[I ran across this interesting article about a 91 year old dentist who uses bee sting therapy for his friends who have various types of arthritis. I smiled as I read it…
When I first started practice almost 30 years ago, the specialty of rheumatology was filled with stuffed shirt academic types who scoffed at anything that wasn’t subjected to a double-blind randomized controlled study at least 50 times.
Since then, it has been shown on numerous occasions that several alternative types of treatment do have value and that they do pass the test of scientific scrutiny- if time is taken to examine them. Most academic rheumatologists are very cynical creatures. That doesn’t mean they’re not nice people.
Bee venom is very interesting because its mode of action involves chemical messengers that have an anti-inflammatory and possibly immunomodulatory effect. Obviously, it should be used with caution because of the danger from anaphylaxis. And it doesn’t work for everyone. NW]
Retired dentist uses bee venom as therapy
01:00 AM EDT on Saturday, May 30, 2009
By Tatiana Pina
Journal Staff Writer
Dr. Edward Ziegler Jr., above, gives a bee sting treatment in a wrist area, at left, for arthritis. Ziegler, 91, a retired dentist, stings himself 21 times every other day and says it relieves his rheumatoid arthritis. He keeps adrenaline in the refrigerator in case someone has an allergic reaction.
The Providence Journal / Kathy Borchers
PROVIDENCE — On the second floor of his Tabor Avenue home, Dr. Edward Ziegler Jr. sits at his kitchen table concentrating on a glass jar that seems to be humming.
Lawrence Knowles, 70, a Providence man with a shock of thick white hair, sits next to him with his left arm outstretched, awaiting relief from osteoarthritis, which pains his hands and makes them stiff.
The 91-year-old retired dentist opens the jar slightly and grabs a woman’s metal hair clip off the table. With all deftness of a man half his age he dips the hair clip into jar and plucks out a honey bee.
He presses the bee’s rump to Knowles’ wrist until it digs its stinger into him.
It hurts but Knowles says the venom from the bee helps alleviate his arthritis. Knowles, an adjunct faculty member at Bryant University, says it takes about three treatments before he starts to feel better. He’s been coming to Ziegler for six years. “He wants to beat me at squash,” Ziegler teases.
“The bee sting doesn’t cure a thing,” he declares. “It enhances the activity of the immune system.”
Ziegler has been practicing bee venom therapy for 30 years. He keeps adrenaline in the refrigerator in case someone has an allergic reaction. He invites people suffering from arthritis, multiple sclerosis and other ailments to his kitchen for treatment Monday, Wednesday and Friday from 12 to 1 p.m. It’s free, although he doesn’t mind the kisses from grateful women who have been helped by the treatment.
The Arthritis Foundation puts out a guide on alternative treatments for arthritis that lists bee venom therapy, saying it’s used as an anti-inflammatory for conditions such tendonitis, bursitis, rheumatoid arthritis and osteoarthritis. The guide says a study of mice with induced arthritis showed that after eight weeks of bee venom injections the incidence of arthritis was significantly lower than in the control group. The guide also says bee stings can hurt and may not work. It suggests that if the patient sees no improvement after eight sessions and a total of 20 to 70 bee stings or injections, it’s probably not going to work.
Ziegler says he scoffed when a colleague suggested bee venom therapy over 30 years ago. But he decided to try it when his feet hurt so much from rheumatoid arthritis that he could barely walk. He wasn’t about to miss out on the things he loved to do like riding a motorcycle, deer hunting or flying a plane. He stings himself 21 times every other day. He keeps five hives in his back yard.
Ziegler estimates that in his lifetime his bees have stung 7,000 people. “I would be a cripple if it weren’t for the bees. I had no choice but to help other people.”
Common Over the Counter Pain Reliever Can Trash Your Liver!
[This “news” is actually not news. For years, rheumatologists have known that patients who take too much acetaminophen – and there are alot of patients who do this- develop liver toxicity and sometimes liver failure. Acetaminophen may be the second leading cause of need for liver trans-plants (after hepatitis C). Patients should be aware that just because it’s over the counter, it’s not necessarily safe. And the risk is also made worse when patients combine over the counter acetaminophen along with prescription painkillers that also contain acetaminophen].
