Chinese herbal remedy works for rheumatoid arthritis

Researchers at the National Institutes of Health say thunder god vine, a Chinese herbal remedy, which has been used in China for centuries to treat a variety of inflammatory diseases, may benefit people with rheumatoid arthritis.

A study, recently published in the Annals of Internal Medicine, compared the efficacy and safety of a Chinese herb called thunder god vine [Tripterygium wilfordii Hook F (TwHF), also known as “lei gong teng”], and a conventional disease-modifying anti-rheumatic drug (DMARD) used for rheumatoid arthritis. Researchers randomly assigned 121 people with rheumatoid arthritis to take either 60 milligrams of the Chinese herb three times a day or 1 gram of sulfasalazine twice a day for 24 weeks.

Nearly half of the participants dropped out before the study was complete. But after 24 weeks of treatment, researchers found that a more people in the Chinese herbal remedy group experienced at least 20% improvement on a standard measure of rheumatoid arthritis symptoms compared with the sulfasalazine group.

Researcher Raphaela Goldbach-Mansky, MD and colleagues say the study was too short to show if thunder god vine also helped slow the progression of joint destruction from rheumatoid arthritis. But if further studies confirm these results in larger numbers of people, “thunder god vine may provide an affordable natural treatment option for rheumatoid arthritis.”

Comment: A much older study authored by Peter Lipsky also demonstrated the anti-inflammatory benefits of thunder god vine [Lipsky, P. E. and Tao, X. L. A potential new treatment for rheumatoid arthritis: thunder god vine. Semin.Arthritis Rheum. 1997;26(5):713-723]… so this isn’t really news.

In fact, it’s more of a curiosity than anything else.  The goal in rheumatoid arthritis (RA) is to help with both symptoms as well as disease progression. Sulfasalazine, the drug used as a comparator in the NIH study, doesn’t have good anti-inflammatory properties.  As a disease-modifier it’s pretty lame also.

Nonetheless, the take-home message is this:  Some herbal remedies do work for symptoms and they’re worth a try.  In the past, physicians, particularly academic types, would debunk these types of therapies as “snake-oil.”  As we learn more about the natural healing effects of herbs… and the natural healing powers we all possess (Examples would be PRP and stem cells), I think our ability to treat arthritis will improve significantly… and with fewer side-effects.   [A word of caution… don’t forget or nglect effective conventional therapies! ] NW.

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Killing two birds with one stone…

Every so often a unique medicine comes along.  Denosumab is a drug that’s going to be used for both osteoporosis as well as rheumatoid arthritis.  Sort of like the old Doublemint gum commercial with the Doublement twins.  Double your fun.

It’s given by subcutaneous injection every six months so the dosing interval is attractive.  What the price tag attached to this invention is the big question.

This is an abstract that appeared in a recent journal…

Denosumab for joints and bones

Current Rheumatology Reports, 07/30/09

Lewiecki EM et al. – Denosumab suppresses bone turnover by inhibiting the action of RANKL on osteoclasts. [Editor’s note: osteoclasts are the cells that break down bone] Denosumab reduces bone turnover and increases bone mineral density in postmenopausal women with low bone mineral density, reduces fracture risk in women with postmenopausal osteoporosis, and inhibits structural damage in patients with rheumatoid arthritis when added to ongoing methotrexate treatment. It is generally well tolerated, with a good safety profile. Adverse and serious adverse events, including infections and malignancy, are similar in patients treated with denosumab or placebo.

When this drug will be approved by the FDA is still uncertain.

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One of those weeks…

It’s been an eventful week.  Last Friday within a span of 5 minutes I got called about one of my sons who was in a serious auto accident and was being sent by ambulance to the emergency room and then another call from my sister who told me my dad had fallen and broken his hip.

Life is certainly quirky.

So anyway, this week I had a great interview with Dr. Rocky Tuan, the world’s foremost scientific expert on stem cell biology.  Dr. Tuan has headed up the Cartilage biology section at the National Institutes of Health since 2001 and is going to the University of Pittsburgh Medical Center to be chief of their new Regenerative Medicine section.

