VOLUME 27 - 2 Arthritis

Health Tips

Don't Take Arthritis Lying Down

Years ago, doctors hardly ever told rheumatoid arthritis patients to "go take a hike" or "go for a swim." Arthritis was considered an inherent part of the aging process and a signal to a patient that it's time to slow down. But not so anymore. Recent research and clinical findings show that there is much more to life for arthritis patients than the traditional recommendation of bed rest and drug therapy.

What Is Rheumatoid Arthritis? The word "arthritis" means "joint inflammation" and is often used in reference to rheumatic diseases. Rheumatic diseases include more than 100 conditions, including gout, fibromyalgia, osteoarthritis, psoriatic arthritis, and many more. Rheumatoid arthritis is also a rheumatic diseases, affecting about 1 percent of the U.S. population (about 2.1 million people.)1 Although rheumatoid arthritis often begins in middle age and is more frequent in the older generation, it can also start at a young age.

Rheumatoid arthritis causes pain, swelling, stiffness, and loss of function in the joints. Several features distinguish it from other kinds of arthritis:

• Tender, warm, and swollen joints.
• Fatigue, sometimes fever, and a general sense of not feeling well.
• Pain and stiffness lasts for more than 30 minutes after a long rest.
• The condition is symmetrical. If one hand is affected, the other one is, too.
• The wrist and finger joints closest to the hand are most frequently affected. Neck, shoulder, elbow, hip, knee, ankle, and feet joints can also be affected.
• The disease can last for years and can affect other parts of the body, not only the joints.

Rheumatoid arthritis is highly individual. Some people suffer from mild arthritis that lasts from a few months to a few years and then goes away. Mild or moderate arthritis have periods of worsening symptoms (flares) and periods of remissions, when the patient feels better. People with severe arthritis feel pain most of the time. The pain lasts for many years and can cause serious joint damage and disability.

Should Arthritis Patients Exercise? Exercise is critical in successful arthritis management. It helps maintain healthy and strong muscles, joint mobility, flexibility, endurance, and helps control weight. Rest, on the other hand, helps to decrease active joint inflammation, pain, and fatigue. For best results, arthritis patients need a good balance between the two: more rest during the active phase of arthritis, and more exercise during remission. During acute systematic flares or local joint flares, patients should put joints gently through their full range of motion once a day, with periods of rest. To see how much rest is best during flares, patients should talk to their health care providers.

The following exercises are most frequently recommended for patients with arthritis:

Range-of-motion exercises, e.g. stretching and dance Help maintain normal joint movement and increase joint flexibility. Can be done daily and should be done at least every other day. Strengthening exercises, e.g. weight lifting Help improve muscle strength, which is important to support and protect joints affected by arthritis. Should be done every other day, unless pain and swelling are severe. Aerobic or endurance exercises, e.g. walking, bicycle riding, and swimming Help improve the cardiovascular system and muscle tone and control weight. Swimming is especially valuable because of its minimal risk of stress injuries and low impact on the body. Should be done for 20 to 30 minutes three times a week unless pain and swelling are severe.

* Adapted from Questions and Answers about Arthritis and Exercise.

If patients experience:

• Unusual or persistent fatigue,
• Increased weakness,
• Decreased range of motion,
• Increased joint swelling, or
• Pain that lasts more than one hour after exercising,

they need to talk to their health care provider. Doctors of chiropractic will help arthritis patients develop or adjust their exercise programs to achieve maximum health benefits with minimal discomfort and will identify the activities that are off limits for this particular arthritis patient.

Nutrition for the Rheumatoid Arthritis Patient Arthritis medications help suppress the immune system and slow the progression of the disease. But for those who prefer an alternative approach, nutrition may provide complementary support. Some evidence shows that nutrition can play a role in controlling the inflammation, and possibly also in slowing the progression of rheumatoid arthritis.

Some foods and nutritional supplements can be helpful in managing arthritis:

• Fatty-acid supplements: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma linolenic acid (GLA). Several studies point to the effectiveness of these fatty acid supplements in reducing joint pain and swelling, and lessening reliance on corticosteroids.4,5
• Deep-sea fish, such as salmon, tuna, herring, and halibut, are sources of EPA and DHA. GLA is found in very few food sources, such as black currants and borage seed.
• Turmeric, a spice that's used to make curry dishes, may also be helpful. A 95 percent curcuminoid extract has been shown to significantly inhibit the inflammatory cascade and provide relief of joint inflammation and pain. · Ginger extract has been shown to be beneficial in terms of inflammation.
• Nettle leaf extract may inhibit some inflammatory pathways.
• A vegetarian or low-allergen diet can help with the management of rheumatoid arthritis as well. The benefits and risks of most of these agents are being researched. Before taking any dietary supplement, especially if you are using medication to control your condition, consult with your health care provider.

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In The News

FDA Panel Nixes OTC Cholesterol Drug Sales
By LAURA MECKLER BETHESDA, Md. (AP) -

Federal health advisers recommended against over-the-counter sales of a cholesterol drug Friday, saying that patients need medical guidance for treatment of a chronic condition that has no symptoms and could require drugs for life.

The safety of Mevacor is well-established, but advisers worried that the wrong people might take it if it sat on open drugstore shelves, particularly after a probable aggressive advertising campaign to sell it.

The vote on the advisory committee was 20-3.

Advisers expressed misgivings because studies that simulated over-the-counter sales indicated that 90 percent of people who took Mevacor didn't meet the requirements of the label. Some people were too young or not sick enough to need it. In other cases, the risk of heart disease was so high that the patients should have seen a doctor and received a stronger drug.

The panel advising the Food and Drug Administration also voiced concern that women who were pregnant and did not know it would take Mevacor and possibly damage the developing fetus.

