Psoriatic Arthritis List NEWSLETTER

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News & Views Newletter
edited by Jack Nicholas, cornishpro@aol.co

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 2 ISSUE 26 December 15, 2002
PSORIATIC ARTHRITIS MEDICAL NEWS

INJECTIONS HOLD PROMISE FOR TREATING PSORIASIS
By Merritt McKinney NEW YORK (Reuters Health)

Injections of a protein called interleukin-4 (IL-4) seem equal to the best therapy now available for relieving symptoms of the chronic skin condition psoriasis, the results of a preliminary study suggest.

The treatment apparently works by causing immune cells that have mistakenly turned against the body's own tissue to stop promoting inflammation and take on anti-inflammatory properties instead. A report on the findings is being published in the advance online edition of the journal Nature Medicine.

The results of the study must be confirmed, but the study's lead author, Dr. Martin Rocken of Eberhard Karls University Tuebingen in Germany, told Reuters Health that "the main hope is that this approach establishes the basis for the development of a vaccine strategy against inflammatory autoimmune diseases, such as psoriasis, multiple sclerosis (and) rheumatoid arthritis."

One problem with current therapy for severe psoriasis is that it suppresses the entire immune system in order to reduce the inflammatory activity of immune cells. In the new study, Rocken's team tested a more targeted approach, hoping that treatment with IL-4, which targets a specific type of immune cell thought to go awry in psoriasis, would relieve symptoms without interfering with normal immune function.

In the study, 22 patients with severe psoriasis gave themselves three daily injections of IL-4 for 6 weeks. The investigators compared the results of the IL-4 treatment to the results in a group of 8 patients who were treated with light therapy.

Overall, the 20 patients who completed the study experienced improvement in symptoms similar to that of the conventional therapy group, according to the report. The skin condition improved more than 50% in 19 patients and more than 68% in 15 patients.

When the researchers examined psoriasis lesions, they found that treatment with IL-4 reduced levels of two proteins that are involved in the skin condition.

The next step, according to Rocken, is to conduct a larger trial in which patients will be randomly assigned to IL-4 or an inactive treatment called a placebo. He added that future research may also focus on the effects of IL-4 on other autoimmune diseases that involve the same sort of immune cells, such as rheumatoid arthritis, multiple sclerosis and type 1 diabetes.

The research suggests that rather than suppressing the entire immune system to treat autoimmune diseases, it may be possible to "re-educate" the immune cells that cause disease by teaching them to develop anti-inflammatory behavior, Rocken said.

SOURCE: Nature Medicine

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WOMEN'S ARTHRITIS ROLLER COASTER
by William C. Shiel Jr., M.D., F.A.C.P.

Why do many women with arthritis feel worsening symptoms before and during their monthly menstrual periods? During the course of any day in caring for women with arthritis, it is not uncommon for a number of them to complain of a monthly regular worsening of their joint pain, stiffness, and swelling. This is not just a coincidence.

Many forms of arthritis and rheumatic diseases are known to occur more frequently in women than in men. Moreover, it is not unusual for the initial presentation of these conditions to occur following a pregnancy. Why?

Researchers are finding that the immune system is influenced by signals from the female reproductive hormones. It seems that the levels of hormones, such as estrogen and testosterone, as well as changes in these levels can promote autoimmunity. "Autoimmunity" is a condition whereby the immune system (which normally wards off foreign invaders of the body, such as infections) turns and attacks the body's own tissues, such as skin, joints, liver, lungs, etc. Autoimmune diseases typically feature inflammation of various tissues of the body.

Autoimmune diseases are also characterized by a disorder of the immune system with the abnormal production of antibodies (autoantibodies) that are directed against the tissues of the body. Examples of autoimmune diseases include not only those that feature inflammation in the joints, such as systemic lupus erythematosus, Sjogren syndrome, and rheumatoid arthritis, but also disease of other organs, such as occurs in Hashimoto's thyroiditis and juvenile diabetes mellitus.

When women report only having symptoms or having increased symptoms at monthly intervals that are coincident with their menstrual periods, many doctors will recommend adjusting or adding medication to reduce inflammation selectively just before and during the period. The rationale for this short-term adjustment is that the immune system may be temporarily more active as women's hormone levels change during their periods. The additional medication can frequently help to avoid the symptom roller coaster that affects many women with arthritis. William C. Shiel Jr., M.D., F.A.C.P.

