Diet for arthritis

Read the full article in a Scientific journal



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827298/

The science of yoga. Adventures with yoga in Dubai

I am a believer and convert to yoga.  No other form of physical exercise brings such peace and equanimity to the practitioner.

There have been 1000s of studies regarding yoga and its health benefits.  In 2008 we published a landmark study detailing the health benefits of yoga for arthritis.  https://www.ncbi.nlm.nih.gov/pubmed/19184028.

https://www.drbadshamedical.com/conditions-treatments/new-treatments/alternative-therapies/yoga-for-arthritis/

Aplar 2017 in Dubai ( Asia Pacific Rheumatology Conference Dubai ) October 16- 20

We are so pleased and excited to be hosting doctors from around the world to teh rheumatology conference in dubai.

Please follow this link : http://www.aplar2017.com

Diet for Rheumatoid arthritis in Dubai. posted by Rheumatologist in Dubai

Many arthritis patients are sensitive to several foods. The mechanism by which food sensitivity is involved in arthritis remains unknown. Some evidence implicates the gut flora. Some of the commonly used drugs for arthritis increase the permeability of the gut, causing it to become “leaky”, allowing larger molecules of foods to pass through than would normally be the case, causing food sensitivity. Many studies have shown that 30-40% of rheumatoid arthritis (RA) patients can improve substantially by using an elimination diet to identify foods that precipitate symptoms and the avoiding of these foods. Some studies have shown, that gluten and/or dairy products may be involved in this food sensitivity at some arthritis patients.

Elimination diets typically involve entirely removing the suspected food from the diet for a period of time from two weeks to two months, and waiting to determine whether symptoms resolve during that time period. If symptoms resolve after the removal of a food from the diet, then the food is reintroduced to see whether the symptom reappear.

Some people feel that cutting out ‘acidic fruit’ such as oranges, lemons and grapefruit helps arthritis. Others believe that vegetables from the so-called nightshade family (which includes several foods – potatoes, tomatoes, sweet and hot peppers and eggplants) are bad for arthritis. There is no scientific evidence that leaving out either of these groups of fruits and vegetables helps arthritis, and such diets may have the undesired effect of reducing the beneficial antioxidants in the diet.

Food sensitivity is highly individual, and varies from person to person. Elimination diet should be done under the supervision of your doctor to eliminate the risk of nutrient deficiency.

Food intolerance tests which test for IGG Antibodies against 200 foods are available at our center

Recently we presented our findings - results of the immune pro food intolerance test on 35 patients with arthritis.  About 100 % were intolerant to cow's milk and 85% to gluten / wheat.  Eliminating these foods has shown to be beneficial to majority of patients.

New oral medication for Rheumatoid arthritis not available yet in Dubai or UAE

Researchers studied the effectiveness and safety of tofacitinib (brand name Xeljanz) in combination with non-biologic DMARDs. Tofacitinib is a JAK (Janus kinase) inhibitor. There were 792 patients with active rheumatoid arthritis involved in the study which was conducted in 114 centers in 19 countries. The study participants were randomly assigned oral tofacitinib (5 mg or 10 mg twice daily) or placebo. At 3 months, patients in the placebo group who did not respond were blindly switched to 5 or 10 mg. tofacitinib twice daily.

Results, published August 20, 2013 in the Annals of Internal Medicine, revealed that response at 6 months was 21% greater for patients taking 5 mg. tofacitinib and 26% greater for patients taking 10 mg. tofacitinib compared to patients who were on placebo for 3 months and then switched to tofacitinib. Optimistic results, yes -- but the study had limitations. Placebo groups were smaller than the tofacitinib groups. Placebo was given for a shorter duration. Patients primarily received methotrexate, not other non-biologic DMARDs. Plus, the assessment of drug combinations other than tofacitinib plus methotrexate was limited. For example, patients were allowed to continue taking corticosteroids during the study.

Do you have steroids for arthritis?

You may have heard people with arthritis talk about what it was like to wean or taper off of prednisone. They describe varying degrees of withdrawal symptoms. For some, it was a nightmare.

It can be worse for people who took the drug for a long time or at a high dose. Prednisone is not a drug that can be stopped abruptly. It must be tapered gradually on a schedule determined by your doctor. Still, there may be withdrawal symptoms.

What has been your experience with discontinuing prednisone?

