Reports of medication injuries have doubled
Study shows painkillers, immune-system drugs account for most serious ills
Sept. 10, 2007
CHICAGO - Reports of deaths or injuries related to drug treatments more than doubled between 1998 and 2005 in the United States, with painkillers and immune-system boosters accounting for most, researchers said on
Monday.

“This study shows that substantially growing numbers of patients are experiencing serious injuries from drug therapy,” they wrote in a report in the Archives of Internal Medicine.

“This growing toll of serious injury shows that the existing system is not adequately protecting patients and underscores the importance of recent reports urging far-reaching legislative, policy and institutional changes,” they
added.

Thomas Moore and colleagues at the Institute for Safe Medication Practices in Huntingdon Valley, Pa., said the findings came from a look at serious adverse drug events as reported to the U.S. Food and Drug Administration
from 1998 through 2005.

A “serious adverse drug event” is one that causes death, birth defects, disability, puts someone in a hospital or was life-threatening.

The FDA gets information about such occurrences directly or from drug makers, who are required to report them. A bill pending in the U.S. Congress would force the agency to do more active surveillance, for instance, by
checking insurance records.

Rise in deaths
The study found 467,809 such occurrences during the period studied, with annual reports growing from 34,966 at the start to 89,842 at the end. The number of deaths due to drugs jumped from 5,519 to 15,107 during the study
period.

“The overall relative increase was four times faster than the growth in total U.S. outpatient prescriptions, which grew in the same period from 2.7 billion to 3.8 billion,” the researchers wrote.

The researchers estimated that a growing population and more intensive use of drug therapy might account for a quarter of the increase.

An additional 15 percent of the increase appears to involve newer biotech drugs such as interferons, which help the body’s immune system attack viruses, bacteria and other invaders.

“Among the most frequently reported drugs associated with fatal events, we observed a disproportionate contribution of pain medications and drugs that modify the immune system,” they added.
The FDA said the reason for the increase in reports is not completely known.
“While some of this has to do with the increasing number of prescriptions, there are clearly other factors responsible for this increase, such as the increase in public attention to drug safety, and use of the Internet to make it
easier for the public to ... report adverse events to FDA,” spokeswoman Sandy Walsh said in a statement.

The agency has been under fire from consumer advocates and Congress for its record of approving drugs — such as Merck and Co’s arthritis drug Vioxx — that are later shown to have dangerous side-effects. Vioxx was
withdrawn in 2004 after being linked to strokes and heart attacks.

At the same time, cancer advocacy groups accuse the agency of being to slow or too strict about approving the use of experimental new therapies.

Copyright 2007 Reuters Limited. All rights reserved.
Aug. 28, 2007
NEW YORK - When patients feel they might be having an adverse drug effect, doctors will very often dismiss their concerns, a new study shows.

In a survey of 650 patients, taking cholesterol-lowering drugs called statins, who reported having adverse drug reactions, many said their physicians denied that the drug could be connected to their symptoms, Dr. Beatrice A.
Golomb of the University of California at San Diego and her colleagues found.

“Physicians seem to commonly dismiss the possibility of a connection,” Golomb told Reuters Health. “This seems to occur even for the best-supported adverse effects of the most widely prescribed class of drugs...Clearly
there is a need for better physician education about adverse effects, and there is a strong need for patient involvement in adverse event reporting.”

The best-known side effects of statins, which include widely prescribed drugs such as Lipitor and Zocor, are liver damage and muscle problems, although statins have also been tied to changes in memory, concentration and
mood, among other problems.

Physician reaction to a potential side effect is crucial because the muscle problems can progress to a rare but potentially fatal condition called rhabdomyolysis if the drug isn’t discontinued.

The researchers investigated the response of doctors to statin patients who believed they were having adverse drug reactions. In the great majority of cases, the patient, not the doctor, initiated the discussion.

Forty-seven percent of patients with muscle problems or cognitive problems said their doctors dismissed the possibility that their symptoms were statin-related, while 51 percent of patients with peripheral neuropathy, a type
of nerve pain affecting the extremities, said their doctors denied a possible connection with statins.

Overall, 32 percent of patients reported that their doctors told them there was no link between their symptoms and statin use, 39 percent said their physicians said such a connection was possible, and 29 percent said their
doctors “neither endorsed nor dismissed the possibility of symptom link to statins.”

