Low birth weight infants predict increased likelihood of rheumatoid arthritis in the mother

April 16th, 2014

A totally unexpected risk factor for rheumatoid arthritis…

Low birth weight infants predict increased likelihood of rheumatoid arthritis in the mother

Kimberly Ma and colleagues from the University of Washington Medical Center studied 202 pregnant patients with rheumatoid arthritis and 1,102 pregnant controls. The found that comparing those with uncomplicated pregnancies, women with very low birth weight or extremely low birth weight infants had a higher risk of rheumatoid arthritis.  The authors concluded that this association may reflect common factors for pregnancy complications and rheumatoid arthritis or possibly the fact that complicated pregnancies themselves might confer a risk for developing rheumatoid arthritis.

Comment: Very interesting study and more data is needed.

Medication use and rheumatoid disease activity… the possible effect on offspring.

April 15th, 2014

Here’s an interesting question… does drug treatment in pregnancy affect the bone density of offspring? The answer next.

Medication use and rheumatoid disease activity… the possible effect on offspring.

Prednisone use and active disease are associated with reduced bone density in patients with rheumatoid arthritis. The question then is this… do these factors also affect the bone density of children born to mothers with either of these issues? A Dutch study from the Erasmus Medical Center in Rotterdam published in Arthritis and Rheumatology followed 255 mothers and 108 children of these mothers.  What the investigators found was that neither medication use nor high rheumatoid arthritis disease activity during pregnancy is associated with low bone density in offspring at an age of 7 years, on average.  The authors concluded the benefit of medication use for rheumatoid arthritis during pregnancy outweighs the effect on bone density in the offspring.

Comment: This is comforting hews for women who are pregnant and need to know about this issue.


April 14th, 2014


The Achilles tendon is the largest tendon in the body. It can be injured by excessive strain, over pronation of the feet, or a sudden increase in exercise intensity.  The term “Achilles tendinitis” is probably wrong since much of the time Achilles tendon problems are due more to tendon degeneration than to inflammation.  Diagnosis is made through history, physical exam, and imaging procedures such as MRI or ultrasound.  Treatment involves rest, ice, physical therapy, an Achilles boot, and anti-inflammatory medicine.

Steroid injections should be avoided at all cost because they weaken the tendon and make the tendon more likely to rupture.  The treatment of choice is ultrasound guided needle tenotomy with injection of platelet-rich plasma (PRP> A newer form of treatment is Tenex which is a needle that both irrigates and vacuums.

Weather may… or may not affect arthritis symptoms

April 11th, 2014

So… does weather affect arthritis?  The surprising answer next…

Weather may… or may not affect arthritis symptoms

One of the most controversial topics in arthritis is this… Does weather affect symptoms? Well maybe we have an answer to this perplexing issue. Nancy Walsh writing in her blog on Medscape reported on a Dutch study of  712 survey participants who were residents of Germany, Italy, U.K., the Netherlands, Spain, and Sweden… a variety of climates.

Patients’ mean age was 73 years, 72% were women, and 67% considered themselves to be “weather sensitive.”

When the researchers compared the weather-sensitive patients with those who didn’t consider themselves sensitive, they found that women, the less educated, and more anxious and depressed patients were more often sensitive.

Weather-sensitive individuals also had less of a sense of mastery over their lives.

Among the 469 individuals who considered themselves weather sensitive, almost 40% said damp and rainy conditions worsened their symptoms, 30% said only cold bothered them, and 5% said hot weather was worse for their pain. Small numbers reported increased pain with both hot and cold weather, or to rain and cold and heat.

Interestingly, the percentage of patients who were weather sensitive was highest in warm, dry climates like Spain and Italy (77%) and lowest in the cold, wet climate of Sweden (57%). In addition, residents of warm, dry climates reported more intense joint pain than those in cold, wet climates.

Possible explanations suggested by Erik Timmermans, the lead author,  included the biologic:

“Changes in temperature and humidity may influence the expansion and contraction of different tissues in the affected joint, which may elicit a pain response. In addition, low temperatures may increase the viscosity of synovial fluid, thereby making joints stiffer and perhaps more sensitive to the pain of mechanical stresses.”

The exposure theory:

“The climates in both Mediterranean countries are warmer compared to the climate in Sweden. As a result, older people with osteoarthritis in Italy and Spain may be more often outside compared to those in Sweden…. As a consequence, they may be more aware of the effect of weather on their pain and are more likely to report weather sensitivity.”

And the mind:

“The disease course of osteoarthritis is often characterized by a low level or absence of symptoms with periods of flare-up or exacerbation. The uncertainty about the recurrence of pain may lead to anxiety in people with osteoarthritis and this might encourage the desire to have an explanation for the worsening of their pain.”

In any case, “the common belief that joint pain in osteoarthritis becomes worse by living in a cold and damp climate is not supported by our results,” they stated.