Doctors treating back pain incorrectly

According to a study published Monday in JAMA Internal Medicine, more physicians are ignoring national guidelines from the American College of Physicians when treating patients with back pain. The group recommends the use of “use of nonsteroidal anti-inflammatory drugs (NSAIDs),” such as ibuprofen and aspirin, combined with physical therapy. However, the study says physicians are instead, “increasingly” prescribing patients with back pain “narcotic drugs, ordering expensive imaging tests or referring them to other physicians.” Furthermore, the study’s lead author, John Mafi, a chief medical resident at Boston’s Beth Israel Deaconess Medical Center, claims that the guidelines “caution against early imaging or other aggressive treatments, except in rare cases.”

Stem Cells for arthritis. Posted by Rheumatologist in Dubai.

Stems cells taken from just a few grams of body fat are a promising weapon against the crippling effects of osteoarthritis.  This interview is from the Chicago Tribune.

For the past two decades, knee, hip or other joint replacements have been the standard treatment for the deterioration of joint cartilage and the underlying bone. But artificial joints only last about 15 years and are difficult to repair once they fail.

Stem cell injections may offer a new type of therapy by either stopping the degenerative process or by regenerating the damaged cartilage, said pioneering researcher Dr. Farshid Guilak, a professor of orthopedic surgery and director of orthopedic research at Duke University.

Guilak, one of the first researchers to grow cartilage from fat, explains why stem cells are a bright light in osteoarthritis research and why widespread clinical use is still years away. Below is an edited transcript of the interview.

Q: How are stem cell injections purported to help?

A: Several studies in animals show that stem cell injections may help by reducing the inflammation in the joint. Stem cells appear to have a natural capacity to produce anti-inflammatory molecules, and once injected in the joint, can slow down the degenerative process in osteoarthritis.

(Since this interview, research published in Stem Cells Translational Medicine has found that stem cells may also be an effective way to deliver therapeutic proteins for pain relief related to rheumatoid arthritis.)

Q: Does the bulk of research look at how stem cells heal traumatic injuries, or does it look at degenerative conditions such as arthritis?

A: Nearly all previous studies on stem cell therapies in joints have focused on trying to repair small "focal" damage to the cartilage. Only a few recent studies have begun to examine the possibility for treating the whole joint, either to grow enough cartilage to resurface the entire joint or to use stem cells to prevent further degeneration.

Q: Meaning one day, entire joint surfaces such as hips and knees could be grown in a lab?

A: That has been one of our primary research goals, so that people with arthritis can simply resurface the cartilage in their joints without having a total joint replacement. To do this, we have developed a fabric "scaffold" that can be created in the exact shape of the joint, while allowing stem cells to form new cartilage. One of our most exciting findings was the discovery that fat tissue contained large numbers of stem cells that could form cartilage and bone. In this way, we could easily get enough cells from a small liposuction procedure to completely resurface a person's worn-out hip or knee.

Q: Is it legal to get stem cell treatment for osteoarthritis in the U.S.?

A: While there is great promise for stem cell therapies, there's little clinical evidence supporting it for arthritis; we don't yet know if this type of treatment is safe in humans, or for that matter, that it even works. Some physicians are offering these treatments without FDA approval, but I feel it is irresponsible and potentially dangerous to perform such a procedure without having a clear understanding of the possible risks and benefits. Several clinical trials are planned and ongoing, mostly outside the U.S.

New test for Rheumatoid arthritis not available in UAE

The only tests available for Rheumatoid arthritis in UAE are rheumatoid factor and anti-CCP>
The 14-3-3eta lab-developed test is based on the 14-3-3eta protein biomarker through an exclusive license agreement in the United States with Augurex Life Sciences. One test provides results of 14-3-3eta blood levels, while a comprehensive panel provides results of blood levels of the novel marker as well as the conventional RA markers CCP antibodies and RF.

Physicians may consider results of RF, CCP antibody and 14-3-3eta tests, along with a medical evaluation and X-rays, to diagnose RA.

Quest Diagnostics already provides the RF and CCP antibody tests, and a panel that incorporates these assays as well as 14-3-3eta has certain advantages, including potentially higher sensitivity for detecting RA, than any of the three markers can provide alone. A panel also allows a physician to test a patient only once and receive a single report.

This “one blood draw, one report” approach is significantly more convenient for the patient and clinician in those cases where a physician may believe consideration of results of all three tests would aid diagnosis.