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CORTICOSTERIODS FOR ARTHRITIS
Edited by Frederick A. Matsen, III, M.D.

When taken as prescribed, corticosteroids can provide welcome relief from pain and inflammation. However, like any other medication, corticosteroids can cause side effects and serious medical problems if not carefully monitored by a doctor. It is very important to understand the differences between safe, proper use and improper use of these powerful drugs. Most side effects are predictable and related to the dose. Some side effects occur in almost anyone who takes them. Other side effects are unpredictable; they may or may not occur.

DOSAGE AND SIDE EFFECTS
The following table is an example of how the risk increases as the dosage for the corticosteroid prednisone increases.

Low dose: Up to 10 mg per day: This level is comparable to what is normally present in the body. Side effects may occur with long-term use, however, and must be monitored.

Intermediate dose: 10-20 mg/day: In the first month or so the risk is usually small. After this, risk increases. Some people still may realize more benefits than risks.

High dose: 20-60 mg per day: Higher risk in all cases. Because of the chance for side effects and serious problems, these amounts of corticosteroids should only be used when clearly necessary. Nevertheless, corticosteroids at this dose have saved many lives and have prevented countless people from serious disease complications.

Very high dose: 100-1,000 mg per day: This is used only in exceptional circumstances, usually in a hospital setting and only for the very short term.

VERY COMMON SIDE EFFECTS
Weight gain. At first, most of the weight is water retention only, but as time goes by, corticosteroids also may increase your body fat. Corticosteroids also will increase your appetite. Anyone with a history of heart trouble or swelling in the legs should consult his or her doctor, since corticosteroids could affect such conditions.
Mood swings. Some people find that corticosteroids make them feel more positive and uplifted while others feel sad, anxious, or depressed. Nervousness may occur, and difficulty in sleeping is common, especially if a dose is taken later in the day. People with a history of serious mental health problems should consult their doctor about how to deal with these risks.

COMMON SIDE EFFECTS
In people who take corticosteroids continuously for more than a few weeks:
Mild weakness in the muscles of arms or legs
Blurred vision
Hair growth: both thinning and excessive growth
Easy bruising of the skin
Slow healing of cuts and wounds
Acne
Round face
Slowed growth in children and adolescents
Osteoporosis (loss of bone calcium), especially in women, people with chronic
kidney disease, those with a history of osteoporosis in the family, people
who smoke, and people who are not physically active

OCCASIONAL SIDE EFFECTS
In people who take corticosteroids for weeks to months, especially at moderate to high doses:
High blood pressure
Elevated blood sugar
Red or purple stretch marks on the skin
Stomach irritation or stomach ulcers, especially when also taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids can make high blood pressure, diabetes, blood sugar problems, or ulcers suddenly worse. If you have had any of these conditions and need to take corticosteroids, it is very important to consult your doctor.

LESS COMMON SIDE EFFECTS
In people whose corticosteroid use is moderate or prolonged:
Blurred vision from cataracts
Glaucoma
Fractures due to osteoporosis, most often in the hip and spine
Osteonecrosis, a serious and painful condition that occurs most often in the
hip or shoulder when the bone is deprived of circulation
Severe weakness of the muscles (myopathy)
Psychosis, which is a severe disturbance of thinking
Serious infections due to suppression of the immune system

MINIMUNIZING SIDE EFFECTS
Corticosteroid use is less likely to cause side effects when you take your medication as prescribed and practice healthy habits (exercise regularly, eat nutritious foods, get enough rest). Following is a list of suggestions to help minimize side effects that can result from corticosteroid use.

Take your corticosteroids and other medications exactly as prescribed. Do not increase, decrease, or stop your dosage unless specifically instructed to do so.

Unless told otherwise, take a once-a-day dosage of corticosteroids early in the morning. It is more effective and less harmful that way. Visit your doctor frequently to prevent side effects or to detect them at an early stage.

Contact your doctor if you develop high fevers with chills or shakes, severe pain in a joint or bone, persistent blurred vision, or severe muscle weakness. Also, contact your doctor if you notice drastic mood changes that affect your behavior.

Wear a medical identification tag because of the possibility of side effects. Ask your doctor about how to get one.

