LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Arthritis

Eleven Deaths Among UK Vioxx Users – (10-16-00)

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Eleven Deaths Among UK Vioxx Users

The new selective COX-2 inhibitors Vioxx and Celebrex have been touted as a new panacea for arthritic disorders. Although the incidence of ulcers does appear reduced, we still cannot view these drugs as completely safe.

(article) Eleven deaths and more than 1,000 reports of suspected adverse reactions to Merck’s new osteoarthritis drug Vioxx (rofecoxib) have been reported in the UK since its launch in June last year, British regulators said on Thursday. Five patients died following gastrointestinal reactions, three following cardiac failure and three following myocardial infarction, the agencies reported in their newsletter “Current Problems.” An estimated 557,100 prescriptions for Merck’s COX-2 inhibitor have been dispensed in the UK up to the end of May 2000, the agencies said. The rate of reported adverse reactions is therefore approximately one per 500 prescriptions. The newsletter reminded prescribers that rofecoxib is contraindicated in patients with active peptic ulceration, GI bleeding, and severe congestive heart failure. It also noted that “caution should be exercised in patients with a history of cardiac failure, left ventricular dysfunction, or hypertension and in patients with pre-existing oedema for any other reason”. In conclusion, the agencies said, “As with all new drugs, the safety of rofecoxib remains under close review.” They pointed out that another COX-2 inhibitor, Pharmacia’s celecoxib (Celebrex), had been launched recently and promised to report on its safety profile in a forthcoming bulletin. Merck officials were not immediately available for comment.

Cannabidiol is anti-arthritic in murine collagen-induced arthritis – (09-18-00)

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Cannabidiol is anti-arthritic in murine collagen-induced arthritis

This article talks about the non-psychoactive component of cannibas being used orally as a treatment for arthritis. It was shown to lower TNF levels…the same messenger that the new expensive drugs for Crohn’s disease and rheumatoid arthritis lower.

PNAS — Abstracts: Malfait et al. 97 (17): 9561

Read entire article here

Muscloskeletal Pain? Primary Care Docs Not Giving Good Advice

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Sciatica.  Knee osteoarthritis symptoms.  While these two conditions seem a world apart, there is something they have in common:  Bad advice.

Both of these conditions have solid research on things that you should and should not be doing to help you recover.  The “should” category involves exercise and moving around.  Almost always with musculoskeletal pain, moving around is better and staying sedentary is a very bad idea.  While my opinion is clearly biased on this one, the acceptable medication approach to most musculoskeletal complaints involves the use of NSAIDs like ibuprofen.  Strong pain medication like opioids (Vicodin, Percocet) should not be used, especially initially, and fall into the “should not” category.

In the “should not” category is also imaging.  While plain X-rays may be appropriate to evaluate for osteoarthritis symptoms, advanced imaging like MRI and CT scan should not be ordered unless certain red flags are present.

All of this is well supported by the medical research over the past 10 years or so.  But one of my continued frustrations with all branches of medicine is just how rare it is for doctors to actually crack open medical journals.  The research itself suggests that doctors are, in general, about 19 years behind the medical literature.  That means that this particular article, looking at just how well primary care doctors understand the current recommendations for sciatica and osteoarthritis symptoms, won’t grace the typical doctor’s eyes for two more decades.

Basically, they won’t know that they don’t know until around 2033.

Just in case you think I’m being a little too facetious, let’s look at what researchers found in the study:

  1. Despite the clear benefit, less than 1/3 of physicians would give exercise advice (30.2% for osteoarthritis, 32.8% for sciatica).
  2. Overall, though, at least newer docs were more likely to give advice on exercise (39.6% of newer physicians versus 26.0% of older docs for sciatica / 20.8% for osteoarthritis).
  3. Newer physicians were less likely to order tests like CBC or CMP (9.4% vs 21.9%) or a urinalysis (4.2% vs 16.7%).
  4. For osteoarthritis, X-rays were more often ordered by newer physicians (85.4% vs 69.8%).

