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 17 - September 30, 2003
PSORIATIC ARTHRITIS MEDICAL NEWS

VACCINE AGAINST AUTOIMMUNE DISEASE TO BE TESTED By Patricia Reaney - (Reuters Health) 9/08/03 MANCHESTER, England

British scientists are developing vaccines to reprogram the body's natural defenses against autoimmune diseases such as arthritis, diabetes and multiple sclerosis.

Dr. Neil Williams, of the University of Bristol in southwestern England, told a science conference on Monday that he and his colleagues hope to begin human safety trials of the vaccine early next year.

Autoimmune disorders, which affect about five percent of the British population, occur when something goes wrong with the immune system and it attacks the body's own tissue.

"The vaccines we are working on are able to re-educate the immune system to reset the balances and put the controls back in place to stop these diseases from continuing to progress," Williams said.

The vaccines are based on a protein derived from a bacterium. Williams found that when it is introduced into the body it turns on the immune system controls and stops inflammatory diseases like arthritis and diabetes.

"So far, we know that this works very well in models of these diseases and we will be moving into our first trials in humans in the next six months," he added at the week-long meeting of the British Association for the Advancement of Science.

Using a vaccine against autoimmune diseases is not a new concept but until now, it has not been very successful. In a study of a strain of mice that naturally develop diabetes, the vaccine, which is being developed with the backing of British biotech company Hunter-Fleming Ltd, reduced the occurrence of the disease from 80 to 15 percent.

If trials of the vaccine in humans were successful, it would be an entirely new approach to treating inflammatory diseases. Williams anticipates the vaccine will have to be given over a short course of time and may have to be repeated periodically.

Thanks to Michael Szczygiel (Micky from London) for sending this article.

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DISEASES ASSOCIATED WITH PSORIATIC ARTHRITIS
From the National Psoriasis Foundation - Copyright 2003

Psoriatic arthritis is a master at mimicry, often making it difficult to recognize its symptoms or diagnose it. People sometimes disregard symptoms as an old sports injury. Psoriatic arthritis may feel like a cartilage tear, thus being misdiagnosed, or the arthritis may be triggered when a person has surgery to repair an old injury.

DISEASES PSORIATIC ARTHRITIS MAY IMITATE
Rheumatoid arthritis: Psoriatic arthritis is closely associated with rheumatoid arthritis, one of the most common forms of arthritis. Rheumatoid arthritis affects joints symmetrically (in the same area on both sides of the body) and may produce bumps under the skin. Psoriatic arthritis may affect only one joint and produce nail changes and skin changes in the form of lesions. Rheumatoid arthritis is diagnosed using a test for a specific antigen called "rheumatoid factor." This antigen is not usually found in patients with psoriatic arthritis.

Gout: Psoriatic arthritis can be mistaken for gout, which causes sudden, severe attacks of pain and tenderness, redness, warmth and swelling in some joints. Gout usually affects one joint at a time--often the big toe. Gout is also diagnosed using a test for uric acid levels, whereas psoriatic arthritis has no such test.

Reiter's syndrome: Reiter's syndrome produces pain, swelling, redness and heat in the joints. It causes inflammation throughout the body, including the joints and soft tissues. The arthritis from Reiter's syndrome affects the knees, ankles and feet, causing pain and swelling. It may result in heel pain, foot pain, and shortening and thickening of fingers and toes. It is diagnosed with a physical exam, a skin exam and a gene test for a specific gene.

Osteoarthritis: The finger joint problems from psoriatic arthritis may feel like osteoarthritis, a form of arthritis where the cartilage wears away from overuse. A rheumatologist will be able to distinguish between the two forms by looking at X-rays.

Ankylosing spondylitis: Ankylosing spondylitis is a chronic, or long-lasting, disease that primarily affects the spine and may lead to stiffness of the back. It is often confused with psoriatic spondylitis because their symptoms and genetic mechanisms are similar. Ankylosing spondylitis is diagnosed with X-rays, a medical examination of symptoms and sometimes blood tests for a specific gene.

WHICH DISEASES ARE LINKED TO PSORIATIC ARTHRITIS?
Crohn's disease: Crohn's disease involves inflammation of the colon or small intestines. It appears to be closely linked to psoriasis. The two may also share a common genetic component. The first treatment ever approved for Crohn's disease, infliximab (brand name Remicade), is also effective at treating psoriatic arthritis, but is not approved for psoriatic arthritis.

