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Insider Arthritis Tips September 2012
September 15, 2012
"When written in Chinese, the word 'crisis' is composed of two characters - one represents danger and the other represents opportunity." -- John F. Kennedy, 35 President of the United States
September Arthritis NewsBotox To Treat Knee Pain From Arthritis
Karen Weintraub writing in USA Today reported that ten years ago this week, the US Food and Drug Administration approved Botox "for treating frown lines. Over the course of that decade it has profoundly changed the work of dermatologists and plastic surgeons, and broadly expanded the use of cosmetic procedures by the general public." The neurotoxin, which has proven itself self and effective, is not just for cosmetic procedures, however. Its manufacturer, Allergan Inc. of Irvine, CA, is now starting studies of the neurotoxin to treat pain resulting from
Comment: Cure your knee pain and get a knee lift at the same time
Acupuncture Alternative To Surgery For Knee OA
Comment: Interesting and refreshing that there might be a low risk option to going to an orthopod and getting cut on.
Low Levels Of Lead In Blood May Raise Risk Of Gout
Amy Norton writing in Reuters reported on a study published in Annals of Internal Medicine that found that levels of lead in the blood that are considered non-elevated may still increase the risk of gout. The finding is new in that while high levels of lead have been linked to gout, this study finds that at levels above 1.2 mcg/dL the risk of gout is increased, though levels up to 25 mcg/dL have generally been thought of as safe and 3 mcg/dL is said to be average in the US.
Comment: Few people know that lead can induce gout. The old moonshiners used lead in their stills and got incredible gout.
Fewer Teeth Increase Risk of RA
Bruce Jancin writing in Rheumatology News reported on a study presented at the European Congress of Rheumatology. First-degree relatives of patients with RA were 8.1 times more likely to have at least one swollen joint on physical examination if they had 20 or fewer teeth than if they possessed the full 32. The study is ongoing and focuses on 366 healthy people at increased risk for RA because they are first degree relatives of affected patients. Tooth loss is intimately associated with periodontitis, an inflammatory condition involving the gums. Investigators have long felt there is an association between chronic gum inflammation and the development of autoimmune diseases such as RA.
Comment: I have too many patients from West Virginia to joke about this. The relationship between dental bacteria and RA is an interesting one.
Psoriatic Arthritis Increases Crohn’s Risk
Bruce Jancin writing in Rheumatology News reported on the findings from the Nurses’ Health Study. Data was obtained from 174,646 participants and demonstrated that psoriasis was an independent risk factor for the development of Crohn’s disease with an age-adjusted increased risk of 3.74.
Comment: This supports what many of us have suspected for a long time.
Obesity Blunts Response to Anti-TNF Treatment in Psoriatic Arthritis
Becky McCall writing in Rheumatology News reported that obese patients with psoriatic arthritis have a worse response to anti-TNF treatment than normal weight patients. But achieving minimal disease activity can be improved by weight loss of 5% or more.
Comment: Just a teensy-weensy bit of weight loss can do wonders.
Herbal Rub Effective for Ankle Sprains
Bruce Jancin writing in Rheumatology News reported on a study that compared Traumeel ointment ve diclofenac gel in a large randomized study of 449 patients with acute ankle sprains. Traumeel proved to be as effective as diclofenac. Traumeel is a homeopathic over-the-counter remedy containing medicinal herbs such as arnica, calendula, hypericum, chamomile, witch hazel, belladonna, and monkshood.
Comment: I don’t know what all those ingredients are but this study supports the notion that non-prescription remedies can be just as effective as prescription ones.
Teratogenicity Risk Low With Humira
Elizabeth Mechcatie writing in Rheumatology News reported on a study that evaluated 312 pregnant women, 69 with RA exposed to Humira, 80 with RA who had not taken Humira, and 163 healthy controls. The rate of major birth defects was 5 % in the Humira group, 4% in the RA group not on Humira, and 7% in the control group.
Comment: Comforting knowledge for those patients who still require a biologic during pregnancy. Fortunately, most women who become pregnant go into spontaneous remission.
CDC Recommends Hepatitis C Testing For All Boomers
Denise Mann writing in WebMD reported on new recommendations from the Centers for Disease Control and Prevention regarding hepatitis C testing. CDC Director Dr. Thomas Frieden and Dr. John Ward, who runs the CDC's viral hepatitis division, were quoted in multiple articles that the government has a "health warning...for an entire American generation" regarding hepatitis C.
Comment: Every Boomer should get a one- time test to diagnose this silent killer.
No Difference In Death Rates From RA Biologics
Nancy Walsh writing in MedPage Today reported on a study published in Arthritis and Rheumatism showing that safety analysis of three "biologic" drugs for rheumatoid arthritis found no difference in terms of risk of death for the patients who use them." The analysis, compared the three biologics: Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab). After five years, "the researchers found no difference in death rates among the three drugs," and that the overall death rate was low.
Comment: This is a study that confirms the notion that the risk of death due to these drugs is low. Nonetheless, it is still important to realize these are powerful drugs that need close monitoring.
