Posts Tagged ‘arthritis’

OSTEOARTHRITIS – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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OSTEOARTHRITIS

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 

Stephen Harper lost my children.  That’s my story and I’m sticking to it.  In our house February is the beginning of Tax Season.  Doris goes back to work at Meyer’s Norris and Penny as a tax preparer.  She likes the job, but if Stephen Harper was a good Conservative, he would eliminate all income tax and make Doris’s job redundant.  But instead Harper greedily keeps taxing us which causes mass confusion as Doris, myself and the two kids all try to get out the door to work and school at the same time.  Last Monday, in all this Harper taxation confusion, Eric went missing.  Emily had last seen him wearing his snow stuff, so we assumed he left for school.  But at 6 years old, he is supposed to walk to school with his older sister.  Now thanks to Harper taxation madness, no one knew where he was.  Doris eventually found him on the play ground at school on her way to MNP.  However, that wasn’t the end of Stephen Harper’s child disappearance shenanigans.  After school, Doris was still preparing taxes for Mr. Harper.  That meant that instead of the kids walking home after school, they were scooped up by Florence at School Aged Daycare.  Mr. Harper’s change in the after school routine caused Doris to forget to call Judith the tutor.  Emily usually sees Judith on Monday afternoons.  Harper’s taxation-greed caused Judith to worry that Emily had gone missing.  Harper’s taxation-gate has played havoc with my family’s routine and caused my kids to go missing.  Harper’s taxation-gate is a royal pain in the…knee.

 

Osteoarthritis can also be a pain in the knee.  Osteoarthritis is the most common type of arthritis.  In fact, by age 75 nearly every one will have at least one joint that under X-Ray will have changes consistent with osteoarthritis.

 

Arthritis means “inflammation of the joint”.   As the Arthritis Society points out, arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus.  In the pharmacy, people seem to get the terms osteoarthritis and osteoporosis confused.  Osteoporosis is NOT a form of arthritis.  Osteoporosis can be debilitating and painful, but it does not directly affect the joints.  Osteoporosis is when the bones get weak and break easily.  We will leave osteoporosis for another article.  Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.

 

In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction.  When we age, the cartilage can break down.  As cartilage breaks down, bits can break off and go into the soft tissue around the joint and cause pain.  I was surprised to learn that cartilage doesn’t have any nerve endings in it.  So cartilage doesn’t feel any pain.  The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down.  When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. 

 

What symptoms might I have with osteoarthritis?  The hallmarks are pain, stiffness and swelling around a joint that lasts longer than 2 weeks.  Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes.  Although there can be swelling around the joint in OA, it is usually less than would be expected in rheumatoid arthritis.  The joints usually affected are the hips, knees and spine.  Finger and thumbs joints may also be affected.

 

How is OA treated?  Osteoarthritis treatment is usually a combination of non-drug and drug treatments.  Non-drug treatments can include physical therapy to strengthen the muscles around a joint, canes to remove stress from a joint or orthotics to correct problems like one leg being slightly longer that the other.  OA can also be treated by surgical replacement of the joint.  Drug treatments can be divided into pain killers, steroid injections, and synovial fluid replacements.

 

One of the least expensive, most safe medications for pain is acetaminophen (common brand name Tylenol).  If that is not fully effective, the doctor may add an NSAID (non-steroidal antiinflammatory drug) like ibuprofen, diclofenac or naproxen.  These medications can work better for the pain, but are more expensive than acetaminophen and have more side effects, like stomach upset, risk of ulcers, and risk of increasing blood pressure.  There are also topical or rub on forms of NSAIDS which get NSAID to the joint and avoid the stomach.  Steroid injections directly into arthritic joints can be an option your doctor may consider if other treatments aren’t working.  They are mostly done on knees, and should be limited to 3 injections per year.  Synovial fluid replacements can also be injected directly into the joint and help lubricate it.  They are used most often on knees and are expensive.

