Category Archives: Inflammation

Bitter Kola boosts libido and beats osteoarthritis

Results of a study published in African Journal of Pharmacy and Pharmacology have confirmed that bitter kola possesses sexual enhancing effects on male rats as evidenced by the increased mounting (MF) and intromission (IF) frequencies with increased number of subsequent ejaculations over the 20 min observation period.bitter-kola

The study is titled “Effects of ethanolic extract of Garcinia kola on sexual behaviour and sperm parameters in male Wistar rats.”

Another study published in Journal of Orthopaedic Surgery and Research by medical doctors, pharmacists and nurses at Obafemi Awolowo University Teaching Hospital (OAUTH) concluded: “Garcinia kola appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. Garcinia kola is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.”

The study is titled “Clinical effects of Garcinia kola in knee osteoarthritis.”

Comment: Whoa…, I think I need this.

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What’s a “sausage finger” or “sausage toe”?

Many types of arthritis can cause a sausage digit.  The technical term for this is “dactylitis.”sausage-toe

This is not the kind of sausage you would have with your eggs and pancakes.

Sausage digits are typically seen in conditions such as psoriatic arthritis (the arthritis that accompanies psoriasis), Reiter’s disease, inflammatory bowel disease, and occasionally ankylosing spondylitis.  Of these, psoriatic arthritis is probably the most common culprit. Dactylitis means inflammation of an entire finger or whole toe.

It is caused by inflammation involving the synovium (lining of the joint) as well as the lining of the tendon sheath.  Tendons are tough fibrous bands that connect muscles to bones.  Most tendons glide through a lubricated sheath lined with synovium. When the synovium in the joint and the tendon sheath becomes inflamed, the entire finger or toe will swell.

The tendons that are most often affected are the tendons that allow a person to bend or flex their fingers or toes.

If a patient has dactylitis, their prognosis is poorer in that the joints are more likely to sustain damage.  The presence of dactylitis indicates a greater chance for disease progression.

Early on, dactylitis may be extremely painful.  However, over time, as destructive changes occur, the inflamed tissue is replaced with bony deformity and the dactylitis no longer causes severe pain.  However, the swelling persists.

The presence of dactylitis should prompt a diagnostic workup.  Diagnosis can be substantiated by magnetic resonance imaging (MRI).  Recently, diagnostic ultrasound has also been found to be helpful.

The treatment of dactylitis depends on the number of digits affected.  If only a few fingers or toes are involved, ultrasound-guided steroid injection can be helpful for the acute situation.

However, the more important part of treatment is to initiate disease modifying therapy as soon as possible.

Generally, the dactylitis is often accompanied by enthesitis.  This is inflammation at tendon insertions such as the Achilles tendon, patellar tendon (the tendon that connects the kneecap to the tibia-lower leg bone, and the iliac crest.

Every disease that causes dactylitis is a systemic disease.  This is because the underlying pathology involves an abnormal immune response. So other organ systems can become affected.  An example is the eye where uveitis- inflammation of the middle layer of the eye- can occur.  Uveitis is a potentially serious complication that can lead to blindness.

Institution of drugs like methotrexate or sulfasalazine (Azulfidine) may be useful.

However, most patients will require the use of biologic therapies.

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Rheumatoid arthritis drugs… which ones are friendly to the heart and which ones aren’t!

Rheumatoid arthritis (RA) is a chronic, autoimmune systemic disease which affects approximately two million Americans. While the symptoms that bring the patient to the doctor are the joint swelling and pain, the area of most concern may not be the joints.  It is well established that cardiovascular risk is markedly increased in RA and in fact it is this complication that shortens lifespan by between ten to fifteen years.

A number of clinical studies have retrospectively examined the relationship between certain medications and the risk of cardiovascular events.  The report card has provided some real surprises.heart-attack_0

For example, methotrexate, the workhorse disease modifying anti-rheumatic drug (DMARD) of choice reduces cardiovascular mortality by almost 70 per cent. The mechanism is felt to be due to a reduction of atherosclerotic plaque formation as well as increased clearance of foam cells (Solomon DH, et al. Circulation 2003; 11: 1303-1307).