More People Walking
Nanci Hellmich writing in USA Today reported "More people in this country say they're walking regularly, a new government survey shows." However, "less than half of people say they are meeting the federal government's physical activity guidelines." Thomas Frieden, MD, MPH, director of the CDC, said "The basic news today is that physical activity is the wonder drug, and more Americans are making a great first step in getting more physical activity." Joan Dorn, chief of CDC's Physical Activity and Health Branch says, "We hypothesize that new walkers appear to be starting with short bouts of walking, so overall the average time people spent walking has gone down slightly.
Comment: Exercise is as important as medication for arthritis.
Lack Of Sleep Reduces Vaccine Effectiveness
Alexandra Sifferlin writing in Healthland reported on a study showing that lack of sleep influences vaccine effectiveness. Each participant also received a standard three-dose hepatitis B vaccine: the first and second doses were given a month apart, and the final booster dose was administered at six months. Researchers measured the volunteers’ antibody levels before the second and third dose, then again six months after the booster to determine whether they showed a “clinically protective response.”
Habitually skipping out on a full-night’s rest took a toll on the vaccine’s effectiveness. Compared with those who slept at least 7 hours a night, those who slept less than 6 were more likely to have a lower antibody response to the vaccine and were less likely to meet the threshold of protection: of the 123 participants, 18 failed to receive adequate protection from the vaccine.
Comment: Disturbing findings. Sleep loss can aggravate many diseases and now we have this.
Gout Risk Increases With Weight
Amy Norton writing in Reuters reported that the risk of getting gout, rises with a person's weight, according to a study published in Arthritis Care & Research. While only 1.6% of normal-weight American adults have gout, 3.4% of overweight adults, 5.5% of obese adults and 7% of severely obese adults do. The study also found that the percentage of Americans with gout has grown from 2.6% from 1998 to 1994 to 3.8% from 2007 to 2010.
Comment: I’m not sure why this is news.
Cataract Removal Leads To Fewer Falls, Fewer Broken Hips
Roni Caryn Rabin writing in the New York Times reported, "Older people who have eye surgery to remove cataracts and improve their vision also significantly reduce their risk of breaking a hip in a fall, with the sickest among them and those in their early 80s experiencing nearly 30 percent fewer hip fractures in the first year," according to a study published in the Journal of the American Medical Association.
Comment: Makes sense. If you can’t see where you’re going, you’re going to fall.
Rituxan Effective As Second Biologic For Refractory RA
Nancy Walsh writing in MedPage Today reported, "Patients with rheumatoid arthritis [RA] who fail on treatment with a tumor necrosis factor (TNF) inhibitor may have a better response if they switch to rituximab (Rituxan) rather than trying a second TNF blocker," according to a comparative analysis published in Arthritis Care & Research. Researchers found that those "who began taking rituximab were significantly more likely to have a moderate or good response on the clinical criteria established by the European League Against Rheumatism."
Comment: I’m mixed. I still tend to use a second TNF inhibitor before considering Rituxan.
Do Biologic drugs Increase the risk of cancer?
Dr. Jonathan Kay elegantly summarized the answer to this perplexing question on Medscape. He said, “Patients with rheumatoid arthritis appear to be at higher risk of developing lymphoma -- both Hodgkin and non-Hodgkin lymphoma -- and lung cancer, and at a potentially decreased risk of developing colorectal and breast cancer compared with the general population. The risk of developing lymphoma is associated with disease activity and functional class. Patients treated with TNF inhibitors do not have a significantly higher risk of developing malignancy than patients treated with traditional disease-modifying antirheumatic drugs. Treatment of patients who had prior melanoma with TNF inhibitors has been found in the British Society for Rheumatology Biologics Register to have been associated with more incident malignancy and recurrent metastases. The risks associated with biologic agents should be weighed against their potential benefits in patients with previous malignancy as they should be done in any patient with rheumatoid arthritis.”
Comment: Comforting news from a well-respected rheumatologist.
Radiation Therapy Provides Relief For Plantar Fasciitis
Helen Albert writing in Medwire reported on a study of 62 patients, published in the International Journal of Radiation Oncology, which showed that "external beam radiation therapy, similar to that used in treating cancer, provided effective pain relief for patients with plantar fasciitis." For the study, "researchers found that 80% of those who received standard-dose therapy experienced complete pain relief, 64% of whom maintained this relief for up to 48 weeks."
Comment: I would be concerned that radiation would bring along its own potential risks. There are better and safer options for this condition. It’s like using a bazooka to kill a mouse.
Fitness May Not Prevent Injuries In College Athletes
Nicholas Bakalar writing in the New York Times reported on a recent study of 86 college athletes published in the journal Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, which found "there was no correlation between overall fitness and the time until a first injury." The researchers "assumed preseason fitness would create greater resilience," but it turned out "the best predictors of early injury were being female and playing volleyball."
Comment: Wow. This is surprising. I knew that women basketball players were at risk for ACL injuries. This does make sense though.