Make sure you eat a healthy diet. Limit foods that are high in fat and salt. Also, make sure your diet provides enough calcium and vitamin D. Dairy products such as milk and yogurt are good sources of both nutrients. As an option, you can take calcium and vitamin D supplements. Your doctor can recommend the most suitable sources and the proper dose.

Exercise to maintain healthy bones and muscles. While it may seem harder to exercise when you're on steroids because of weight gain or muscle weakness, it's worth doing. Try a steady routine of walking, biking, or hiking three or four times a week, without overdoing it. A physical therapist or your doctor should prescribe an exercise program for you.

PREGNANCY
In spite of the many possible side effects, corticosteroids, especially prednisone, can be used with relative safety during pregnancy. If you see different doctors for your rheumatic disease and for your pregnancy, both need to be involved in the decision of whether or not to use corticosteroids. If you are taking corticosteroids and planning a pregnancy, be sure to discuss this with your doctor. If you are taking corticosteroids and are pregnant, don't stop the medications suddenly--you must see your doctor and discuss this first. Since corticosteroids get into breast milk, nursing babies may experience side effects just like adults do, except more so. Discuss the alternatives with your doctor if you wish to nurse your baby.

WITHDRAWAL SYMPTONS
It may be difficult to lower your dosage of corticosteroids. If you have been on corticosteroids for more than just a few days, it can be dangerous to suddenly stop taking them.

Your body must have corticosteroids in case of stress, but the adrenal gland that produces them may not respond quickly enough. That's why your doctor usually will prescribe a "tapering schedule" for you, which is a gradual dose reduction. Be sure to follow your doctor's advice on how to do this.

Anyone who has taken corticosteroids for a couple of weeks or months will experience some discomfort when going through a dose reduction period. This "steroid withdrawal syndrome" may involve aching in the muscles, bones, and joints; nausea; weight loss; headache; and/or fever. Fortunately, the symptoms usually are not very severe, and they don't last more than a couple of weeks at the most. If your corticosteroids are being tapered and you develop symptoms, check with your doctor to make sure it is not the disease flaring up.

REDUCING WITHDRAWAL SYMPTONS
Sometimes, when you have been on corticosteroids for a while, your doctor may prescribe an "alternate-day" schedule. This means you take a higher dose one day, then a lower dose or none the next day, then the higher dose the third day, and so on. The regimen is altered so your body can function with less corticosteroids on low-dose days while the overall total dose (over two days) will keep your disease under control. Writing the dosage schedule on your calendar will help you remember it.

Your doctor may prescribe a "steroid-sparing agent" if your disease flares when corticosteroids are tapered. A steroid-sparing agent refers to another medication that can help keep the disease under control while corticosteroids are being tapered. It usually is an immunosuppressive drug. A steroid-sparing agent might be safer for long-term medication use than corticosteroids. You still will need to taper the corticosteroids slowly, though. The most commonly used steroid-sparing agents are methotrexate (Rheumatrex), azathioprine (Imuran), and hydroxychloroquine (Plaquenil). If you only have muscle or joint symptoms while tapering, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control your symptoms.

POST-CORTICOSTERIOD WARNINGS
If you have been on corticosteroids for more than a few months, and now you are off, be sure to mention this to your doctors for the next year. This is especially important if you become very ill, require surgery for any reason, or need invasive diagnostic tests. In such instances you may be given a brief course of corticosteroids because your body may be making less than what would be required under those stressful circumstances.
The Arthritis Foundation and the University of Washington Department of Orthopedics.
Adapted from the pamphlet originally prepared for the Arthritis Foundation by James L. McGuire, MD, and Ronald F. Van Vollenhoven, MD, PhD.
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AVENTIS-ARAVA SAFETY AND EFFICACY UPDATE TO BE PRESENTED
FDA's Arthritis Drugs Advisory Committee will receive an update on the safety and efficacy of Aventis' arthritis agent Arava on Jan. 30, 2003
The committee will hear data regarding Arava's (leflunomide) efficacy in improving physical function of patients with rheumatoid arthritis and safety.
Aventis has been in discussions with FDA regarding labeling changes concerning the toxicity of the drug. The company conducted a six-month Phase IIIb study in 263 rheumatoid arthritis patients that, Aventis says, shows no increase in hepatic events when leflunomide is added to methotrexate.

Public Citizen's Health Research Group has called for Arava's removal from the market. The drug currently carries a black box warning on pregnancy and warnings about hepatotoxicity.