The other major player in the treatment of RA is the TNF inhibitor group.  These are used in more than 50 per cent of RA patients in the US. These drugs apparently reduce the risk of cardiovascular events by almost 50 per cent (Gonzalaz A, et al. Ann Rheum Dis. 2008; 67: 64-69). Why this occurs is still not clearly understood.

Steroids have been used to treat RA since the early 1950’s.  Steroids have been shown to worsen cardiovascular risk because of their effects on both blood pressure as well as blood glucose.  Steroid use in RA has been associated with increased carotid plaque formation as well as increased arterial stiffness.  So what dose is a safe dose?  The answer is still unknown.

Non-steroidal anti-inflammatory drugs (NSAIDS) raise blood pressure.  Randomized clinical trials have shown that cardiovascular risk is associated with COX-2 inhibitors but also with non-selective COX drugs also.  The upshot? All NSAIDS regardless of class, are associated with increased cardiovascular risk.

Hydroxychloroquine, a drug often used to treat mild RA, is associated with a decrease in diabetes and may also improve lipid status.  Actemra increases lipid profile but the long term effects are still unknown.  Leflunomide (Arava) increases blood pressure.  The eventual effects are still a subject of conjecture.

So what about aspirin?  This medication is used for cardiovascular prophylaxis.  In higher doses it also has anti-inflammatory effects although these are limited by the potential gastrointestinal side effects known to be caused by high dose aspirin. It is well known that other NSAIDS should not be used in patients taking aspirin for cardiovascular prophylaxis since they blunt that effect.

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Are you at risk for the complications due to ankylosing spondylitis? Discover what they are…

Ankylosing spondylitis (AS) is an inflammatory form of arthritis that preferentially attacks the spine.  Many people are under the impression it’s one of the less serious forms of arthritis. Uh-uh.  Unfortunately, it has a number of potential complications associated with it.  These include:

  1. Acute eye inflammation, termed “uveitis”, in one-third of patients.  Symptoms include pain, redness, blurred vision, light sensitivity, and if left untreated, blindness.
  2. Osteoporosis occurring in a significant number of patients.  This is a condition where the bones become brittle and more likely to fracture.
  3. Approximately 10-15% of patients have inflammatory bowel disease such as Crohn’s or ulcerative colitis.
  4. Skin involvement occurs in as many as a quarter of patients.  The most common skin condition is psoriasis.
  5. AS can lead to conduction abnormalities in the heart as well as inflammation of the aorta.
  6. Fibrosis of the lungs can cause restrictive lung disease.
  7. Neurologic complications are due to compression of the spinal cord and can be life-threatening.
  8. Long term ankylosing spondylitis can cause a condition called amyloidosis of the kidneys leading to kidney failure.

Comment: Not such a benign condition is it?

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What’s a safe dose of prednisone? Is there such a thing?

A spirited debate was published in the Rheumatologist, a magazine I get. The topic was the use of prednisone in rheumatoid arthritis.  Recent guidelines produced by the American College of Rheumatology regarding treatment of rheumatoid arthritis omitted the use of prednisone.

prednisone-5Dr. John Kirwan, a professor at the University of Bristol, who wrote several papers showing that prednisone had disease-modifying effects and held back the destructive processes of rheumatoid arthritis (RA) made his pitch. He advocated the use of prednisone in combination therapy for this condition.

Dr. Theodore Pincus, a professor at NYU, advocated the use of low dose prednisone (less than or equal to 5 mgs a day). He provided evidence that it was safe and effective at that dose.

Dr. Anthony S. Russell, a professor at the University of Alberta issued the counterpoint. He provided historical data showing that prednisone had long term toxicity without significant benefit (in his opinion.)

With all due respect to Dr. Russell, much of the data he cited was old data when higher doses of prednisone were used.  He also contended that primary care doctors would be tempted to use prednisone if they saw rheumatologists using it.

