Psoriatic Arthritis List NEWSLETTER

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

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 3 ISSUE 7 April 30, 2003
PSORIATIC ARTHRITIS MEDICAL NEWS

ANTIOXIDENT SOOTHES DIABETIC NEUROPATHY
By Sid Kirchheimer - WebMD Medical News Reviewed By Michael Smith, MD

April, 2003 -- Alpha lipoic acid, an over-the-counter antioxidant supplement, eases the burning, pain, and numbness associated with diabetic neuropathy, say researchers. In a new study, alpha lipoic acid offered quick and dramatic relief without the side effects of drugs currently used.

After just 14 treatments, patients with diabetic neuropathy who received high doses of intravenous alpha lipoic acid had a threefold improvement in pain, numbness and other symptoms compared with those treated with placebo.

"But it didn't act only as a pain medication," says researcher and Mayo Clinic neurologist Peter Dyck, MD. "Alpha lipoic acid seems to actually change the metabolism of the nerve or blood supply to the nerve, and we noted some relief in symptoms."

His study, reported in the March issue of Diabetes Care, involved 120 patients with the most common form of diabetic neuropathy, which causes pain, numbness, and a burning sensation and often leads to foot problems.

Half of the patients received five treatments a week consisting of 600 mg of alpha lipoic acid in intravenous form, while the others got a placebo. They didn't know which substance they received. In just 2½ weeks, the alpha lipoic acid patients reported -- and the researchers noted in examinations -- dramatic improvements in symptoms, including a six-point drop in pain levels on a 10-point scale. The placebo group reported a two-point improvement in pain relief.

Alpha lipoic acid is available over-the-counter in dosages of 50 to 150 mg. Dyck is currently conducting a study measuring the efficacy of those capsules in other diabetic patients. The powerful antioxidant has been used for nearly 30 years in Europe to treat diabetic neuropathy and is being studied in the U.S. as a treatment for HIV, Parkinson's disease, Alzheimer's disease, and other conditions.

"I'm glad to see we have now jumped the Atlantic and the evidence gathered by German researchers decades ago has been read and is being considered by prominent American researchers," says Richard A. Passwater, PhD, retired biochemist who has studied antioxidant treatments since the 1960s and wrote the book, Lipoic Acid: The Metabolic Antioxidant. He says that he is not surprised by Dyck's findings.

Dyck, who conducted the study with Russian researchers, says that alpha lipoic acid offered several benefits to his patients with diabetes. "It is a very strong antioxidant and it is assumed that oxidation plays a role in the development of diabetes," he tells WebMD. This means the substance -- produced in very small amounts by the body and also found in foods such as potatoes and red meat -- protects against damage by cell-ravaging "free radicals." This oxidation process is implicated in various diseases, including heart disease, cancer, and neurologic conditions including Parkinson's and Alzheimer's.

"Besides that, alpha lipoic acid also seems to promote better blood flow and oxygen to the nerves and may also promote the entry of glucose and the breakdown of it into cells," he says.

Passwater says this is because alpha lipoic acid improves the function of cell "transporters" that carry and distribute glucose. "This helps insulin do its role," he tells WebMD. "It also has a specific effect on nerves that we don't know too much about but have noted. Overall, it has universal benefits, affecting various body sites, and works with other antioxidants to help them protect the body."

Though hundreds of studies have been done on alpha lipoic acid -- including several that suggest a benefit in treating diabetic neuropathy in patients with both type 1 and type 2 diabetes -- few large trials have been conducted in the U.S. In several foreign studies on mice and people, dosages ranging from 60 mg to 800 mg seemed to produce improvements in blood sugar levels and insulin production and decrease diabetic neuropathy pain.

Diabetic neuropathy is currently treated with painkillers, including narcotics -- which can be habit-forming -- and antiepileptic drugs, which can cause sedation. Alpha lipoic acid, meanwhile, appears to be safe and has few side effects, says Dyck.