The investigators were “surprised” at how frequently patients reported that their doctors dismissed their concerns, Golomb said. While her study wasn’t designed to find out why, the researcher notes that while the
pharmaceutical industry is sure to get the word out about a drug’s benefits, there is ”really no corresponding interest group to make sure that physicians learn about adverse effects.”

Patients should be aware of the potential adverse effects of any medication they’re taking, she said. And those who find their doctors dismiss their concerns should probably look elsewhere for medical care, she added. “In
general patients should always have physicians that they feel are hearing them.”
FDA warns nursing moms of pain drug risk
Side effect of codeine can cause overdose in breast-feeding infants

Aug. 17, 2007
WASHINGTON - Nursing mothers who take codeine should watch their infants for increased sleepiness or other signs of overdose, federal health officials warned Friday.

The Food and Drug Administration warning of the rare but serious side effect was prompted by a 2006 report of the death of a nursing infant whose mother was given codeine for episiotomy pain.

Genetic testing later showed the woman’s body converted the codeine to morphine more rapidly and completely than in other people. That led to higher-than-expected morphine levels in her breast milk.

While the rapid conversion of codeine to morphine is a very rare side effect in some mothers, it can result in high and unsafe levels of the latter drug in the blood and breast milk, the FDA said in an alert.

Codeine is among the most common drugs taken by new mothers, FDA officials said.

It is included in several prescription pain drugs and in some over-the-counter cough syrups, Dr. Sandra Kweder, the FDA’s deputy director, Office of New Drugs, Center for Drug Evaluation and Research, said in a telephone
briefing.

The risk of having the genetic mutation ranges from about 1 percent in Hispanics, Chinese and Japanese, to 3 percent in African-Americans, 1 percent to 10 percent in Caucasians, and as high as 16 percent to 28 percent in
North Africans, Ethiopians and Saudis, Kweder said.

Given the risk, doctors should prescribe nursing mothers the smallest dose of codeine for the shortest period of time, the FDA recommended. Doctors also should closely monitor both mother and child.

Watch for overdose signs
In children, signs of morphine overdose, beyond increased sleepiness, include difficulty breast-feeding or breathing and limpness. Nursing mothers may also experience overdose symptoms, such as extreme sleepiness,
confusion, shallow breathing or severe constipation, the FDA said.

The FDA has asked drug companies that make those products to include information about the potential risks to nursing mothers who are ultra-rapid metabolizers of codeine.

There is a test available to determine if an individual is a rapid metabolizer of codeine, but Kewder said the agency is not currently recommending routine testing.

“Our point is to pay attention,” she said.

New mothers taking codeine who find themselves extremely sleepy should consult their doctor, and if their baby seems unusually sleepy or has trouble nursing they should contact their physician or take the baby to an
emergency room, she said.

63 percent of Americans age 50 or older use herbal treatments, survey finds

Updated: 12:02 p.m. ET Jan. 26, 2007
NEW YORK - Most Americans age 50 and older use complementary and alternative medicine (CAM), such as herbal products or acupuncture, often unbeknownst to their doctor, according to a survey conducted by AARP and
the National Center for Complementary and Alternative Medicine.

"Communication between patients and physicians about CAM and conventional therapies is vital to ensuring safe, integrated use of all health care approaches," the report states.

An open dialogue "allows patients and physicians the opportunity to identify CAM practices that might be beneficial and also minimizes risks to a patient from potential therapy interactions."

Among a total of 1,559 individuals age 50 and older surveyed in the spring of 2006, 63 percent reported having used one or more CAM therapies.

Forty-five percent of CAM enthusiasts used massage therapy, chiropractic manipulation or other bodywork; 42 percent used herbal or dietary supplements; 15 percent used mind/body practices, including hypnosis and
meditation; 14 percent used naturopathy, acupuncture, or homeopathy; and 10 percent had tried energy therapies.

