LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Arthritis

ABILITY OF GALT IN GUT REGULATES ENTIRE IMMUNE SYSTEM – (09-01-03)

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Normal intestinal microbiota in aetiopathogenesis of rheumatoid arthrits

There has been much theory in the past about an infectious etiology for RA and this article further supports the idea that an improper response to bacteria may be responsible for the onset of RA. Remember that the gut has the ability to regulate the entire immune system via the GALT (gut activated lymphoid tissue). If there is something in the GI tract that the GALT does not like, it can send a signal out to the rest of the immune system to up-regulate, thereby opening up a Pandora’s box of potential autoimmune problems.

Ann Rheum Dis — Abstracts: Toivanen 62 (9): 807

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TNF-ALPHA IS BETTER FOR BONE HEALING AND FIGHTING CANCER – (09-24-03)

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Impaired Fracture Healing in the Absence of TNF-alpha Signaling: The Role of TNF-alpha in Endochondral Cartilage Resorption

It is quite common for drugs to be developed and marketed that affect certain biochemical pathways before we fully understand these pathways. This is evidenced by the withdrawal of many medications after they are approved by the FDA. Of particular concern for me is the new drugs that block TNF-alpha being used for rheumatoid arthritis, Crohn’s and psoriasis.

While I understand that many patients with these conditions are suffering with their symptoms, I know that many of these patients have not exhausted (or, in many cases, even attempted) natural approaches. TNF-alpha is now known to be an integral component of bone healing and formation, fighting off cancer and fighting off infections. Blocking this messenger may yield more long term problems than it solves.

Impaired Fracture Healing in the Absence of TNF- Signaling: The Role of TNF- in Endochondral Cartilage Resorption.

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ASPIRIN ACCELERATE DAMAGE TO LINING OF GI TRACT – (10-01-03)

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Interaction of a selective COX-2 inhibitor w/ aspirin and NO-releasing aspirin in the human gastric mucosa

The dominoes of the newest wonder-drug for arthritis pain continue to fall. They don’t mention on those fairy-tale like commercials that combining the new drugs such as Celebrex and Vioxx with aspirin will accelerate damage to the lining of the GI tract. This is a major concern since many patients self-medicate with aspirin in an attempt to lower risk of heart attacks.

PNAS — Abstracts: Fiorucci et al. 100 (19): 10937

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ARTHRITIS DRUGS CAN CAUSE VISUAL IMPAIRMENT – (12-22-03)

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Celecoxib, rofecoxib, and acute temporary visual impairment

Another wonderful example of how little we know of human physiology. Basically, we don’t fully begin to grasp the complexity of an enzyme until we begin shutting it down on a grand scale; i.e. FDA approval. We thought we knew what cyclo-oxygenase 2 did until we released the new wonder arthritis drugs Celebrex and Vioxx. Now we are seeing that COX-2 is essential for heart health, bone formation and now maybe some visual impacts as well.

bmj.com Coulter et al. 327 (7425): 1214.

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Knee Cartilage Damage? Alternatives to Knee Replacement

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The knees bear a tremendous amount of abuse in a lifetime, resulting in knee cartilage damage. Luckily, there are many viable alternatives to knee replacement.

Treatment in our office can be very, very effective at relieving knee pain. However, even we understand that there are limits to pain relief that can be obtained. While the numbers are low, we have had patients who did not respond proceed to knee or hip replacements.

Personally, I want to save everybody from surgery and keep them as functional as they want to be. In a perfect world this would be an obtainable goal.

Luckily, there are additional options that are available to arthritis sufferers that were not available even 10 years ago.

Before we get into those other options, we need to cover some important points first.

  1. Just because you have arthritis does NOT mean it is causing your pain. Countless times we have had patients with “arthritis pain” get total relief in just a few visits.  We did nothing to the arthritis, but the arthritis was not causing the pain.
  2. Treatment around the knee HAS to consist of solid soft tissue techniques such as Graston, fascial manipulation or ART. Anything less is not the best. That means that mobilization, manipulation, exercises, ultrasound, laser and interferential therapies are just likely not going to cut it.
  3. You HAVE to get off your butt and use the darn joint. It is abundantly clear that exercise and strengthening the knee joint will improve arthritis pain and function.
  4. The use of any type of anti-inflammatory may likely keep you from getting the best improvement possible because it blocks the healing process.
  5. Weight loss will always help. Drag out the old physics book and do some math on how much extra force the knee has to deal with at 10 extra pounds. Jack that number up to 50 and the forces start to have more zeros on the end. The weight’s go to go.

Ok…now that that’s out of the way we can address the findings of this particular article.

