NSAID’s in the News (again)

Medication - Over the Counter - otcLet me start by saying, that despite spending the last 20-something years in or around the pharmaceutical industry, I don’t like taking pills. That said, I’m not particularly partial to pain either. So when my knees or back hurts or I’m doubled over with dysmenorrhea, like many other people, I’ll reach for the ibuprofen.

But that may be about to change. Results from a new, large international study of non-steroidal anti-inflammatory drugs (NSAIDs), showed that high doses of them increase the risk of a major vascular event such as heart attack, stroke or death from cardiovascular disease by around a third.

In other words, for every 1,000 people with an average risk of heart disease who take high-dose ibuprofen for a year, about three extra would have an avoidable heart attack, of which one would be fatal, the researchers said.

vioxxThis puts the heart risks of generic NSAIDs on a par with Vioxx – the painkiller that U.S. drugmaker Merck famously pulled from sale in 2004 because of links to heart risks.

The study team from Oxford University in the UK, gathered data, including on admissions to hospital, for cardiovascular or gastrointestinal disease, from all randomized trials that have previously tested NSAIDs.

This allowed them to pool results from 639 trials involving more than 300,000 people and re-analyze the data to establish the risks of NSAIDs in certain types of patients.

In contrast to the findings on ibuprofen and diclofenac, the study found that high doses of naproxen, another NSAID, did not appear to increase the risk of heart attacks. The researchers said this may be because naproxen also has protective effects that balance out any extra heart risks.

Researcher, Colin Baigent stressed that the risks are mainly relevant to people who suffer chronic pain, such as patients with arthritis who need to take high doses of for long periods. “A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” he said.

He also warns patients not to make hasty decisions or change their treatment without consulting a doctor.

For many arthritis patients, NSAIDs reduce joint pain and swelling effectively and help them to enjoy a reasonable quality of life,” he said. “We really must be careful about the way we present the risks of these drugs. They do have risks, but they also have benefits, and patients should be presented with all those bits of information and allowed to make choices for themselves.”

Donald Singer, a professor of clinical pharmacology and therapeutics at Warwick University, who was not involved in the study, said its findings “underscore a key point for patients and prescribers: powerful drugs may have serious harmful effects.

In the meantime, I for one, will be revising my pain versus pill-popping habit, or switching to naproxen.

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Jumping For Joy? Gene Therapy shows promise in Osteoarthritis

osteoarthritis-knee-pain-ssAs regular readers of SRxA’s Word on Health know, your blogger is one of the estimated 34 million US adults who suffer from osteoarthritis.  The disease, the most common form of arthritis, is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. The breakdown of these tissues eventually leads to pain and joint stiffness. Disease onset is gradual and usually begins after the age of 40, although in some people, myself included, signs and symptoms can appear in your teens or twenties, usually as a result of the wear and tear of repeated sports injuries.

The joints most commonly affected are the knees, hips, hands and spine.

The specific causes of osteoarthritis are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Treatment focuses on relieving symptoms and improving function, and can include a combination physical therapy, weight control, medications and joint replacement surgery. But there is currently no cure.

osteoarthritis-276x300So we were very interested to hear of a new study in mice in which researchers used gene therapy to reduce the risk of osteoarthritis.

And while there’s no way to know if the gene therapy treatment will help humans, or what the treatment’s side effects and costs might be, the findings are more than just good news for mice with creaky joints.

This work identifies an approach that can make a difference,” explained study co-author Brendan Lee MD, PhD, director of the Rolanette and Berdon Lawrence Bone Disease Program of Texas. “There’s a great need for treating and preventing osteoarthritis.”

mouse (1)His study examined a protein that appears to be crucial to the lubrication of joints.  Researchers injected a gene related to the protein into mice and found that not only did the rodents begin producing it themselves, they also appeared to be resistant to joint and cartilage damage resulting from injury and aging.

Still, before our creaky knees start jumping for joy, as with all early research, there are caveats.

The research was in mice, not humans; the next step is to test the approach in horses, whose joints are similar to those of people. And the gene therapy doesn’t seem to do anything for damage that’s already occurred.

This kind of therapy would probably not be very useful in patients who have advanced disease,” Lee said, adding that the treatment would likely have to be used with other strategies.

osteoarthritis 3Dr. Joanne Jordan, director of the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill, said the findings “would be really very exciting if this translates up into humans.” The study, she said, appears to be reasonable and especially strong because it looks at osteoarthritis in the mice from different angles.