Sixty-six percent of CAM users said they did so to treat a specific health problem; 65 percent for overall wellness; 45 percent to supplement conventional medicine; and 42 percent to prevent illness.Study links house dust to cat
illness
Common flame retardant may cause thyroid condition; could affect children
Updated: 11:37 a.m. ET Aug. 16, 2007
WASHINGTON - A new federal study suggests that household dust containing a common flame retardant may be linked to an increase in cats getting sick from overactive thyroids.
That could be a warning sign for how young children could get exposed to the chemical, said Linda S. Birnbaum, director of experimental toxicology at the U.S. Environmental Protection Agency and co-author of the study.
The small study looks at chemical flame retardants called polybrominated diphenyl ethers (PBDEs), which were used in foam, plastics, furniture, electronics, fabrics and carpet padding. The sole American manufacturer in
2004 agreed to phase out the types of PBDEs included in the study because of concern about toxicity in animals.
But PBDEs remain in American homes.
The study of 23 cats found the older felines with high levels of certain types of PBDEs tended to have overactive thyroids, the researchers reported online Wednesday in the peer-reviewed journal Environmental Science and
Technology.

Hyperthyroidism is treatable in both cats and humans. In cats, the disease started soaring in America in the late 1970s and 1980s, soon after PBDEs became common, according to the researchers.

The EPA study adds to recent research that raises serious questions about human exposure to PBDE. One study found a significant relationship between indoor dust exposure and PBDE levels in first-time mothers in the
Boston area. Another found PBDE levels in Americans are three to 10 times higher than in Europeans. And small studies in California and Norway show that children, especially toddlers, have higher PBDE levels than adults.

Tom Webster, a professor of environmental health at Boston University, said animal research has found PBDEs to damage the nervous system and disrupt hormones, but studies haven’t been done to look at people’s health.

“I don’t think we know about (human) health yet, but I don’t like the sound of this,” said Webster, who co-authored the Boston dust study but was not part of the EPA research, which he praised. “Levels in people are going up.”

But because the cat study is so preliminary, Birnbaum said people shouldn’t overreact and sell their furniture or rid themselves of carpets. However, she said she makes sure to wash her grandchildren’s blankets more
frequently and checks on flame retardant use when buying furniture.

Most people don’t have PBDE levels that are anywhere near that of cats, Birnbaum said. PBDE is just one of many chemicals that accumulate in our body with unknown effects, but the dust exposure route is unusual, Birnbaum
said.
The EPA study suggests household dust as the key way PBDE gets into cats, and likely, people. It also found elevated PBDE levels in certain cat food, mostly fish, but tests showed food couldn’t be blamed for the high levels in
cats, Birnbaum said.
She said if PBDEs get into bodies through household dust, that means children are likely to be more exposed than their parents.
“To me, it’s a consumer product issue,” said Myrto Petreas, chief of the state of California’s environmental chemistry branch and co-author of other studies looking at PBDE levels in women and San Francisco Bay harbor
seals. “You get exposed while you’re in your home.... It’s in the carpet. It’s in the monitor. It’s in your chair.”
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Rheumatoid arthritis
From MayoClinic.com


The nagging pains and physical limitations of the more than 100 forms of arthritis are common to millions of people. Rheumatoid arthritis is among the most debilitating of all forms,
causing joints to ache and throb and eventually become deformed. Sometimes these symptoms make even the simplest activities — such as opening a jar or taking a walk —
difficult to manage.

Unlike osteoarthritis, which results from wear and tear on your joints, rheumatoid arthritis is an inflammatory condition. The exact cause of rheumatoid arthritis is unknown, but it's
believed to be the body's immune system attacking the tissue that lines your joints (synovium).

Rheumatoid arthritis is two to three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis can also affect young
children and adults older than age 50.

There's no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with this condition.


Signs and symptoms

The signs and symptoms of rheumatoid arthritis may come and go over time. They include:

Pain and swelling in your joints, especially in the smaller joints of your hands and feet
Generalized aching or stiffness of the joints and muscles, especially after sleep or after periods of rest
Loss of motion of the affected joints
Loss of strength in muscles attached to the affected joints
Fatigue, which can be severe during a flare-up
Low-grade fever
Deformity of your joints over time
General sense of not feeling well (malaise)
Rheumatoid arthritis usually causes problems in several joints at the same time. Early in rheumatoid arthritis, the joints in your wrists, hands, feet and knees are the ones most often
affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It generally affects both sides of your body at the same time. The knuckles of
both hands are one example.

Small lumps, called rheumatoid nodules, may form under your skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also
occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size — from as small as a pea to as large as a walnut. Usually
these lumps aren't painful.