I also talked with Dr. Joseph Purita, an orthopedist who does alot of regenenerative stuff with PRP and stem cells in Florida.  Very nice man.  And we had a nice chat exchanging ideas.

Like any specialty in medicine there are those who are willing to share and eager to learn… and there are those who are bloodsuckers.  I prefer to avoid the latter.

The field of regenerative medicine for arthritis, tendinosis, etc. is exploding.  I just had a recent article published in the Journal of Musculoskeletal Medicine on stem cells and PRP.  Here’s the link

Stem cell technology for the treatment of osteoarthritis and related conditions is constantly evolving as we learn newer techniques.

This coming week I’ll be interviewing Don Margolis, a stem cell crusader.

Which brings me to my secret.  I’m working a a new project on stem cells and PRP.  I’ll be letting out little hints pretty soon.  Some great content.  So make sure you follow the blog.

P.S. My Achilles that I had PRP on is doing very well.  Have started light jogging and rope skipping.

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My Achilles tendon…

It’s been a little more than 3 weeks since my tenotomy/PRP  procedure for my Achilles tendon.  I have to confess, it hurt alot for the first 2 weeks.  But this past week I’ve seen the light at the end of the tunnel.

I’ve done my eccentric stretching exercises religiously- the ones Dr. Mulvaney gave me.  (And believe me, I’m the world’s worst patient when it comes to following orders). And I have no pain and I no longer limp.  The lump that was really painful where my tendonitis and tear was located isn’t tender anymore.

I haven’t started to run yet but I can do the bike and the elliptical without pain.

Would I recommend this procedure to others?  Absolutely!  In fact, now that I have first hand experience with tenotomy and PRP, I am a real zealot.

I’ll go way out on a limb and say that this is the procedure of choice for people with chronic Achilles tendonitis with or without a partial tear.

Great news for us Baby Boomers.

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New treatment for shoulder tendonitis

Healthday (6/30 Preidt) reported a study from the University of Milan, published in the July issue of Radiology, showing that a minimally invasive procedure is helpful for patients with calcific tendonitis of the shoulder. 

What the researchers did was to randomize 287 patients with calcific tendonitis of the shoulder to one of two grouops.  One group underwent ultrasound guided needling of the tendon with “washing out” of the shoulder and the other control group had no treatment.

Followup of the patients showed that the treatment group had significantly less pain and more mobility at one month, three months, and one year.

[This study actually describes a not so new procedure.  The “new” part is the use of ultrasound guidance, which actually is “old news”.  And the ability to break up the calcific depositis and wash out the shoulder is something that’s been done by many practitioners for several years.  This study confirms through a controlled study what has been known for quite some time. 

What really is new is something I’ve written about before… and that is the use of tenotomy… poking holes in a diseased tendon under ultrasound guidance  and injecting platelet rich plasma to heal the tendon and make new stronger tendon tissue. This is particularly useful for people with chronic rotator cuff problems.

My feeling is that  any press regarding the use of ultrasound guidance is a good thing since it informs prospective patients that they should demand a technology that will help them recover faster. NW]

Practice What You Preach…

This past Friday was a busy day.  I performed three stem cell procedures on patients with osteoarthritis of the hip and knee, a PRP procedure on another patient with posterior tibial tendonopathy…  and then (drumroll please….)

…had a PRP procedure done to me… on my Achilles tendon.

So let me explain…

As you know my area of expertise is regenerative medicine for patients with arthritis.  That’s why my practice focuses on conditions like OA, RA, and tendonitis.

And when my nurses and I talk to patients and prospective candidates for these procedures, we tell them what to expect.  But how  can you tell a patient what to REALLY expect unless you’ve undergone the experience yourself.

Actually, one of our nurses had a stem cell procedure on her knee for osteoarthritis (yes… I did it),  so she’s been there and can tell patients bout the experience.

Now… don’t think I had this procedure done to me because I just wanted to be able to tell patients what to expect.  I think I’m a pretty empathetic physician but there are limits!

Here’s the background…

Twenty-seven years ago, I tore my left Achilles tendon playing basketball… (so beware, Mr. President).  It was not fun.  The injury was painful, plus I had to undergo major surgery to repair it, then I was confined to a long leg cast for 7 weeks, then a short leg cast for another 6 weeks.

