapy. It is also a great “bridge” if the patient is transitioning therapies. I have seen very little long term toxicity associated with this low dose approach. And I think the benefits derived from improved activities of daily living far outweigh the negatives. I do think that doses higher than 5 mgs should be avoided if possible. I also don’t think the primary care issue is that big a deal although I admit… I have seen some indiscriminate use in my community.

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Wei’s World May 2013

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“Always Look on the Bright Side of Life" is a comedy song that was originally featured in the 1979 film Monty Python’s “Life of Brian”.  It was written by Eric Idle as a parody. The main character, Brian, has been sentenced to death by crucifixion. Attempts to rescue him are unsuccessful. A character on a nearby cross attempts to cheer him up by singing "Always Look on the Bright Side of Life". As the song continues, many of the other crucifixion victims (there are supposed to be 140 of them) begin to sing along.

Trust me, you had to see it to get it.

But anyway, I thought about the song last night when I looked at the front page of the Washington Post.

I’m not sure if it’s me but my perception of the news around the world is that things are worse than they were, say, 30 years ago.  Maybe, it’s technology that affords us instant access to what’s going on.  But what’s going on doesn’t look so great.

I guess what gets to me is the complexity of life now.  When I was younger, it seems that there was less going on, that decisions were easier, that right versus wrong was not a difficult call, that people were more civil and polite.

I just don’t see it as much now.

Of course I live near a big city.  When I visit a small town… an example would be Brunswick, Maine, where one of our kids is in college, I feel there is still that old time feeling. People are more polite (they even stop their cars to let you cross the street- Try that in downtown D.C.!) and I feel more insulated from the world.

Of course, life is going to go on regardless. I’ve thought about solutions to this uncomfortable feeling.  One, of course, is to stop reading the newspaper and watching TV.  Not a bad idea.

Another is to count my blessings, of which I have many.

And still another is to make sure my patients also maintain perspective. To cheer them up when they’re down and help them get over the speed bumps.  After all, isn’t that what a doctor is supposed to do? Part of healing- in fact a big part- is soothing the mental and emotional pain.

So I guess the secret is to recognize the fact that the world is always going to be… the world.

And how we view it and cope with it is up to us.

“Always Look on the Bright Side of Life"

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