Simple Blood Test Reduces Complications Of Hip Fractures
Ann Lukits writing in the Wall Street Journal reported on a study published in journal Injury, which found that the incidence of complications and death in elderly people who suffer from hip fractures can be lowered by administering a simple blood test. Researchers analyzed 15 studies and found that the five most common biomarkers in blood tests are highly correlated with a higher risk of death after a hip fracture.
Comment: If this is true, this could be helpful in determining prognosis.
Lyme Disease Bacteria Fragments Stay in Joints After Treatment
Ann Lukits writing in the Wall Street Journal reported on a study published in the Journal of Clinical Investigation. Scientists discovered bacterial fragments in the joints of mice treated for Lyme disease that may be the underlying cause of persistent arthritis-like joint pain following Lyme infections.
Lukits writes, “Lyme disease is caused by Borrelia burgdorferi, a bacterium also called a spirochete that is transmitted by tick bites. There were more than 22,500 confirmed cases of Lyme disease and another 7,600 probable cases in the U.S. in 2010, according to the Centers for Disease Control and Prevention. Infections usually start with a skin rash but can damage the heart, joints, and nervous system. Lingering joint pain affects up to 25% of people, despite effective treatment with antibiotics.
Yale University researchers induced Lyme infections in mice and then treated them with antibiotics. Researchers found remnants of Lyme spirochetes in the knee joints of all antibiotic-treated mice, indicating the antibiotics eliminated the bacteria but not the residual debris.”
Comment: This news may explain the chronicity of the disease and the fact that so many people who are “cured” still have symptoms.
Yoga Reduces Back Pain
Better Than Routine Medical Care
Deborah Kotz writing in the Boston Globe
reported, "A recent study funded by the
government's National Center for Complementary
and Alternative Medicine found that regular
yoga practice improved function and reduced
back pain symptoms better than routine medical
care in 228 back pain sufferers who participated
in a clinical trial. But the researchers found
that those study participants who took regular
stretching classes also experienced increased
mobility and less pain - on par with those
who took yoga." So no matter how you do it,
maintaining flexibility is the key to relief.
Comment: Yoga has been around for thousands of years. I’ve taken yoga for the last year and find it very helpful for relieving aches and pains.
Rheumatoid arthritis drug limits stroke damage
An article appearing in Health.India.com reported that anakinra, a drug already used for rheumatoid arthritis, has shown promising results in stroke patients by limiting the amount of brain damage, according to a study at the University of Manchester. Researchers induced a stroke in the rats and compared the effects of the drug IL-1Ra, versus placebo. MRI scans revealed that the rats that were given IL-1Ra up to three hours after the stroke had only about half the brain damage of the placebo group.
IL-1Ra works by blocking the naturally occurring protein interleukin 1. Researchers have identified that it is a key cause of brain injury following a stroke. Interleukin 1 encourages inflammation in the area of the brain affected by stroke. This sends out signals to attract white blood cells. Because the barrier surrounding the brain has been weakened by the stroke, the white blood cells find it easier to enter the brain where they kill nerve cells and worsen the injury.
Comment: It’s a good to know that this drug which really doesn’t work well for RA has found another potential use.
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Wei’s World September 2012It’s back to school time. My mom and dad moved from New York City to Norwich, New York ( a small town located in the middle of New York state) when I was three years old. We stayed there until I was 11.
I still remember the names of all my teachers. Going back to school for a new year was always a big deal. I remember my mother getting the pencils, pens, paper, composition books, and other paraphernalia required for elementary school. I especially remember Binney & Smith crayons that came in the green and orange box. I loved the smell of the crayons and all the different colors. I was not particularly good at coloring though. I remember watching in envy as the other kids colored and stayed inside the lines. I never could. I guess things don’t change, do they?
In kindergarten, we had naps and also bomb drills when we had to crawl under our desks. I got my first lesson in math then. One of my classmates told me “2 plus 2 equals 4.” I said, “No it doesn’t. 2 plus 2 equals 22.” We got into an argument and the teacher came over to referee. She told me that 2 plus 2 was, indeed , 4. Well… I was devastated and started to cry.
My first grade teacher didn’t think I knew English and put me in the lowest reading group on the first day of school. Well… I showed her! My first experience with death occurred during that year also. One of the girls in the class wasn’t there one day and the teacher told us she had “died of cancer.” I’m not sure any of us quite grasped what that meant.
On a lighter note, it was my second grade teacher, Mrs. Anderson, who taught me to never run outside using my ruler to play “swords” again. She whacked me and three of my friends across our knuckles in front of the whole class to make sure we got the point. How times have changed!
It was my third grade teacher who got me interested in stamp collecting. Her name was Mrs. Byrne and she was my favorite. I remember it was a thrill being picked to clean the erasers. There was a machine down the hall that whirled and you held the eraser on it and it cleaned out all the chalk powder. We had morning milk that cost two cents. And I remember the shepherd’s pie for lunch. And Bert the bus driver who never missed a day…
When our children went to elementary school, I saw how much things had changed. Some for the better… and some for the worse, I think. I remember talking with my children about my experiences.
I never could convince my kids that I walked uphill to school both ways through hip-deep snow!
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