The NBC Nightly News (5/27, story 9, 0:20, Williams) reported, “An FDA report recommends stronger warnings and dose limits on drugs containing the painkiller acetaminophen,” which is “the active ingredient in Tylenol and a host of other pain relievers.” The report “cites an increased risk of liver damage.”
The AP (5/28) adds that the recommendations cover “both prescription doses and over-the-counter medication” and “include enhanced public information efforts, stronger labels warning of liver side effects, and dose limitations.”
The FDA working group that issued the report, “made up of 12 top officials in the FDA’s Center for Drug Evaluation and Research, recommended lowering immediate-release tablet strength to no more than 325 milligrams from the current 500 milligrams and reducing the single adult dose to 650 milligrams, from 1,000 milligrams,” according to Bloomberg News (5/28, Larkin). The FDA also said acetaminophen “overdose was linked to 458 deaths and 26,000 hospitalizations annually from 1990 to 2001,” and the drug “is a leading cause of acute liver failure in the US.” Meanwhile, the FDA “has asked members of its advisory panels on drug safety, anesthetic and life-support drugs, and nonprescription drugs to meet June 29-30… to discuss the group’s recommendations…and how they may be implemented.”
This is a really interesting study. A biologic drug that’s used to treat rheumatoid arthritis- a drug that, I might add, doesn’t seem to be all that effective for RA- might prove useful in combating the flu. At least it seems to work in mice. So if we all develop tails,whiskers, and pink eyes… who knows? This article was published in Science Daily which is an awesome website for new news in science.
Arthritis Drug May Be Effective in Fighting Flu
ScienceDaily (May 26, 2009) — Researchers at the University of Maryland School of Medicine have found that an approved drug for treating rheumatoid arthritis reduces severe illness and death in mice exposed to the Influenza A virus. Their findings suggest that tempering the response of the body’s immune system to influenza infection may alleviate some of the more severe symptoms and even reduce mortality from this virus.
The scientists report in the June 1 edition of The Journal of Immunology, which is now available online, that mice infected with the Influenza A virus responded favorably to a drug called Abatacept, which is commonly used to treat people with rheumatoid arthritis. The mice had been given “memory” T-cells, or white blood cells that have been primed to fight the invading virus as the result of previous exposure to Influenza A.
“We found that treating the mice with Abatacept minimized tissue damage caused by the immune response, but still enabled the body to rid itself of the virus. The mice didn’t become as sick, recovered much faster and had much less damage to the lungs, compared to mice that weren’t given the drug,” says Donna L. Farber, Ph.D., a professor of surgery and microbiology and immunology at the University of Maryland School of Medicine and the study’s senior author.
“Moreover, treatment with Abatacept significantly improved survival for mice infected with a lethal dose of influenza virus,” Dr. Farber says. “The survival rate for the treated mice was 80 percent, compared to 50 percent for the mice that weren’t treated.”
She explains that the drug does not interrupt the immune system’s early, rapid attack in the lungs, which helps to kill the virus, but it prevents “memory” T-cells from overreacting, which produces multiple negative effects. “It’s this overactive immune response that can make you feel sick – and can also lead to pneumonia,” she says.
The study’s lead author, John R. Teijaro, a researcher in Dr. Farber’s lab, notes that tissue damage caused by this vigorous immune response – often most prevalent in young, healthy people – is thought to be the leading cause of death from pandemic strains of flu, such as the avian flu and the 1918 Spanish flu. It is also thought to be true of the early cases of H1N1 “swine” flu.
Dr. Farber says, “We believe that our findings are very significant because they provide a potential new treatment for infection by the influenza virus – one that would dampen the immune response, yet still preserve its protective effects.”
The researchers are now testing Abatacept in mice that have not previously been exposed to the flu virus, trying to determine how well they respond to the drug once they have become very sick. Instead of having “memory” T-cells, these mice have what are known as “naïve” T-cells, which have never been activated by being exposed to influenza previously. Depending on the results, Dr. Farber hopes to one day bring this promising new immunotherapy to the clinic for the benefit of patients.
E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs, University of Maryland, and dean of the University of Maryland School of Medicine, says, “The results of this study are very promising. Influenza is a significant public health problem, affecting millions around the world each year. We hope that this study – and Dr. Farber’s continuing research – will pave theway for identifying an effective treatment,” Dr. Reece says.