Arava was approved in September 1998 to reduce signs and symptoms of active rheumatoid arthritis and to retard structural damage and joint space narrowing.

Editors note: I will advise our members as soon as the outcome of the hearing is known.

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ARTHRITIS PAIN HAS A DAILY CYCLE - PAIN AND STIFFNESS LINKED TO BODY CLOCK (HealthScoutNews)

What do the U.S. Navy Observatory Master Clock and your arthritis have in common? They both help you measure time.

Arthritis stiffness and pain closely follow the rhythms of your body clock, says a study in the Annals of the Rheumatic Diseases Journal.

The study included 21 people with osteoarthritis in their hands. They were asked to rate their pain and stiffness levels at six specified points during the day -- on waking, at bedtime, and every four hours in between. They did this for 10 days.

Most of the participants were women and their average age was 62. None of them was being treated with steroids.

At the same time they rated their pain and stiffness, the study participants also performed manual dexterity tests. They picked up beads and fed them through a narrow tube into a container. If they dropped any of the beads, they had to start over again. The tests were timed.

The study found that pain and stiffness varied with the body's circadian rhythms. For 75 percent of the participants, pain and stiffness were greatest in the morning and at bedtime and lowest in mid-afternoon.

Those levels of pain and stiffness also affected manual dexterity, which peaked at 3:48 p.m. and was best within the zones of least overall pain, from 1:12 p.m. to 6 p.m., and stiffness, from 3:20 p.m. to 5:30 p.m.

This link between body rhythms and arthritis pain and stiffness, along with the effect on manual dexterity, can be used by people with arthritis to better schedule their daily activities, the researchers say. It might also be used to better time drug treatments for maximum benefit, they say. SOURCE: British Medical Association - Copyright © 2002 ScoutNews, LLC.

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CANCER DRUG HELPS RHEUMATOID ARTHRITIS
By Jeanie Davis WebMD Medical News Reviewed By Michael Smith, MD

A new cancer drug might also be effective for rheumatoid arthritis.

Preliminary results of a study -- which tested the drug Rituxan -- were presented at the American College of Rheumatology Annual Scientific Meeting in New Orleans in November.

Rituxan is used to treat non-Hodgkins lymphoma, cancer of the lymph nodes. The drug works by targeting cells in the immune system called B cells, which make antibodies that contribute to the disease process.

For the 24-week study, researchers recruited 161 people with active rheumatoid arthritis (RA) who were also taking methotrexate -- a mainstay of RA treatment. Patients were divided into four groups: those who took only methotrexate; those who took only Rituxan; those who took Rituxan and cyclophosphamide, another RA drug; and those who took Rituxan and methotrexate.

More people who took Rituxan -- either alone or in combination with one of the arthritis medications -- had significant improvement in their arthritis. Patients tolerated the drug well, researchers report. One person died from pneumonia after receiving Rituxan by itself for five months. However, the patient's doctor did not think the death was related to the drug.

"[Rituxan] has a great advantage in that benefits last for many months at a time," says study researcher Jonathan CW Edwards, MD, professor in connective tissue medicine at University College London, in a news release. "However, further studies to ensure a high level of safety are needed before the drug can be generally recommended."

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ARTHRITIS OF SPINE OFTEN NOT DIAGNOSED - MANY SUFFERERS ENDURE LONG WAIT FOR CONFIRMATION OF CAUSE, SURVEY SAYS (HealthScoutNews)

A new survey says many people who suffer from arthritis of the spine experience delayed diagnosis, putting them at increased risk for permanent spinal damage.

Ankylosing spondylitis (AS) typically strikes people in their 20s. The disease can progress to the point where the spine fuses, making it difficult or impossible for a person with the disease to move the spine or neck.

The survey included more than 2,000 people with AS and was commissioned by the Spondylitis Association of America. It found that 61 percent of the people with AS have symptoms by the time they're 29, and that many have to see a number of doctors before they receive a correct diagnosis.

The survey found that 54 percent of the respondents weren't diagnosed with AS until at least five years after initial symptoms, and 30 percent said they had to wait more than 10 years before they were diagnosed with AS.

Almost a quarter of the respondents said they saw at least five health professionals during their efforts to get a diagnosis.