We agree. Any research that provides insight into the mechanisms of osteoarthritis development and a potential protective approach to its treatment are very exciting indeed.  A future with no more horse pills sounds good!

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Papal Poor Health

frail Pope On February 11, Pope Benedict XVI stunned the Catholic Church and the world when he announced his resignation by saying he no longer had the mental and physical strength to carry on.

At 8pm local time yesterday, he ended his difficult reign, marking the first time in six centuries a pope has resigned instead of ruling for life.

But what do we really know of his health or that of other popes before him?

The Vatican recently confirmed Benedict had a pacemaker for years, indicating a long-standing heart problem. And his older brother told the press that age had taken its toll.

Other observers have noticed the pope’s reduced energy. The press reported that he was ferried to the altar at St. Peter’s for Midnight Mass Christmas Eve on a wheeled platform and then appeared to doze off during the service.

Pope frailVisiting Mexico last year, he awoke at night and couldn’t locate a light switch in his room, then fell and bloodied his head when he hit the bathroom sink.

Beyond these few facts, we know very little about the health problems that led Benedict to announce his retirement. We don’t even really know if his flagging stamina was the true reason behind his resignation.

And while Pope Benedict XVI might be the first Holy Father to voluntarily resign because of old age and deteriorating health, the papacy has a past medical history of poor health.  According to the history books, these ailments range from depression to gout to cancer.

According to church law, as long as a pope is able to conduct Mass, he can continue in his role even if he is suffering, in pain or even bedridden, as was the case with Pope Alexander VII.

Pope Alexander VII’s surgeon and confessor tried to persuade him not to go before the crowd on Easter Sunday of 1667, but he did it anyway. The pope died three days later, according to author Wendy J. Reardon in The Deaths of the Popes.”

Pope_Clement_XII,_portraitMore than a century later, Pope Clement XIV became known as the pope who drooled and had eyes that “darted in their bulging sockets” as he fearfully clung to walls for fear of a Jesuit assassination attempt. He died after correctly predicting his own death in 1774.

In 1958, Pope Pius XII died after enduring recurring bouts of hiccoughs for five years. At one point, his hiccoughs became so intense, that they tore the lining of his stomach. He died of complications from pneumonia at 82 years old.

Pope John Paul II, was sick until he died on April 2, 2005 at 85 years old. He lived with Parkinson ‘s disease for decades, but he died of cardio-respiratory failure, kidney failure and septic shock.

Death has never been an issue that has worried popes,” says papal historian Anura Guruge,  “Popes talk about no purgatory for popes.” Instead they believe if God is ready for a new pope, he will simply call the current one home to heaven where they will immediately be admitted to God’s house and be in the presence of the Holy Father. Not surprising then, that many popes have gone so far as to express enormous amounts of joy on their death beds.

Emeritus Pope Benedict XVI, was one of the oldest popes when he was elected in 2005 at age 78. In 1991 he had a stroke that reportedly temporarily affected his vision. He fell in 1992 and again 2009. He was also thought to have either arthritis or arthrosis, a similarly painful and debilitating joint condition.

Father Virgilio Elizondo, a professor at the University of Notre Dame in Indiana, said he thinks Pope Benedict XVI made a very difficult but wise decision by resigning. He added that the papacy has a history of unpredictability, and the surprise resignation fits right in.

pope John paulI think when you consider the sincerity of the man, when you consider the weight of the universal church, and the greatest variety of issues affecting the church and the rest of the world, I could see how he could come to that decision,” says Elizondo. “What’s really needed is a younger person with more vigor and up-to-date knowledge about what’s happening. I think that’s the rationality behind this pope.

But not everyone agrees.  “This pope’s resigning is essentially overriding God’s will,” said Guruge. “We had suspected that he had more health issues than had been made public. … A pope resigning is really not the right thing to do.”

Pope Benedict XVI was just 73 days away from being the third oldest pope. However, he will remain the fourth oldest pope because his resigned before his 86th birthday. The three older popes were Pope Clement X, who lived to be just over 86 years old; Pope Clement XII, who lived to be 87; and Pope Leo XIII, who before his death at 93 was known as the “eternal pope” because he kept on living! Back then, it might be argued, the job was less demanding because the pope didn’t have to be on television or travel the world or tweet.

