Transcript: Arthritis | May 14, 2001

(music plays)

An animated slate shows the title inside the shape of a house: "More to health." The opening sequence shows a wooden table with a small lit candle. Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine. In animation, the title appears inside the shape of a house: "More to life."

Then, Maureen Taylor appears in a studio with textured yellow walls and the logo of the show in the background, which reads "More to life."

Maureen is in her late thirties, with wavy auburn hair in a bob. She's wearing a blue blazer over a matching blouse.

She says Hello, I'm Maureen TAYLOR AND THIS IS More to Life.
RHEUMATOID ARTHRITIS IS A PAINFUL, DEBILITATING DISEASE. PATIENT HAVING PAINFUL AND SWOLLEN INFLAMED JOINTS THAT CAN LEAVE THEM CRIPPLED AND IMMOBILE. THERE IS NO CURE BUT DOCTORS ARE EXCITED ABOUT NEW DRUGS COMING ONTO THE MARKET. WE'RE GOING TO TALK ABOUT THOSE DRUGS AND OTHER TREATMENTS FOR BOTH RHEUMATOID AND OSTEOARTHRITIS WITH Dr. ED KEYSTONE BUT FIRST, HOW ONE YOUNG WOMAN IS FIGHTING TO KEEP HER RHEUMATOID ARTHRITIS FROM TAKING OVER HER LIFE.

A clip plays on screen showing a woman's mouth and sneakers walking on snow at night.

A female voice says I'M HOT, SWEATY, RED-FACED, EXTREMELY THIRSTY AND IN DIRE NEED OF THE BATHROOM. I'M ON MILE 13 OF MY REGULAR 14 MILE SUNDAY MORNING RUN. IT'S RAINING, COLD, AND MY LEGS FEEL AS THOUGH THEY'RE MADE OF LEAD. I'M TRAINING FOR MY FIRST MARATHON. MY NAME IS JACKIE SAN. THIS IS IMPORTANT TO KNOW ABOUT ME. I'M competitive BY NATURE, YOUNG, RELATIVELY FIT AND I HAVE RHEUMATOID ARTHRITIS.

Clips show Jackie stretching her arms in a living room. She's in her thirties, with long straight black hair in a ponytail.

Now a physician sits in an office.

A caption appears on screen. It reads "Doctor Ed Keystone. Rheumatologist."

Ed, in his forties, clean-shaven, with short dark hair, says
ARTHRITIS IS INFLAMMATION IN THE JOINT. A BONE IS WHERE TWO BONES COME TOGETHER ON A JOINT. AND INFLAMMATION MEANS HEAT, SWELLING REDNESS PAIN AND DYSFUNCTION. RHEUMATOID ARTHRITIS IS ONE FORM OF 150 DIFFERENT KINDS OF ARTHRITIS SO IT'S ONE OF THOSE KINDS. IT'S AN AUTO IMMUNE DISEASE IN WHICH THE BODY'S IMMUNE SYSTEM ATTACKS THE PATIENTS' OWN TISSUES. 300,000 CANADIANS SUFFER FROM RHEUMATOID ARTHRITIS, TWO THIRDS AS I SAID ARE WOMEN AND WITHIN ABOUT 10 YEARS YOU CAN GUARANTEE 50 percent OF THOSE PEOPLE NO LONGER BE WORKING AND WILL BE SIGNIFICANTLY DISABLED.

The caption changes to "Jackie Song."

Jackie sits in a couch in the living room and says I GUESS IT STARTED WHEN I WAS ABOUT 16. MY ANKLE... MY RIGHT ANKLE WAS REALLY SORE. I COULDN'T GET OUT OF BED. LIKE IT WAS... IT JUST ALL OF A SUDDEN WENT FROM THE ONE ANKLE TO EVERYTHING. AND I FOUND THAT I HAD TO CRAWL TO MY PARENTS' ROOM BECAUSE I COULDN'T GO TO WORK AND EVERYTHING HURT AND I WAS CRYING. AND SO I CALLED INTO WORK, AND YOU KNOW, I COULDN'T COME AND THEN BY TEN O'CLOCK I WAS FINE, I WAS WALKING AROUND, AND IT, IT DOES A LOT TO A PERSON'S PSYCHE BECAUSE YOU THINK, YOU KNOW, AM I JUST IMAGINING THIS? WHY AM I FINE NOW BUT NOT BEFORE?

