Osteoporosis: A Common Complication
of Rheumatoid Arthritis

When you think about who’s at risk for osteoporosis, a stereotypical portrait probably comes to mind: a thin Caucasian or Asian woman who’s over age 50. But if you have rheumatoid arthritis (RA), add yourself to that picture.

In fact, according to a 2010 study in Arthritis Research & Therapy, people with RA are 1.5 times more likely to experience an osteoporosis-related fracture than those who don’t have RA. The study, which looked at the medical claims records of about 47,000 U.S. residents with RA and 235,000 without it, found that women face the greatest odds, but men are at risk as well. What’s more, the increased risk of fracture is seen across all age groups, although the chances of experiencing a fracture heighten with age. The most likely location of a fracture? The hip, followed by the pelvis, thighbone and wrist.

What raises the risk? Although scientists are still trying to sort out why people with RA are more likely to develop osteoporosis than others, they do know some of the factors that heighten risk.

  • Disease activity. In addition to the joint damage that the disease’s chronic inflammation may cause, RA itself appears to trigger bone loss in the affected joint as well as other bones throughout the body. Some studies suggest that proteins that control inflammation (cytokines) also regulate cells called osteoclasts that are responsible for breaking down bone.
  • Corticosteroids. These medications are frequently prescribed to slow the progress of RA. Examples of medications in this category include prednisone, prednisolone, dexamethasone and cortisone. Unfortunately, corticosteroids (also called glucocorticoids) jump-start bone loss by suppressing bone formation and increasing bone breakdown. They also interfere with the way the body uses calcium and lower the levels of sex hormones (estrogen and testosterone), both of which add to bone loss. Although short-term use doesn’t appear harmful to bones, anyone taking corticosteroids for more than three months raises his or her risk of osteoporosis.
  • Lack of exercise. The pain and damage caused by RA can limit both your ability and your desire to exercise. But making the effort to do some exercise is important: The tug of muscles on bones whenever you move strengthens your bones.


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Another email blast from Johns Hopkins that I’ve shamelessly copied and redistributed.  At least I’ve copied the Copyright.  I do not nor ever will claim authorship, ownership, or attempt to redistribute for personal profit or gain the contents of this particular post.

Too much expert litigation work with attorneys.  Can you tell?

Johns Hopkins Health Alert – Potassium and Sodium

Reprinted from the original email.

Potassium and Sodium:
Achieving the Proper Balance

 Potassium is an important nutrient everyone needs, but if you have heart disease or are at risk for it, potassium takes on particular importance. Getting plenty of potassium from food is a wise move for most people. Others, however, may need to limit potassium in their diets, including those who are taking certain blood pressure or heart medications or have kidney disease.

Why potassium is important. Potassium is an electrolyte with many essential jobs: It helps conduct nerve impulses and muscle contractions, regulates the flow of fluids and nutrients into and out of body cells, and helps keep your blood pressure in check. Essentially, the level of potassium in your blood can make the difference between normal and abnormal activity in your heart and blood vessels.

Potassium does not act in a vacuum, though. It interacts with other electrolytes, including sodium. It’s long been known that sodium raises blood pressure, while potassium lowers it. But it’s becoming clearer that getting the right balance between sodium and potassium in the diet may be key to your heart health.

How much potassium do you need? In general, adults should get at least 4,700 mg of potassium daily, while limiting themselves to 1,500 mg of sodium. But most Americans are not meeting either goal.

Why is this? The main culprit is too many packaged and prepared foods. During processing, typically a large amount of salt (and, therefore, sodium) is added to foods, while any natural potassium may be stripped away. In contrast, many unprocessed whole foods — fruits and vegetables, in particular — contain adequate levels of potassium but little sodium.

In fact, the vast majority of salt in your diet comes not from your salt shaker, but from processed foods. And some of the biggest sources may surprise you: bread and rolls, prepared pasta dishes, and fresh poultry, for example. Others are less surprising — like cold cuts and cured meats, canned soups and sauces, and snack foods like chips, pretzels and popcorn. So you can optimize your potassium intake and minimize sodium intake by emphasizing fruits and vegetables, whole grains, low-fat dairy, beans, fish and lean meat in your daily diet.

Here are some examples of high-potassium foods followed by healthy alternatives that you can substitute:

  • High-potassium foods (at least 250 mg/serving): wholegrain breads, wheat bran and granola; peanut butter; fruits like apricots, bananas, melon, mango, oranges and pears; vegetables like potatoes, tomatoes and tomato sauces, parsnips, cooked spinach and broccoli, and raw carrots; milk and yogurt.
  • Low-potassium foods (less than 250 mg/serving): White bread and rice; some fruits like apples, berries, grapes, pears and peaches; some vegetables, such as asparagus, green beans, cooked carrots and cabbage, cauliflower, corn and eggplant; poultry, tuna and eggs.

Johns Hopkins Health Alert – Updated Guidelines for Knee OA

Updated Guidelines for Knee Osteoarthritis

Many nonsurgical treatments are touted as being able to ease the symptoms of knee osteoarthritis, but which ones really work? Last year, the American Academy of Orthopaedic Surgeons (AAOS) issued revised recommendations, updating its 2009 guidelines. The group made two important changes that may affect the way you manage knee osteoarthritis.

