Patients Don’t Store Biologics Properly

A word of caution to patients who take biologics

Most Patients Do Not Store Their Biologic Drugs Within the Recommended Temperature Range

Dr. Kevin Deane writing in Medscape reported on a Dutch study which evaluated the temperatures at which patients with rheumatic diseases stored their biologic disease-modifying antirheumatic drugs (DMARDs). They did this by providing patients with an electronic temperature logger.

Of the 293 study participants given a temperature logger, 255 (87.0%) returned their logger to the pharmacy. Of these 255 participants, only 17 (6.7%) had stored their medication within the recommended temperature range. Of those who did not, 24.3% stored their medication for more than 2 hours outside of the recommended range.

The authors did not evaluate the effect of these storage conditions on the biologic activity of the medication but speculated that storing these medications outside of the recommended temperature range may adversely affect their efficacy.

Comment: It’s important to know what the temperature restrictions are for your medication.

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FDA Nixes Antacids With Aspirin

An over the counter preparation that could be life-threatening… next

FDA warns OTC antacids with aspirin can cause stomach or intestinal bleeding

Lydia Wheeler writing in The Hill reported that the Food and Drug Administration “is warning consumers to beware of over-the-counter drugs that contain both an antacid and aspirin.” According to the agency, these products “can cause stomach or intestinal bleeding.” Although rare, the FDA says it has identified eight cases of serious bleeding since 2009.

Comment: Not a big surprise here. In the old days when we used high doses of aspirin, people would get bleeding ulcers frequently.


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Barefoot Running Fewer Musculoskeletal Injuries

Are you a runner… the next item is for you…

Running Barefoot May Protect Against Some Musculoskeletal Injuries

Dr. Lara Pullen writing in enews rheum reported on a study published in the British Journal of Sports Medicine. “We aren’t seeing more musculoskeletal injuries in barefoot runners,” explains Dr. Altman-Singles, one of the authors, in an interview. “If anything, we are seeing fewer of certain types of musculoskeletal injuries.”

The researchers examined the differences in injuries between habitually barefoot and habitually shod runners. They categorized participants as barefoot runners if individuals spent at least 50% of their running time barefoot. Barefoot runners were allowed to run in minimalist footwear for the balance of their running time. In many cases, barefoot runners had experienced injuries, such as fasciitis and iliotibial band syndrome, prior to switching to barefoot running.

The researchers also noted that plantar fasciitis was more common in the shod group than the barefoot group. Additionally, shod runners experienced more patellofemoral pain syndrome and ITBS than did barefoot runners. Dr. Altman-Singles describes this difference as huge. Although barefoot running may have offered some protection against plantar fasciitis, barefoot runners had a greater number of Achilles or calf and posterior tibialis strains when compared with shod runners.

Comment: If you want to try this, be careful.

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Computer Vision Syndrome

Got blurred vision after spending time at the computer?   You’re not alone

“Computer vision syndrome” could affect millions, report suggests

Jane Brody writing for The New York Times reported that up to 70 million workers worldwide are at risk for “computer vision syndrome,” according to a report published in Medical Practice and Reviews.

Researchers found that workers who spend three or more hours per day looking at computer monitors are most at risk for the condition, and that many of those workers complain of “blurred or double vision as well as burning, itching, dryness and redness.”

Comment: Hope this is informative

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T’ai chi as effective as PT for Knee OA

Now that we know acetaminophen doesn’t work for osteoarthritis, is there something else that might. There is and the answer will surprise you… next

Tai Chi May Be as Good as PT for Knee Arthritis Pain

Janis Kelly writing for Medscape reported the first randomized head-to-head comparison of tai chi and conventional physical therapy (PT) in patients with knee osteoarthritis (OA) shows equally good pain relief with either intervention, researchers report in an article published in the Annals of Internal Medicine. The researchers also show that tai chi was more effective than PT at relieving depression and improving the physical component of quality of life.

Comment: No side effects either. Nice.

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FDA Nixes Fluoroquinolones

Commonly prescribed antibiotics receive strict FDA warning… next

Limit Fluoroquinolone Use in Light of Risks, FDA Says

Robert Lowes writing in Medscape reported the US Food and Drug Administration (FDA) said that unless they lack other treatment options, patients with uncomplicated infections should not receive fluoroquinolones, given the risk for disabling and potentially permanent adverse events.

Labels for these antibiotics already warn about the risks for tendonitis, tendon rupture, central nervous system effects, peripheral neuropathy, myasthenia gravis exacerbation, QT prolongation and torsades de pointes- these are severe heart rhythm abnormalities, phototoxicity, and hypersensitivity. These adverse events can occur together.

Comment: This is not new news. I personally have seen several patients who suffered from tendon problems related to this set of antibiotics.