But he isn't suggesting that people with diabetes self-medicate themselves with alpha lipoic acid. "We're not quite at that stage; we first need to complete studies using the oral capsules. If you have diabetes, the first line of treatment is glucose control," Dyck tells WebMD. "But the reality is that some people cannot or will not get desired control of blood sugar. And if further research proves conclusive, it looks as though alpha lipoic acid might be one of the ways they can do it."

SOURCES: Diabetes Care, March 2003.

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DOCTORS FEES OFFSET RISING COST by David B. Caruso Associated Press - PHILADELPHIA

People quick to phone their family doctor for medical advice, a prescription renewal or information for a health-history form may soon find themselves paying for the convenience.

Doctors around the country have begun charging patients for services that have traditionally been free, according to the American College of Physicians.

The fees range from per-page charges for copies of medical records to $10 or $20 for filling out the forms people need to apply for medical-leave benefits. A few doctors have begun charging patients up to $20 to respond to e-mail questions about their health.

Dr. Allen M. Dennison of Barrington, R.I., said he charges patients $2 a minute to diagnose minor ailments over the telephone, and around $15 to fill out the health history forms parents need to send their children to camp.

''We are really on the ropes financially,'' he said. ''I think the patients know that if they are going to take a doctor's time, they are going to have to pay for it.''

Dr. Joel S. Levine, dean of clinical affairs at University of Colorado School of Medicine, said doctors' administrative responsibilities have grown tremendously over the past two decades.

Most primary-care doctors now spend an average of two to three hours a day on tasks for which they are not compensated, such as returning phone calls and filling out insurance forms, he said.

That means less time to see patients, and the fewer patients doctors see in person, the less they get paid, he said.

Dr. Paul Williams, president of the Pennsylvania chapter of the American Academy of Family Practitioners, said he has considered imposing fees for after-hours phone calls, which he now routinely handles at no charge, but worries patients will react badly. ''If you call your attorney at 4 o'clock in the afternoon on a Friday, they are going to send you a bill. I don't understand why I shouldn't send a bill if someone wakes me out of a dead sleep at 4 a.m.,'' he said. ''The problem is, we get this reaction: 'You are part of a learned profession, and how dare you nickel-and-dime patients.'''

Margie Kahn of Oakland, Calif., said she switched doctors after she called for guidance on an illness and was rebuffed.

''She basically interrupted me in mid-sentence and said, 'Are you looking for free medical advice? If I can't bill for my time, I can't survive,''' Kahn said. ''Doctors do spend a lot of time on the phone, but to me, that is part of their job description. The time that they spend reviewing charts or returning phone calls, that should all be built into their charges.''

Still, many practices feel that with operating costs on the rise and reimbursements from insurance companies and government health programs stagnating, they have no choice but to charge patients for more things.

Queen City Physicians, a doctors group in Cincinnati, is thinking of charging $12 to $15 for the calls that anxious parents make to the office's late-night pediatric triage service. The phones are staffed by nurses who take questions about colicky babies and feverish toddlers and decide whether the child needs to see a doctor right away.

''Our patients absolutely love it,'' said Pamela Coyle-Toerner, Queen City's president, ''but it is a very expensive service to offer for free.''

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EXTRA VITAMIN B MAY KEEP MIND SHARP IN OLD AGE
By Alison McCook - NEW YORK (Reuters Health)

Elderly people who get relatively low amounts of the B vitamin niacin in their diets may be more likely to develop Alzheimer's within the next few years than others, according to preliminary research.

However, study author Dr. Martha Clare Morris of Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois cautioned in an interview with Reuters Health that this is a very early finding, which needs to be confirmed by additional studies before the B vitamin can be linked to Alzheimer's.

"This is just something of interest for further study," Morris said. "It's way too early in the research to make recommendations."

In the current study, presented during the Gerontological Society of America's 55th Annual Scientific Meeting in Boston, Massachusetts, the researchers recorded how much niacin a group of 815 dementia-free people at least 65 years old ate in their diets, and tracked who developed Alzheimer's over the next 4 years.