Two out of three of the people in the survey said that AS has forced them into a forward-stooping posture, and 55 percent said they have at least partial fusing of the spine.

About 60 percent said AS limits their ability to walk, get into a car, sleep and/or have a satisfying sex life, and 25 percent said AS forced them to change their job or career.

Early warning signs of AS include: gradual onset of lower back pain before age 35; early-morning spine stiffness; pain and stiffness that worsen with immobility; pain and stiffness that improve with physical activity; symptoms that last longer than three months.

Treatments for AS include stretching and strengthening exercises, deep breathing, attention to posture, and medicines to counter pain and stiffness.. Robert Preidt - SOURCE: Spondylitis Association of America

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SMOKERS' INFECTIONS INCREASE RISK OF EARLY ATHEROSCLEROSIS DALLAS, TEXAS (American Heart Association)

Cigarette smoking turns the entire body into a breeding ground for infection, which may allow artery-clogging plaque to take hold, according to a study reported in the September issue of Stroke: Journal of the American Heart Association.

Chronic infection may explain why some smokers prematurely develop the artery-clogging process that causes most heart attacks and strokes, while other smokers remain free of arterial plaque buildup until they are older.

Current and ex-smokers who had common chronic infections - such as bronchitis, ulcers, urinary tract infections and even gum disease - were more than three times as likely to develop early atherosclerosis than people without such infections. Early atherosclerosis was defined as new plaques in previously normal arteries.

Infection also promoted artery disease in people exposed to secondhand smoke.

"This study provides the first epidemiological evidence that the atherosclerotic effects of smoking are mediated in part by chronic infectious illnesses in smokers," says lead researcher Stefan Kiechl, M.D., professor of neurology at Austria's Innsbruck University Hospital.

Previous research has shown that smoking is linked to respiratory infections, gum infections and chronic ulcer infections. The study by Austrian, Italian and British researchers considered how smoking and exposure to secondhand sm oke influences the development of arterial plaques, and the effects of smoking cessation, in patients with and without evidence of chronic infection.

"Active and passive smoking represents one of the most severe risks for atherosclerosis," Kiechl notes. "Smokers are at significantly higher risk of developing severe early atherosclerosis, but we found the risk falls to that of nonsmokers soon after they quit, unless there is a history of chronic infection."

Researchers used ultrasound scans to examine changes in the carotid arteries (the main vessels supplying blood to the brain) of 826 men and women ages 40 to 79. The participants were part of the Bruneck Study, a prospective, population-based survey in Bruneck, Italy, designed to identify factors contributing to atherosclerosis.

Over the five-year study period, 332 men and women developed new carotid plaques.

The risk of developing atherosclerosis was closely associated with the number of years and quantity of cigarettes smoked (pack years), regardless of gender, but chronic infection also had a role in plaque development, notes Kiechl.

"Remarkably, in both analyses, increased risk of atherosclerosis was observed only in smokers and ex-smokers with clinical signs of chronic infection. The risk burden in people without evidence of infection did not differ from that in nonsmokers."

Nonsmokers with chronic infection had 1.8 times the risk of premature atherosclerosis as nonsmokers free of infection. Among former smokers with infection, the risk was 1.9 times higher, while current smokers with infection had 2.9 times the risk for premature atherosclerosis as infection-free nonsmokers.

In ex-smokers with chronic infection, the risk of early atherosclerosis remained elevated even 10 years after they quit, while ex-smokers without infection showed a gradual decrease in risk over time, Kiechl says.

"We found that the ongoing risk after quitting is probably the result of chronic infections that develop during the active smoking period, especially respiratory infections, such as smokers bronchitis or chronic obstructive pulmonary disease," he says.

The group of passive smokers with chronic infection in the study also faced an increased risk of early artery disease. Researchers hypothesize that secondhand smoke renders individuals susceptible to respiratory infection and that infection increases the risk of artery disease.

Smokers should be made aware of the findings and should be advised to seek treatment for their chronic infections, he adds.

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INFLAMMATION TRIGGERS HEART ATTACKS
BOSTON (AP)

Despite their seemingly healthy cholesterol levels, new research shows many people are at high risk of heart attacks because of painless inflammation in the bloodstream.

The inflammation comes from many sources and triggers heart attacks by weakening the walls of blood vessels, making fatty buildups burst. A large study published Thursday concludes it is twice as likely as high cholesterol to trigger heart attacks.