Abatacept, which is manufactured by Bristol-Myers Squibb and marketed under the name Orencia, is already approved by the U.S. Food and Drug Administration for treatment of rheumatoid arthritis. The drug is not approved for treating influenza.
The study was funded by the National Institutes of Health and Bristol-Myers Squibb.
There are three types of seasonal influenza, A, B and C, and a number of subtypes of Influenza A, including a new strain of the H1N1 virus, also known as the “swine flu,” which has recently emerged and caused illness and a number of deaths this year in Mexico, the United States and other countries around the world.
Vaccination is the most effective way to prevent someone from getting the flu or having a serious case of the disease. An antiviral drug, Tamiflu, can help to prevent the flu virus from spreading within the body if it is taken within 48 hours of the first symptoms.
Dr. Farber points out that an immunotherapy with a drug such as Abatacept would be effective against different strains of the virus because the target of the drug would be the immune system, not the virus itself. “We’re very excited about the potential of developing a new therapy, which possibly could be given to people even after they are very sick,” she says.
- Teijaro et al. Costimulation Modulation Uncouples Protection from Immunopathology in Memory T Cell Responses to Influenza Virus. The Journal of Immunology, 2009; 182 (11): 6834 DOI: 10.4049/jimmunol.0803860
Adapted from materials provided by University of Maryland Medical Center.
This is an excerpt from an article that appeared in the May 26, 2009 edition of the Wasington Post and was then picked up by the American College of Rheumatology.
Those of us who are Boomers (and I’m one of them since my birthdate was in August of 1949), want to stay young. fit, healthy, and in shapte. Sixty is the new 30, as they say…
This is one reason why the field of regenerative medicine with the use of PRP and stem cells is picking up momentum. We all want to feel as good as we look!
More baby boomers joining gyms to improve health.
The Washington Post (5/26, Gowen) reports, “With the baby boomers’ impact on demography, people older than 55 make up the fastest-growing segment of the fitness industry, and more gyms are adding programming especially for them. In places where hip-hop once blasted as buff bodies hefted weights, a grayer clientele is signing up for yoga and aquatics classes, or exercising on recumbent bicycles and elliptical machines designed for older bodies.” Joe Moore, chief executive of the International Health, Racquet and Sportsclub Association, said, “It’s a natural trend as this segment of the population ages. … We’re seeing many [seniors] going to health clubs because of the health benefits, and not just the aesthetics of looking better.” Notably, the “association estimates that there were nearly 10 million health club members older than 55 in 2007, up from two million in 1990. Nearly a third of the member clubs now have senior programming.”
Prolotherapy is type of treatment where dextrose (sugar water) is injected into a tendon, ligament, or joint. The dextrose acts as a “proliferant” to induce inflammation.
This artificially created inflammatory response then leads to increased blood flow and migration of inflammatory cells into the area. The end result is acceleration of the healing process and creation of stronger connective tissue.
An added plus is that symptoms of pain also improve.
Prolotherapy has been used to treat chronic tendonitis, whiplash, fibromyalgia, sports related injuries, ligament tears, back and neck pain, osteoarthritis, degenerative disc disease, sciatica, and temperomandibular joint dysfunction (TMJ syndrome).
Multiple treatments are often required.
Prolotherapy has been referred to as the “poor man’s PRP”.
In the right hands, prolotherapy is very effective and has been shown to be a cost effective solution for the treatment of many soft tissue injuries.
[The first study looking at gene therapy for RA was done by Targeted Genetics in Seattle, Washington. Their results have been published in a number of journals and presented at a number of conferences. The Targeted Genetics product looked at a method for transferring a gene for anti-tumor necrosis factor via an adeno-associated virus. The preliminary data looked very promising. This study on an anti-IL-1 gene transfer model also looks promising. NW]
BIDMC Contact: Bonnie Prescott
Phone: (617) 667-7306
BOSTON — Researchers have reported the first clinical evidence that gene therapy reduces symptoms in patients with rheumatoid arthritis, an important milestone for this promising treatment which has endured a sometimes turbulent past. Described in the February issue of the journal Human Gene Therapy the findings stem from a study of two patients with severe rheumatoid arthritis conducted in Germany and led by an investigator at Beth Israel Deaconess Medical Center (BIDMC).