Food intake was recorded using a questionnaire in which participants indicated how often they ate certain foods during a previous period, often a year. Foods that contain relatively high levels of niacin include meat such as chicken, nuts, legumes and enriched grains and cereals. The current recommended daily allowance (RDA) is 16 milligrams (mg) per day for men and 14 mg per day for women.

The investigators divided people into five groups based on their niacin intake. They discovered that people who ate the most niacin--of whom half consumed more than 22 mg each day--were 79% less likely to develop Alzheimer's than were those who ate the least. Half of the lowest consumers of the B vitamin took in less than 13 milligrams per day.

Brain Benefit from B Vitamin - Morris explained that the benefits of niacin appeared to kick in as soon as people increased their intake only slightly, for the second-lowest niacin consumers were also 70% less likely to develop Alzheimer's during the study period than those who ate the least.

"So it really looked like it was more of an increase in risk for people who had a low intake" of the B vitamin, Morris said.

But why levels only slightly below the niacin RDA were linked to an increased Alzheimer's risk remains unclear, she added.

She noted that the previous analysis did not factor in the effect of niacin, or vitamin B3, that participants took in from supplements. Later, she and her colleagues combined intake from supplements and diet, "and basically got pretty much the same results," she said.

Although how low levels of niacin in the body could lead to Alzheimer's remains unclear, Morris said that people who eat relatively little of the nutrient may develop a condition marked by confusion and psychosis, which niacin supplements can correct. Animal studies also suggest that low levels of niacin in the body could lead to brain cell damage.

Previous reports have shown that some vitamin supplements contain much higher levels of niacin than the RDA, and too much niacin may cause flushing, itching and other symptoms. As a result, Morris recommended that people who want to take in more niacin focus on getting it from foods.

"Supplemental forms of niacin should be taken under the supervision of a physician," she said.

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MEDICAL PRIVACY RULES FACE BUMPY ROAD
By Karen Pallarito - NEW YORK (Reuters Health) Apr 11 - New federal rules establishing the nation's first medical privacy standards that took effect Monday April 14th are likely to cause confusion in the short run, experts say.

The rules dramatically change the way hospitals, doctors, health plans and pharmacies must handle personal health information. They also impose criminal and civil penalties for breaching patient privacy.

Under the rules, patients will receive notices from their providers describing their new rights. Those rights include the ability to examine their own medical records.

The rules also give consumers limited new powers to prevent sensitive data from slipping into the wrong hands. They forbid healthcare providers from sharing identifiable health information with employers, for instance. And unless a patient has specifically granted his or her consent, providers may not sell lists of patients to companies for marketing purposes.

"But there's still a lot of gray areas here, and a lot of areas that are constantly popping up," cautioned healthcare attorney Robert Falk of Powell, Goldstein, Frazer & Murphy.

He cited a recent incident in which a patient's parole officer sent a release form requesting medical information from the patient's doctor. Because the release form did not meet the new privacy standards, the doctor won't be able to supply the requested information.

"We're going to be dealing with a lot of unintended consequences or transition issues here," Falk warned.

The rules will set in motion a collection of patient privacy standards adopted in the waning days of the Clinton administration as part of a landmark law known as HIPAA, the Health Insurance Portability and Accountability Act of 1996. Bush health officials adopted the rules in April 2001, giving providers a two-year window to develop policies and systems to comply with the new requirements.

While many large hospitals, medical practices, insurers and pharmacy chains are ready for the changes, "a lot of the small providers probably don't know about it at all or are not prepared," Falk said.

Health and Human Services Secretary Tommy Thompson said that the administration has "worked aggressively" over the past two years to give providers the information they need to comply with the rules. But he also conceded that the process remains ongoing.

"We will continue our efforts to encourage covered entities to comply with the regulations' requirements," he said. "After all, this is the best way to ensure that patients get the rights and protections they expect."