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CHOLESTEROL DRUGS - SUICIDE LINK DISPUTED
CHICAGO (AP) September 8, 2003

Widely used cholesterol-lowering drugs do not appear to raise the risk of suicide, and might even reduce depression, according to researchers trying to clarify conflicting earlier studies.

Some previous studies appeared to connect older cholesterol-lowering drugs to an increased risk of unintentional injury, aggression and suicide. Other recent research suggested no such link.

In fact, some research connected newer medications called statins, taken by millions of people, to a reduced risk of depression or dementia.

The new study, an analysis of data on 94,441 adults in the United Kingdom, included 458 diagnosed with depression and 105 who thought about, attempted or committed suicide. The findings appear in Monday's Archives of Internal Medicine.

There was no increased risk for suicidal behavior among adults using any type of cholesterol-lowering drugs, and depression was less common among the medication users.

About 3 percent of patients on statins and 4 percent on other cholesterol-lowering drugs were depressed, compared with 11 percent of nonusers. The link was strongest among long-term statin users.

The researchers speculated that cholesterol-lowering drugs might indirectly boost psychological well-being by reducing heart-related ailments and improving people's quality of life.

Also, patients on cholesterol-lowering drugs might be more health-conscious and take better care of themselves, "which will further reduce their risk of developing depression," they wrote.

Co-author Susan Jick of Boston University and the Boston Collaborative Drug Surveillance Program said the size of the study and its design makes the data convincing.

While the Boston program received funding from several drug companies that make cholesterol medication, Jick said industry financing played no role in the study's design or in the interpretation of the findings.

Dr. Lynn Smaha, a spokesperson for the American Heart Association, said the suggestion that statins might reduce depression is important because depression is common but under diagnosed in heart patients.

But University of Pittsburgh researcher Dr. Matthew Muldoon said the findings do not prove statins reduce depression and are not convincing enough to erase concerns about older drugs' effects on mental health.

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LEG CRAMPS LESS WITH LIPITOR From MedicineNet - 9-1-03

The Gist: Treatment with 80 mg of Lipitor (atorvastatin) a day was found to improve pain-free walking for people who have intermittent claudication (leg cramps on exertion) from peripheral artery disease.

The Cost: We know someone who has intermittent claudication and now takes 10 mg of Lipitor. We wondered what it would cost to increase his Lipitor from 10 mg to 80 mg. Would his taking 8 times as much Lipitor cost him 8 times as much? We checked with an online US pharmacy and found that 90 of the 10 mg tablets cost $175 whereas the same number of 80 mg tablets would cost $270. So our friend's cost per month would go up from about $90 to $95. Eight times the dose for just half again as much money.

Comment: We have given up on understanding the stock exchange (and medical economics). Barbara K. Hecht, Ph.D. Frederick Hecht, M.D. Medical Editors, MedicineNet.com

CHOLESTEROL DRUG RELIEVES LEG ARTERY DISEASE
By Megan Rauscher NEW YORK (Reuters Health)

Treatment with the statin-type cholesterol-lowering drug Lipitor improves pain-free walking for patients with a condition called claudication, caused by peripheral artery disease.

"It turns out that statins, which are effective in reducing the risk of heart attack, stroke, and death in patients with atherosclerosis -- including those with peripheral arterial disease -- also benefit the symptoms of patients who have claudication, the cardinal symptom of peripheral arterial disease," Dr. Mark A. Creager of Brigham and Women's Hospital in Boston told Reuters Health.

In a double-blind study described in the latest rapid access issue of the American Heart Association's journal Circulation, Creager and a multicenter team randomly assigned 354 patients with peripheral artery disease and claudication to take Lipitor or an inactive placebo pill for 1 year.

After 12 months, there was no significant difference between the two groups in the maximum time they could walk on a treadmill, the main outcome measured in the study.

However, the amount of time patients could walk pain-free did improve by 63% in those taking 80 milligrams of Lipitor atorvastatin. In contrast, pain-free walking time improved by 38% in patients taking 10 milligrams of Lipitor or the placebo.

Patients taking either dose of Lipitor also reported improvement in their ability to participate in physical activity, compared with those given the placebo.

These findings are in line with "the reduction in cardiovascular events that have been reported consistently in secondary prevention trials of statins in patients with coronary artery disease," the team writes.

