ARTHRITIS and OSTEOARTHRITIS
INTESTINAL PERMEABILITY AND INFLAMMATION IN PATIENTS ON
NSAIDs
A major concern of non-steroidal anti-inflammatory drugs
(NSAIDs) is the frequency and severity of gastrointestinal
side effects. A trial was carried out to examine small intestinal
permeability and inflammation in-patients on long term NSAIDs.
Over 6 months the patients underwent combined absorption-permeability
tests at 3 different test dose osmolarities (iso-, hypo-,
and hyper-osmolar). The iso- and hyperosmolar tests showed
significant malabsorption of 3-0-methyl-D-glucose, D-xylose,
and L-rhamnose. Intestinal permeability changes were significantly
more pronounced and frequent with the hypo- and hyperosmolar
as opposed to the iso-osmolar test. There was no significant
difference in the prevalence or severity of intestinal inflammation
in the patients taking the various NSAIDs except that there
was no evidence of intestinal inflammation for those taking
aspirin or nabumetone.
Sigthorsson, G. et al
GUT 1998, 43 (4) 506-11
MAGNETIC ATTRACTION MAY HELP ARTHRITICS
Damaged cartilage in joints can be regenerated by pulling
cells into the affected area with a magnet. Small biodegradable
magnets inserted into bone can attract injected magnetised
chondrocytes which migrate to the magnets and then form
new tissue.
NEW SCIENTIST, 11th April 1998, p10
EFFECTS OF THE MENSTRUAL CYCLE ON MEDICAL DISORDERS
It is well recognised that certain medical conditions are
exacerbated at specific phases of the menstrual cycle. Abrupt
changes in the concentrations of circulating ovarian steroids
at ovulation and premenstrually may account for menstrual-cycle
related changes in these chronic conditions. Accurate documentation
of symptoms on a menstrual calendar allows identification
of women with cyclic alterations in disease activity.
The evidence supporting a relationship between oestrogen
withdrawal and migraine headache is compelling. The frequency
of migraine headaches in women increases considerably after
menarche and 60% of women with migraine link attacks to
menstruation. Seventy to ninety percent of women with menstrual
migraine experience improvement during pregnancy but may
experience migraine attacks in the postpartum period.
Menstrual exacerbations occur with all types of seizures.
Catamenial epilepsy is believed to result from cyclic alterations
in both ovarian hormone levels and drug metabolism.
In many women with asthma there is an increased frequency
and severity of attacks premenstrually or at menstruation
and may be related to changing levels of progesterone or
prostaglandins.
Symptoms of rheumatoid arthritis often improve in the luteal
phase when gonadal steroid production is maximal. A subjective
increase in morning stiffness and arthritic pain during
menstruation and the early follicular phase has been shown.
In women with irritable bowel syndrome symptoms tend to
recur and become cyclic, with exacerbation during the postovulatory
and premenstrual phases of the menstrual cycle, suggesting
a hormonal influence.
Menstrual cycle-related alterations in glycemic control
during the luteal and premenstrual phases have been reported
in some women with diabetes.
Other disorders exacerbated by the postovulatory and premenstrual
phases of the menstrual cycle include acne, endocrine allergy
and anaphylaxis, erythema multiforme, urticaria, apthous
ulcers, glaucoma and multiple sclerosis.
Case, A.M. and Reid, R.L.
ARCH.INT.MED. 1998, 158 (13) 1405-12
THE EFICACY OF FOLIC ACID AND FOLINIC ACID IN REDUCING METHOTREXATE
GASTROINTESTINAL TOXICITY IN RHEUMATOID ARTHRITIS
A study was carried out to determine the efficacy of folic
acid and folinic acid in reducing the mucosal and gastrointestinal
(GI) side effects of low dose methotrexate (MTX) in patients
with rheumatoid arthrits (RA). Out of the trials which met
the inclusion criteria, the total sample included 307 patients
of which 147 were treated with folate supplementation, 67
patients with folic, and 80 with folinic acid. A 79% reduction
in mucosal and GI side effects was observed for folic acid
[OR=0.21], and for folinic acid a clinically, but not statistically
significant reduction of 42% was found [OR=0.58]. No major
differences were found between low and high doses of folic
or folinic acid. The results, therefore,support the protective
effect of folate
supplementation in reducing MTX side effects related to
the oral and GI systems.