In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the linings of your heart and lungs,
your lungs themselves and, in rare cases, your blood vessels.

Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares —
alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.

Swelling or deformity may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you'll probably retain flexibility in many joints.

Causes
As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your movable joints. When you have
rheumatoid arthritis, white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into your synovium. Here,
these blood cells appear to play an important role in causing the synovial membrane to become inflamed (synovitis).

This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins can also damage cartilage, bone, tendons and
ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

Some researchers suspect that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease
itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes won't necessarily develop rheumatoid arthritis. But they may
have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved
in the development of rheumatoid arthritis.

Risk factors
The exact causes of rheumatoid arthritis are unclear, but these factors may increase your risk:

Getting older, because incidence of rheumatoid arthritis increases with age. However, incidence begins to decline in women over the age of 80.
Being female.
Being exposed to an infection, possibly a virus or bacterium, that may trigger rheumatoid arthritis in those with an inherited susceptibility.
Inheriting specific genes that may make you more susceptible to rheumatoid arthritis.
Smoking cigarettes over a long period of time.

When to seek medical advice
See your doctor if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your doctor can work with you to develop a pain management and
treatment plan. Also seek medical advice if you experience side effects from your arthritis medications. Side effects may include nausea, abdominal discomfort, black or tarry stools,
changes in bowel habits, constipation and drowsiness.


Screening and diagnosis
If you have signs and symptoms of rheumatoid arthritis, your doctor will likely conduct a physical examination and request laboratory tests to determine if you have this form of
arthritis. These tests may include:

Blood tests. A blood test that measures your erythrocyte sedimentation rate (ESR or sed rate) can indicate the presence of an inflammatory process in your body. People with
rheumatoid arthritis tend to have elevated ESRs. The ESRs in those with osteoarthritis tend to be normal.

Another blood test looks for an antibody called rheumatoid factor. Most people with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early in the
disease. It's also possible to have the rheumatoid factor in your blood and not have rheumatoid arthritis.

Imaging. Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of
arthritis.

Complications
Rheumatoid arthritis causes stiffness and pain and may also cause fatigue. It can lead to difficulty with everyday tasks, such as turning a doorknob or holding a pen. Dealing with the
pain and the unpredictability of rheumatoid arthritis can also cause symptoms of depression.

Rheumatoid arthritis may also increase your risk of developing osteoporosis, especially if you take corticosteroids. Some researchers believe that rheumatoid arthritis can increase
your risk of heart disease. This may be because the inflammation that rheumatoid arthritis causes can also affect your arteries and heart muscle tissue.

In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. That's not as likely today
because of better treatments and self-care methods.


Treatment
Treatments for arthritis have improved in recent years. Most treatments involve medications. But in some cases, surgical procedures may be necessary.