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Stiffness, Swelling and the Sticky Issue of Sugary Soda

knee osteoarthritisThose of us of a certain age, probably know all about osteoarthritis, the “wear and tear” disease in which joint cartilage is lost. Losing cartilage from your knee is similar to having the shock absorbers go on your car.  It leads to pain, stiffness and other symptoms.

According to a large 2007 study, nearly 20% of women and 15% of men over the age of 45 have  symptoms of knee osteoarthritis.

Until now, many experts thought disease progression was inevitable. I’m pretty sure that’s what my knee surgeon thinks. One such clue: he always says “when I see you again” rather than “if I see you again” at the end of every visit.

Bloomberg Moves To Ban Sugary Drinks In NYC Restaurants And Movie TheatersNow, for men at least, this may be about to change. A new study of more than 2,000 with osteoarthritis of the knee showed that disease progression in men is linked to consumption of sugary soda.

Researchers reviewed the records of 2,149 men and women with confirmed osteoarthritis of the knee.

All filled out dietary questionnaires that asked how many soft drinks, not including sugar-free beverages, they drank on average each week.

Every year for four years, the researchers tracked their osteoarthritis progression by measuring the space between the joints. The more cartilage that is lost, the less the space. Body Mass Index (BMI) was also measured.

After taking into account BMI and other risk factors, men who drank five or more soft drinks a week had twice as much narrowing of joint space compared with men who did not drink sugary soda.

man drinking sodaOur main finding is that the more sugary soda men drink, the greater the risk that knee osteoarthritis will get worse,” says researcher Bing Lu, MD, DrPh. Lu is assistant professor of medicine at Harvard Medical School and associate biostatistician at Brigham and Women’s Hospital in Boston.

If you’re thinking something along the lines of ‘Duh! Tell me something new. Soda=calories=weight gain= risk factor for osteoarthritis, think again.

Much to the researchers’ surprise, the link between knee osteoarthritis progression and sugary soft drinks could not solely be explained by weight.  When the men were divided into obese and non-obese, the link between sugary drinks and worse knee damage held true only in the non-obese men, suggesting that soft drinks worsen knee osteoarthritis independently of the wear and tear on the joints caused by carrying around excess weight.

So what’s a man who enjoys soda to do?  According to Lu the answer is simple. “just don’t drink it!”

Causes-and-Symptoms-of-OsteoarthritisAnother expert says that’s going too far. “As with everything, enjoy soda in moderation. If you are a man with knee osteoarthritis and are drinking a lot of soda, this might be a reason to curb back,” says American College of Rheumatology spokesman Scott Zashin, MD.

He argues that the study doesn’t prove cause and effect and needs to be repeated before any recommendations to patients can be made, he says.

Furthermore he advises, that in patients with osteoarthritis of the knee, every excess pound of weight is 4 extra pounds of dead weight on the knee joint.

And it’s not only Zashin who’s speaking out. The American Beverage Association (ABA), has also taken issue with the findings.

In a statement, the ABA writes: “The authors’ ‘novel  findings’ – as they call them – suggest only a possible association of soft drink consumption with osteoarthritis in knees, which they state cannot be proven without further testing. Consequently, this presentation fails to establish that drinking soft drinks causes any negative health outcomes or even that they are linked to negative health outcomes.”

Lu however is defending his work. He claims that certain ingredients in soda, including phosphoric acid, caffeine, as well as coloring and sweetening agents may affect absorption of calcium and overall bone health.

He even has an explanation as to why the link between soda and disease progression could not be established in women. “It could be due to sex hormones. For example, estrogen has been associated with cartilage degeneration. Further research is needed to understand the pathways.”

Although the jury is still out on this issue, it seems cutting back, or cutting out soda may not be a bad idea.

Could or would you give up your cola?  Let us know!

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Ho Ho Ho: health hazards for Santa

santa_claus obesityAfter weeks of harried holiday shopping, when the stores finally close on the evening of December 24, it will be a welcome reprieve from the madness. Families and friends gather together and enjoy a relaxing day or two of rest.

But for one man, the real work is just beginning. That’s right – Santa Claus is coming to town!

And while he spends most of the year enjoying a flexible work schedule, monitoring naughty-and-nice behaviors around the world and occasionally checking in on his elves and reindeer, things are about to get frantic for Old Nick.

And to be honest, this year we’re a little concerned about his health.  That belly fat!  The all-nighter he’s about to pull!  All those cookies!