Ed says WHEN THEY WAKE UP IN THE MORNING THEY FIND THEIR JOINTS EXTREMELY STIFF AND AS THE DAY WEARS ON THEY FEEL BETTER AND IT'S A SYMMETRICAL ARTHRITIS WHICH MEANS IT INVOLVES BOTH SIDES OF THE BODY AND PREDOMINANTLY THE SMALL JOIVET THE HANDS AND FEET BUT ALL JOINTS OF THE BODY CAN BE INVOLVED.

As fast clips show Jackie stretching, she says WHY WOULD SOMEONE WITH ARTHRITIS WANT TO RUN A MARATHON? AN EVENT THAT PUSHES EVEN COMPLETELY HEALTHY PEOPLE TO THEIR LIMITS? WELL, FIRST, THE MARATHON NO LONGER SEEMS LIKE AN EVENT FOR THE ELITE. IT SEEMS TO ME THAT EVERYBODY HAS EITHER DONE ONE OR IS TRAINING TO DO ONE. FOR GOD'S SAKE, EVEN OPRAH'S DONE ONE. IT WASN'T ACTUALLY UNTIL HE USED THE TERM DISEASE THAT IT REALLY HIT HOME. I ALMOST STARTED CRYING IN HIS OFFICE. I THOUGHT OH, MY GOD. LIKE THAT'S, THAT'S WHAT IT IS. IT'S A DISEASE. AND IT'S... I DON'T KNOW, SOMETHING ABOUT THAT WORD REALLY STRUCK HOME.

Ed says THE REASON WHY RHEUMATOID ARTHRITIS IN ITS EARLY STAGES IS DIFFICULT TO DIAGNOSE IS BECAUSE IT ACTUALLY SPREADS OVERTIME FROM ONE JOINT TO ANOTHER TO ANOTHER. SO INSTEAD OF BEING THIS SYMMETRICAL OR ON BOTH SIDES AND MANY JOINTS OF THE HANDS AND FEET, THAT'S THE FINAL POSITION THAT THE PATIENT FEELS.

Jackie says IT'S FRUSTRATING FOR ME IN PARTICULAR, BECAUSE PEOPLE DON'T SEE THE DISEASE WHEN THEY LOOK AT ME. LIKE THEY DON'T SEE ANY SIGNS OF IT, SO THEY JUST ASSUME THAT YOU'RE, THAT YOU'RE OKAY. AND THEN JUST MAKE THE ASSUMPTION THAT YOU CAN DO THINGS THAT EVERYBODY ELSE CAN DO WHEN IT'S JUST, IT'S NOT TRUE.

A clip shows her holding a toothbrush with both hands to brush her teeth.

She says ONE ROUTINE THAT'S REALLY, I FIND A BIT OF A CHALLENGE FOR ME IS... THIS IS PARTICULARLY IN THE EVENING HOURS WHEN I'M GOING BED, BRUSHING MY TEETH. I CAN'T... BECAUSE I DON'T HAVE THE GRIP STRENGTH TO HOLD THE TOOTHBRUSH IN A NORMAL WAY, USUALLY WHAT I DO IS I EITHER TUCK MY LITTLE FINGER UNDER MY TOOTHBRUSH TO GET A TIGHTER GRIP TON OR I ACTUALLY HAVE TO BRUSH MY TEETH WITH TWO HANDS. ANOTHER THING IS JUST GOING DOWN THE STAIRS LATE AT NIGHT, USUALLY. IT CAN BE REALLY DIFFICULT. I HAVE TO HOLD ONTO BOTH SIDES OF THE STAIRS, SO IT'S KIND OF LIKE A LITTLE KID WHEN THEIR LEGS ARE TOO SHORT AND THEY GO DOWN ONE STEP AT AUTO TIME. OR EVEN JUST IN THE MIDDLE OF THE NIGHT, LIKE USING... LIKE QUITE OFTEN I USE MY TEETH TO PULL YOU UP THE SHEETS IN THE BEDSPREAD BECAUSE I DON'T HAVE THE STRENGTH IN MY HANDS TO DO IT. HEY, WE ALL DEAL WITH PERSONAL CHALLENGES DIFFERENT WAYS. I USE HUMOUR. LAUGHTER CAN CURE JUST ABOUT ANYTHING, AND I TRY TO PUSH MY LIMITS. THAT'S WHY MY ARTHRITIS ARE OUT HERE AT MILE 13.