For the last 10-15 years I’ve had intermttent pain in my right Achilles with activities like running and so forth.  My fear was that I was going to tear it like I did the other (there is an increased risk for tearing the other Achilles if you’ve torn one side).

So, I made my mind up to have a percutaneous needle tenotomy with PRP done.  If you’re experiencing chronic tendonitis, this is by far and away the best treatment for it.

But what do you do when you feel like you’re THE GUY.

What I mean is this…  There are those who think I’m the person to see when it comes to these types of ultrasound-guided tissue regenerative procedures.

But what do you do if you can’t do this type of thing to yourself?  Well… I did the next best thing.  I arranged  it for when doctors I really trusted and respected would be around.

I had planned for Dr. Tom Clark, the world’s foremost ultrasound anatomy expert and Dr. Sean Mulvaney, one of the best sports medicine physicians  in the area, to visit me Friday to observe and assist me in my cases.

So at the end of the afternoon, I said… “OK, let’s do it…”

Before I go on, let me explain one thing.  I am a WUSS.  I hate needles and I hate pain. I am a wimp, a coward when it comes to pain.  I admit it. So this thing was scaring me.  I had this upside down feeling in the pit of my stomach and I was breaking out in a cold sweat.  But, I told myself, “Nathan… how can you honestly talk with patients about this procedure … be brave… suck it up!)


I had my nurses draw my blood for the PRP collection, then I went to our procedure room and Dr. Mulvaney did the procedure.  Probably half the staff came in to observe and giggle.

(By the way I had the whole thing videotaped and you’ll be able to see it sometime soon).

I can tell you it hurt.  Not unbearable, but not like laying out on a beach, listening to the waves (but that’s what I focused on to take my mind off what was happening).

Afterwards, Dr. Mulvaney gave me post-procedural instructions:

He told me, “Tonight, it’s going to hurt.”

I asked, “How much?”

He said, “You’re going to feel ‘this hurts so bad there’s gotta be something wrong’ kind of pain.”


Well later that evening, Judy and I watched  the DVD, ‘Risky Business’ (by the way if you haven’t seen this movie with the young Tom Cruise, you should).

I had some discomfort… OK… I had pain. and I actually had to take some pain medicine (which I ordinarily dislike doing). But not excruciating… even for a wimp like me.

But today, even though it’s sore, I think I’m going to make it.  I start my stretching exercises tomorrow.

I know this procedure will make my Achilles tendon strong and normal so I won’t have to worry about tearing it.  No substitute for peace of mind. And I know it won’t hurt when I run – a major plus.

And I’m going to see my son, Jeffrey, in a play tonight, so when I hobble in with my crutches, maybe I won’t have to wait in line.

#@$%*&%^ Insurance companies!!!

[This news segment highlights a little known but clearly typical insurance company tactic.  There is so much written about how pharmaceutical companies are to blame for the health care system breakdown.  And everybody is taking shots at them… including different medical organizations. 


Even the American College of Rheumatology, of which I’m a member, publicly distances itself from pharmaceutical companies, but privately demands funding from these companies for various functions.


Insurance companies get a pass for reasons which are a complete mystery to me.  Any patient or doctor in practice knows that insurance companies call the shots when it comes to tests that patients can have or medicines that are ordered. 


I may order drug A, but the likelihood is about 80% the patient will receive drug B, because that’s what the insurance company wants them to have.  I have a patient who’s been taking a medicine that works great for her for three years.  But now the company says “they made a mistake” authorizing that medicine in the first place. They want her to take something she’s already failed.  GRRR!


I recently ordered a diagnostic test for a patient.  The insurance company denied it.  When I called the medical director and accused the insurance company of making medical decisions that were not in the patient’s best interest, he said, “We’re not making medical decisions.  She can have the test.  We’re just not going to pay for it…” 


I’ve got to admit, it takes alot of balls to say something like that…]



Segment highlights how health insurers hit consumers with unexpected fees.


