Arthritis Blog

An unusual fracture pattern has been seen in some people who have used bisphosphonates (bone-building drugs) for five years or more. A study published in the May/June issue of The Journal of Orthopaedic Trauma reported on 20 patients who experienced the fracture -- 19 of whom had been using Fosamax for an average of 6.9 years. Bisphosphonates prevent fractures and have been effective drugs for the treatment of osteoporosis.

In the United States, adults suffer 300,000 hip fractures each year. Fractures can be devastating and even have life-threatening consequences, especially in the elderly. The unusual fracture pattern that seems to be associated with bisphosphonates is cause for concern but doctors emphasize it's a rare complication. Patients who have experienced the fractures reported that after a period of achiness, their thighbone snapped while they were walking or standing. The fracture, straight across the upper thighbone, is usually seen after trauma or in the elderly. Merck, the maker of Fosamax, said "the fracture accounted for only about 5 or 6 percent of all broken hips, while drugs like Fosamax reduced the risk for the other 95 percent", according to a report in the New York Times. It may be that bisphosphonates should not be used in people who don’t have a high risk of fracture. More reports from doctors and researchers will likely follow now that the problem has been recognized.

Related Resources:

• Osteoporosis Risk Factor Quiz
• Osteoporosis Screening Quiz
• What Can People Do to Prevent Osteoporosis?
• Bone Up on Osteoporosis
• Americans Over 50 At Risk For Bone Fractures

_{Photo by Tomaz Levstek (iStockphoto)}

Arthritis patients take several medications that increase the risk of gastrointestinal bleeding. If you have taken one of these medications for a long time, you may be lulled into a false sense of security that all is well. It's critical that you know the signs of gastrointestinal bleeding -- because it can happen at any time and it can quickly become an emergency. Gastrointestinal bleeding refers to any bleeding that occurs in the gastrointestinal tract, which runs from your mouth to your anus. More specifically, the gastrointestinal tract is divided into the upper gastrointestinal tract and the lower gastrointestinal tract.

Gastrointestinal bleeding ranges from microscopic amounts of blood to massive bleeding. The amount of bleeding and the location of bleeding determine what needs to be done to stop the bleeding. There are numerous conditions that can cause gastrointestinal bleeding. Because it is a known potential serious side effect of certain medications taken for arthritis -- NSAIDs (nonsteroidal anti-inflammatory drugs) and corticosteroids -- patients taking those drugs must not ignore any sign of bleeding. It's critical that you know the warning signs and that you get immediate medical attention if you start to have symptoms. To learn more about the warning signs and symptoms of gastrointestinal bleeding, read Gastrointestinal Bleeding - Don't Ignore Your Symptoms.

Related Resources:

• Gastrointestinal Bleeding - What Happens?
• The Facts of NSAIDs
• The Facts of Corticosteroids
• Nexium Reduces Risk of Ulcers for Long-term NSAID Users

_{Photo © A.D.A.M.}

Eating pomegranate extract can reduce inflammation associated with several diseases, including arthritis. According to researchers from Case Western Reserve University in Cleveland, Ohio, blood tests done on rabbits that were fed pomegranate showed an anti-inflammatory effect -- a reduction in the chemicals involved in the inflammatory process. About 6 ounces of pomegranate juice was given to the rabbits. Blood tests related to inflammatory activity were taken before and after the rabbits ingested the pomegranate extract. Cyclooxygenase-2 (COX-2) was among the proteins that showed significantly reduced activity in causing inflammation.

Pomegranate juice has been touted for some time as an alternative treatment for arthritis. While it is certainly no cure, there appears to be a real benefit in reducing inflammation and that may translate into less pain for some arthritis patients -- especially those with mild disease symptoms. As with any treatment -- alternative or otherwise -- keep your expectations real. Want to learn more about pomegranates? Read Everything You Wanted to Know About Pomegranates. Be sure to talk to your doctor before trying pomegranate juice -- it can cause a drug interaction with some medications.

Related Resources:

• Diet and Arthritis: The Link is Complex
• Fruits And Vegetables May Cut Arthritis Risk
• Foods With Antioxidants May Ward Off Knee Osteoarthritis
• Arthritis and Diet Quiz

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Vitamin D deficiency has been linked to chronic pain conditions, including various types of:

• bone / joint pain
• muscle pain
• rheumatic diseases
• osteoarthritis
• fibromyalgia

After researchers reviewed 22 clinical studies involving patients with chronic pain and fatigue syndromes, it was discovered that in almost all cases, the patients had inadequate levels of vitamin D. Of even more interest, it was noted that when the patients were given sufficient vitamin D supplementation, their aches and pains improved dramatically or went away in some cases.