A short clip shows her running at night.

Ed says THE EARLIER YOU TREAT, THE MORE LIKELY YOU ARE TO RESPOND TO THERAPY. IT IS MORE DIFFICULT TO DIAGNOSE EARLY ON, BUT IF YOU HAVE JOINT SWELLING AND EVEN IF IT DOESN'T MANIFEST COMPETELY SO A ALL THE JOINTS ARE INVOLVED BUT YOU HAVE A SENSE THAT THIS IS RHEUMATOID ARTHRITIS, THEN OFTEN YOU WILL TREAT BECAUSE THERE ARE REAL PROBLEMS ARE COMPLICATIONS IF YOU DO NOT TREAT EARLY. WE ARE MORE AGGRESSIVE IN OUR THERAPY. WE USE COMBINATION THERAPY EARLY ON BECAUSE WHAT WE'RE TRYING TO DO IS PREVENT IRREVERSIBLE DAMAGE. CURRENTLY FOR RHEUMATOID ART LIGHT TIS IN TERMS OF THERAPY THERE IS NO CURE. BUT THERE ARE MED KAILGS THAT CONTROL THE ILLNESS, REDUCE THE SWELLING, REDUCE THE PAIN AND STIFFNESS, PROVIDE THE PATIENT A BETTER QUALITY OF LIFE, AND NOW, EVEN MORE THAN EVER, STOP THE PROGRESS OF DAMAGE AND DESTRUCTION TO THE JOINT.

Jackie says COMPARED TO SOME FOLKS MY OWN AGE WITH ARTHRITIS I'M DOING QUITE WELL. I'M RUNNING. A ALONE IS REASON FOR JOY. BUT I'M ONLY DOING WELL BECAUSE OF THE EIGHT TO 14 PILLS I SWALLOW DAILY. I KNOW THAT SOME OF THESE PILLS HELP EASE THE PAIN. SOME ARE DISIB DESIGNED TO HELP SLOW THE PROGRESSION OF THE DISEASE AND SOME ARE TO PREVENT THE DEBILITATING SIDE EFFECTS OF THE ONES THAT EASE PAIN. DOES IT EVER END? I'M NOT SO SURE. AND TO THINK AT ONE TIME I HAD ISSUES WITH THE FLINTSTONE CHEWABLE VITAMINS. IF ONLY FRED AND WILMA COULD SEE ME NOW?

In the living room, Jackie says IN SPITE OF ALL MY PROBLEMS OR MY ISSUES WITH MY JOINTS I'M RUNNING THE MARATHON BECAUSE IT'S IT'S A PERSONAL CHALLENGE THAT I'VE ALWAYS WANTED TO ACCOMPLISH, AND I'VE NEVER BEEN ONE REALLY TO LET MY DISEASE STOP ME FROM DOING THINGS.

Ed says THE CONCEPT OF IMPROVING EARLY DIAGNOSIS IS VERY IMPORTANT, AND WILL IS A PATIENT-PARTNER PROGRAMME WHICH IS A PROGRAMME IN WHICH PATIENTS LEARN TO TEACH PHYSICIANS ABOUT RHEUMATOID ARTHRITIS AND HOW TO DIAGNOSE IT AT LEAST AT THE BEDSIDE. I MUST ADMIT THAT EDUCATION IS PROBABLY THE MOST IMPORTANT ISSUE THESE DAYS TO TEACH THE PRIMARY OR FAMILY PHYSICIAN TO LOOK FOR JOINT SWELLING AND THE SIGNS AND SYMPTOMS OF RHEUMATOID. THAT'S WHERE WE'RE GOING TO DIAGNOSE IT EARLIER IF WE CAN DO TWO THINGS. HELP THE PHYSICIAN DIAGNOSE IT QUICKER BY UNDERSTANDING HOW TO FIND IT AND THEN ALSO MAKE THE FAMILY DOCTOR AWARE THAT THIS IS A SERIOUS, POTENTIALLY DESTRUCTIVE AND DAMAGING DISEASE SO THAT THEY SHOULD REFER TO THE RHEUMATOLOGIST OR SPECIALIST ONCE THAT DIAGNOSIS IS MADE.