Overall, these numbers reflect poorly on the typical primary care doctors’ ability to handle common musculoskeletal complaints.  For my entire chiropractic practice life I have been confronted with patients and people in the community that ask whether they should see his or her primary care doctor or a chiropractor first.  The evidence is very clear–seeing a chiropractic physician first is the best option that will be more likely to lead you down a path with the best and most efficient outcomes.

But clearly I’m biased.

Frequency of triggering bacteria in patients with reactive arthritis – (04-09-01)

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Frequency of triggering bacteria in patients with reactive arthritis

The well known fact that certain organisms infecting the GI tract can cause systemic arthritic symptoms becomes lost on most clinicians when they consider such conditions as fibromyalgia and many of the autoimmune disorders causing joint pain. In talking with a gastroenterologist and a rheumatologist that I know, they would never entertain the idea that the GI tract could be a source of joint pain unless the “well know” organisms are present. Maybe that’s why we’re missing the boat on chronic pain in civilized health systems…

Ann Rheum Dis — Abstracts: Fendler et al. 60 (4): 337

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COX-2 implications and gastric mucosal integrity, ulcer healing – (08-23-01)

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COX-2 implications and gastric mucosal integrity, ulcer healing

This is an informative review article on the new wonder-drug arthritis meds, and the concept that maybe they are not so friendly to the gastric mucosa as they were marketed to be. Recently this class of drugs has also come under fire from the cardiology sector. Remember that, just like nature, there are no “wonder drugs.” This applies even more to science’s mutation of natural compounds. This class of drugs hit the ground running and created quite a profit for the two drug companies producing them. Unfortunately, it appears that most of the patients taking these drugs are guinea pigs when it comes to identifying the long term side effects and efficacy.

Gut — Abstracts: HALTER et al. 49 (3): 443

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Oral Type II Collagen Therapy Shows Promise in Juvenile Arthritis – (09-02-01)

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Oral Type II Collagen Therapy Shows Promise in Juvenile Arthritis

This type of therapy for RA patients was already published many years ago with wonderful benefits and few side effects to the patients in the study. This is believed to work by teaching the GI tract to send a signal to the rest of the body saying that Type II collagen is “okay,” thereby lowering the immune response to the body’s own Type II collagen. This is truly a wonderful approach with virtually no side effects. Unfortunately, without big money behind a study like this it may not go far.

Arthritis Rheum 2001;44:1775-1781 Oral type II collagen (CII) therapy appears to reduce the autoimmune process of juvenile rheumatoid arthritis (JRA) and promote clinical improvement. Autoantibodies to CII, a cartilage-specific protein, have been found in the sera of JRA patients. By mimicking this protein, oral bovine CII therapy may serve as a tolerogen that attenuates the autoimmune process in these patients, Dr. L. K. Myers, from the University of Tennessee in Memphis, and colleagues explain in the August issue of Arthritis and Rheumatism. Dr. Myers’ team assessed the clinical outcomes and T-cell cytokine profiles of nine JRA patients who were treated with oral bovine CII for 3 months. The patients, who were 3 to 15 years of age, included seven with rheumatoid factor-negative JRA with polyarticular disease and two with pauciarticular disease. Two patients had disease exacerbations when treatment was discontinued, so therapy was restarted for an additional 3 months. Eight of the 11 treatment courses were associated with a clinical improvement, the authors state. Six of the eight patients who responded clinically had a decrease in interferon-gamma levels. Of the seven patients who had detectable levels of transforming growth factor beta-3 mRNA, six showed an increase after receiving CII therapy. No side effects were noted with CII therapy in any of the patients.

TNF–dependent maturation of local dendritic cells is critical for activating the adaptive immune response to virus infection – (10-18-01)

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TNF–dependent maturation of local dendritic cells is critical for activating the adaptive immune response to virus infection

I know this is a very long title, but I wanted to illustrate a point. TNF-alpha is an integral part of the immune response and we are only now just beginning to understand how it works. Using the new class of drugs for Crohn’s and rheumatoid arthritis that blocks TNF-alpha just seems dangerous to me if we don’t even fully understand what it does.

PNAS — Abstracts: Trevejo et al. 98 (21): 12162

Read entire article here