 

Maybe it really was poor planning and poor parenting that caused of my kids to go missing when Doris went back to work.  Maybe Stephen Harper isn’t to blame.  But I still think paying taxes is a pain in the knee.  If you think the pain in your knee might be osteoarthritis, talk to your pharmacist.  Maybe we can help that knee pain better than Harper can cut taxes.

 

As always if you have any questions or concerns about these or other products, ask your pharmacist.

 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 

Arthritis Society’s website : www.arthritis.ca

 

Osteoarthritis-Mayo Clinic: www.mayoclinic.com/health/osteoarthritis/DS00019

 

Canadian Arthritis Patient Alliance: www.arthritispatient.ca

NSAIDs & Heart Attacks – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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NSAIDs & Heart Attacks

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

 “Eric, stop chewing your shirt!”  Some kids chew their nails.  Others suck their thumbs.  I was a thumb sucker.  My son Eric chews the collar of his shirt.   Yes, it annoys me.  Apparently it annoys me enough that I repeat the phrase, “Eric, stop chewing your shirt!”  a lot.  We were at Eric’s soccer practice and I was saying things like, “Good kick Eric!”  and “Go get the ball!” when apparently I let a “Eric, stop chewing your shirt!”  slip out.  My daughter, Emily commented, “Dad you are addicted to saying that aren’t your?”  Maybe I am.  Some repetitive phrases are repetitive because they are true.  Like when it comes to prescription medications, you have to weigh the risk versus the benefit.

A customer came into the pharmacy and was very worried by what she had seen on the news.  Her husband was on heart medications and he also needed to take NSAIDs for his arthritis.  She thought the news segment had said that NSAIDs would be dangerous for his heart.  It was time for me to do some reading.

There was a CTV news story on May 9, 2011 that talked about NSAIDs and heart attacks.  The news story referenced a study that had been published in the May 2011edition of the journal  Circulation.  Olsen et. al looked at people in Denmark who had their first heart attack between 1997 and 2006.  Then the Danish scientists looked at how many of these people took NSAIDs.  NSAIDs are non-steroidal anti-inflammatory drugs and are used to treat pain and inflammation.  They have names like ibuprofen, naproxen, diclofenac, rofecoxib and celecoxib.  What the Danish scientists found was that people who took NSAIDs after their first heart attacks were more likely to have another heart attack or die than those people who didn’t.

It was an interesting study.  It had over 83,000 people in it, which is impressive.  And it showed evidence that even short courses of NSAIDs in these patients who had previous heart attacks may be harmful.  We had assumed that short courses of treatment with NSAIDs should be safe in heart patients.  This study says maybe short courses of NSAIDs aren’t safe.  But the study wasn’t perfect either.

The biggest problem with this study was that it was a retrospective observational study.  So the Danish researchers looked back on data that had already happened.  They didn’t start an experiment and see how it turned out in the future.  That means that although the researchers seemed to have taken great care to track the patients carefully using Danish hospital and pharmacy records, some biases may have crept into the data.  The best type of study is called a prospective double blind placebo controlled study.  In that type of study half the people get the active pill and half the people get the sugar pill.  Neither the doctors in the study or the patients know which is which. 

Despite its weaknesses, the study found some interesting things.  It found that the NSAID diclofenac was the most likely to cause a recurrent heart attack or death and the NSAID naproxen didn’t seem to increase the risk of a recurrent heart attack or death at all.  The OTC NSAID we all use, ibuprofen, seemed to be okay for 7 days or less, but increased the risk of recurrent heart attack and death after that.  If that all sounds a little confusing, well it is.

I was confused because the study said diclofenac was more likely to cause a recurrent heart attack or death than rofecoxib or Vioxx.  Vioxx was pulled off the market in September 2004 because it caused too many heart problems.  So is diclofenac a dangerous drug?  Was Vioxx really not that bad?  These questions still need to be answered.

So what does this study really tell us?   Well not a whole lot by itself.  Although there have been other studies that seem to indicate that NSAIDs can cause or worsen heart problems, we still need more studies to say for sure one way or the other.  So don’t throw out your NSAIDs. 