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DEPRESSION WEAKENS IMMUNE SYSTEM - Study finds mood affects development of antibodies - ASSOCIATED PRESS- WASHINGTON, 9/01/03

Depression does not just make people feel bad mentally, it can leave them vulnerable to physical illness, too.

That's the word from a research team led by Richard Davidson of the University of Wisconsin-Madison. Their findings are being published this week in the online edition of Proceedings of the National Academy of Sciences.

The scientists were studying links between a person's psychological state and their immune response.

To do this, they asked 52 volunteers, male and female, to write about the worst time of their lives and the best time. Researchers then measured their brain activity electronically.

Increased activity in the right prefrontal area of the brain has been associated with stronger emotional response and depression.

After the testing, the individuals were given flu shots and were tested two weeks, four weeks and six months later to determine their reaction to the shots.

Individuals who had shown greater activity in the right prefrontal part of the brain later had lower amounts of flu antibodies in their blood, indicating a weaker response by their immune system. © 2003 Associated Press

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CHOLESTEROL DRUG MAY ALSO PREVENT DEPRESSION
NEW YORK (Reuters Health)

Long-term treatment with cholesterol-lowering "statins" -- drugs like Zocor or Lipitor -- seems to be good not only for the heart but also for mental health, researchers in Boston report.

That news, while welcome, is somewhat unexpected. More than a decade ago, vigorous cholesterol lowering was actually linked with depression and violent behavior, Dr. Charles M. Blatt, of the Harvard School of Public Health, and associates point out in the Journal of the American College of Cardiology.

To investigate, Dr. Blatt's team followed a group of patients receiving statin treatment to treat high cholesterol levels. Beginning in 1994, the researchers enrolled 140 patients who were continuously prescribed statins and another 219 patients who used the drugs intermittently. They were compared with 231 people who had never been prescribed a cholesterol-lowering drug.

"Statins seem to be associated with a reduced risk of anxiety, depression and hostility," co-author Yinong Young-Xu commented in a press release. "We saw somewhere between a 30 to 40 percent reduction of risk."

Furthermore, the researchers found, the odds of mental illness continued to decline with each additional year of statin treatment.

"Although this study does not demonstrate that statin use itself caused increases in positive well-being, it certainly supports that possibility," Dr. C. Keith Haddock, of the University of Missouri, Kansas City, said in the press statement.

On the other hand, "It also suggests that factors related to coronary artery disease may have rendered the patient vulnerable to negative mood and that statin reversed that process."

Whatever the exact cause-and effect, the study helps dispel concerns about the psychological side effects of lowering cholesterol.

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LOW-CHOLESTEROL DIET AS GOOD AS DRUGS
By Daniel DeNoon - WebMD Medical News Reviewed By Brunilda Nazario, MD

You can lower your cholesterol by diet alone. Conventional wisdom says most people can't do it. But a head-to-head showdown says otherwise. The astonishing truth: A cholesterol-busting diet can work as well as new anti-cholesterol drugs. And there's a bonus. Unlike the drugs, the diet has no side effects and costs little.

Diet inventor David J.A. Jenkins, MD, PhD, DSc, is a vegetarian, but he's no scientific lightweight. He's director of the clinical nutrition and risk factor modification center at St. Michael's Hospital in Toronto, Canada, and professor of nutritional sciences at the University of Toronto.

Last year, he showed that a vegetarian diet combining four types of cholesterol-lowering foods works as well as cholesterol-lowering drugs known as statins. But the study appeared in the relatively obscure journal Metabolism. Now, with the direct comparison to statins, his work has hit the big time. It's featured in the July 23/30 issue of The Journal of the American Medical Association.

"The big thing is, we have tested the diet against statins directly and showed the same benefit," Jenkins tells WebMD. "This head-to-head comparison now makes this diet more relevant to the average person."

Jenkins' team signed up 25 men and 21 healthy postmenopausal women. All had high cholesterol levels. Their average age was 59 and they were overweight but not obese. All started the study by stopping use of all statin drugs (used by 21 of the volunteers, all looking for a dietary alternative). A month before starting the study, all the volunteers followed their own low-saturated-fat diets that were similar to diets recommend for people with elevated cholesterol.

