Back to Back Issues Page
Insider Arthritis Tips November 2013
November 15, 2013

Be sure you put your feet in the right place, then stand firm. Abraham Lincoln

November Arthritis News

New study to evaluate methotrexate for osteoarthritis

Jo Willey writing in the Express reported on a study in the United Kingdom. Scientists are launching a nationwide trial on how effectively the drug methotrexate relieves the agony of osteoarthritis in the knees. It is already prescribed for rheumatoid arthritis, a different condition. After a successful pilot trial, it is hoped methotrexate could also ease pain significantly for the UK’s six million osteoarthritis sufferers. In the pilot, 37 per cent of patients with knee osteoarthritis had a 40 per cent reduction in discomfort. Leader of the research, Professor Philip Conaghan from the University of Leeds, said: “Current drug treatments have significant side-effects and are not suitable for many people. “As a result, people often live with severe pain and have significant difficulty in carrying out normal day-to-day activities. There is, therefore, an urgent need to find new and better ways of managing their pain.” Prof Conaghan, of the Leeds Institute of Rheumatology and Musculoskeletal Medicine, will run the 15-centre clinical trial from early next year on up to 160 people whose osteoarthritis is not helped by treatments such as painkillers. He said: “Methotrexate (MTX) is very good at reducing inflammation in rheumatoid arthritis. Inflammation is also very common in osteoarthritis, though it is caused by a different mechanism. “We think treating inflammation should reduce pain. We hope MTX will reduce pain and stiffness. Although it’s less likely to stop joint destruction, we will perform MRI scans to see if we have altered structure.

Comment: Methotrexate often is useful for inflammatory erosive osteoarthritis so the results of this study will be valuable.

Circadian rhythm disruption causes joint damage

An article in Arthritis and Rheumatism presented data indicating that cartilage cells possess an autonomous circadian clock that plays a role in cartilage biology. Cartilage clocks are affected by temperature changes and these shifts affect gene expression. Gossan and colleagues from the University of Manchester described how circadian rhythms are disrupted by aging and this may increase susceptibility to joint damage.

Comment: So that’s why my knees hurt when I’m watching the 2 minute drill during a football game…

Creatine supplementation may work in fibromyalgia

Investigators from the University of Sao Paolo performed a randomized double-blind, controlled study in a group of patients fulfilling American College of Rheumatology criteria for the diagnosis of fibromyalgia. They found that the group that received creatine supplementation had increased muscle phosphorylcreatine content and improved upper and lower body muscle function.

Comment: I would call this good news for fibromyalgia sufferers. …

MRI Useful for predicting who’s going to need knee replacement?

In an article published in the Annals of the Rheumatic Diseases, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) came to the conclusion that MRI is a viable alternative to x-ray for evaluating structural changes in knee osteoarthritis. Currently, MRI parameters such as medial compartment cartilage volume/thickness loss, and the assessment of cartilage defects, bone marrow lesions, meniscal lesions and synovitis- inflammation of the joint- seem to be able to predict progression to knee replacement surgery.

Comment: I’m not sure if I go along with this. To me symptoms and function are better predictors of who will need joint replacement. And to me also, I think we should be thinking about alternatives to knee replacement such as stem cell procedures.

Folate levels predict response to methotrexate?

Nancy Walsh writing in MedPage Today reported patients with rheumatoid arthritis who had low baseline levels of folate in their red blood cells were less responsive to treatment with methotrexate, continuing to have more active disease at 3 months, Dutch researchers found. Methotrexate remains the cornerstone of therapy for rheumatoid arthritis, but a substantial number of patients either don't respond clinically or can't tolerate the drug. Researchers from Erasmus University Medical Center of Rotterdam showed in a cohort of 285 patients, lower levels of erythrocyte folate were associated with more disease activity. They explained, "Baseline erythrocyte folate is a functional assay for the body's capacity to accumulate and retain cellular folate, and thereby predicts how much methotrexate will be taken up and accumulated during therapy."

Comment: Interesting study.

40% adults have difficulty swallowing pills

An article in doctor directory pointed out a very common but shocking statistic. . A 2003 Harris Interactive survey of 679 adults found that 40% of U.S. adults experience discomfort when swallowing pills. Nearly 20% of those who have taken oral medication reported having hesitated prior to taking the pills because they feared they might have trouble swallowing them due to size of the pill or its shape. Of those who have experienced difficulty swallowing, 80% report having the pill stuck in their throat, 48% report having a bad after taste and 32% report gagging. This study supports the assertion that difficulty swallowing pills negatively impacts medication adherence as it found that 14% reported delaying doses, 8% reported skipping doses, and 4% reported discontinuing medication due to difficulty swallowing it.

Comment: This is another cause of lack of compliance… and a serious one!

FDA warns of nerve damage due to fluoroquinolones

Rosemary Frei writing in Pain Medicine News stated the FDA is warning physicians about the danger of peripheral neuropathy-damage to nerves- that can occur with the use of commonly prescribed antibiotics called fluoroquinolones. Peripheral neuropathy can occur within days of initiation of the antibiotics and can continue for more than a year after discontinuation. Fluroquinolones have previously been associated with severe tendon damage also.

