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.

Lupus test

The ANA test or anti-nuclear antibody is used to test for SLE or lupus.  Normal or healthy people can also test positive for ANA but in low titers.  ANA test greater than 1/160 are significant and need follow up tests.  Tests such as dsDNA or Smith can confirm lupus.  An antiRO and anti La test is suggestive of Sjogren's.  This test should only be done if there is a suspicion of connective tissue 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.

Physiotherapy for torn meniscus. Posted by Rheumatologist in Dubai

A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
"This study demonstrates what physical therapists have long known," explained APTA President Paul A. Rockar Jr, PT, DPT, MS. "Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis."
According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, "our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial. These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options."
Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery.
Patients who were given standardized physical therapy -- individualized treatment and a progressive home exercise program -- had the option of "crossing over" to surgery if substantial improvements were not achieved. Thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.
According to an accompanying editorial in NEJM,"millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial." Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, "Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications."

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.