On the other hand, a physician may not believe results of all three tests are required for a reliable diagnosis or perhaps a patient received certain tests already, perhaps under care of a different doctor, and additional testing would be redundant and unnecessary. In these cases, single tests may be more appropriate.

How do these novel tests allow for early diagnosis of RA?
Research shows that elevated blood levels of the 14-3-3eta biomarker outperform conventional RF or CCP antibody testing for RA. When physicians consider results of all three markers, the sensitivity improves even further.

In addition, co-morbid conditions, such as type 1 diabetes, osteoporosis and gout, do not abnormally raise blood levels of 14-3-3eta.

What to ask your doctor regarding your Lupus?

1. Do I have kidney or other organ involvement?

2. How active is my SLE presently?  Are my C3 C4 low and dsDNA high as these can be signs of active lupus?

3. Should I take calcium and Vitamin D supplements?

4.  I have heard lupus patients are at high risk for heart disease.  Do I need to have my cholesterol checked?

5.  I have heard a medication called Hydroxycholoroquine can reduce lupus flare.  Should I take this?

6.  Should I have a bone density test?

Back pain treatment

(HealthDay News) – Injection of autologous, bone marrow mesenchymal cell concentrate (BMAC) into degenerated lumbar discs may relieve low back pain of discogenic origin, according to research presented at the American Academy of Pain Medicine's 29th Annual Meeting, April 11–14, in Fort Lauderdale, FL.

D. Joseph Meyer Jr., MD, PhD, of the Columbia Interventional Pain Center in Columbia, MO, and colleagues conducted a retrospective study of 24 consecutive patients treated with injections of autologous BMAC into degenerated lumbar discs for pain relief.

According to the researchers, of the 24 patients treated with BMAC injections, 12 patients received only one treatment, and 12 patients received one or more lumbar injections or surgical treatments. None of the patients reported worsening of pain after BMAC injections. Of the 12 patients who received only one treatment of lumbar disc BMAC, 10 patients reported to have pain relief at two to four months. Long-term efficacy and safety results are pending.

"The results of our case review are encouraging," said Meyer in a statement. "Currently, when conservative treatment measures fail, therapeutic options are limited for individuals with back pain due to disc degeneration. Many resort to disc surgery or spinal fusion with mediocre results. Our goal is to help develop a safe, natural method to boost the body's own capacity to heal discogenic pain."

Coffee decreases gout attacks

According to researchers from Boston University and Harvard Medical School, four cups of coffee per day can halve the chances of gout in women.

The latest findings were published in the American Journal of Clinical Nutrition.
The report comes after a long-term study that included almost 90,000 female nurses in the US for over a 26-year period during which researchers monitored their health and dietary habits.
Almost 900 nurses developed gout during that time.

While analyzing the beverage intake, researchers found that women who had consumed larger amounts of coffee during that period were at less risk.
Researchers did not know the reason of the positive effect of coffee however the theory is that it can reduce the insulin level in the blood.

“Long-term consumption of coffee is associated with a lower risk of gout in women”, researchers said.
Gout develops when uric acid, a natural byproduct, is not disposed properly by the body. And it is known that there is a link between higher insulin and higher uric acid.

Although there is a genetic predisposition to it, diet and excess in alcoholic drinks can also trigger the condition.
Gout attacks can produce unbearable pain and can last up to a week.
There are also studies that suggest that gout could be an early warning of heart disease.

Osteoporosis in Dubai

Today while chairing the "Women's Health Conference " in Dubai and speaking about "Osteoporosis and Vitamin D deficiency" I noticed an overwhelming interest in this subject.  These are a few points I would like to highlight:

1) The daily requirement of calcium is 1000 mg / day.  Please get this through your diet.  One 200 ml glass of milk or yogurt has 300 mg of calcium.  If lactose intolerant try soya milk or alternatives.  One cup of green veggies has about 100 mg of calcium.

2) Vitamin D requirement is 1000 IU per day.  This for very fair skinned people can be obtained by 20 minutes of direct sunlight exposure per day.  If darker skinned may require 1 hour of sun!  If unable to expose to sun take a vitamin D supplement 1000 IU once daily.