Comment: Avoid them if you can!

Acetaminophen associated with serious skin reactions The FDA has warned that acetaminophen, the active ingredient in Tylenol and also a component in many prescription drugs carries the risk of Stevens-Johnson syndrome, a life-threatening skin disorder that causes high fevers and skin damage equivalent to massive third degree burns. Other drugs that are used for pain such as non-steroidal anti-inflammatory drugs also have been linked to the condition.

Comment: Scary stuff indeed.

Fish oil may help improve response to triple drug therapy in RA

A recent study showed that adding dietary fish oil to triple drug therapy for rheumatoid arthritis provided an additional boost in effectiveness. Triple drug therapy involves the use of methotrexate, sulfasalazine, and hydroxychloroquine, better known as Plaquenil for treating RA. It has been touted by some as an alternative to using biologic therapy.

Comment: Triple drug therapy is less expensive than biologic therapy. However, it does not slow disease progression as assessed by x-ray, which is the major determinant of future disability. Also, it contains its own share of potential side effects. I’m not a big fan of it.

Vitamin D does not reduce knee pain in OA

A study published in JAMA looked at a group of 45 patients with knee OA. The patients were randomized to receive either vitamin D enough to maintain a vitamin D level of 36 ng/ml or placebo. Investigators found no difference in knee pain reduction between the two groups. No differences in MRI measurements were noted either.

Comment: Was the vitamin D level high enough? Or is the power of placebo stronger than we think?

Asymptomatic adults have abnormal MRI scans 75% of the time!

A study published in the American Journal of Sports Medicine looked at 45 healthy volunteers from a local skiing community. The average age of the volunteers was 38 years and there were 28 men and 17 women. 75% of those studied had abnormalities seen on MRI.

Comment: This certainly tells us that abnormal MRIs don’t necessarily mean a lot. You have to correlate symptoms to findings.

5 Practical Strategies for Long Term Stress Reduction Stress reduction strategies that keep paying off (without ongoing effort) Published on February 4, 2013 by Alice Boyes, Ph.D. in In Practice

My favorite type of stress reduction strategies are the kind that (1) require one-time effort but produce ongoing benefits, and (2) where the benefits particularly kick in during the times I'm busiest / most stressed.

You'll need to personalize these stress strategies to reflect your own sources of stress but these five examples will illustrate the principles.

1. Get a spare set of keys cut. When I'm at home, my keys live on a hook just inside my front door. However, when I'm stressed, I get absent minded and put them down other places. At least once every couple of months I find myself at risk of being late for work because I can't find my keys. I've solved the stress of this problem by getting a spare set cut. Do it next time you're at the hardware store.

2. Keep $20 in the car glove compartment. Something else I do when I'm excessively busy is leave the house without my purse. Keeping $20 in the glove compartment means I can still run to the store on the way home and pick up whatever I need for that night's dinner.

3. Buy an extra USB charger. I was forever jumping in the car and realizing the battery on my phone was low. Buying a USB charger that sits in the cigarette lighter slot in my car solved this problem. I no longer need to run back inside to find my charger when I'm already late. The charger I bought (for less than $13) charges both the iphone and ipad, and also works great for road trips.

4. Establish a more convenient location to store a household item when it's not in use. If I don't put something away after using it it's usually because the place it's "supposed to" live when it's not in use is either inconvenient and cluttered.

5. If I have to fight for space in a drawer or cupboard when I want to put something away, I'm much more likely to leave it lying around. Try establishing a more convenient home for one of your household items.

6. Try a 30-day project of throwing out 1 item per day. I love doing 30-day personal projects. One of my most enjoyable projects was also one of the simplest (and least time consuming!). For 30 days, I threw out one item per day. There are lots of low-hanging fruit options for this project e.g., throwing out something from the fridge that's past it's use by date. The ongoing benefits of this project came from having less clutter to tidy and get in the way of cleaning.

Stress Reduction Strategy Selection Criteria To review: choose strategies that (1) require one-time effort but produce ongoing benefits, and (2) where the benefits particularly kick in during the times you're busiest /most stressed.

Pumpkin Cheesecake with Gingersnap-Walnut Crust From Eating Well: November/December 2011

We pulled out a few of our favorite EatingWell tricks to achieve plenty of creaminess in our pumpkin cheesecake without all the saturated fat of a typical recipe: nutrient-packed canned pumpkin and pureed nonfat cottage cheese replace some of the cream cheese. A touch of pumpkin pie spice warms up the flavor. For the crust, shop the natural-foods section for gingersnaps without any hydrogenated oil. Simple toasted walnuts are an elegant garnish. Or try making candied walnuts. Just be careful not to eat all of them before they make it to the cake!