The administration has the power to wield stiff civil and criminal penalties to enforce the rules. Violators are subject to fines of $100 "per incident" up to a maximum of $25,000 per year for each breach of a privacy standard. Offenders who knowingly flout the law with malicious intent or for commercial or personal gain could face fines of up to $250,000 and up to 10 years in prison.

Despite the 24-month implementation phase, "misinformation and confusion" abound, say officials at the Health Privacy Project, a nonprofit health privacy information outfit based at Georgetown University.

One myth is that hospitals will be barred from giving out patient information to the public, they said. The truth is hospitals may continue to share information about patients unless a patient specifically asks that the information be kept private.

Project leaders are also troubled by the continued ability of pharmacies to send health-related information about products and services to patients without consumers' knowledge that the information may have been paid for by a drug company.

On Tuesday, project leaders announced the launch of a "privacy complaint monitoring initiative" to keep tabs on HHS' enforcement of the law.

"Given that HIPAA does not give people the right to sue, individuals must rely on the Bush administration to represent their interests," Janlori Goldman, director of the Health Privacy Project, said in a statement. "Our monitoring initiative is intended to ensure that consumers' voices are heard."

While the law does not allow patients to sue for breaches of privacy related to medical data, it does give them the right to file a complaint with HHS' Office for Civil Rights.

Some health and consumer groups still have concerns about the new requirements. On Thursday, a coalition representing mental health organizations and health privacy activists filed suit in U.S. District Court in Philadelphia challenging the HIPAA privacy rules.

The complaint contends that rather than safeguarding patients' private information, HIPAA actually grants "unprecedented, unconstitutional access" to the data without patients' consent.

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THE SCIENCE OF GRAY HAIR By Rhonda B. Graham - InteliHealth Staff Writer

Gray hair. Some consider it the beginning of the end. Others gracefully accept its arrival as a public token of wisdom. Whether dyed, rinsed or allowed to grow naturally in its spongy, wiry manner, the arrival of gray hair can be a signature event.

Health, heredity and environmental factors all affect when your hair begins turning gray. But the predominant cause is the normal course of life called aging.

Getting To The Root Of It - It all begins when your body stops producing the color-producing substance called melanin. Each strand of your hair grows out of a follicle that has cells filled with melanin. These melanin-filled cells are called melanocytes.

"Melanocytes pass this pigment [melanin] to adjoining epidermal cells called keratinocytes, which produce the protein keratin - hair's chief component," explains Laurence Meyer, M.D., Ph.D., professor of dermatology at the University of Utah.

"When keratinocytes undergo their scheduled death, they retain melanin. Thus, the pigment that is visible in hair and in the skin lies in these dead keratinocyte bodies."

There are two types of melanin, which determine the color of your hair depending on their concentration: Eumelanin is dark brown or black. Pheomelanin is reddish yellow.

Over time, the melanin in the keratinocytes decreases. Gray hair is simply hair with declining levels of melanin. And white hair has no melanin at all.

The declining presence of melanin in the cells also appears to contribute to the lack of moisture in gray or white hair. So as your hair becomes lighter, its texture becomes dryer and coarser.

The Process Of Turning Gray - At the beginning of the graying process, follicles produce colorless strands in a random pattern. The first gray or white strands usually appear on your temples and the top of your head.

Your existing hairs don't actually "turn" gray - they grow in this way. Every day, hairs fall out and new ones replace them in a normal process of shedding. At any given time, about 85 percent to 90 percent of your hairs are actively growing, while the rest are in a resting state.

Typically, one strand grows for two to four years. It then naturally enters a resting state for about two to four months, after which it falls out and is replaced by a new growing hair. On average, most people lose approximately 50 to 100 strands of head hair a day.

Although it may seem like you "went gray overnight," in reality the gray strands become more noticeable in the normal course of shedding. Darker hairs normally hide the graying strands when they first come in.