Supporters argued that making Mevacor more easily available would help get needed treatment to millions of Americans at moderate risk of heart disease who needed to lower cholesterol levels but were not taking helpful drugs.

And several advisers said they liked the idea of wider availability of statins like Mevacor, which lower cholesterol by limiting the buildup of artery-clogging fat deposits and reduce risk of heart attack by about a third.

``There have been times in my career when I thought the statins ought to be in the drinking water,'' said Dr. Frank F. Davidoff, editor emeritus of Annals of Internal Medicine. But at this point, making them available over the counter ``would be a massive, uncontrolled experiment.''

The application was filed by Johnson & Johnson-Merck Consumer Pharmaceuticals Co., a joint venture set up to market over-the-counter versions of drugs with expiring patents.

The companies said in a statement Friday they were disappointed by the decision but encouraged by the discussion and would work with the FDA toward getting the drug sold without prescription. ``We continue to believe in the benefits of Mevacor ... as an over-the-counter medication to help lower cholesterol and contribute to improved overall public health,'' said spokesman Tony Plohoros.

The FDA, which rejected a similar application in 2000, isn't bound by its advisers' recommendations but usually follows them.

The agency has been under intense scrutiny lately by critics who question whether it is vigilant enough in policing the safety of drugs already on the market. That criticism could weigh on the government as it makes a final decision. The agency has until Feb. 24 to decide whether to continue the drug's prescription-only status.

As is, allowing over-the-counter sales for Mevacor would mark an unprecedented step. Unlike treatments for coughs, colds and allergies, Mevacor is meant to prevent future heart disease, rather than treat existing symptoms. And while a cough or cold is apparent, the only way to know one's cholesterol level is to be tested.

Several members of the panel said they would like to see an in-between option, where patients can buy the drug without a prescription but only after speaking with a pharmacist. This option is available in Britain, which last year began selling a similar drug, Zocor, under these rules. U.S. states sometimes order the drugs only be sold be from ``behind-the-counter.''

FDA officials said they believe it would take a change in federal law to make that option available nationally under FDA rules, though they were consulting their attorneys to be certain. In any case, the pending application asks for freely available, over-the-counter sales, so that's what will be considered, said Dr. Charles Ganley, director of the FDA's over-the-counter drug products division.

He had no comment on what the FDA would do with the application but suggested nonprescription sales may be coming eventually.

The committee, he said, offered ``a lot of various, very positive statements, even though the vote may seem lopsided.''

``Personally, I think it's an option we ought to look at, particularly when you're trying to control health care costs and provide therapies to people without health insurance,'' he said.

Over-the-counter drugs are typically less expensive than prescription medication, making them more affordable for those without insurance. It can raise the price for those who have insurance, however, because insurance companies pay nothing toward over-the-counter drugs.

Company officials have said they would charge about $1 for each daily 20-milligram pill if over-the-counter sales were approved.

Study: Colorectal Screening Test Fails
By PATRICK WALTERS PHILADELPHIA (AP) -

A common screening test failed to detect potentially cancerous colon growths 95 percent of the time, falsely reassuring patients and doctors, according to a new study.

Researchers found that the digital, in-office test on stool samples was not as reliable as a six-sample test given to patients to do on their own at home - although even that test detected potentially cancerous growths less than 24 percent of the time.

``What we found is that it was pretty worthless,'' Dr. David Lieberman, one of the study's authors, said of the in-office test. ``It's a wake-up call that we shouldn't be relying on this test.''

The study, published Tuesday in the Annals of Internal Medicine, was conducted at 13 Veterans Affairs medical centers and involved 2,665 patients - most of them men - who were given the at-home test and the in-office test followed by a colonoscopy.

The digital fecal occult blood test was positive in only 5 percent of patients with tumors or large, precancerous growths called polyps; the take-home test found 24 percent.

The reliability of the at-home test, however, improves if patients use it every year, said Lieberman, gastroenterogy chief at Portland VA Medical Center in Oregon.

Because polyps and tumors often bleed intermittently, the chances of detecting them increase as more samples are taken over periods of days and years, he said.

Early testing can find growths before they turn cancerous, a process that can take five to seven years, Lieberman said. The take-home test was positive for 43 percent of patients who actually had cancer, the study said.

An accompanying survey of physicians also published in the Annals of Internal Medicine found that about a third used only the office test, a fourth used only the home test, and about 40 percent used both.

The survey, funded by the National Cancer Institute and the Centers for Disease Control and Prevention, said one possible reason for using the office tests was concern that patients won't complete the home tests. The completion rate varies greatly, with the median between 40 and 50 percent.

``My guess is that many physicians may not be aware that the in-office test is such a poor test,'' said Marion R. Nadel, a CDC epidemiologist who worked on the survey. Nadel said doctors should be trying to find more ways to get patients to complete the home test.

But while the new research should make doctors and patients more skeptical of a negative result from an in-office digital test, it shouldn't be written off altogether, said Dr. Christine Berg, chief of the early detection research group of the cancer institute. Doctors shouldn't miss an opportunity to give a patient an annual digital FOBT while they're in the office, she said. ``I wouldn't say it's worthless,'' Berg said. ``I would say you shouldn't rely on it solely.''

The Rear End Collision

These are becoming more frequent now and you need to know what to do if you are hit from behind or slip into someonw else. Follow these simple rules if you are involved in a car accident and are not hospitalized:

• Stay calm and reduce movements of the spine
• Ice packs on the spine and neck for 5 minutes per hour will help for the first few days
• See your chiropractic physiciain right away - He is the only provider trained to evlauate spinal subluxations

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THIS MONTH'S SPECIAL OFFERS

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