Clips show Ed examining an elderly woman in a doctor's office.

He continues
WHEN WE LOOK AT THE PATIENT, WHAT WE'RE TRYING TO DO IS ASK HOW MUCH INFLAMMATION IS THERE, HOW MUCH DAMAGE IS THERE AND HOW MUCH FUNCTION IS THERE. SO WE LOOK AT THE JOINTS FOR INFLAMMATION, THE REDNESS, HEAT, SWELLING. WE LOOK AT THE JOINTS FOR THEIR RANGE OF MOTION WHICH IS THE FUNCTION AND THEN LOOK AT THE JOINTS FOR DAMAGE. THAT IS, IS ONE BONE GRINDING AGAINST ANOTHER? IS THERE DEFORMITY? AND THOSE ARE THE KINDS OF WAYS THAT WE ASSESS A PATIENT.

As he examines the woman, Ed says CAN YOU YOU MAKE A FIST FOR ME? GREAT. MAKE A FIST. OPEN YOUR FINGERS UP FOR ME. BEND YOUR WRIST DOWN. GOOD. BEND YOUR WRIST BACK. GREAT.

Jackie says I THINK MY ADVICE TO PEOPLE WHO ARE JUST BEING DIAGNOSED WITH IT OR EVEN WHO HAVE HAD IT FOR A LONG TIME IS TO JUST NOT LET IT RULE YOUR LIFE. KNOW THAT THERE'S THINGS THAT YOU CAN ACCOMPLISH IF YOU WANT TO.

Ed says THIS IS THE MOST EXCITING TIME EVER IN THE HISTORY OF THE TREATMENT OF RHEUMATOID ARTHRITIS. THERE HAS NEVER BEEN A TIME IN OUR HISTORY OF TREATMENT WHERE WE HAVE MORE HOPE FOR OUR PATIENTS. NEVER! BECAUSE WE HAVE MANY MORE MEDICATIONS. WE HAVE BETTER MEDICATIONS. WE KNOW HOW TO DIAGNOSE IT EARLIER, AND THEREFORE WE ARE DOING MORE FOR OUR PATIENTS FOR PREVENTING DAMAGE AND DESTRUCTION AND PREVENTING DISABILITY THAN WE'VE EVER DONE BEFORE.

Jackie says WE'RE EACH DEALT A HAND THAT IS ACCOMPANIED BY CHALLENGES. SOME MORE DIFFICULT THAN OTHERS. THIS IS MINE. FOR SOME REASON I FEEL THE NEED TO PROVE TO MYSELF, AND PERHAPS OTHERS THAT I'VE NOT BEEN BEATEN BY MY DISEASE. BUT I'M STILL ABLE TO DO THE EVERYDAY THINGS AND ACCOMPLISH MY PERSONAL GOALS. ONE OF WHICH IS COMPLETING A MERIT TON... MARATHON. MY IDEAL GOAL? FOR THE MARATHON WOULD BE THE FINISH IN LESS THAN FIVE HOURS.

Fast clips show Jackie completing a marathon. She smiles and cheers, as other participants congratulate her.

The clips end.

Back in the studio, Maureen says A POSTSCRIPT NOW, LAST JANUARY JACKIE SONG COMPLETED A 26 MILE MARATHON IN 4:56. CONGRATULATIONS AGAIN, JACKIE. IF YOU HAVE RHEUMATOID OR OSTEOARTHRITIS I'M SURE YOU HAVE QUESTIONS ABOUT TREATMENTS, AND THE MAN WITH THE ANSWERS IS Dr. ED KEYSTONE, A rheumatologist AND DIRECTOR OF THE CENTRE FOR ADVANCED THERAPEUTICS IN ARTHRITIS AT MT. SINAI HOSPITAL IN TORONTO.

A caption reads "416-484-2727. 1-888-411-1234."
Then, it changes to "moretolife@tvo.org"

Maureen says WELCOME BACK. HI.

Ed says HI.