"It is often the case that when you hear the story about somebody's hair turning white overnight, it's because they have hair that is mixed, and the darker hair is more prominent until it begins falling out," Dr. Meyer says. This is especially true for people with telogen effluvium, a condition in which a major change to the body or shock speeds up shedding to 300 hairs a day.

When It Happens - There is currently no scientific way to tell when a particular cell or group of cells will stop producing melanin. "In the early stages of graying, the melanocytes are still present but inactive. Later on, they seem to decrease in number," Dr. Meyer says.

This natural process of graying can begin as early as in your teens. In most people, however, graying first becomes noticeable in their late 30s. Some researchers have shown that gender plays a role in the graying process. The average male starts to gray around age 30, while women typically began to notice lighter strands around age 35.

Genetics are also a contributing factor. In some families, many members develop white hair in their 20s. "It obviously clusters in families in one sense. Whether that is a single gene or common gene we don't know," writes Dr. Meyer in the magazine Scientific American. "Generally speaking, among Caucasians 50 percent are 50 percent gray by age 50. There is, however, wide variation. This number differs for other ethnic groups, again demonstrating the effect of genetic control."

But this biological fact of life varies greatly from person to person, which lead dermatologists and geneticists to conclude that age is not the most accurate indicator of when gray hair will appear.

"The problem with this kind of science it that it has never been funded. Outside of hair dyes, nobody has ever looked at the genetics of graying hair specifically," says Dr. Meyer, who specializes in internal medicine and geriatrics. Some Potential Reasons - Despite the lack of funded research into the role of genetics and gray hair, medical experts have been able to find a relationship between graying and the environment and graying and lifestyle choices. They have also shown a relationship, to some degree, between graying and illnesses and conditions.

Smoking. A 1996 British Medical Journal study reported that smokers are four times more likely to go gray at a young age. Why is not yet clear, but preliminary research is focusing on the concept that nicotine, when absorbed by the body, constricts the body's vessels. Illnesses. Sometimes, the arrival of gray hair can be a sign of an underlying health problem. Werner's syndrome, a disease that mirrors the symptoms of aging in people as young as 20, can spur the premature growth of gray hair. Pernicious anemia, a vitamin B12 deficiency caused by an inability to absorb the vitamin from the gastrointestinal tract, is sometimes associated with decreased melanin production. Any illness or condition that causes your hair to fall out may reveal graying strands formerly hidden by your original hair color or sheen. For example, slow-growing or new gray wisps may become more obvious if you are coping with alopecia areata, an autoimmune disease that causes hair to fall out in small patches. Drug treatment and alternative medicine. Several drugs can cause growing hair to stop its growth cycle and fall out. For example, drugs such as lithium and amphetamines can contribute to hair loss, revealing more gray strands. Certain herbs and supplements - including vitamin E and echinacea - are also known to cause graying. Interestingly, some cancer patients, whose gray hair falls out as a result of chemotherapy, experience regrowth of the lost strands in their original color. This phenomenon reinforces the mysteries of the science of gray hair.

Embrace Your Individuality - Whereas English humorist and author P.G Wodehouse concluded that the guillotine is the only cure for gray hair, religious texts consider the loss of pigmentation as "the beauty of the aged." At the very least, the first sign of white specks can be taken as affirmation that you are aging normally.

For millions, this is a painful reality. If you are among the many people who don't want to be gray, there are any number of commercial products that promise to return your hair to its natural color. However, keep in mind that credible scientific and medical evidence of such claims has not been verified. At best, such products are temporary. And some may cause harm, depending on the chemicals they include.

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WALKING RECOMMENDED FOR THOSE WITH PAD (HealthScoutNews)
It benefits people with peripheral arterial disease, new research finds.

"Walk off the pain" is a common expression in sports when someone receives a minor injury. It can also be applied to people with peripheral arterial disease (PAD).

Scientists at Johns Hopkins Medical Institutions say a supervised walking exercise program is an effective remedy for people with PAD who suffer cramping leg pain. Their report appears in tomorrow's issue of The New England Journal of Medicine.