Over the past five years, research by Dr. Paul Ridker of Boston's Brigham and Women's Hospital has built the case for the "inflammation hypothesis." With his latest study, many believe the evidence is overwhelming that inflammation is a central factor in cardiovascular disease, by far the world's biggest killer.

"I don't think it's a hypothesis anymore. It's proven," said Dr. Eric Topol, chief of cardiology at the Cleveland Clinic.

Inflammation can be measured with a test that checks for C-reactive protein, or CRP, a chemical necessary for fighting injury and infection. The test typically costs between $25 and $50.

Diet and exercise can lower CRP dramatically. Cholesterol-lowering drugs called statins also reduce CRP, as do aspirin and some other medicines.

Doctors believe the condition often begins when the fatty buildups that line the blood vessels become inflamed as white blood cells invade in a misguided defense attempt. Fat cells are also known to turn out these inflammatory proteins. Other possible triggers include high blood pressure, smoking and lingering infections, such as chronic gum disease.

Ridker's study says for the first time what level of CRP should be considered worrisome, so doctors can make sense of patients' readings. However, experts are still divided over which patients to test and how to treat them if their CRP readings are high.

Some, such as Dr. Richard Milani of the Ochsner Clinic in New Orleans, recommend a CRP check for almost anyone getting a cholesterol test. "If I have enough concern to check a patient's cholesterol, it seems naive not to include an inexpensive test that would give me even more information," he said.

Others are reluctant to test people at low outward risk. Dr. Sidney Smith, research director of the American Heart Association, said CRP testing is likely to be most helpful in guiding the care of the 40 percent of U.S. adults already considered at intermediate risk of heart attacks because of other conditions, such as age, obesity and high blood pressure.

In March, the heart association and the Centers for Disease Control and Prevention held a meeting of 50 experts to review the evidence and make recommendations on CRP testing. Although it hoped to be finished this month, the committee went back to the drawing board after learning last week of Ridker's latest results, which are being published in the New England Journal of Medicine.

Though the study involved only women, Ridker said he is confident the findings apply to men as well, because earlier, small studies in men reached similar conclusions.

A skeptical editorial in the journal by Dr. Lori Mosca of Columbia University questioned the need for widespread testing, at least until more studies are done to show that lowering CRP actually saves lives.

Such studies are planned. Until then, Ridker said he believes a high CRP reading can help doctors persuade people with low cholesterol that they still need to diet and exercise.

"The CRP test can predict risk 15 to 25 years in the future," Ridker said. "We have a long time to get our patients to change their lifestyles, and the change does not have to be huge - modest exercise, modest weight loss and stop smoking."

However, Mosca said telling people they have low CRP may falsely reassure them they can continue slothful habits. "Why do we need a test to help us motivate patients to improve their lifestyles?" she said.

She also worried that doctors will immediately put patients on drugs to lower CRP before there is proof it saves lives.

Ridker's latest study is based on an eight-year follow-up of 27,939 volunteers in the Women's Health Study. About half of heart attacks and strokes occurred in those with seemingly safe levels of LDL, the bad cholesterol.

The lowest risk was in women whose CRP readings were below one-half milligram per liter of blood. It more than doubled when readings went over about three.

Dr. Wayne Alexander of Emory University in Atlanta said he already uses CRP testing to help make treatment decisions, such as whether to prescribe statins for people with borderline high cholesterol.

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TIPS ON LOWERING HEART INFLAMMATION
(The Associated Press)

You've heard it before: Eat sensibly and get some exercise. But new findings on the dangers of inflammation offer still another reason to shape up.

Doctors say that both inactivity and obesity increase inflammatory proteins that can trigger heart attacks. People can substantially lower their levels of these proteins simply by improving their living habits.

Even modest changes help, though studies show that vigorous exercise and a strict diet can cut inflammation levels in half in just three months.

Some research suggests that moderate alcohol consumption and fish oil are good for inflammation levels. So too are giving up smoking and keeping blood pressure under control.

A variety of drugs may also do the trick, though many think more research is needed before doctors actually begin prescribing them to lower inflammation. The list of medications includes:

Statins, the medicines already widely used to lower cholesterol. Aspirin, a mainstay of treating and preventing heart attacks. Plavix, a common blood thinner.

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Good Health to All

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2002 12/15/02-26