They concluded that clinicians’ appreciation of older patients’ potential weather sensitivity — wherever they live — may be key. “Early treatment of weather-sensitive individuals with osteoarthritis using cognitive and psychological interventions may reduce suffering and may help them to maintain a functionally effective lifestyle,” they concluded.

Comment: So there it is… your answer.

Otrexup… a novel methotrexate delivery system

April 10th, 2014

New form of methotrexate making its debut…

Otrexup… a novel methotrexate delivery system

The FDA recently approved a new form of methotrexate.  Otrexupo is an injectable form of the drug administered via an autoinjector. It is hoped that the higher drug levels and ease of administration may help with patient compliance.

Comment Otrexup or throw up.  Not sure I see the value in this product.

First biosimilar biologic approved in Europe.

April 9th, 2014


Biologics going down in price? Maybe… coming up next

First biosimilar biologic approved in Europe.

Reported in Value-based Rheumatology, an article indicating the European Commission has approved the first biosimilar biologic for the treatment of rheumatoid arthritis. Two versions, Remsima and Inflectra are copies of the popular drug Remicade. Approval of biosimilars may herald the reduction in costs for these costly drugs.

Comment: Let’s hope these work as well as the brand name drugs.

How to get rid of the agony of shoulder tendonits!

April 8th, 2014

The shoulder is a complex joint consisting of three bones (the scapula, the humerus, and the clavicle) and held together by an arrangement of ligaments, tendons, muscles, and bursae.  Shoulder pain is a common complaint.  It’s important to separate shoulder pain from referred pain coming from the neck.  Most primary shoulder pain is due to degeneration occurring in the rotator cuff or biceps tendons.  The term “tendonitis” is incorrect since there is very little inflammation.  The problem is tendon degeneration. Accurate diagnosis is important.  Examination with history, physical, and imaging procedures can establish the correct diagnosis. Treatment involves the use of rest, ice, physical therapy, stretching and strengthening exercises.  More aggressive measures include steroid injection, needle tenotomy with  platelet rich plasma,  and Tenex.

PET useful for detecting early disease

April 7th, 2014

Coming up next…A new test that might be useful if you own a Ferrari…

PET useful for detecting early disease

Published in Arthritis Care and Research, an article indicated that positron emission tomography or PET scanning is a useful tool for monitoring disease activity.  The study analyzed data from 18 studies encompassing 276 patients with inflammatory joint disease.  Results showed PET was highly sensitive and correlated well with clinical assessments.

Comment: Good luck getting insurance companies to pay for this one!

Tennis Elbow

April 4th, 2014

Tennis elbow.

Tennis elbow, also known as lateral epicondylitis, is a common form of painful tendon disorder involving the outside part of the elbow. Interestingly, very few people who suffer from tennis elbow actually play tennis.

Risk factors for tennis elbow include aging, repetitive motion, excessive load on the arm, and trauma.

The diagnosis is made by history, physical examination, and imaging procedures such as magnetic resonance imaging and diagnostic ultrasound.

The treatment for this disorder consists of physical therapy, stretching and strengthening exercises, nonsteroidal anti-inflammatory drugs, a tennis elbow band, and avoidance of those activities that brought the disorder on in the first place.

Extracorporeal shock wave therapy has shown some promise. The treatment of choice today is platelet rich plasma, and ultra concentrate of blood, that contains a large number of platelets. Platelets are cells that are packed with growth and healing factors. Platelet rich plasma is administered using ultrasound guidance. A more recent treatment is Tenex. This is the device that uses at an oscillating needle along with irrigation and suction to vacuum out debris. This also uses ultrasound guidance. At our institution. We use a combination of 10 ask and platelet rich plasma with excellent results. I want to stress that cortisone should not be used for tennis elbow. While it may provide short-term relief, it causes long-term tendon degeneration.

Jumpers Knee

April 3rd, 2014


Jumpers knee.

Jumpers the, also known as patellar tendinopathy, is a common injury affecting athletes who do a lot of running and jumping. It is considered a repetitive stress injury and affects people who play basketball, volleyball, soccer, and who engage in high jumping.

Risk factors include overtraining and training on hard surfaces.

Symptoms include pain at the insertion of the patellar tendon into the patella.  The diagnosis is made by history, physical examination, and imaging studies such as MRI and ultrasound.

Often there is an area of cartilage irregularity where the patellar tendon inserts into the patellar.

Treatment includes modification of activity, ice, joint motion, stretching, strengthening, a patellofemoral race, and occasionally arch supports. Knee immobilization is contraindicated.

More aggressive treatment includes sport specific physical therapy, electric shock wave therapy, and more recently the use of platelet rich plasma and Tenex. Corticosteroids should never be used because they weaken tendon and cartilage.