Originally conceived as a means of treating genetic diseases, such as cystic fibrosis and hemophilia, gene therapy involves implanting a normal gene to compensate for a defective gene in the patient. The first clinical trial to test gene therapy was launched in 1990 for the treatment of a rare, genetic immunodeficiency disease.
“This study helps extend gene therapy research to nongenetic, nonlethal diseases,” explains principal investigator Christopher Evans, PhD, Director of the Center for Advanced Orthopaedic Studies at BIDMC. “Rheumatoid arthritis [RA] is an extremely painful condition affecting multiple joints throughout the body. Arthritis is a good target for this treatment because the joint is a closed space into which we can inject genes,” adds Evans, who is also the Maurice Muller Professor of Orthopaedic Surgery at Harvard Medical School.
A classic autoimmune disease, RA develops when, for unknown reasons, the body’s immune system turns against itself, causing joints to become swollen and inflamed. If the disease is inadequately controlled, the tissues of the joint are eventually destroyed. Although anti-inflammatory agents and biologics can help to mitigate symptoms, there is no cure for the condition, estimated to affect more than 2 million individuals in the U.S. alone.
Evans has spent many years studying the molecules responsible for the breakdown of cartilage in patients with arthritis, identifying interleukin-1 as a good target. But, he adds, once he had this answer, another question was not far behind: How could he effectively reach the joints to block the actions of this protein?
Gene therapy provided the answer.
By implanting a gene in the affected joint, he was able to stimulate production of a human interleukin-1 receptor antagonist protein, which serves to block actions of the interleukin-1 protein.
“The idea is that by remaining in place, the new gene can continuously block the action of the interleukin-1 within the joints,” says Evans. “In essence, the gene becomes its own little factory, continuously working to alleviate pain and swelling.”
In 2005, in a study published in the Proceedings of the National Academy of Sciences (PNAS), Evans and colleagues demonstrated that the IL-1Ra gene could be safely transferred to human joints in patients with RA. In this new paper, the authors aimed to prove that the therapy was not only safe, but that it was of therapeutic benefit.
Two study subjects were recruited. (The number reduced from six study subjects following severe adverse events in an unrelated gene therapy trial taking place elsewhere, according to Evans.) Both subjects were postmenopausal females under the age of 75 with a diagnosis of advanced rheumatoid arthritis. After tissue was removed from the subjects’ knuckle joints, a harmless retrovirus was inserted into the tissue cells, in order to serve as a “vector” to transport the gene into the patients’ joints. After being placed in culture to grow and replicate, the cells were injected back into the afflicted joints
After four weeks, patients reported reduced pain and swelling, according to Evans. “In one of the two subjects, these effects were dramatic, and the gene-treated joints remained pain-free even though other joints experience flares.” Subsequent laboratory tests showed that tissues removed from the subject’s joint tissue synthesized lower amounts of disease-related proteins, confirming that the reduction in pain and swelling resulted from the actions of the implanted gene.
“Existing treatments for rheumatoid arthritis are costly and need to be administered regularly,” says Evans, adding that in addition to risk of side effects, not all patients respond well. “This paper provides us with the first real evidence that painful symptoms can indeed be lessened through gene therapy.”
Ongoing work will focus on the use of gene therapy for the treatment of osteoarthritis, as well as rheumatoid arthritis.
This study was funded, in part, by grants from the National Institutes of Health and Orthogen, a German biotechnology company.
Study coauthors include Peter Wehling, Julio Reinecke, Axel Baltzer, Marcus Granrath, Klaus Schulitz, Carl Schultz, and Rudiger Krauspe of the University of Dusseldorf School of Medicine, Germany; Theresa Whiteside, Elaine Elder and Paul Robbins of the University of Pittsburgh School of Medicine; and Steven Ghivizzani of the University of Florida College of Medicine.
The FDA approved the use of Cimzia, an injectable drug, on Wednesday, May 13, 2009. Cimzia is manufactured by UCB, a company based in Belgium.