Maureen says SO YOU YOU SAY IN THAT PIECE THIS IS ONE OF THE MOST EXCITING TIMES FOR THERAPIES IN HUMAN I HAD TO ARTHRITIS.

Ed says IN THE HISTORY OF THE TREATMENT OF ARTHRITIS. ABSOLUTELY.

Maureen says SINCE WE LAST TALKED ABOUT THIS, UPPED TO TALK ABOUT REMECAID AND EMBRIL.

The caption changes to "Doctor Ed Keystone. Rheumatologist."

e says EMBRIL JUST CAME ON THE MARKET FOUR TO SIX WEEKS AGO. THE OTHER IS ASSUMED... SOON TO BE ON THE MARKET IN THE NEXT MONTH OR SO I CAN'T TELL YOU EXACTLY WHEN BUT THOUGHT IS WITHIN THE NEXT COUPLE OF MONTHS IT SHOULD BE ON THE MARKET.

Maureen says GO OVER THIS FOR US. WHY ARE YOU SO EXCITED ABOUT THESE PARTICULAR THERAPIES.

Ed says THESE ARE NEW THERAPIES WHICH ARE GENETICALLY ENGINEERED, CREATED ESSENTIALLY FROM LIVING TISSUE, IN A SENSE. THEY ARE SELECTIVELY TARGETING OR GOING AFTER WITHIN THE BODY THE ABNORMAL ELEMENT THAT DRIVES INFLAMMATION IN THE BODY. AND ONE OF THE MAJOR HORMONES... IT'S ACTUALLY RELEASED FROM IMMUNE CELLS, IS CALLED TMF, TUMINOCROSIS FACTOR. TMNF, TUMOR NECROSIS FACTOR. WE ALL HAVE IT, USE IT TO PROTECT US AGAINST INFECTIONS BUT IN RHEUMATOID ARTHRITIS IT IS PRODUCED EXCESS. BUT IT IS LIKE THE OIL ON A FIRE, IT'S DRIVING THE FIRES, TURNING ON THE CELLS, RECRUITING THE CELLS INTO THE JOINT RELEASING CHEMICALS, IT CONTROLS OTHER HORMONES THAT CONTINUE TO AMPLIFY OR TURN ON THE IMMUNE SYSTEM. SO IT'S IN A SENSE SOMETHING LIKE THE GENERAL OF THE IMMUNE SYSTEM, NOT QUITE. IT'S SOMETHING LIKE THE ORCHESTRATOR, YOU KNOW, WHO RUNS THE ORCHESTRA. SO IF YOU THINK ABOUT IT IN THAT WAY, IF YOU CAN TARGET THAT PERSON THAT'S LEADING THE BAND, TO SOME EXTENT, THEN YOU TEND TO DAMPEN THE IMMUNE SYSTEM AND WE KNOW THAT TNF IS A MAJOR CULL PRINT... CULPRIT, IT'S THERE IN EXCESS. THESE MEDICATIONS BRING THE HORMONE DOWN TO A MORE NORMAL LEVEL AND 45E7 HEP TO SHUT OFF THE FIRE, HEAT, REDNESS AND SWELLING AND DO IT SUPREMELY WELL AND LET ME TELL YOU THEY DO IT QUICKLY. MOST OF THE OTHER DISEASE MODIFYING DRUGS, LIKE METHITREAIDE, PLAQUIN, THEY CAN ACTUALLY ALTER THE NATURAL COURSE OF THE DISEASE TO PREVENT JOINT DAMAGE. THESE DRUGS, THE NEW AGENTS, INSTEAD OF WORKING OVER MONTHS, THEY TAKE WEEKS TO START TO WORK IN A WEEK IN TWO WEEKS, THREE OR FOUR WEEKS, THE PATIENT FEELS BETTER, THAT'S FEELING OF GOOD HEALTH. THAT'S FEELING OF WELL-BEING THAT WE HAVE NOT SEEN BEFORE WITH ANY OF THE OTHER AGENTS EXCEPT CORTISONE OR HIGH DOSE PREDNISONE WHICH HAS MANY MANY SIDE EFFECTS SO RAPID ACTING, VERY EFFECTIVE, NOT ONLY TO RELIEVE SYMPTOMS, MAKE THE PATIENT FEEL BETTER, REDUCE THE SWELLING, BUT SUBSTANTIALLY PREVENT THE DAMAGE FROM OCCURRING. PROGRESSION.