The researchers randomly assigned each of the 46 men and women to:
The control group. These people ate a diet very low in saturated fats (less than 7% of total calories as saturated fats). The diet was based mainly on low-fat dairy products and whole-grain cereals. The statin group. These people ate the same diet as those in the control group. But they also took a statin known as lovastatin (sold as Mevacor). The "dietary protocol" group. These people ate a combination of cholesterol-fighting foods. It had four basic components: plant sterols in the form of a cholesterol-lowering margarine; soy proteins; sticky or soluble fibers such as fruits, vegetables, oats, and legumes; and almonds. (For a sample menu, see the end of this article.)

After a month, the control group's cholesterol went down by 8%. That's pretty good -- but the statin group had a 30.9% cholesterol drop. Yet without taking the drug, the "dietary protocol" group had almost the same result -- a 28.6% drop in cholesterol.

There's more. Study participants also had drops in C-reactive protein, or CRP. The higher one's CRP level, the higher the risk of heart disease. The control group had a 10% drop in CRP. The statin group had a 33.3% CRP drop. The dietary protocol group had a 28.2% drop.

The findings don't surprise James W. Anderson, MD, professor of medicine and clinical nutrition at the University of Kentucky and president of the Obesity Research Network. He's long advocated a heart-healthy diet based on restricted fats, sticky fiber, and soy protein.

"What the Jenkins study shows is that if people enhance a heart-healthy diet with three things -- soluble fiber, soy protein, and plant sterols and stanols -- they can get substantially better cholesterol reduction," Anderson tells WebMD. "With the combination of rather modest dietary change and this, they can get 30% cholesterol reduction."

And don't forget nuts, Jenkins says. "We've always liked almonds." And just last week, he points out, the FDA allowed nut producers to make heart-health claims for their products.

In his study, the successful dieters ate four types of cholesterol lowering foods:
Soy. "We were looking at soy-based meat substitutes such as soy burgers, soy hot dogs, and soy cold cuts," Jenkins says. "And we also used soy milk as a dairy substitute." Sticky fiber. Study patients used the natural psyllium product Metamucil -- many used it to thicken their soymilk -- and ate oat-bran cereal and barley-based soups. Plant-sterol enriched margarine. This Unilever product is sold in the U.S. as Take Control and in other countries as Becel/Flora pro.activ. A similar product is Benecol from McNeil Nutritionals. Sterols and stanols are naturally occurring substances in plants. Nuts. Study patients ate a handful of almonds every day.

And if you prefer pills, Anderson notes that plant sterols and sticky fiber are available in capsule form. However, he warns against using sterol-enriched spreads because they are high in calories. Some of the products, he says, have hydrogenated fats.

If switching to this type of diet sounds daunting, Jenkins and Anderson both stress that small changes to the diet, have big health effects. And you don't have to change your eating habits all at once, Jenkins says.

"My advice is, try a little of all of these foods," he suggests. "A few nuts are never a bad thing. A handful of almonds are enough. Try some of the soy foods. Try soymilk with breakfast cereal, try soy substitutes. Try oats -- oat bran is a good breakfast. And try a few things on a cold day, like vegetable barley soup. Try incorporating these things into your diet little by little. If you find ones you like, eat them more often. If you do that each day, have one or two and build up, you soon should get a measurable effect on you cholesterol levels."

Meanwhile, Jenkins is working with several food manufacturers. Those who provided foods for the study include Loblaw Brands Ltd, the Almond Board of California, Unilever Research, the Hain-Celestial Group, Nestle Canada Inc., Kraft Foods, Proctor & Gamble Inc., Bartlett Farms, Barwell Food Sales Inc., and Burnbrae Farms Ltd.

"We are on the road with our industrial collaborators to making these foods palatable and presenting an alternative to the starting dose of statins," Jenkins says. "That is all many people need to control their cholesterol and lower their risk of heart disease."

SOURCES: The Journal of the American Medical Association, July 23/30, 2003. David J.A. Jenkins, MD, PhD, DSc, director, clinical nutrition and risk factor modification center, St. Michael's Hospital, Toronto, Canada; professor of nutritional sciences, University of Toronto, Canada. James W. Anderson, MD, professor of medicine and clinical nutrition, University of Kentucky; president,

Obesity Research Network.
© 2003 WebMD Inc. All rights reserved.

