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NEWS BULLETIN produced by Sue Romanick MD PLLC
SOME OF THE NEWEST DEVELOPMENTS FROM THE 2008 American College of Rheumatology ANNUAL MEETING in San Francisco, California
This is an exciting time in the field of arthritis, pain and autoimmune disorders (rheumatology). Research is a dynamic force in rheumatology. Never before has there been such optimism in restoring patients back to health and preventing disease!
In this bulletin, I would like to summarize some exciting developments in this field. Many patients would like to understand their conditions more fully and have some control over progress. Knowledge is power and we believe that we can empower our patients through what we teach patients in our clinic about their individual health. We are excited that the field of medicine recognizes the importance of lifestyle, diet, exercise and supplements in addition to conventional medical therapies.
VITAMIN D
There has been a lot of excitement about this vitamin in the past year. Initially believed to be important mostly for strong bones and teeth, we now know that this vitamin can directly help the immune system. In fact, there is some evidence that vitamin D has been important in fighting certain infections as well as influencing whether certain autoimmune disorders develop. In certain geographical locations where the population has less exposure to sunlight, conditions such as multiple sclerosis and sarcoidosis may be more prevalent. Sunlight can be helpful by helping the body to make active vitamin D, but sunlight can also lead to several skin cancers. Let us evaluate whether you may be at risk and we’ll help you decide whether supplementation with vitamin D makes sense.
SMOKING
There have now been associations between the development of several autoimmune conditions (such as rheumatoid arthritis and scleroderma) and smoking. In addition, smoking has been linked to chronic back pain. We’ve known all along that smoking is associated with many cancers as well as chronic lung disease. When I asked a prominent lung specialist about patients who have trouble quitting “cold turkey,” he answered that you benefit from each cigarette not smoked. So, start cutting down even if you can’t cut it out (yet) altogether! You’ll be helping your body.
SLEEP and STRESS
Remember the adage: “Early to bed, early to rise, makes a man/woman healthy, wealthy and wise”? Well, there is wisdom in that saying! We now know that pain as well as conditions such as rheumatoid arthritis and fibromyalgia can be directly affected by sleep quality. In fact, there is evidence that poor quality (or quantity) of sleep can be associated with coronary artery disease and sudden death. We will work with you to learn how to optimize your sleep quality.
RHEUMATOID ARTHRITIS
We have seen dramatic improvements in patients with rheumatoid arthritis since the biologic agents were made available. We can prevent the crippling effects of this form of arthritis. Even more exciting, the increased risk of heart disease associated with rheumatoid arthritis appears to lessen with the use of certain of these agents. At the same time, you should make sure that your cholesterol and blood pressure are optimal. We will gladly work with your primary care physician on these issues. Finally, it is important to make sure patients beginning biologic agents are screened for tuberculosis and hepatitis. Because these agents can affect the ability of the body to fight infection, we recommend several vaccines before beginning these medications. These may include influenza, pneumococcal and possibly meningococcal vaccines, depending on the patient. If you are on one of these agents you must inform your doctor if symptoms of infections such as fever, cough or shortness of breath develop.
AUTOIMMUNE DISORDERS
Research is demonstrating subtypes of disorders rather than blanket categories. Previously, we knew that lupus comes in different forms. We now know that scleroderma similarly has approximately five subtypes. Thanks to research, new tests are available to help not only with diagnosis but to assist health providers in being able to give you an idea as to prognosis. In some of these conditions, the kidneys or lungs can be affected. In others we are concerned that ability to concentrate, mood or even serious complications that could lead to stroke can occur. Therefore, keeping your doctor informed about new symptoms is very important. Remember, the more we learn about these diseases, the more we realize the importance of considering the patient as a unique individual. We do not use a “cookie-cutter approach” with our patients!
FIBROMYALGIA
This condition is common, more so in women, and offers much evidence of how the mind and body are connected. We feel it is important to look for conditions that can mimic its symptoms, including thyroid problems, vitamin D deficiency, chronic hepatitis and medication side effects. We consider the patient’s lifestyle and even past stressors. A wellness approach includes diet, appropriate supplements, exercise, sleep modification and non-addictive medications.
GOUT
This condition is a common form of arthritis in men. Usually it presents as intense pain and swelling in one joint. It was known as the disease of emperors in Byzantine times. We now know that not only alcoholic beverages but also certain artificial sweeteners (such as corn syrup solids) can lead to a painful attack. Lifestyle, medications (some of which can contribute to an attack) and even weight must be considered on an individual basis. New research links gout with heart disease and high blood pressure. With a healthier lifestyle, you can enjoy a healthier outlook!