On its website, KTVT-TV Fort Worth, Texas (6/12) highlights “how some health insurers get you to pay more — so they can pay less.” Several incidents are presented, such as the plight of Camille Privitt, who “slipped down a flight of stairs” and fractured “three thoracic vertebrae.” Privitt received a letter from her “insurance company, United Healthcare,” which among other things, said the “ambulance was an ‘out-of-network’ service” and said the fees “for the medical supplies that held Privitts’ neck in place” were not covered. The segment also provides “Tips to Fight Back” against insurance fees, such as calling the insurer and send letter via certified mail; and, as a “last resort,” consulting a lawyer.

Knife-happy surgeons?

[I thought this was a real good indicator of a couple of things.  The first is that the health care system is too focused on treatment rather than prevention.  And that orthopedic surgeons do far too many joint replacements. 


Most joint replacements are done for arthritis.  The emphasis should be on slowing the disease process and maybe even reversing it, rather than subjecting a patient to a potentially dangerous – even life-threatening- procedure.  The point CBS was trying to make was that informed consent- the process where risks of a procedure are explained to the patient- is confusing and most patients don’t understand what’s going to happen.  And that’s true.


I have many patients who have gone through joint replacement and are happy… however, I also have a significant number of patients who have had bad outcomes and rue their decision.  Too late!


That’s why more emphasis should be placed on regrowth of connective tissue- ie. prolotherapy, the use of natural growth factors such as platelet-rich plasma (PRP) and the use of stem cells to regrow cartilage.  Natural healing.


There are efforts now at some centers evaluating the use of stem cells for spine-related disorders.


Our experience with the implementation of an autologous stem cell program (using the patient’s own stem cells harvested from their bone marrow) for osteoarthritis of the hip and knee  is proving that tissue regeneration is an option- a far better one that joint replacement.  That’s why the orthopods are so angry with us!!!]



Study indicates informed consent forms may be of “limited value.”

The CBS Evening News (6/9, story 10, 3:45, Couric) reported that “the high cost of medical care is a huge issue today, and…patients often make the problem worse by giving doctors permission to do procedures they don’t need. Experts point to four procedures — coronary angioplasty, spinal fusion, knee replacement, and hip replacement — that are responsible for billions of dollars in hospital costs every year.” In fact, data indicate that 30 “to 40 percent of those procedures are considered unnecessary.” But, Dr. Elliott Fisher, the Dartmouth Institute for Health Policy, noted that “proper informed consent would eliminate 30 to 40 percent of other unnecessary expensive procedures.” He explained, “The problem starts with consent forms. A review of hundreds of consent forms at more than 150 hospitals found them to be of, quote, ‘limited value.’ They are not standardized, loaded with confusing language. They are often missing specific risks, and generally not well explained by doctors.”

Doctors…Modern Day Natural Healers

If you are a Baby Boomer who wants to stay active and stay in the game…. (and no, I’m not talking about male enhancement)…and recover from nasty problems like tendonitis and arthritis, you ought to pay attention to this post …

Because this past week I interviewed Dr. Sean Mulvaney, a sports medicine doctor who specializes in PRP (platelet-rich plasma) techniques and Dr. Dean Reeves, a specialist (in fact one of the foremost experts in the world) in prolotherapy.

Both of these physicians discussed the  revolution in natural healing of conditions such as tendonitis and arthritis using the body’s own growth factors.

While our ability to regenerate new tissue declines as we age, it is not completely lost.  It’s possible to turbocharge it using newer methods.

With old technologies like prolotherapy and new technologies like PRP and stem cells, we are able to accomplish amazing things.  Some of these medical approaches sound like stuff out of Star Wars. Truly amazing stuff and important if you’re a Boomer who wants to continue to do the things you want to do without having to take toxic medicines or worry about joint replacement surgery lurking in the background.

Dr. Mulvaney discussed the biology and indications for PRP. 

Since he is an Army guy with hush-hush connections, he told me that if he revealed any more, he’d have to kill me….

… and Dr. Reeves talked about the amazing regenerative and rejuvenating properties that our bodies have if given the right opportunity.  While he uses the standard prolotherapy solutions (generally dextrose), he is also an advocate of PRP.

In future discussions, I’ll be yapping about PRP and stem cells. 

The reason? …I’m working a on a big project  on regenerative medicine.  In the upcoming weeks, I’ll be telling you more about it. Stay tuned.

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