12 servings Active Time: 30 minutes Total Time: 7 hours Ingredients 4 ounces gingersnap cookies (18-20 1 3/4-inch cookies) 1 cup walnut halves, divided 4 teaspoons walnut oil or canola oil 12 ounces reduced-fat cream cheese (Neufchâtel) 1/2 cup granulated sugar 1/2 cup packed dark brown sugar 2 teaspoons pumpkin pie spice 3 large eggs 1 tablespoon vanilla extract 1 16-ounce container nonfat cottage cheese 1 15-ounce can unseasoned pumpkin puree

Preparation Preheat oven to 325°F. Coat a 9-inch springform pan with cooking spray. Tightly wrap the outside of the pan bottom and sides with heavy-duty foil to help keep the water bath from leaking into the cake. Put a kettle of water on to boil for the water bath.

Grind cookies and 1/3 cup walnuts to a fine meal in a food processor. Drizzle in oil and process, scraping the sides as needed, until the crumbs are evenly moistened. Press the crumb mixture firmly into the bottom of the prepared pan. Place the pan in a roasting pan and set aside. Clean the food processor.

Beat cream cheese, granulated sugar, brown sugar and pumpkin pie spice in a large bowl with an electric mixer on medium-low speed until the spice is incorporated. Increase speed to medium-high and beat until completely smooth, scraping down the sides occasionally. Beat in eggs one at a time, scraping down the sides occasionally. Beat in vanilla. Process cottage cheese in the food processor until completely smooth, about 2 minutes, scraping down the sides once. Gradually beat the cottage cheese and pumpkin puree into the cream cheese mixture on medium speed. Scrape down the sides and beat a final time to make sure no streaks remain. Pour the batter into the crust.

Pour enough boiling water into the roasting pan to come 1 inch up the side of the springform pan to create a hot water bath for the cake. Carefully transfer the roasting pan to the oven. Bake the cheesecake in the center of the oven until it’s set around the edges but the center still jiggles slightly, 1 1/2 to 1 3/4 hours.

Remove the roasting pan from the oven. Let the cake cool in the water bath until the water is room temperature. Coarsely chop the remaining 2/3 cup walnuts. Toast them in a dry skillet over medium-low heat until fragrant, 3 to 5 minutes. Remove the pan from the water bath. Remove the foil. Place the nuts decoratively around the edge of the cheesecake. (Alternatively, turn the nuts into Candied Walnuts and decorate just before serving; see Variation.) Refrigerate, uncovered, until very cold, at least 4 hours. Wrap tightly and refrigerate overnight if desired. To serve, remove the sides of the pan. Transfer the cheesecake to a cake stand, if desired.

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 November 2013

The recent revelations of bullying on the Miami Dolphins football team brought back many unpleasant memories for me. My first memory of bullying occurred when I was in sixth grade. Interestingly, I was not the recipient… but rather I was a co-conspirator.

Here’s the story…

My family had moved from Norwich, NY, a small town in central New York State to Upper Darby, Pennsylvania, a suburb of Philadelphia. I attended Highland Park Elementary School. Since I was the new kid, I wanted to fit in.

When I started classes the first day, I discovered there was a cruel game the kids played. One girl in the class, Carol Wild, came from a poor home. She kept to herself in the rear of the classroom. Other children would touch her and yell out “Wild’s germs” and try to touch other kids. She was an outcast. I hate to admit it but I joined in as well. All to try and fit in.

There were also the slam books. These were composition binders where students would write comments about other kids in the class and pass them around. Most of the comments were cruel and demeaning. Ironically, despite my attempts to fit in, I didn’t.

One of my classmates lived next door to me. I can remember she had a birthday party in the spring and I wasn’t invited. I could hear the party though from my window on the second floor of our house.

Things changed in junior high school and high school. In those places I was bullied… a lot. I remember in junior high… walking home was torture. Groups of boys would be waiting for me, grabbing my bookbag, calling me “chink” and beating me up. I was too afraid to fight back. The feeling of powerlessness was overwhelming. This continued on into high school as well. I hid the bruises from my parents since I doubted they would understand.

But I eventually found out that bullying isn’t something that just occurs in childhood and adolescence. As I progressed through the educational process of becoming a physician, I saw examples of bullying everywhere. The interns and residents who dumped on students… the senior medical staff berating and demeaning the students and junior staff… the gauntlets of 120 hour work weeks that were a rite of passage. The passive aggressiveness that occurred in faculty meetings when discussing a colleague’s work. If you couldn’t take it, you were “weak.” So… bullying really is a pervasive societal phenomenon. It isn’t a small problem. And, it’s not an unimportant one. I still have nightmares about the bullying I underwent as a child. I still harbor feelings of resentment and guilt… resentment against my attackers and guilt about my own inadequacy when it came to fighting back.

I remember an English class in junior high school. One of the assignments was to read the book, “Lord of the Flies” by William Golding and write an essay about it. The novel is about a group of boys stuck on an island who try to govern themselves… with disastrous results. Probably the archetypical story of bullying. It appears that we all inhabit this large island. Can we, as adults, escape our more atavistic tendencies and create a more caring world? And can we instill that notion in our children as well? I hope so.

Back to Back Issues Page