Meetings for Rheumatologists in Dubai, UAE

Upcoming meetings will be the Rheumatology Review Course in 09/2013 and Bone and Joint Conference in 10/2013

Rheumatoid arthritis treatment in Dubai

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Previous studies have shown that early, intensive intervention can help RA patients achieve remission, and reduce joint damage and disability. Treat-to-target (T2T) is a medical strategy that sets remission – or at the very least, low disease activity – as a goal; specific drugs and doses are stepped up systematically if remission is not reached within certain time periods.

Earlier findings of this Dutch study – called the DREAM trial – showed that remission can be achieved using the T2T strategy among patients with early RA (with symptom duration of one year or less) in the everyday world of daily clinical practice. But could the remission be sustained over the long-term?

A total of 342 patients from the DREAM trial had three-year follow up data for this phase of the analysis. Among them, nearly 62 percent were in remission at the three-year mark. Remission was defined as having a DAS28 score of less than 2.6. DAS28 measures disease activity in 28 key joints and certain blood markers.

Sustained DAS28 remission – defined as a DAS28 of less than 2.6 for six months or more – was achieved by more than 70 percent of patients at least once during the three years, with nearly 75 percent of those patients achieving a sustained remission for greater than a year. At the end of the three-year period, about 43 percent of the study subjects were in a period of sustained remission. The protocol called for a gradual decrease in medication for those experiencing sustained remission – and eventual discontinuation of drug therapy. At the three-year mark, a quarter of the subjects in the remission group were taking no medications.

New medicine rheumatoid arthritis

This is an oral therapy – only avaiable in Japan:
In a clinical study of iguratimod administered as a monotherapy in patients with rheumatoid arthritis, the agent demonstrated superiority over placebo and non-inferiority compared to an existing DMARD (salazosulfapyridine). In addition, in a trial of iguratimod in combination with methotrexate (MTX), the standard of care, conducted in rheumatoid arthritis patients who did not achieve satisfactory benefit with MTX alone, patients who were administered a combination of the two agents demonstrated favorable tolerability as well as significant improvements compared to those treated with placebo (MTX-only arm) in the study’s primary endpoint of ACR20 response rate at Week 24. Out of all the orally-administered anti-rheumatic drugs currently approved in Japan, iguratimod is the first agent evaluated in domestic clinical trials to demonstrate efficacy as an add-on therapy to MTX in patients who did not achieve satisfactory benefit with MTX alone

Anti-inflammtory diet for arthritis

Many types of foods can lessen inflammation in the body.  Examples are foods containing ginger, garlic , turmeric.  In addition diets high in Omega oils are good.  These include fish especially salmon, tuna and tilapia, cod, avocados, nuts such as walnuts and almonds.  Lean proteins such as chicken and fish and soya are advisable.  dairy products, especially low fat yogurt are beneficial.  Include at least 5 servings of fresh vegetables and fruits.  It is preferable to eat the vegetables closer to a raw or undercooked state.  Dark green and brightly colored vegetables have phytochemicals that are useful.  Avoid processed foods and meats, foods high in sodium, white breads, excessive starchy foods, and sugars.  There is no real evidence that night shade plants such as tomatoes, potatoes, egg plant or citrus fruits worsen arthritis. 

For Rheumatologists, Orthopedic doctors, Family doctors taking care of Bone and joint problems in Dubai , Abu Dhabi UAE

The 2nd Bone & Joint Conference is coming back to the Primary Healthcare Congress during the Abu Dhabi Medical Congress on the 16th of October, 2012.  After a successful conference last October, this This October 15th 2012, Abu Dhabi UAE This year’s program is looking to provide a comprehensive and in-depth one day agenda once again.   Covering new topics and the latest advances, there will be four sessions throughout the day: Orthopaedics Workshop, Back Pain Session, Rheumatology and General Rheumatology.  The presentations are geared towards GPs, who often see such cases and would benefit from learning the appropriate methods of diagnoses and treatment from specialists. Accreditation Statement The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Cleveland Clinic Foundation Center for Continuing Education designates this live activity for a maximum of 7.25 AMA PRA Category 1 CreditsTM.   Physicians should claim only the credit commensurate with the extent of their participation in the activity. Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit. Advisory Board: Dr. Donald Ford, Cleveland Clinic Dr. Humeira Badsha, Dr. Humeira Badsha Medical Center Dr. Chris Whately, Medcare Hospital What are the main topics covered in this event? Orthopaedics Workshops Back Pain Session Physiotherapy Rheumatology Lupus