My opinion is this.  I use low dose prednisone a lot in my practice.  By low dose, I mean 5 mgs or less. I think it is effective as an add- on therapy.  It is also a great “bridge” if the patient is transitioning therapies. I have seen very little long term toxicity associated with this low dose approach.  And I think the benefits derived from improved activities of daily living far outweigh the negatives. I do think that doses higher than 5 mgs should be avoided if possible. I also don’t think the primary care issue is that big a deal although I admit… I have seen some indiscriminate use in my community.

 

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Bad Teeth= Bad RA

 

Mary Ann Moon writing in Rheumatology News  described a study comparing 31 patients with new-onset rheumatoid arthritis (RA), 34 patients with chronic RA, and 18 healthy controls.The study examined the relationship between bad dentition and rheumatoid arthritis.bad-teeth

The upshot?

The prevalence of severe periodontal disease was 75 % in patients with new-onset RA… just as much as the prevalence with long-standing RA and much higher than the prevalence in healthy controls (39%). The culprit?

Porphyromonas species bacteria.

The association between periodontal disease and RA has been written about a lot. This should be added to genetics and smoking as big risk factors for RA.

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Is inflammation responsible for disease?

Chronic inflammation appears to be the final common denominator for many conditions. And while there have been many advances in the treatment of multiple disorders, many people still cling to the hope that natural remedies might be as effective as prescription drugs.

So let’s start with the supposition that chronic inflammation is responsible for many illnesses.

A prime example is rheumatoid arthritis.  The chronicrheumatoid-arthritis-hand
inflammation from this disease affects not only joints but internal organs as well.

In addition, chronic inflammation is responsible for the marked increase in cardiovascular events such as heart attack and stroke seen in RA.

Gingival infection and inflammation has been linked to both
RA as well as atherosclerotic cardiovascular disease.

An excellent article was published on the anti-inflammatory effects of cilantro
in RA in the Indian Journal of Medical Research by The All India Institute of Medical Sciences (AIIMS) researchers..  Similar articles have been published on the role of turmeric (curcumin) and other spices such as boswellia, bromelain, garlic, and ginger.

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Chronic inflammation= BAD NEWS

Laura Landro writing in the Wall Street Journal reported that the final common pathway for many deadly diseases is chronic inflammation. Growing evidence suggests that immune regulation can be altered by obesity, cigarette smoking, and fatty diets.inflammation

The end result could be heart disease, stroke, arthritis, Alzheimer’s disease, cancer, and diabetes. In particular, rheumatoid arthritis has been shown to be associated with a marked increase in cardiovascular events presumably related to chronic inflammation.

obese-manOne striking discovery is that fat cells, particularly those in the abdominal region  “act like small factories to churn out molecules known as cytokines, which set inflammation in motion,” says Peter Libby, chief of the division of cardiovascular medicine at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School. “We’ve learned that abdominal fat tissue is a hotbed of inflammation that pours out all kinds of inflammatory molecules,” Dr. Libby says.

Blood testing using the C-reactive protein often uncovers the presence of inflammation.

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A new use for Botox?

First reported in Singapore, then confirmed by a number of studies elsewhere, the popular cosmetic drug, Botox, has another novel use.botox

For sufferers of chronic plantar fasciitis, it appears to not only relieve pain but actually reduces the thickness of the plantar fascia, as measured by diagnostic ultrasound.

I found out about this from a physician in our community who wanted me to try the treatment for his chronic plantar fasciitis.  Using our standard ultrasound-ultrasound-guided-plantar-fascia-injectionguided technique, I did so.  Not only have his symptoms resolved, the serial measurement of plantar fascial thickness has shown improvement as well.

Botox is also being studied as a symptomatic treatment for knee osteoarthritis.

It apparently has an effect on nocioceptive receptors (pain receptors.)

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Acute liver injury due to Limbrel

A recent study in the Annals of Internal Medicine described 4 patients out of 877 enrolled in the study who had signs and symptoms of acute liver injury due to limbrel  taking the medical food, Limbrel, for osteoarthritis.  Liver function abnormalities were substantial but resolved within 3 to 12 weeks of drug discontinuation. The fact that something is a “food” or “natural” doesn’t make it 100% safe.

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