The Food and Drug Administration approved the drug for patients with moderate to severe rheumatoid arthritis. The injectable medication was previously approved to treat Crohn’s disease in April, 2008.
Cimzia is the fifth tumor necrosis factor blocker approved in the U.S. The three other products are Humira (Abbott), Remicade (J&J), Enbrel (Wyeth/Amgen), and Simponi (J&J).
The drugs all work by targeting and neutralizing a protein called tumor necrosis factor which plays a pivotal role in causing inflammation and damage to joints and internal organs.
Patients will inject themselves with the drug. One advantage that Cimzia has is a syringe designed for arthritis patients. UCB, collaborated with a consumer product manufacturer, OXO Products, to design a pre-filled syringe with oversized finger grips and a rounded needle cap. This will make it easier for patients to uncap and inject the drug.
Cimzia was approved, based on data from four clinical trials, involving more than 2,300 patients. The combination of Cimzia and a disease-modifying drug, methotrexate, significantly reduced arthritis signs and symptoms after six months. The drug combination also slowed progression of joint damage. Longer term data is being evaluated. Data has also been collected on functional improvement measures.
Cimzia also has a relatively flexible dosing schedule, in which the drug is injected every two or four weeks.
Previously approved drugs like Enbrel and Humira are injected every one or two weeks.
The side-effect profile of Cimzia is similar to that of other TNF-inhibitors. There appears to be less discomfort at the injection site compared with Enbrel and Humira. It appears the major competitor for Cimzia will be Simponi, which is injected once a month.
[This new post is from Healthday, a great health portal. It summarizes the results of a recent study done on the effects of acupuncture in back pain. The consensus among those of us in practice is that acupuncture works. We just don’t know why or how. This artricle presents a surprising take…NW]
Acupuncture, Real or Fake, Eases Back Pain
By Amanda Gardner
TUESDAY, May 12 (HealthDay News) — Any kind of acupuncture, whether it pierced the skin or not, eased chronic lower back pain in a group of adult patients.
“All were superior to usual care,” said Daniel Cherkin, lead author of a report published in the May 11 issue of the Archives of Internal Medicine. “Acupuncture is an effective treatment for chronic back pain. People receiving acupuncture are more likely to get better.”
But the unusual finding that non-penetrating acupuncture did as well as acupuncture that used standard needles will raise questions about how this works, added Cherkin, who is a senior investigator with the Group Health Center for Health Studies in Seattle.
Chronic back pain is a chronic health issue in the United States, and is the top reason why patients go to acupuncturists, often when traditional therapies disappoint.
Although there have been previous studies on whether acupuncture represents a viable treatment option, “the evidence of the value of acupuncture in general is very murky because the quality of the research is not very good,” Cherkin said.
This trial, the largest randomized one of its kind, was funded by the National Center for complementary and Alternative Medicine, part of the U.S. National Institutes of Health.
More than 600 adults with chronic lower back pain were randomized to one of four study arms: individualized acupuncture, standardized acupuncture, simulated acupuncture (non-penetrating) or “usual care.”
In the simulated acupuncture group, practitioners mimicked needle acupuncture by using a toothpick in a needle guide tube — poking at traditional pressure points without breaking the skin.
Participants received 10 treatments over seven weeks, at the end of which dysfunction and symptom scores improved equally among the three treatment arms.
Also, medication use in all the acupuncture groups decreased immediately and over the next year. About two-thirds of patients were taking medication, mostly painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs). By eight weeks, that had declined to 47 percent in the acupuncture groups and 59 percent in the usual-care group.
There were no cost savings for the health plan (treatments were estimated to cost from $600 to $1,200).
But the real surprise was that acupuncture was effective even when the treatment didn’t break the skin. “It’s not necessary to penetrate the skin. There’s no advantage to tailoring and no advantage to using a needle. Why?” Cherkin said. “It throws open the question of how does this work.”
There are no answers to that question yet, but some theories persist. It’s possible that the “superficial” acupuncture still kicks off a cascade of physiological processes that result in relief, the authors wrote. Or the benefit may come from “nonspecific effects such as therapist conviction [or] patient enthusiasm.”
Some previous studies have found similar physiological responses from both types of acupuncture.
