Archive for arthritis
Ciprofloxacin For Reactive Arthritis Has No Advantage Over Placebo
Although it is well known that certain gastrointestinal infections can cause a reactive arthritis, this study suggests that long term strong antibiotics do not help with symptoms. Unfortunately, these researchers have missed the evidence that suggests that it is not the infectious agent itself that causes the problems, but rather the environment set up by the presence of the infection. Adding strong antibiotics will just kill off more of the normal flora that’s supposed to be there, and evidence suggests that this flora may protect our bodies from the environment.
Ann Rheum Dis 2000;59:565-570 Treatment of reactive arthritis with a 3-month course of ciprofloxacin is no more beneficial than placebo, according to study results published in the July issue of Annals of the Rheumatic Diseases. Antibiotic treatment of reactive arthritis is controversial, the investigators note. “Eradication of the causative microbe appears logical,” but previous studies have shown that “short-term antibiotic treatment has no beneficial effect on the outcome of reactive arthritis,” they write.
Benefit of Tripterygium Wilfordii Hook F in rheumatoid arthritis
That’s the beauty of natural medicine…just when you think you have at least a partial grasp on many therapeutic against you get hit with a curve. When I first read this I thought it was a new approach to RA, but apparently this agent has had some rather extensive history of use for other autoimmune conditions, including systemic lupus erthythematous.
Severe Hepatic Reactions With New Arthritis Drug
I know sometimes it may seem that I highlight some of these “drugs are killing us” type of findings, but I only do it to stress how important it is for patients with diseases such as rheumatoid arthritis (the disease this drug is used for) to make lifestyle modifications before trying some of the more harmful pharmaceutical options. Oral tolerance, food allergy avoidance, detoxification and GI restoration are all methods used by natural practitioners to manage a case of RA. And with virtually unheard of incidence of side effects, let alone deaths.
(article) Severe liver injuries, some with a fatal outcome, have occurred in patients treated with Aventis’ novel rheumatoid arthritis drug leflunomide (Arava), the European Medicines Evaluation Agency (EMEA) said. In a public statement on its web site, the agency said a total of 296 cases of hepatic reactions had been reported. “Of these, 129 cases were considered as serious, including 2 cases of liver cirrhosis and 15 cases of liver failure, 9 with a fatal outcome.” The statement, dated March 12, said that most adverse events occurred within 6 months of starting therapy. “Although confounding factors were present in many cases, a causal relationship to leflunomide cannot be excluded.” Arava, a disease-modifying antirheumatic drug, is the first new treatment for rheumatoid arthritis in more than 10 years. It has been available from hospital specialists since 1999 for the treatment of adults with active disease.
Arthritis Puzzle: Two Pieces Snap Into Place
This article may be a little technical for some, and the clinical relevance of it is still a long way off, but this article may trigger a fundamental change in the way we view immune responses. I personally have always considered antigens (substances that elicit an immune response by the body) as proteins.
This article challenges that assumption, and suggests that the immune system can also recognize carbohydrates as antigens. As I said…this has no clinical relevance as of yet, but stay tuned.
Cyclo-Oxygenase 2 Function Is Essential for Bone Fracture Healing
This is a clinical decision nightmare. The newest arsenal in the fight against arthritis pain is the highly overused class of drugs called COX-2 selective inhibitors (Celebrex, Vioxx). These are supposed to be safer on the GI tract. Recent concerns have arisen over potential damage to the heart with their use, and now we see that the COX-2 enzyme is needed for proper bone healing. How many patients out there are improperly given the selective COX-2 inhibitors for pain relief following joint replacement surgery or fracture? Have to admit that those pharmaceutical reps are doing a good job pushing off-label uses for their drugs!
High Antioxidant Activity Reverse Age-Induced Decreases in Cerebellar beta-Adrenergic Function and Increases in Proinflammatory Cytokines
While this article has some very interesting aspects (including the ability to reverse damage to the brain), clinically, the ability of spirulina to lower TNF-alpha levels was most significant. This would definitely put spirulina on the necessary list of nutrients with the potential to positively affect conditions such as Crohn’s and rheumatoid arthritis.
J. Neurosci. — Abstracts: Gemma et al. 22 (14): 6114
Getting Hip to Chiropractic
An estimated 85 percent of people between the ages of 55 and 64 suffer from osteoarthritis – a debilitating condition that causes extreme joint pain and stiffness in the knees, hip, hands and spine. But osteoarthritis of the hip can be especially debilitating, since pain around the hip joint can radiate to the groin and thigh, and impede walking and other movement.
In a small pilot study, researchers assessed the effectiveness of chiropractic manipulation in patients with hip osteoarthritis. Eight patients diagnosed with osteoarthritis or suffering from hip pain were assigned to a chiropractic group or a sham treatment group. Patients in the chiropractic group were assessed for limitation in hip range of motion and joint-play restriction, and received chiropractic manipulation six times over a three-week period. Patients in the sham group did not receive any hands-on assessment, but were treated with a device modified to deliver a series of “thrusts” without any real force.