  • First, if you use acetaminophen (Tylenol) for osteoarthritis pain relief, take no more than 3,000 mg per day. The AAOS formerly advised not exceeding 4,000 mg daily. The change was made to reflect the Food and Drug Administration’s current guidelines for safe use of acetaminophen.
  • Second, the AAOS found insufficient evidence that intra-articular hyaluronic acid provides significant symptom relief for knee osteoarthritis so the organization no longer recommends the therapy.

The AAOS continues to give a thumbs-up to some familiar commonsense strategies, such as exercising and a minimum 5 percent weight loss for people whose body mass index (BMI) is greater than 25.

Other highlights: The AAOS is unable to recommend for or against the use of bracing, growth factor injections and/or platelet-rich plasma knee osteoarthritis. In addition, although acupuncture continues to grow in popularity, there is not sufficient scientific evidence to support its use in patients with knee osteoarthritis.

Published online in Treatment of Osteoarthritis of the Knee. Evidence-Based Guideline, 2nd Edition, May 18, 2013

Click to access TreatmentofOsteoarthritisoftheKneeGuideline.pdf

Here’s the link if you want to download the entire set of guidelines in pdf format.

Johns Hopkins Health Alert – The Compelling Case Against Sugar

Re-posted from the Johns Hopkins Health Alert email The Compelling Case Against Sugar

For years, nutrition experts have warned that consuming too much sugar contributes to excess weight gain. Now, a mounting body of scientific evidence suggests that sugar is even more detrimental to the body than was previously believed. As a result, a growing chorus of scientists and public health advocates is urging the U.S. Food and Drug Administration to set safe limits for sugar consumption.

Recently, researchers at the University of California, San Francisco, took matters even further, suggesting that sugar should be regulated by the government to protect public health — just like alcohol and tobacco. Sugar, they argue, is a toxic substance with a tremendous potential for abuse because it affects the brain in a way that encourages people to consume larger amounts, even when they should be satisfied with what they’ve already had.

What’s more, they contend, sugar changes a person’s metabolism, altering the signaling of hormones (including leptin, ghrelin, and dopamine, which regulate satiety, hunger, and pleasure, respectively) in a detrimental way. In other words, the researchers say, sugar is addictive.

That point of view is quite controversial, however, so it’s not likely that sugar is going to be banned or regulated by the government — at least not anytime soon. Nevertheless, the latest research makes a compelling case for determining just how much sugar is safe for human consumption — and for cutting back on the amount of sugar you consume.

The dangers of added sugar. First, it’s important to distinguish natural sugars from added sugars. Natural sugars are an essential part of our diet because the human body converts them to glucose to meet its energy needs. Natural sugars are found in varying amounts in fruits and vegetables, which contain fructose, and in dairy products, which contain lactose.

Added sugars, on the other hand, are not essential. Added sugars are sugars and syrups that are added to foods or beverages when they are processed or prepared, as well as the sugar you add to your coffee, tea, cereal or other foods. Whether it’s added in the form of white sugar, raw sugar, brown sugar, high fructose corn syrup, honey or molasses, it’s all sugar.

Added sugar has been implicated in a variety of ills, from raising blood pressure and increasing the risk of gout to causing liver damage and accelerating the aging process. Some of the strongest evidence to date shows associations between excess sugar consumption and diabetes, heart disease and obesity.

How much added sugar is too much? Surprisingly, the answer to this question varies. Currently, the USDA recommends that people consume no more than 10 teaspoons of added sugar in a 2,000-calorie per day diet. At 16 calories per teaspoon, that’s 160 calories each day. These days people typically consume twice that amount.

Cardiac Catheterization: A New Route – Johns Hopkins Health Alerts

Cardiac Catheterization: A New Route: Johns Hopkins Health Alerts.

Cardiac Catheterization: A New Route

Doctors use cardiac catheterization to diagnose and treat heart conditions. The technique involves threading a thin tube called a catheter through an artery (usually the femoral artery in the upper thigh or groin) to the heart. Serious complications during cardiac catheterization are rare. But the procedure comes with risks of bleeding and damage to arteries.

Increasingly, cardiologists perform cardiac catheterization from an alternate site — the radial artery in the wrist — an equally effective tactic that’s linked to fewer bleeding and vascular complications, according to a review published in Circulation.

Why the wrist? After patients undergo cardiac catheterization through the femoral artery, they must remain flat on their back with their leg immobile for two to six hours to allow the artery to heal and help prevent both internal and external bleeding. Because the radial artery is smaller and closer to the skin’s surface, there’s no risk of internal bleeding, and external bleeding is easier to stop or prevent, an advantage for obese patients or those taking blood thinners.

Patients who undergo cardiac catheterization through the wrist can sit up, walk and eat immediately after the procedure — good news for people with back problems who find it difficult to lie still. A compression device is worn around the wrist for two hours. Patients must refrain from heavy lifting with the hand for a few days.

Radial cardiac catheterization most benefits patients in the highest risk groups — women, patients 75 and older and people with acute coronary syndrome. Yet doctors have been less likely to use the wrist site for these groups.

The decision to use radial versus femoral artery cardiac catheterization is largely based on the abilities and the experience of the cardiologist who’ll perform the procedure. The radial procedure is more technically challenging, and a greater number of U.S. doctors have more experience with the femoral approach — something that’s likely to change in the near future.