Janet Konefal, a licensed acupuncturist and assistant dean for complementary and integrative medicine at the University of Miami Miller School of Medicine, said she was not surprised that non-puncture stimulation had equal effects.
“You can stimulate a point with pressure, needle, electricity, even now with laser light and different frequencies of laser light,” she said. “‘Pecking’ on a point is a Japanese technique for stimulation. You might use that with someone who is older or weak in their constitution. That could explain why two different methods of stimulation work equally well.”
Acupuncture of all types is “well on its way to the mainstream,” Konefal said. “When we understand that different stimulations may be effective rather than doing deep-needle stimulation which, for some people when in pain can be painful, we can now use laser or light needling or even just electric stimulation on the points; I think that part is great.”
And, Cherkin pointed out, “just because you don’t understand how it works doesn’t mean it doesn’t work. It could be worthwhile to pursue it.”
The U.S. National Center for Complementary and Alternative Medicine has more on acupuncture.
SOURCES: Daniel Cherkin, Ph.D., senior investigator, Group Health Center for Health Studies, Seattle; Janet Konefal, licensed acupuncturist and assistant dean, complementary and integrative medicine, University of Miami Miller School of Medicine; May 11, 2009, Archives of Internal Medicine
[This was an interesting article that was published in MedPage. Since so many people suffer from these conditions and many of them also work on computers, I though putting this up on the blog made sense. NW].
Arthritis Patients Cite Computer Problems
By Todd Neale, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
LITTLE FALLS, N.J., May 8 — About three-quarters of patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia reported some discomfort while using a computer, a survey revealed.
An even higher proportion , 84%, reported a problem with computer use stemming from their condition, Nancy Baker, Sc.D., of the University of Pittsburgh, and colleagues reported in the May issue of Arthritis Care & Research.
“The extent of problems is of concern due to the effect that these limitations may have on [the patients’] ability to use a computer for work-related tasks . . . and the increased risk of people with arthritis developing musculoskeletal disorders of the upper extremity related to computer use,” the researchers said.
Individuals with arthritis should evaluate their home and work computer environments to identify ways to reduce problems, they said.
In addition, they said, “health professionals must work with people with arthritis to identify problems experienced during computer use and implement computer workstation modifications to ensure safe, effective, and comfortable use of all computer equipment.”
Because of their condition, many arthritis patients choose less physically demanding jobs, such as administrative or clerical positions, the researchers noted.
Today, these jobs often involve extensive computer time, but little is known about the problems arthritis sufferers face in a computer-based work environment.
So Dr. Baker and colleagues surveyed patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia about their computer use and associated problems. The questionnaire, a letter explaining the survey study, and a return envelope were mailed to 1,190 people in the Registry (including 502 with rheumatoid arthritis, 406 with fibromyalgia, and 282 with rheumatoid arthritis).
Three hundred and fifteen responded. Of the 84% who reported a problem with computer use related to their condition, most had difficulties with their chairs — such as having a hard time getting comfortable, standing up, or sitting down. They were followed by problems with the keyboard, mouse, and monitor.
Surprisingly, patients with fibromyalgia reported significantly more problems involving the keyboard (P=0.009), mouse (P=0.002), and monitor (P=0.009) than those with rheumatoid arthritis or osteoarthritis.
“Based on the type of impairments characteristic of each disorder, those with rheumatoid arthritis and osteoarthritis should have reported more problems with the keyboard and mouse than those with fibromyalgia,” the researchers said.
They proposed three possible explanations for this:
“People with fibromyalgia may have increased clumsiness related to abnormalities in sensory processing or fatigue, the presence of diffuse rather than localized pain may result in problems in manipulation, or those with movement limitations may have found methods to adapt their environment more easily than those with diffuse pain, resulting in fewer perceived problems,” they wrote.
Overall, 76.5% of the survey respondents reported some discomfort while using a computer. The offending pieces of equipment were most often the chair (54.9%), keyboard (50.5%), and mouse (49.5%).
“Because those with arthritis may experience pain and discomfort even under ideal circumstances, it is not surprising that the prevalence of respondents reporting discomfort with computer use is considerably higher than the general population of computer users,” the researchers said.
Reported rates of discomfort for the general population range from 10% to 55%.