Maureen says NOW HOW IS IT GIVEN? IT'S NOT AN ORAL THING, IS IT?

Ed says IT IS NOT AN ORAL THING. ENBRIL, OR TENECEPT IS GIVE UNDER THE SKIN TWICE A WEEK AND REMECAID IS GIVEN INTRAVENOUSLY INITIALLY TWO WEEKS, SIX WEEKS AND THEN EVERY TWO MONIES. ONE IS AN EVERY TWO WEEKS INTRAVENOUS INFUSION THAT TAKES ABOUT TWO HOURS AND EMBRILL IS GIVEN UNDER THE SKIN TWICE A WEEK EITHER BY THE PATIENT THEMSELVES OR THE FAMILY PHYSICIANS.

Maureen says AND I KNOW THIS IS HARD, BECAUSE THERE ARE SO MANY MODIFYING FACTORS BUT WHAT HAS BEEN THE SUCCESS RATE OF THESE TWO THERAPIES IN THE CLINICAL TRIAL SFS.

Ed says WELL, IN TERMS OF THE GOLD START... IF WE LOOK AT METHITREX. AIDS THE GOLD STANDARD, AND THAT'S THE ONE WE'VE HAD UP UNTIL NOW, IT WORKS EXTREMELY WELL BUT HAS A SIGNIFICANT NUMBER OF SIDE EFFECTS. THE SIDE EFFECT PROFILE OF THESE MEDICATIONS SO FAR, IN THE SHORT TERM... REMEMBER, THEY'VE REALLY ONLY BEEN OUT FOR A COUPLE OF YEARS, THREE FOUR YEARS, IN OTHER WORDS THERE ARE A NUMBER OF PATIENTS OUT TO FOUR YEARS, THEIR SIDE EFFECT PROFILE IS MUCH BETTER THAN METHITREXAID, SO THEY'RE SAFER YET THEY DO WORK AS WELL YET THEY WORK QUICKER, AND THEY ARE SHOWN TO HAVE IMPROVEMENT IN TERMS OF JOINT PROGRESSION. THAT IS PROGRESSING... PREVENTING PROGRESSION OF JOINT DAMAGE SO WITH METHITREXAID YOU DON'T ALWAYS FEEL SO GOOD. MAY HAVE A HEADACHE, NAUSEA, THE LIVER TESTS YOU HAVE TO WATCH IT SUPPRESSES THE IMMUNE SYSTEM. WITH THESE THEY DO SUPPRESS THE IMMUNE SYSTEM TO SOME EXTENT BUT THEY HAVE THAT FEELINGING OF WELL BEING, GOOD HEALTH, THEY FEEL LIKE DOING MORE AND IT'S DIFFERENT THAN THAT FEELING THEY HAVE WITH METHITREXADE. I DON'T WANT TO KNOCK METHITREXADE, IT IS THE GOLD STANDARD BUT THIS DOES IT A LITTLE SOONER AND MAKES THE PATIENTS FEEL BETTER.

Maureen says WILL YOU BE ABLE TO AFTER THIS TO ALL PATIENTS ONCE THEY COME ONLINE?

Ed says PART OF THE ISSUE IS COST. THESE MEDICATIONS ARE MUCH MORE COSTLY THAN METHITREXAID. IN GENERAL THE INSURANCE COMPANIES HAVE BEEN VERY GOOD IN ALLOWING THE PAYMENT FOR THE PATIENT. THE PROBLEM IS BECAUSE THEY'RE IN THE ORDER OF WE'LL SAY 12,000 TO 16,000 dollars PER YEAR IT MEANS IF YOU'RE 80 percent COVERED THERE'S A SIGNIFICANT PROPORTION YOU MAY HAVE TO PAY SO SOME PEOPLE CAN'T AFFORD TO PAY THAT ON THE OTHER HAND, TRILLIUM, YOU KNOW, IS AVAILABLE. IT'S THE ONTARIO BENEFIT WHERE BY THEY MAY BE ABLE TO HELP WITH COVERAGE, SO PEOPLE ARE APPLYING TO THAT AS WELL. AND I MUST SAY, THE ONTARIO DRUG BENEFIT PLAN HAS RECENTLY ACCEPTED EMBRILL FOR PATIENTS OVER 65 WHO HAVE RHEUMATOID ARTHRITIS SO EVEN THE ONTARIO DRUG BENEFIT HAS SAID YOU KNOW WHAT? THIS IS A NEW AGENT, AN IMPORTANT AGENT, AND THEREFORE WITHIN WEEKS OF IT COME COMING ON THE MARKET, THEY HAVE ACCEPTED IT FOR PATIENTS OVER 65. SO HOW WE APPLY FOR THAT, WE'RE STILL WORKING THROUGH THE SYSTEM, ALL THE PAPER WORK AND LOGISTICS, BUT IT LOOKS QUITE GOOD THAT PATIENTS UNDER 65 WHO ARE INSURED, AND THAT'S GENERALLY ABOUT 90 percent OF THE POPULATION OR 80 percent, AND THEN THOSE PATIENTS OVER 65 WILL HAVE ACCESS THIS.