He may know when you are sleeping, but the only way for Santa to get the job done is to stay up all night on December – and that can lead to some serious health concerns.
Studies have suggested that drowsy driving is as dangerous as drunk driving.  Even if he manages to get Rudolf and his friends safely parked on the rooftops, sleep deprivation could cause his judgment to become fuzzier, leading to the wrong presents traveling down the wrong chimneys.
What’s worse is that sleep loss has a cumulative effect. So while people in the Southern hemisphere might do OK, those of us in Northern climes, and especially those on the West Coast aren’t so lucky. Chronic sleep deprivation could mean he could fly over some houses altogether.

santa + sackBut even if we manage to keep him awake with coffee and Red Bull rather than the usual glass of milk, we’ve got to change Santa’s sack. By carrying something that weighs more than 10% of his body weight, one shoulder is going to end up taking on most of the burden, which could lead to back strains, sprains and spasms.
If you’re thinking of getting Santa a gift this season maybe you could consider a backpack, or better still, a rolling suitcase.

That’s not to say Santa doesn’t need the exercise of his Christmas Eve jaunt. Like 70% of adult men in the US, he is severely overweight. The health risks linked to obesity include Type 2 diabetes, coronary heart disease, stroke, hypertension, certain types of cancer and osteoarthritis.

With his giant waist comes the risk of belly fat associated problems such as insulin resistance, high triglycerides, heart disease and metabolic syndrome.

Santa beardThen there’s that beard to worry about. After a month or so of letting thousands upon thousands of kids sit on your lap at the mall, we wouldn’t be surprised if he’s harboring some germs in his whiskers.  So if Santa touches his beard followed by his eyes, ears or mouth, he’s pretty much bound to catch something, especially in the midst of this cold and flu season.

We suggest leaving some hand sanitizer next to the milk and cookies this year to give him a fighting chance.

And finally we’re worried about that thin Red Suit. While we’ll give Santa props for covering his head with a hat, traveling outside all night in December in a red velvet suit and a touch of faux fur seems ill advised. In addition to the hat, he should probably throw on a scarf or knit mask, mittens, thermals and a water-resistant coat to ward off hypothermia.

So whether you’ve been naughty or nice, there’s still time to give some thought to Santa’s Health, as well as your own this Christmas season.

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Getting Cheery Over Cherries!

Regular readers of SRxA’s Word on Health will be familiar with the many claimed health benefits of fruit. Bananas for HIV prevention, citrus to safeguard us against stroke, berries to prevent Parkinson’s Disease and even exotic cupuaçu for improved reproductive health.

According to many, including TV’s Dr. Oz, the latest superfruit on the block is tart cherries. Extensive research has linked the delicious bright red fruit to a number of benefits, including better sleep, reduced pain from gout and arthritis, reduced post-exercise muscle and joint pain as well as reduced cholesterol, and decreased risk for atherosclerosis and metabolic syndrome.

Dr. Oz, has gone so far as to say that tart cherries are the ultimate antioxidant.

New research from Oregon Health & Science University presented last week at the American College of Sports Medicine Conference confirmed that tart cherries can help to reduce chronic inflammation and can help people with osteoarthritis manage their disease.

In a study of twenty women ages 40 – 70 with inflammatory osteoarthritis, the researchers found that drinking tart cherry juice twice daily for three weeks led to significant reductions in important inflammation markers – especially for those women who had the highest inflammation levels at the start of the study.

With millions of Americans looking for ways to naturally manage pain, it’s promising that tart cherries can help, without the possible side effects often associated with arthritis medications,” said principal study investigator Kerry Kuehl, M.D. “I’m intrigued by the potential for a real food to offer such a powerful anti-inflammatory benefit – especially for active adults.”

Often characterized as “wear and tear” arthritis, osteoarthritis is the most common type of arthritis. Athletes are often at a greater risk for developing the condition, given their excessive joint use that can cause a breakdown in cartilage and lead to pain and injury.

Anthocyanins – the antioxidant compounds in tart cherries – appear to reduce inflammation to levels comparable to some well-known pain medications.

Previous research on tart cherries and osteoarthritis found that a daily dose of tart cherries helped reduce osteoarthritis pain by more than 20%.

Leslie Bonci, Director of Sports Nutrition at the University of Pennsylvania Medical Center for Sports Medicine, has incorporated tart cherries into the training menu of her professional athletes. She claims they are a natural and easy way to manage pain and also taste great.

Never heard of tart cherries, or concerned that they have such a short season?  The great news is that they are available year-round in dried, frozen, powder and juice forms too.