Compared to patients with other diagnoses, those with rheumatoid arthritis reported significantly lower levels of discomfort with the chair (P=0.002), and those with fibromyalgia reported significantly higher levels of discomfort with the monitor (P<0.001).
The researchers acknowledged limitations of the study, including possible selection and nonresponse rate bias (65%), which varied by diagnosis. In fact, rheumatoid arthritis patients were twice as likely to respond as the others.
They authors suggested that the differential response rate “may have also overestimated the prevalence of problems in one or more groups. It is quite likely that nonrespondents either used a computer very little or had few perceived computer use problems. Respondents with severe impairments may not have responded because their impairments precluded computer use.”
In addition, they noted the fact that the survey did not account for differences in computer usage patterns, environmental factors such as the setup of the workstation, or the psychosocial environment.
The study was supported by a Chapter grant from the Arthritis Foundation of Western Pennsylvania. Dr. Baker’s work was supported by the Arthritis Foundation, Western Pennsylvania Chapter.
The authors did not report any conflicts of interest.
Baker N, et al “Problems experienced by people with arthritis when using a computer” Arthritis Rheum 2009; 61: 614-22.
Rheumatologists typically use drugs that either reduce the amount of uric acid a patient is making… or they give them a drug that makes them pee the uric acid out. The target is to get the uric acid in the blood down to 6mg/dL.
Probenecid is the drug of choice to make patients pee the uric acid out. It is generally safe but shouldn’t be used for patients with abnormal kidney function, a history of kidney stones, during aspirin therapy, and in those who already pee out a lot of uric acid. Patients should drink plenty of fluid.
Benzbromarone is a drug that also acts as a uricosuric agent (makes patients pee uric acid out). It is not FDA-approved. And, unfortunately, it can be extremely toxic to the liver.
Allopurinol is a drug that suppresses uric acid production. While it’s effective, it’s also potentially toxic with side-effects including severe rash, liver damage, bone marrow toxicity, and hypersensitivity. It should be started at a low dose and slowly increased.
Patients started on either probenicid or allopurinol often have flares of gout. Therefore, they should also be treated with colchicine, a drug that prevents flares of gout in patients who are started on anti-gout meds. Once the target uric acid level is achieved and maintained for 6 months, colchicine prophylaxis can be discontinued.
Febuxostat is a new alternative to allopurinol. It was FDA approved in March 2009 and marketed as Uloric. Uloric is an oral tablet that comes in both 40 mg as well as 80 mg strengths. Allopurinol is excreted primarily by the kidney while febuxostat is metabolized by the liver. Therefore, febuxostat can be administered in patents with less than normal kidney function.
Its efficacy at attaining a serum uric acid level of 6.0dL or better and side-effect profile seems to be somewhat better than that of allopurinol, and is an alternative to allopurinol in patients who are allergic to that drug. The only drawback is that there may be a higher incidence of cardiovascular events in patients taking high dose febuxostat.
Uricase is a substance that breaks down uric acid. It’s used in Europe to prevent the high levels of uric acid that can occur in the blood of patients with cancer who are receiving chemotherapy and also in some patients with treatment-refractory gout.
A recombinant form of uricase made from a fungus, called Aspergillus, has been FDA-approved for use in patients undergoing chemotherapy who may develop massive amounts of uric acid in the blood with treatment. The problem is that it induces significant immune reactions in patients and can cause anaphylactic shock.
A type of uricase preparation linked to polyethylene-glycol is currently being studied in clinical trials for gout.
The angiotensin receptor blocker losartan (Cozaar), used for hypertension, and the triglyceride-lowering agent fenofibrate (Tricor) have moderately potent uricosuric effects.
One study of 10 patients with severe gout treated with the anakinra, a drug that blocks a protein messenger called IL-1, substantially reduced pain in all patients within two days, without side effects. Clinical signs of inflammation were reduced in 9 of 10 patients by the third day of treatment.
So… the future looks pretty bright for this old disease. Right now I’m using alot of febuxostat because I have quite a few patients with gout who’ve had allergic reactions to allopurinol. Plus, alot of people with gout have less than normal kidney function, so it’s nice to have a drug where that isn’t quite such an issue.