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Alcohol Methotrexate


For years, patients taking methotrexate have been told by rheumatologists to avoid alcohol altogether. Maybe these rheumatologists were wrong… next

Moderate Alcohol Intake While on Methotrexate Appears Prudent

Research presented at the annual British Society for Rheumatology conference revealed that rheumatoid arthritis (RA) patients who drink moderately while taking methotrexate (MTX) appear to be at no greater risk for liver damage than nondrinkers. They found the risk of increased liver function tests were not different between drinkers and nondrinkers. In the UK, it is advised that patients keep their alcoholic intake under 14 units per week. Similar to practitioners in the United States, UK rheumatologists tend to restrict alcohol consumption by their patients, as they believe alcohol to be hepatotoxic. But the evidence supporting a presumed adverse interaction is scant.

Dr. Jenny Humphreys of the Arthritis Research U.K. Centre for Epidemiology at the University of Manchesterl presented findings from a database of more than 8,000 RA patients who started MTX between 1987 and 2011. They correlated alcohol intake with routinely collected serum alanine or aspartate aminotransferase (ALT/AST) levels.

With 38,000 person-years of follow-up, they found 241 patients with abnormal LFTs (ALT/AST levels more than three times the upper limit of normal). The incidence rates of abnormal LFTs per 1,000 person-years was 5.58 in nondrinkers, 5.57 in those who drank 1-7 units of alcohol per week, 5.99 in those who drank 8-14 units, 7.58 in those who drank 15-21 units, 8.61 in those who drank 22-28 units, and 9.05 in those who drank more than 28 units.

They concluded that alcohol consumption does not significantly increase your risk of abnormal LFTs, especially if you drink less than 14 units a week.  Hence, moderation appears to be prudent.

Comment: Good news. By the way, a drink contains anywhere from 1-3 units depending on the alcohol content.

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Blood Lipids Osteoarthritis

You are what you eat as the next item shows…

Researchers Work to Untangle the Relationship Between Blood Lipids, Bone Health & Diet

Dr. Lara Pullen writing in the Rheumatologist reported metabolic factors, such as obesity, hypertension, hypercholesterolemia and blood glucose/insulin levels, all appear to be somehow related to the pathology of osteoarthritis (OA). Specifically, decreased levels of high-density lipoprotein (HDL) have been associated with OA, as well as several other systemic conditions.

Comment: Another link between diet and arthritis.

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Acetaminophen Dulls Brain Processing

Popular pain killer… it doesn’t just dull pain… it may dull the brain too… next

Acetaminophen Dulls Brain Processing

Reported in bottom Line Personal, Tylenol dulls “evaluative processing”—your ability to notice something out of place (i.e., incorrect) in routine activities that you perform on “autopilot.”

Researchers at The University of Toronto gave 30 men and women a placebo, and another group of 30 1,000 mg of acetaminophen, which is what you’d get if you took two extra-strength Tylenol. The researchers hooked up the participants’ brains to EEG machines and gave them a fast-paced computer task designed to mimic the kind of autopilot we normally lapse into when doing routine or repetitive tasks.

Compared with the group that didn’t take the drug, the acetaminophen group failed to notice deliberate errors that were part of the computer task…and showed less activity in a part of the brain that normally lights up when you realize that you’ve made a mistake. In other words, the drug not only made them less aware of errors but reduced their ability to evaluate their actions…to realize when they’re off their game.

This skill is important. According to study author Dan Randles, PhD, a postdoctoral fellow at the university, “Sometimes you need to interrupt your normal processes or they’ll lead to a mistake. When you’re talking to a friend while crossing the street, for example, you should be ready to react to an erratic driver.”

More research is planned to investigate implications raised by this study, including whether acetaminophen also causes people’s minds to wander and to actually make more mistakes—not just fail to notice them.

Comment: Now that’s interesting!

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Cannabis Retards Cartilage Loss In Arthritis

Can marijuana be useful for arthritis? Many so-called experts Say no… but new research says yes…next

Study: Cannabis Fights Arthritis-Related Cartilage Loss

Emily Gray Brocious writing in Extract reported a study published recently in the US National Library of Medicine National Institutes of Health shows that synthetic cannabinoid treatment reduces osteoarthritis-related cartilage breakdown, as reported by The Weed Blog.

The findings align with years of anecdotal evidence suggesting cannabis may fight osteoarthritis-related cartilage breakdown as well as treating pain and discomfort that typically accompany the degenerative joint disease.

Due to marijuana’s analgesic (pain relieving) and anti-inflammatory properties, it makes logical sense that the drug would act as an effective treatment option for osteoarthritis patients.

The most recent study, conducted by researchers at The Second Xiangya Hospital of Central South University in China’s Hunan province, provides scientific evidence to support “a novel mechanism by which cannabinoids may prevent cartilage breakdown in OA (osteoarthritis).”

Comment: there it is. You decide.

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