For Runners Only… Tips From The Orthopods.

For Runners Only… Tips From The Orthopods.

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Fat Kids Become Fatter Adults.

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Treating Ra Patients With Anti-Tnf Drugs May Lessen Their Likelihood Of Alzheimer’s.

John Gever reporting in MedPage Today stated that, according to research presented at the American College of Rheumatology’s annual meeting, “treating rheumatoid arthritis (RA) patients with anti-tumor necrosis factor (TNF) drugs appears to lessen their likelihood of developing Alzheimer’s disease.” After analyzing claims data from “a large medical and pharmacy claims database that included 8.5 million US adults,” researchers found that “use of anti-TNF therapy was associated with a lower risk of Alzheimer’s disease.  Both rheumatoid arthritis and Alzheimer’s disease seem to be caused by inflammatory chemicals called cytokines. Very important finding.

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What Do I Do With A Woman Who Is Pregnant And On Biologics?

Dr. Sunanda Kane at the Mayo Clinic recently presented this important information… biologic drugs are protein antibodies, and most cross the placenta. They do not begin to cross until the second trimester, around week 20 of pregnancy. Maximal transfer occurs between weeks 30 and 38 of pregnancy. Thus, if a pregnant woman is on Remicade, we instruct her to time her last dose around week 30-32 of pregnancy, and then re-dose her after delivery. Women on Humira should be instructed to self- inject their doses until around week 33-34 of pregnancy.  Interestingly, data suggests Cimzia does not cross the placenta at all. The above recommendations are for patients who are in remission.

Experts do not endorse switching biologics during pregnancy If a pregnant woman has active RA, then we continue her biologic therapy. The first trimester has the lowest risk for transfer of antibodies and the highest for disease flare. The benefits of controlling disease outweigh the risks to the unborn baby.  There does not appear to be any increased risk for infection following caesarean section if biologics are given right after delivery, as long as there is assurance that no placenta has been retained, which could be a source for infection.  Furthermore, there’s data to show that biologics do not cross into breast milk, so breastfeeding is permitted for women on most biologic therapy.

I’d like to add that fortunately, many women with RA go into spontaneous remission during pregnancy.

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Uric Acid May Increase Likelihood Of Severe Osteoarthritis

Mary Jane Gore writing for the Duke University News reported that the amount of uric acid in one’s joints may increase the likelihood of severe osteoarthritis, the most common form of arthritis worldwide, according to researchers at Duke University Medical Center.  Osteoarthritis is a debilitating joint degeneration for which no drug has been proven to slow or halt its progression.  Physicians can only offer to treat the symptoms associated with osteoarthritis, and people with the condition are often subject to a reduced quality of life.

Dr Virginia Byers Kraus senior author of the study published in PNAS, stated, “This research is a step towards identifying uric acid as a risk factor for osteoarthritis.”  The researchers looked at 159 people, who had knee osteoarthritis but no history of gout, a type of arthritis triggered by uric acid crystals in the joints. The researchers found the severity of osteoarthritis in their knees to be strongly correlated with the amount of uric acid in their knees. Good Stuff!

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