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MYOSITIS (MUSCLE INFLAMMATION)... CHECK THE MEDS!
Medical Author: William C. Shiel Jr., MD, FACP, FACR

I am a rheumatologist - an internal medicine specialist who is trained to evaluate, diagnose, and treat diseases that involve the muscles and joints. Because rheumatologists have a keen interest in undiagnosed conditions, I see a number of patients every week who are seeking a first diagnosis.

It is commonplace for doctors to refer patients to a rheumatologist for the evaluation of painful muscles. There are many diseases that are associated with inflammation of muscles. Furthermore, many conditions may appear to involve muscles, but may actually be a result of disease of the tendons, joints, or bones.

By way of illustration, I want to call viewers' attention to a patient that I just saw in the office this week. I feel that this patient is very representative of a muscle condition that is under appreciated nowadays. I also know that patients and doctors should have a heightened awareness of this condition since it is easily managed when discovered early. When discovered late, it can lead to serious injury - not only to the muscles, but also potentially to the kidneys and heart.

Mr. Jones is a 75-year-old man who was referred by a cardiologist because of pains and stiffness in the muscles of his arms, shoulders, thighs, and buttocks. He has been taking Lipitor (atorvastatin) for six months to control elevated cholesterol levels in his blood. Mr. Jones reported muscle aching for the past eight weeks. He was also weak in the locations of pain. Blood testing for the muscle enzyme, CPK, was mildly elevated.

Now, here's the point:
Lipitor is a member of a class of cholesterol-lowering drugs called statins. The statins include lovastatin (brand name: Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor), and cerivastatin (Baycol) (Baycol was withdrawn from the market in August, 2001). Statin drugs are known to cause muscle pains and inflammation around the muscle cells (myositis). It should also be noted that the risk of muscle injury is greater when a statin is combined with other drugs that also cause muscle damage by themselves. For example, when lovastatin (Mevacor) is used alone to lower cholesterol, muscle damage occurs on the average in one person out of about every 500. However, if lovastatin (Mevacor) is used in combination with other drugs such as niacin, gemfibrozil (Lopid) or fenofibrate (Tricor) to further reduce cholesterol levels, the risk of muscle injury skyrockets to one person out of every 20 to 100 who receive the combination. The risk of muscle damage is thus multiplied 5 to 25-fold by using a combination of a statin and another cholesterol-lowering drug rather than by just using statin alone.

In fact, the manufacturers of statins recommend that any patient taking a statin "should be advised to report promptly any unexplained muscle pain, tenderness or weakness…. When a muscle disease is suggested, the doctor stops the statin drug."

You see, statin drugs cause three types of muscle conditions. First, they can cause muscle aching. This condition generally reverses itself within weeks of discontinuing the drugs. Second, they can cause muscle pains and mild muscle inflammation that may also be accompanied by minor weakness. Blood testing for the muscle enzyme, CPK, is mildly elevated. This condition also generally reverses, but it may take several months to resolve. Third, statins can cause severe muscle inflammation and damage so that not only are the muscles painful all over the body, they also become severely weakened. Heart muscle can even (rarely) become affected. Blood testing for the muscle enzyme, CPK, is markedly elevated. When the muscles are severely damaged, the muscle cells release proteins into the blood that collect in and can damage the kidneys. This can lead to kidney failure and require dialysis.

In each of the above three forms of muscle conditions that result from statin drugs, the outcome is always much better when the condition is detected early.

My patient is expected to do well. I have discontinued his Lipitor and his muscle pain and stiffness will resolve in the upcoming weeks. He will follow-up with me in a month for a progress report.

There are many other medications (aside from statins) and diseases that can cause muscle aching. Of all causes, however, statin drugs are what I see as the most common culprits. If you or someone you know has muscle pains, check the medications being taken first!

Finally, please understand that the statin drugs have been shown to be the most effective (and widely prescribed) medications to optimally lower cholesterol and prevent heart attacks and stroke. This perspective article is intended to highlight the fact that even the best drugs require monitoring and can have side effects.

For additional Doctor's Views written by Dr. Shiel, visit the Doctor's Views Library. A Network of Doctors- Since 1996, MedicineNet has been providing 100% doctor-produced educational health information for consumers. The aim of MedicineNet.com and its network of over 70 U.S. Board Certified Physicians, is to ensure that this information is reliable, integrated, and easy to access, read and understand. Visit www.medicinenet.com and Meet the Doctors.