We don’t know for sure how bad NSAIDs are for the heart.  But let’s assume we knew for certain that all NSAIDs caused an increased risk of heart attacks, would we throw out all the NSAIDs then?  Still, no.  There are very few black and white answers when it comes to medications.  All medications have side effects.  In every case we have to weigh the risks versus the benefits in that particular patient.  Let’s say we had a patient who had a previous heart attack who also has arthritis.  We have been treating his arthritis successfully with diclofenac.  Every time we change to another drug his pain becomes unbearable.  If we assume diclofenac increases his chance of another heart attack or death, what should we do?  After discussing the options with his doctor, I think it might be very reasonable to keep him on diclofenac if he is aware of the risks.

So if you have a heart condition should you throw out your NSAID’s?  No.  We just don’t know enough yet on how NSAIDs effect the heart.  If you want to discuss with your doctor whether you want to try a non-NSAID pain killer instead, that could be reasonable.  Just remember the new pain-killers will have their own side effects and potential risks.  So again you and your doctor will have to weigh the risks and benefits.  And Eric should really stop chewing his shirt.

CTV news article:

http://www.ctv.ca/CTVNews/Health/20110509/nsaid-painkillers-heart-risks-110509

Circulation article: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.110.004671v1?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=duration+and+treatment+with+nonsteroidal+anti-inflammatory+drugs&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Arthritis – Audio

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

ARTHRITIS

 

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.mb.ca

 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

The Public Health Agency of Canada released a tiny little 128 page report on July 19 called “Life with Arthritis in Canada”.  While I was manning my post at the Winnipegosis Clinic Pharmacy last week, I had a flip through it, and it contained some surprising things.

Manitoba has an average amount of arthritis according to the report.  For people 15 and over, Manitoba had 156,349 people with arthritis in 2007-08.  That works out to 15.2 people with arthritis for every 100 people in Manitoba.  In 2001 survey of disabilities in Canada, in the top ten causes of disability, arthritis was the most frequently reported cause of disability among women and second most frequently mentioned condition among men.  Arthritis costs the Canadian economy $6.4 billion per year in health care expenses and lost work days.  Arthritis accounts for 6% of all hospitalizations in Canada.

What is arthritis?  Arthritis literally means “inflammation of the joint”.   As the Arthritis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus.  We are going to talk about the two most common types: osteoarthritis and rheumatoid arthritis.  Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone.  Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. 

So if the joint wears out in osteoarthritis, what is a normal joint like?  In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction.  As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain.  The new thing I learned as I was researching this article is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain.  The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down.  When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs. 

What symptoms might I have if I had osteoarthritis?  Pain, stiffness and swelling around a joint that lasts longer than 2 weeks.  Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes.  Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis.  The joints usually affected are the hips, knees and spine.  Finger and thumbs joints may also be affected.

Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints.  The first symptom a patient might notice is pain in the hand or foot joints but can also affect other joints.  Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes.  The pain of RA can be in 3 or more joints at the same time.  (Often osteoarthritis effects only one joint like a knee.)  The pain from RA can last all night long.  The pain from RA can be symmetrical on both sides of the body.  That means, for example, both your wrist are sore.  Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills.  RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.

Treatment for both types of arthritis often starts with non-steroidal anti-inflammatory drugs or NSAIDS like ibuprofen, diclofenac or naproxen.  These medications can work well for the pain, and inflammation but have side effects like stomach upset, risk of ulcers, and risk of increasing blood pressure.  In osteoarthritis sometimes synovial fluid replacements can be injected directly into the joint and help lubricate it.  It can be effective.  It is used most often on knees and it is expensive.  In rheumatoid arthritis the body’s own immune system is attacking the joints.  The most common medication to calm the immune attack in mild RA is hydroxychloroquine and is generally well tolerated.  For moderate RA, methotrexate once a week is very common and seems to work very well.  Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.

As our population ages, more disability will be caused by arthritis.  Hopefully new and better treatments will keep pace.

For more information visit www.arthritis.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.

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