Accept nothing less than remission in RA

This post in Rheumatology Mornign… an excerpt from Medpage gladdened my heart…

Clinical Remission Should Be Primary Goal Of RA Treatment, Task Force Suggests.

MedPage Today (3/26, Walsh) reported that, according to a study published in the April issue of the Annals of the Rheumatic Diseases, “clinical remission should be the primary goal of rheumatoid arthritis (RA) treatment.” Spelling out “benchmarks toward reaching that target,” an international task force of 60 experts on RA also suggested “the early institution of disease-modifying therapy, the development of composite measures for accurate assessment of disease activity, and the licensure of the biologic agents, which ‘have enabled the attainment of unprecedented outcomes.'”

Remission has to be the goal!!!

Interesting article summarized well in Science Daily on the effects of shoes on people with OA of the knee. It’s the flexibility that seems to be the protective factor as far as the knees are concerned.

Turns out, flip-flops and sneakers with flexible soles are easier on the knees than clogs, cushioned running shoes,  or even special walking shoes.

The authors caution though that there are other things to consider… for instance the chances of tripping and falling in flip-flops…

Another issue that wasn’t raised is that flip flops increase the incidence of plantar fasciitis and Achilles tendonitis.

Mom told me life wasn’t easy.

Another note.  Soon, this blog will be inside our new website at

It’ll be a video blog and lots of fun.

It struck me with so much clarity two days ago.  We are watching the death of Medicare.

While I’ve generally reserved this blog for arthritis issues, I want to weigh in on the Medicare issue.

As many of you are aware, Congress keeps delaying the across the board 21 per cent Medicare pay cut to doctors.  But what has occurred over the last ten or so years has been both reductions in reimbursements for most services as well as de facto cuts since no adjustments have been made for inflation.

Which brings me to the thesis I propose…

In some old civilizations, one of the methods of execution favored by a few rulers was “the death of a thousand cuts.”  In essence, a person endured multiple deep cuts through the skin and subcutaneous tissue.  They died from accumulated blood loss and shock.  Since this was a particularly slow and painful mode of punishment, it was favored by many sadistic despots.

So I find a curious similarity between this method of execution and what politicians have been doing to physicians.

Private health insurance was started in the mid-twentieth century as a method to allow employers to give their employees a tangible benefit without increasing their pay.

Medicare then came along in the mid-1960’s as the government’s method of ostensibly helping the elderly.  And while reimbursements remained adequate, doctors were foolishly seduced.  But the rules of the game changed along the way.

And this strikes deep at the heart of the issue of whether healthcare is a right or a privilege.

There is no doubt that out Founding Fathers wanted to ensure citizens would have the right to “life, liberty, and the pursuit of happiness.”  There is less clarity, though, when it comes to the “right” to healthcare.

I feel entitlement programs have destroyed the fabric of American society.  People have come to expect the government to pay for everything… to take care of them from cradle to grave.  And that’s wrong.

When pioneers first headed west, there was no government to help them build a new barn or to help them plow the fields.  They depended on themselves and their neighbors.  And people pitched in to help each other because they knew they would need the same help later themselves.  There was no government “assistance.”  You made it or you didn’t.

So… I find it particularly galling when I hear people treat medical care like it was toilet paper or laundry detergent, to be paid for by Uncle Sam.

What I provide to my patients is a valuable service that cannot be obtained anywhere else.

I am not a “health care provider”.  I am an arthritis expert and physician.  What I have to offer is not a commodity.

Ran across another article that showed in a very nice study that PRP works a heckava lot better than cortisone for tennis elbow…

Platelet-Rich Plasma May Heal Tennis Elbow Faster Than Corticosteroid Shots.

WebMD (3/10, DeNoon) reported that, according to research presented at the American Academy of Orthopaedic Surgeons meeting, “platelet-rich plasma (PRP)…heals tennis elbow better than corticosteroid shots.” After randomizing “patients with chronic lateral epicondylitis — tennis elbow lasting longer than six months and pain ranking at least 5 on a 10-point scale — to get either PRP or corticosteroid injection,” researchers found that “patients in the PRP arm were much more likely to have less pain and more function than those who received the corticosteroid” after 26 weeks of treatment. However, the patients who received the corticosteroid injection had considerably faster relief of their pain.

This study confirms our findings.  I try to use a lot less cortisone now.

Disturbing info about Fosamax, the prototypical bisphosphonate drug used for osteoporosis.

Nice summary of discussion to date in Rheumatology Morning…

FDA Evaluating Atypical Femur Fracture Risk From Long-Term Bisphosphonate Use.

ABC World News (3/10, story 3, 1:00, Sawyer) reported, “The FDA sent out a nationwide announcement today” about “the potential side effects of osteoporosis drugs like Fosamax [alendronate].” ABC (Besser) added that the agency “said in their announcement…physicians need to watch for the possibility of possible risk of femur fractures. And this didn’t just apply to Fosamax, this applied to all four drugs that are in this group Fosamax, Actonel [risedronate], Boniva [ibandronate], and Reclast [zoledronic acid].”

Meanwhile, NBC Nightly News (3/10, story 4, 2:00, Williams), reported that “two small studies presented at a meeting of orthopedic surgeons suggest that in a small portion of patients who use the drug for five years they can” increase “the rate of a rare type of hip fracture.”

USA Today (3/11, Lloyd) reports that the “studies show the bones of some post-menopausal women who take bisphosphonates…to ward off osteoporosis can stop rejuvenating and become brittle after long-term use.” Researchers found that “the drugs are effective initially in slowing bone loss,” but “the quality of the bone diminished after long-tern bisphosphonate use.” A separate study indicated that “bone densitometry (DXA) scans show a buckling potential in the femur area of the hip in patients being treated for osteoporosis with bisphosphonates.”

According to the Wall Street Journal (3/11, Dooren), the FDA is now examining whether long-term use of the drugs increases the risk of atypical subtrochanteric femur fractures, but so far, the agency said the data it “has reviewed have not shown a clear connection.”

Still, ABC (3/10, Romo, Salahi, Childs) points out on its website that the FDA “is working closely with outside experts, including members of the recently convened American Society of Bone and Mineral Research Subtrochanteric Femoral Fracture Task Force, to gather additional information that may provide more insight into this issue.” Reuters (3/11, Clarke) and MedPage Today (3/10, Gever) also covered the story.

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