Medications
Medications for rheumatoid arthritis can relieve its symptoms and slow or halt its progression. They include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of medications, which includes aspirin, helps relieve both pain and inflammation if you take the drugs regularly. NSAIDs
that are available over-the-counter include aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). These are available at higher dosages, and other NSAIDs are
available by prescription — such as ketoprofen, naproxen (Anaprox, Naprosyn), tolmetin (Tolectin), diclofenac (Voltaren), nabumetone (Relafen) and indomethacin (Indocin). Taking
NSAIDs can lead to side effects such as indigestion and stomach bleeding. Other potential side effects may include damage to the liver and kidneys, ringing in your ears (tinnitus),
fluid retention and high blood pressure. NSAIDs, except aspirin, may also increase your risk of cardiovascular events such as heart attack or stroke.
COX-2 inhibitors. This class of NSAIDs may be less damaging to your stomach. Like other NSAIDs, COX-2 inhibitors — such as celecoxib (Celebrex) — suppress an enzyme
called cyclooxygenase (COX) that's active in joint inflammation. Other types of NSAIDs work against two versions of the COX enzyme that are present in your body: COX-1 and
COX-2. However, there's evidence that by suppressing COX-1, NSAIDs may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining.
Unlike other NSAIDs, COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. Side effects may include fluid retention and causing or exacerbating high blood
pressure. Furthermore, this class of drugs has been linked to an increased risk of heart attack and stroke.
Corticosteroids. These medications, such as prednisone and methylprednisolone (Medrol), reduce inflammation and pain, and slow joint damage. In the short term, corticosteroids
can make you feel dramatically better. But when used for many months or years, they may become less effective and cause serious side effects. Side effects may include easy
bruising, thinning of bones, cataracts, weight gain, a round face and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering
off the medication.
Disease-modifying antirheumatic drugs (DMARDs). Physicians prescribe DMARDs to limit the amount of joint damage that occurs in rheumatoid arthritis. Taking these drugs at
early stages in the development of rheumatoid arthritis is especially important in the effort to slow the disease and save the joints and other tissues from permanent damage.
Because many of these drugs act slowly — it may take weeks to months before you notice any benefit — DMARDs typically are used with an NSAID or a corticosteroid. While the
NSAID or corticosteroid handles your immediate symptoms and limits inflammation, the DMARD goes to work on the disease itself. Some commonly used DMARDs include
hydroxychloroquine (Plaquenil), the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin) and methotrexate (Rheumatrex). Other forms of
DMARDs include immunosuppressants and tumor necrosis factor (TNF) blockers.
Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. In addition, some of these drugs attack and eliminate cells
that are associated with the disease. Some of the commonly used immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune)
and cyclophosphamide (Cytoxan). These medications can have potentially serious side effects such as increased susceptibility to infection.
TNF blockers. These are a class of DMARDs known as biologic response modifiers. TNF is a cytokine, or cell protein, that acts as an inflammatory agent in rheumatoid arthritis.
TNF blockers, or anti-TNF medications, target or block this cytokine and can help reduce pain, morning stiffness and tender or swollen joints — usually within one or two weeks
after treatment begins. There is evidence that TNF blockers may halt progression of disease. These medications often are taken with methotrexate. TNF blockers approved for
treatment of rheumatoid arthritis are etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). Potential side effects include injection site irritation (adalimumab and
etanercept), worsening congestive heart failure (infliximab), blood disorders, lymphoma, demyelinating diseases, and increased risk of infection. If you have an active infection, don't
take these medications.
Interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra is another type of biologic response modifier and is a recombinant form of the naturally occurring interleukin-1 receptor antagonist
(IL-1Ra). Interleukin-1 (IL-1) is a cell protein that promotes inflammation and occurs in excess amounts in people who have rheumatoid arthritis or other types of inflammatory
arthritis. If IL-1 is prevented from binding to its receptor, the inflammatory response decreases. The first IL-1Ra that has been approved by the Food and Drug Administration for use
in people with moderate to severe rheumatoid arthritis who haven't responded adequately to conventional DMARD therapy is anakinra (Kineret). It may be used alone or in
combination with methotrexate. Anakinra is given as a daily self-administered injection under the skin. Some potential side effects include injection site reactions, decreased white
blood cell counts, headache and an increase in upper respiratory infections. There may be a slightly higher rate of respiratory infections in people who have asthma or chronic
obstructive pulmonary disease. If you have an active infection, don't use anakinra.
Abatacept (Orencia). Abatacept, a type of costimulation modulator approved in late 2005, reduces the inflammation and joint damage caused by rheumatoid arthritis by inactivating T
cells — a type of white blood cell. People who haven't been helped by TNF blockers might consider abatacept, which is administered monthly through a vein in your arm
(intravenously). Side effects may include headache, nausea and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, can occur.
Rituximab (Rituxan). Rituximab reduces the number of B cells in your body. B cells are involved in inflammation. Though originally approved for use in people with non-Hodgkin's
lymphoma, rituximab was approved for rheumatoid arthritis in early 2006. People who haven't found relief using TNF blockers might consider using rituximab, which is usually
given along with methotrexate. Rituximab is administered as an infusion into a vein in your arm. Side effects include flu-like signs and symptoms, such as fever, chills and nausea.
Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.
Antidepressant drugs. Some people with arthritis also experience symptoms of depression. The most common antidepressants used for arthritis pain and nonrestorative sleep are
amitriptyline, nortriptyline (Aventyl, Pamelor) and trazodone (Desyrel).
Surgical or other procedures
Although a combination of medication and self-care is the first course of action for rheumatoid arthritis, other methods are available for severe cases:

Prosorba column. This blood-filtering technique removes certain antibodies that contribute to pain and inflammation in your joints and muscles and is usually performed once a week
for 12 weeks as an outpatient procedure. Some of the side effects include fatigue and a brief increase in joint pain and swelling for the first few days after the treatment. The Prosorba
column treatment isn't recommended if you're taking angiotensin-converting enzyme (ACE) inhibitors or if you have heart problems, high blood pressure or blood-clotting problems.
Joint replacement surgery. For many people with rheumatoid arthritis, medicines and therapies can't prevent joint destruction. When joints are severely damaged, joint replacement
surgery can often help restore joint function, reduce pain or correct a deformity. You may need to have an entire joint replaced with a metal or plastic prosthesis. Surgery may also
involve tightening tendons that are too loose, loosening tendons that are too tight, fusing bones to reduce pain or removing part of a diseased bone to improve mobility. Your doctor
may also remove the inflamed joint lining (synovectomy).

Self-care
Treating rheumatoid arthritis typically involves using a combination of medical treatments and self-care strategies.

Exercise regularly. Different types of exercise achieve different goals. Check with your doctor or physical therapist first and then begin a regular exercise program for your specific
needs. If you can walk, walking is a good starter exercise. If you can't walk, try a stationary bicycle with little or no resistance or do hand or arm exercises. A chair exercise program
may be helpful. Aquatic exercise is another option, and many health clubs with pools offer such classes.

It's good to move each joint in its full range of motion every day. As you move, maintain a slow, steady rhythm. Don't jerk or bounce. Also, remember to breathe. Holding your breath
can temporarily deprive your muscles of oxygen and tire them. It's also important to maintain good posture while you exercise. Avoid exercising tender, injured or severely inflamed
joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it. If pain persists for more than a few days, call
your doctor.

Control your weight. Excess weight puts added stress on joints in your back, hips, knees and feet — the places where arthritis pain is commonly felt. Excess weight can also make
joint surgery more difficult and risky.
Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with
your arthritis. However, there's no special diet that can be used to treat arthritis. It hasn't been proved that eating any particular food will make your joint pain or inflammation better
or worse.
Apply heat. Heat will help ease your pain, relax tense, painful muscles and increase the regional flow of blood. One of the easiest and most effective ways to apply heat is to use
Thermomedic Therapy Garments to warm specific muscles and joints. If your skin has poor sensation or if you have poor circulation, don't use heat treatment.
Apply cold for occasional flare-ups. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. Don't use cold treatments if you have poor
circulation or numbness. Techniques may include using cold packs, soaking the affected joints in cold water and ice massage.
Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.
Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.

Coping skills
The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Physical and occupational therapists can help you devise
strategies to cope with specific limitations you may experience as the result of weakness or pain. Here are some general suggestions to help you cope:

Keep a positive attitude. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease. Studies show that people who take control of their
treatment and actively manage their arthritis experience less pain and make fewer visits to the doctor.
Use assistive devices. A painful knee may need a brace for support. You might also want to use a cane to take some of the stress off the joint as you walk. Use the cane in the hand
opposite the affected joint. If your hands are affected, various helpful tools and gadgets are available to help you maintain an active lifestyle.
Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness. A rest or short nap that doesn't interfere with nighttime sleep may help.
Avoid grasping actions that strain your finger joints. Instead of using a clutch purse, for example, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from
your palm to open it, or use a jar opener. Don't twist or use your joints forcefully.
Spread the weight of an object over several joints. For instance, use both hands to lift a heavy pan.
Take a break. Periodically relax and stretch.
Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. Some people
find that swimming also helps improve their posture.
Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

Complementary and alternative medicine
Many complementary medicine approaches haven't been studied extensively by researchers using scientific methods. As a result it's difficult for the scientific community to evaluate
the effectiveness and safety of these alternative approaches. And with much of today's research funding coming from the pharmaceutical industry, some low-tech, nontraditional
approaches to managing diseases such as arthritis may not get as much attention from the research community as they deserve. For these reasons, many Western physicians just
don't know enough about these methods to endorse them. Nonetheless, a growing body of evidence indicates that complementary medicine practices could have a role in treating and
managing some diseases.

Common forms of complementary and alternative medicine for treatment of arthritis include:
Acupuncture
Copper jewelry
Nutritional supplements, including glucosamine and chondroitin sulfate
Homeopathy
Magnets
Massage

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