So, what's a sufficient level of vitamin D supplementation? According to pain-topics.org, authors of "Vitamin D -- A Neglected 'Analgesic' for Chronic Musculoskeletal Pain" believe the current recommendation for vitamin D (600 IU per day) is outdated. Most adults and children need at least 1000 IU/day and people with chronic musculoskeletal pain could benefit from 2000 IU or more per day of cholecalciferol (vitamin D3 supplement).

Vitamin D is a nutrient that functions like a hormone and it is useful for many body tissues and organs -- including bones, muscles, and nerves. Vitamin D is easy to self-administer and it is relatively inexpensive. While vitamin D should not be viewed as a cure, patients may derive much benefit from extra supplementation of vitamin D. You should discuss vitamin D supplementation with your doctor so that an optimal dose can be recommended for you.

Related Resources:

• Vitamin D May Protect Against Rheumatoid Arthritis
• Osteoporosis Prevention: The Role of Calcium and Vitamin D
• Is a Daily Multivitamin Important for Arthritis Patients?
• Vitamin C and Arthritis: The Effect of Vitamin C on Joints

_{Photo by Dan Fletcher (iStockphoto)}

Researchers from The Children's Hospital of Philadelphia have found a specific gene region that is present in some types of adult rheumatoid arthritis and all types of juvenile arthritis. The genetic variant is found on chromosome 9 in a region that houses two genes known as, TRAF1 and C5. According to researchers, the TRAF1 gene codes for a protein that regulates tumor necrosis factor (TNF). TNF has previously been associated with juvenile arthritis.

The study, published in the July 2008 issue of Arthritis & Rheumatism, compared 67 Caucasian patients being treated for juvenile arthritis to 1,952 healthy Caucasian subjects serving as controls. There are only a few genes that can act as master switches to turn on diseases like arthritis. When the master switch interacts with other genes and environmental triggers, a child may develop juvenile arthritis. Researchers concluded that more studies are needed to determine if TRAF1 or C5 are altered in juvenile arthritis.

Related Resources:

• Juvenile Arthritis Screening Quiz
• Guide to Juvenile Arthritis
• Arthritis Is A Children's Disease Too
• How to Prepare Yourself and Your Young Child for a Doctor Visit

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Patients with severe ankle arthritis have been faced with just two surgical options -- a total ankle replacement or an ankle fusion. Now, there's a third option and researchers believe the non-metal, biologic ankle replacement will perform best. Daniel K. Lee at University of California San Diego Medical Center, who developed the new biologic ankle replacement explained that the new design restores the ankle with an FDA-approved biologic material, similar to collagen found in cartilage.

The surgery is a 2 hour minimally-invasive procedure during which Dr. Lee removes damaged cartilage from the ankle joint through a 4 centimeter incision. The collagen material is molded into the joint where it adapts to the contour of the patient's own ankle. The advantage seems obvious -- the biologic ankle implant can be customized for each individual ankle. The biologic material is processed from human or animal collagen sources and has been used for a decade in other types of surgery. An external fixation brace is used for 4 to 6 weeks to "distract" the ankle, so the biologic material can fully mesh with the ankle joint. Once the external fixation brace is removed, the hope is that the biologic ankle will offer the patient better mobility and stability in the ankle joint.

Related Resources:

• What Is an Ankle Fusion?
• Too Young For Joint Replacement?
• 20 Tips To Help You Prepare For Surgery
• Joint Replacement Screening Quiz - When Is It The Right Time?

_{Photo © UC San Diego Medical Center}

People with a birthweight of 10 pounds or more are twice as likely to develop rheumatoid arthritis when they are adults compared to people who were of average birthweight. Researchers are unclear about the exact mechanism that would explain the association between birthweight and disease risk but the study does suggest there is a modifiable risk factor (a risk factor that can be changed).

The study from Hospital of Special Surgery, a study to be published in the Annals of the Rheumatic Diseases, played out the results of a 2003 study that forumulated similar conclusions. The HSS study was on a larger population and researchers explained that patients with rheumatoid arthritis have a dyregulated HPA (hypothalamic-pituitary-adrenal) axis. The axis can be affected in utero. “The HPA axis is the neuroendocrine system — responsible for handling stress by regulating production of cortisol, neurotransmitters, and key hormones.” Knowing all of this, researchers believe it gives more pieces of the puzzle — what causes or contributes to rheumatoid arthritis.