While the sham group reported some positive benefits, the study showed that at least six chiropractic treatments over a three-week period could benefit patients suffering from hip osteoarthritis. Researchers noted, however, that additional research on such treatment for the condition is still warranted.
This study adds to the growing body of evidence that affirms the benefits of chiropractic in treating more than just back and neck pain. If you suffer from osteoarthritis or any other debilitating condition, pain relief may be as close as your doctor of chiropractic.
Click here for more information about maintaining musculoskeletal health.
Reference: Brantingham JW, Williams AM, Parkin-Smith GF, et al. A controlled, prospective pilot study of the possible effects of chiropractic manipulation in the treatment of osteo-arthritis of the hip. European Journal of Chiropractic 2003;51(3):149-166.
Effects of a ginger extract on knee pain in patients with osteoarthritis
Ginger is another of those natural compounds that has shown some pretty strong potential as an anti-inflammatory, particular in cases of osteoarthritis. Remember, also, that ginger has some very strong anti-emetic (anti-nausea) properties as well and can work well for morning sickness.
High incidence of cardiovascular events in a rheumatoid arthritis
Do we need any more evidence that CVD has a strong inflammatory component? I would think not, and anti-inflammatory lifestyles/approaches should be an integral part of any intervention designed to lower risk of CVD. I recently had a patient that we ran a CRP on looking for inflammation related to joint pain. She came back with an very elevated CRP. This patient had a strong family history of heart disease and her twin brother had lymphoma (she is mid 30′s). Well, we made some lifestyle changes including avoidance of refined carbs and hydrogenated oils. Several months later her CRP had dropped to just above normal. There is a strong chance this patient just cut her risk of CVD dramatically through a lowering of her overall inflammatory state.
Nothing slows you down like pain in hips. But sometimes hip pain causes may not be coming from the hip and it takes an experienced physician to tease out answers.
First, though, this is one of those blog posts that I need to make full disclosure up front. I’m going to be biased. There. Now we can move on…
As a practicing chiropractor, patients come into our office with all types of complaints. Only rarely do they present with textbook-like cases that are as clear cut as putting together an IKEA desk (ok…so maybe a little easier than following that little guy scratching his head…).
The point is, the value in chiropractic treatment is that we understand the pain that our patients experience. We understand that just because it hurts HERE does not mean that HERE is where the problem is. This knowledge comes from years of study in school (chiropractors get FAR more education on the musculoskeletal system than any other physician out there) and is honed with years of clinical practice.
This is why the patient who has been getting epidurals for a year to treat her “sciatic” pain was better in 2 visits with a heel lift and some work on the hip in our office.
This is why the patient who was told they have a disc problem (because it was found on an MRI that shouldn’t have been ordered in the first place) really just had joint dysfunction in his back that was better in 2 chiropractic treatments.
It is why a long term patient who’s MRI of the shoulder led her to 2 surgical recommendations, but I explained that what she really needed was a quick steroid injection to control the inflammation caused by a vaccination.
This is why chiropactors shine at treating musculoskeletal pain. And sometimes, our diagnosis is not really ironed out on the first visit. I usually tell patients that, if they REALLY want to know what is causing his or her pain, I recommend autopsy.
It is common for a patient to present to our office with low back, hip and leg pain. Believe it or not, far too commonly a diagnosis can’t be made with clear cut certainty. An MRI can be a very bad idea here (and what do we order? A lumbar MRI? A hip MRI? Xrays?). The answer? Diagnosis made by clinical response to treatment.
I think it’s a hip, so I treat the hip for a visit or two. Disc problem? We start a protocol of Flexion Distraction. Sacroiliac joint dysfunction? Soft tissue work, stretching and chiropractic manipulation. If the patient gets better, I was right. If the patient doesn’t get better, time to move to the next likely diagnosis.
That’s why they call it “practice.”
But what about that 5 minute consultation with the orthopedic or neurosurgeon (after waiting in the waiting room for 2 hours past your appointment time)? If it takes me, a seasoned chiropractor who thinks he’s pretty good, several visits to pin down more exactly what is going on with a patient, how can it possibly be done in 5 minutes?
It can’t. And maybe this is why surgical outcomes are so unpredictable. I can’t tell you how many times I’ve had a patient undergo some type of surgery for something that clearly was not causing the pain.
So why all this rambling?
Of course it has to do with this particular study looking at arthritis in the upper lumbar spine and hip pain. Researchers looked at the presence of self reported hip pain and the presence of arthritis in the upper lumbar spine in over 2800 patients aged 55+. Here’s what they found:
- Those with disc space narrowing at L1/L2 (the top part of the lumbar spine) had double the likelihood of hip pain in the last month for men.
- For women, the increased risk was 70%.
- For reported chronic hip pain in men, the likelihood of having disc space narrowing at L1/L2 jump to 2.5 times more likely.
- Disk space narrowing at the lower levels (L3/L4/L5/S1) was not associated with hip pain.
What does this mean?
It means that if you have hip pain, you need to see a provider who understands the way the body works (hint, hint, wink, wink). If not, you may get that hip replaced when it wasn’t the problem.
But heck–hip replacement surgery these days is a cake walk, right…?