Ortiz, Z. et al.
J. RHEUMATOL. 1998, 25 (1) 36-43
CHANGE IN BODY FAT, BUT NOT BODY WEIGHT OR METABOLIC CORRELATES
OF OBESITY, IS RELATED TO RELIEF OF OBESE PATIENTS WITH
OSTEOARTHRITIS
Osteoarthritis (OA) of the knee is the most common joint
disorder, accounting for a large proportion of disability
in adults. One factor often cited as a possible cause of
OA in general and in knee OA in particular is obesity. A
study was therefore carried out to determine the variable
most closely related to symptomatic relief of OA of the
knee in response to a weight control program. The study
group consisted of 22 patients diagnosed with knee OA whose
body mass index (BMI) was more than 26.4. The patients were
treated with a low calorie diet, an appetite suppressant,
and nonsteroidal anti-inflammatory drugs for 6 weeks and
were instructed to follow a walking program. BMI, percent
body fat, the average number of steps per day by pedometer,
and the metabolic correlates of obesity (blood pressure,
fasting blood serum glucose, total cholesterol, triglycerides,
and serum insulin) were measured at the beginning and end
of therapy.
It was found that the remission score of knee OA (using
the Severity Index of Lequesne) was more strongly associated
with reduction in percent body fat than other variables.
A significant correlation was also observed between the
number of steps per day and remission score. Thus, in a
weight control program, decreasing body fat and increasing
physical activity are more important than body weight loss
or decreasing other indices of obesity in producing symptomatic
relief of knee OA.
Toda, Y. et al
J. RHEUMATOL. 1998, 25 (11) 2181-6
UFOs OF THE INTESTINESInterstinal parasites are much closer
to home than we think. Antony Haynes reviews evidence which
highlights the prevalence of previously unidentified faecal
organisms (UFOs) and their significance to health. Parasitic
infestations are now so widespread thay they affect about
150 million people in the US and at least 40% of the world’s
population. Dr. Hermann Bueno, one of the world’s
most experienced parasitologists, believes that parasites
are the missing diagnosis in the genesis of many chronic
health problems. Signs of parasitic infection in adults
include:
• abdominal pain
• abdominal bloating
• aches and pains
• anaemia
• arthritis
• autoimmune disease
• chronic fatigue
• colitis
• constipation
• diarrhoea
• fever
• flatulence
• food allergy
• gastritis
• headaches
• inflammatory bowel disease
• immune system problems
• irritable bowel syndrome
• malabsorption
• skin conditions and itching
• sleep disturbances
• rectal bleeding
• vomiting
While over 130 different parasites have been found in Americans,
the following are the most common:
Blastocystis hominis, which can be asymptomatic, but can
cause irritable bowel, chronic fatigue, arthritis and rheumatism.
Dientamoeba fragilis, which can also be asymptomatic, or
cause diarrhoea, tenderness and melaena.
Entamoeba coli, often asymptomatic, but can cause systemic
illness and auto-immune reactions.
Giardia lamblia, which adhere to the upper part of the
small intestine, preventing digestion and assimilation and
causing a range of symptoms.
Endolimax nana, the smallest of the intestinal amoebas,
and suspected of being the cause of rheumatoid arthritis
and collagen-related diseases.
Most NHS laboratories do not use techniques which could
help to identify parasites, and some organisms are thought
to be harmless. It can take an average of 16 investigations
to diagnose the presence of Giardia.
The major sources of infection are tap water, badly cooked
or stored food, human and pet faeces, and holidays abroad.
The best laboratories for detecting UFOs are:
Parascope Laboratory, Tel: 01133 292 4657.
Diagnos-Techs Labs., Tel: 0121 458 3407.
Health Interlink (agents for Great Smokies Diagnostic Lab.),
Tel: 01582 794 094.
OPTIMUM NUTRITION 1998, 11; 1; 22-7