I remember the first time I had a discussion with a patient about injections of hyaluronic acid into the knee (Sandy–if you’re reading this I’m talking about you…). It was probably about 12-13 years ago, so this is not a new technology.

Basically, the procedure involves injecting hyaluronic acid, or some version of it, into the joint. Hyaluronic acid injections contain the building blocks of cartilage, so it makes at least some sense that this might be a good idea.

The results over the years seems to have been okay. Not stellar, but okay. With one exception (a patient who developed an infection in the joint after the injection–but this was a technique problem and not a problem with the treatment), I have not seen any downsides to this. Some seem to respond, some don’t.

In this particular study, researchers compared the effectiveness of two types of substance used in the injections. Hyalgan has been one of the main products available almost since the beginning and is considered a low molecular weight product. The results on pain reduction were compared to an intermediate weight product.

The pain reduction was better with the intermediate weight product. While the difference was not great, it was enough to suggest that this product was a better option for pain control and certainly adds to the total picture of what this type of approach can add to treatment of knee arthritis.

Have you tried these injections before? If so, how did they work for you?

Reduce Uric Acid to Prevent Gout: Details on the Gout Diet

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We’ve always known you can reduce uric acid levels, prevent gout and improve your health with diet. But recent evidence clarifies what is worse in a gout diet.

Gout sucks.  In school we were taught that the textbook presentation of gout is when the big toe is so painful that merely the weight of the sheet is too much to bear.

Rarely do the “textbook” descriptions fit in clinical practice.  But, with gout, it seems that every patient I have seen in the middle of a flare up give some variation of this scenario.

For those of you who don’t know, gout is a condition where the levels of uric acid in the bloodstream accumulate to a saturation point.  At this point, the uric acid crystallizes into sharp little shards to broken glass texture that sit in between the surfaces of the joint.

Every movement of that joint grinds those crystals into the soft surface of the joint.  Just thinking about it makes me cringe.

In the long run, gout can destroy a joint and lead to a very, very painful arthritis.

Certainly there are medications that help to lower uric acid levels. Allopurinol and colchicine are some of the most common (although there were some changes with colchicine that recently occurred that have driven the costs up 12,000% because of a single drug company taking advantage of a FDA loophole).

But the reality is that gout IS prediabetes.  One of the things that will drive up uric acid levels is the elevated insulin levels that we see in prediabetes.  (Certain blood pressure meds, ironically, will also increase your risk of developing gout)

This also means that elimination of gout and prevention of flare ups is entirely within your control.

Besides a anti-diabetic lifestyle, lowered intakes of purine rich foods has been known to lower the risk of a gout flare up.  Purine is a portion of a DNA molecule that is found in much higher in certain animal based proteins like

herring, mussels, yeast, smelt, sardines and sweetbreads.

This particular article begins to show just how much of an impact lifestyle plays on gouty flare ups.  Researchers looked at the dietary choices for 2 days prior in patients who had a flare up of gout.  They found:

  1. In those with the highest levels of purine intake (when compared to the lowest levels, they had a 476% increased risk of a gout flare up (Tweet this)
  2. In those with the highest levels of purine intake from animal sources, there was a 241% increased risk of a flare up
  3. When compared to an increased intake of purine from plant based sources, this increased risk shrunk to 39%

Clearly, if you have a history of gout and you’d have some sick desire for self-abuse, you can, quite easily, initiate a flare up.

For the rest of you who don’t particularly like the exquisite pain associated with a gout flare up, you know that an anti-diabetic lifestyle and a diet low in purines (animal sources in particular) will go a long way towards preventing a flare up.

If you suffer from gout, are there any foods or drinks that you have identified as almost guaranteeing a flare up?

ROLE OF LIGAMENTS AND TENDONS IN OSTEOARTHRITIS – (12-27-06)

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Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis

As a chiropractor that has a strong focus on the soft tissue component of musculoskeletal health, I found this article rather intriguing.  Basically, whenever they looked at arthritis in the small joints of the hand, those areas that had ligaments with pathological changes (basically scar tissue and thickening) had more arthritis.  While no one study confirms anything, this articles does lend support to those physicians focusing much more strongly on how much the soft tissues contribute to long term joint health.

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VEGETABLES AND FRUITS GOOD FOR POWERFUL MOTHER NATURE – (09-06-05)

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Dietary beta-cryptoxanthin and inflammatory polyarthritis

So we all know that fruits and veggies contain compounds that are good for us.  Most notable are the carotenoids–those compounds that bring the brilliant colors to fruits and veggies (reds, yellows, purples, blues…).  But one glass of OJ can fight off rheumatoid arthritis?  By half?  Sometimes we really forget just how powerful Mother Nature is, but studies like this really bring the concept back home.

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