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YES, FIBER IS GOOD FOR YOUR HEART
NEW YORK (Reuters Health) 9/09/03

The likelihood of developing heart disease is indeed lower with a diet high in fiber, especially water-soluble fiber, according to a study in the latest issue of The Archives of Internal Medicine, published by the American Medical Association.

The findings are based on data from nearly 10,000 subjects participating in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up study. When they enrolled, the participants completed a 24-hour dietary recall questionnaire, which was used to calculate nutrient intake

They were then followed for an average of 19 years. During that time, over 1800 cases of coronary heart disease occurred, as well as nearly 3800 cases of other vascular diseases.

Dr. Jiang He of Tulane University in New Orleans, and others, estimate that individuals with the highest amount of fiber in their diet had a 12 percent lower risk of heart disease than those with the lowest intake of fiber The reduction in risk of other vascular diseases with high fiber consumption was 11 percent.

Protection against heart disease was even stronger for high levels of soluble fiber consumption, with a reduction in risk of 15 percent.

The results "support the existing American Heart Association recommendations to increase dietary fiber intake from foods to approximately 25 to 30 grams per day," Dr. He's group concludes.

Major sources of soluble fiber include oats, beans, dried peas, and legumes whereas major sources of insoluble fiber include wheat bran, whole grain products, and vegetables. Fruits, vegetables, and barley contain both insoluble and soluble fiber. Soluble fiber delays the time of transit through the intestine and lowers cholesterol. Insoluble fiber does not. Copyright © 2003 Reuters Limited.

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GUT SAFETY OF CELECOXIB DEMONSTRATED IN YOUNGER PATIENTS
By Stephen Pincock - LISBON (Reuters Health)

The COX-2 inhibitor celecoxib (Celebrex; Pfizer) produces fewer upper gastrointestinal side effects than nonspecific NSAIDs in all age groups, including younger patients, according to research presented on Friday.

Dr. Gurkipal Singh from Stanford University Medical Center, California, and colleagues retrospectively analyzed data from a large randomized trial of celecoxib, sponsored by Pfizer.

Co-author Professor Jay Goldstein told Reuters Health that the focus of treatment with COX-2 inhibitors has largely been the older population, because they are at highest risk for NSAID-induced GI events. "What has occurred, and probably erroneously, is that people say there is lesser benefit in people that are younger," he said.

In a poster at the Annual European Congress of Rheumatology, the researchers presented their findings from the analysis of data from 8,800 osteoarthritis patients given celecoxib at 200-400 mg/day and 4,394 taking diclofenac or naproxen.

There was no correlation between age and incidence of upper gastrointestinal symptoms in either treatment arms, according to their report.

"These findings extend our understanding of the safety profile of coxibs as compared to traditional nonsteroidals by demonstrating that the benefit of coxibs exists across the wide range of ages studied," said Professor Goldstein, from the University of Illinois.

The researchers classified all mild, moderate or severe abdominal pain, nausea or dyspepsia as upper gastrointestinal events.

For patients under 45, the incidence was 13% in the NSAID group and 10% for those given celecoxib. Among those over 75, 14% of those in the NSAID group experienced events compared to 10% of those receiving celecoxib.

"I think this is the beginning of the concept that regardless of who you are, where you are on the continuum of risk, there's a benefit to COX-2 inhibitors," Professor Goldstein said.

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VIEWER QUESTION: FROM MEDICINE NET. COM
What causes costochondritis? Is there something she does to aggravate it (like exercise or diet) or is it possibly viral? Doctor's Response: The cause(s) of costochondritis are not known and may involve several factors. Possible causes include heredity (genetic predisposition), viruses, and trauma (injury).

Costochondritis can be an independent condition by itself or sometimes be a feature of a more widespread disorder. Examples of illnesses that can feature costochondritis include fibromyalgia, psoriatic arthritis, ankylosing spondylitis, Reiter's disease, and inflammatory bowel disease. Costochondritis can be aggravated by any activity that involves stressing the structures of the front of the chest cage. It is generally best to minimize these activities until the inflammation of the rib and cartilage areas has subsided.

I am unaware of any particular diet causing worsening of costochondritis. On the contrary, it is known that fish oils can have a degree of anti-inflammation effect. Theoretically, they could be of some benefit. This effect is probably minor, however.

The closest to perfection a person ever comes, is when he or she fills out a job application.

Good Health to all,

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2003 9/30/03-17