Cramping leg pain is the most common symptom of PAD, which affects 8 million to 10 million American adults and 5 percent of people aged 50 and older. PAD is a form of atherosclerosis that affects blood vessels in the legs.

Cholesterol-laden plaque builds up in the blood vessels and reduces blood flow to the legs. That limited blood flow can't meet the demand from legs when a person with PAD is walking or exercising, and that shortfall results in pain, aching and fatigue in the legs.

The researchers reviewed more than 120 studies and concluded that people with PAD should walk until they reach a moderate level of pain and then continue walking for several minutes after that. They should rest and then resume walking. The cycle should be repeated until the person can walk for 50 minutes.

A supervised exercise program where the person with PAD walks on a treadmill several times a week may be the best way to lessen PAD-related leg pain.

SOURCE: Johns Hopkins Medical Institutions Copyright ScoutNews, LLC.

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WORK SUPPORT HELPS HEART
By Jeanie Lerche Davis - WebMD Medical News Reviewed By Michael Smith, MD

April, 2003 -- During a stressful day, support from co-workers can keep your blood pressure from boiling. That's good news for the millions out there suffering from work stress.

A new study, the first of its kind, shows that support from colleagues literally keeps blood pressure down. It's an important issue, since work stress has been linked with increased rates of high blood pressure and heart disease.

It all points to the importance of developing good relationships with co-workers, says senior researcher Elizabeth Brondolo, PhD, a psychology professor at St. John's University in Stony Brook, N.Y.

"How people care for each other in the workplace has very clear and measurable effects on their blood pressure," she tells WebMD. Her study appears in the latest issue of Psychosomatic Medicine.

Social support from family and friends has long been recognized as key to easing daily stresses and protecting us against heart disease and high blood pressure. However, psychologists have not understood exactly how work stress might factor into the equation.

Is it because social isolation leads to high blood pressure in everyday life, causing blood pressure to dangerously spike in times of stress? Or does support from friends and family act as a buffer during high-stress times? How does the support system factor into the effects of work stress?

In their study, Brondolo and colleagues focused on the work stress of New York City's traffic enforcement agents -- the people who issue parking violations and traffic tickets. "Motorists often insult, threaten, or curse at the agents," writes Brondolo.

The study involved 70 male and female traffic agents. Each agent wore a small monitor that recorded heart rate and blood pressure throughout the day. Each also kept a journal on his or her workday whereabouts and activities.

At the day's end, each agent completed a questionnaire measuring the emotional support they got from co-workers, immediate supervisors, and unit supervisors.

"The more people felt supported by their co-workers, the smaller the increases in their blood pressure in the work environment," she tells WebMD. In fact, they had lower blood pressure during the most stressful times as well as throughout the workday.

Men seemed to derive more support from co-workers. For women, support from an immediate supervisor provided the most relief from work stress.

"Most people turn to women for emotional support, so women may be a little overburdened," Brondolo explains. "The supervisor may be somebody she can rely on, but she won't have to take emotional care of the supervisor. After all, when you talk to a friend about your problems, you expect the friend to talk to you about theirs. You honor that reciprocity. Disclosing carries a burden. But it would be inappropriate for a supervisor to talk to you about his or her emotional problems."

If a co-worker seems stressed out, reach out to them, advises Nadine Kaslow, PhD, professor of psychiatry and behavioral sciences at Emory University and chief psychologist at the Grady Health System, both in Atlanta.

"When people are stressed at work, they sometimes retreat, they shut down," she tells WebMD. Someone else in the trenches can indeed offer the best support, Kaslow says. "Who doesn't have work stress? It it's not interpersonal difficulties, it's the demands of the job, sometimes the office culture causes stress. This study shows us to that our co-workers can make a measurable, physical difference in the effect of work stress." SOURCES: Psychosomatic Medicine, April 2003.

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A truly happy person is one who can enjoy the scenery on a detour.

Good Health to All,

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2003 4/30/03 -7