Related Resources:

• Rheumatoid Arthritis May Be Tied To Birth Weight
• 10 Things You Should Know About Rheumatoid Arthritis
• Rheumatoid Arthritis Screening Quiz
• Test Your Knowledge - Rheumatoid Arthritis

_{Photo by Ekaterina Monakhova (iStockphoto)}

What are the 10 most popular arthritis drugs prescribed by rheumatologists? A rheumatologist is a medical doctor (M.D.) who specializes in the diagnosis and treatment of arthritis and related conditions. Based on an analysis of 7,945,910 prescriptions written by rheumatologists from January to March 2008, published in the journal Rheumatology News, Vol.7 No.6 June 2008, study results show that the top 10 drugs prescribed by rheumatologists are:

• Methotrexate and Folic Acid
• Prednisone
• Plaquenil (hydroxychloroquine)
• Vicodin (hydrocodone and acetaminophen)
• Ultram (tramadol)
• Mobic (meloxicam)
• Celebrex (celecoxib)
• Flexeril (cyclobenzaprine)
• Lyrica (pregabalin)

Arthritis medications are used by most patients as part of their arthritis treatment plan. Patient response to arthritis drugs can vary, so it's impossible to say ahead of time which drug will be most effective for an individual patient. Learn more about drug usage, side effects, and warnings in the 10 Most Popular Arthritis Drugs.

Related Resources:

• How Is Arthritis Treated?
• First Visit to the Rheumatologist
• 10 Ways to Ensure Drug Safety
• Arthritis Medications: What Are My Options?
• Are You Taking Medication You No Longer Need?

Share Your Advice and Experiences:

• Join Us in Our Arthritis Forum / Message Board

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Rheumatoid arthritis treatments include medication options that have expanded over the last decade. The American College of Rheumatology (ACR) has released its 2008 guidelines for rheumatoid arthritis treatments -- an update of the 2002 guidelines. The 2008 recommendations focus on the use of non-biologic DMARDs (disease-modifying anti-rheumatic drugs) and biologic DMARDs to treat the disease.

The 2008 guidelines were developed by an expert panel of doctors, researchers, and patient representatives following extensive review of scientific evidence related to non-biologic and biologic treatments. The recommendations are not to be used like a cookbook, or to replace a doctor's judgment regarding an individual patient.

The ACR expects to regularly update the recommendations as new scientific evidence becomes available. To reiterate an important point, these are only recommendations. Individual patients may require a different treatment plan. Read more in Rheumatoid Arthritis Treatments - 2008 ACR Recommendations.

Related Resources:

• Rheumatoid Arthritis Screening Quiz
• Test Your Knowledge: Rheumatoid Arthritis
• Signs and Symptoms of Rheumatoid Arthritis
• Rheumatoid Arthritis: Explained With Pictures
• 10 Things You Should Know About Rheumatoid Arthritis

_{Photo by Joanne Green (iStockphoto)}

Darvocet is a popular medication prescribed to relieve arthritis pain. Darvocet is a combination of acetaminophen and propoxyphene. According to Public Citizen, a National Non-Profit Public Interest Organization, "Darvocet, Darvon, and all medications that contain propoxyphene should be withdrawn from the market". The organization has actually sued the FDA because it failed to act on a petition submitted February 28, 2006. In that petition, Public Citizen stated that propoxyphene:

• is physically and psychologically addictive
• is no more effective than safer alternatives
• has been associated with more than 2,000 accidental deaths in the U.S. since 1981

Propoxyphene was one of the 25 most prescribed generic drugs last year. There were 22 million prescriptions for propoxyphene filled in 2007. According to Public Citizen, "A large proportion of the deaths from propoxyphene occurred because most of the drug is converted into a metabolite that is highly toxic to the heart, lasts longer in the body than the original compound and results in cardiac depression. Adverse cardiac events associated with propoxyphene include an interruption of heart transmission of electrical impulses, slowed heartbeats and a decreased ability of the heart to contract properly." Public Citizen’s book, “Worst Pills, Best Pills,” has listed propoxyphene as a DO NOT USE drug since its first edition in 1988. Public Citizen states in its complaint that darvocet is a relatively ineffective painkiller -- and the pain relief is comparable to ibuprofen.

Arthritis patients and their doctors have the difficult task of finding the best combination of medications that relieve arthritis pain. When a medication is found to be effective, it becomes part of the patient's arthritis treatment regimen. For those who have found darvocet to be an effective pain reliever, the complaint from Public Citizen is alarming. The benefits and risks of all medications must be considered. Discuss the benefits and risks of darvocet or other drugs that contain propoxyphene with your doctor. Your doctor may or may not believe the Public Citizen complaint has merit.

Related Resources:

• The Facts of Painkillers
• 10 Ways to Increase Your Pain
• Pain Management: Ways to Manage Your Pain
• 10 Things You Should Know About Darvocet
• When Are Pain Medications Appropriate for Arthritis Patients?

_{Photo © Gold Standard}