Maureen says NOW, THAT'S ALL THE GOOD NEWS ON THE RHEUMATOID ARTHRITIS FRONT. WHAT ABOUT OSTEOARTHRITIS? ANYTHING NEW THERE?

Ed says WELL ACTUALLY WHAT'S EXCITING ABOUT OSTEOARTHRITIS IS THE IDEA THAT WE ARE DEVELOPING... NOT ME PERSONALLY, I COULD BE A MILLIONAIRE IF I WERE, BUT I'M NOT. THEY'RE DEVELOPING MEDICATIONS THAT HAVE THE ABILITY TO SLOW THE PROGRESSION. I.E. DISEASE-MODIFYING DRUGS. AND THERE ARE A NUMBER OF AGENTS NOW BEING TESTED IN THE CLINIC TO SEE IF YOU CAN PREVENT PROGRESSION OF OSTEOARTHRITIS. PRIOR TO THIS TIME WE SIMPLY RELIEVE THE SYMPTOMS, THE PAIN AND THE STIFFNESS. ONE OF THE MOST EXCITING THINGS WAS WHAT WE CALL THE COX-2 NON-STER ROIDAL ANTI-INFLAMMATORIES WHICH ARE MUCH SAFER. OSTEOIS A CONDITION IN THE ELDERLY AND WHEN OVER 65 YOU TEND TO HAVE A HIGHER FREQUENCY WITH NON-STER ROIDAL DRUGS OF ULCERS. WHICH MADE IT MORE COST EFFECTIVE IN TERMS OF SAFETY BUT NOW WE'RE LOOKING BEYOND SAFETY. IT SEEMS THEY'RE SAFE, WE'RE PROTECTING PATIENTS AND RELIEVING SIM STOMS NOW WE WANT TO STOP PROGRESSION. WE'RE DOING A STUDY RIGHT NOW OF AGENTS THAT HAVE THE POTENTIAL TO PREVENT OSTEOART TIGHT TIS FOR EXAMPLE INY. WE DON'T KNOW IF IT WORKS. THESE ARE TRIALS WHERE YOU USE A REAL AND FAKE DRUG. ALL I CAN SAY THE PHILOSOPHY, SCIENCE BEHIND IT LOOKS GOOD. NOW WE HAVE TO PROVE IT. SO IT'S A NEW ERA FOR US WHERE WE'RE THINKING OF PREVENTING THE MOST COMMON TOMORROW OF OSTEOARTHRITIS.

Maureen says OSTEO AND RHEUMATOID ARTHRITIS ARE OUR TOPICS TODAY WITH Dr. ED KEYSTONE.

A Caller says STARTED TO HAVE ALL THESE SIGNS THAT YOU'RE TALKING ABOUT SPREADING ALL OVER MY BODY. IT STARTED FROM THE NECK, AND THE KNEES AND THEN IT STARTED TO GO ALL OVER, AND I HAVE ALL THESE SIGNS AND I'M WONDERING, IF A TRAUMA TO THE BODY CAN CAUSE THAT OR AM I GOING TO END UP TO HAVE RHEUMATOID ARTHRITIS?

Ed says GOOD QUESTION. SO LET ME ANSWER THE QUESTION. NOW FIRST OF ALL, I HAVEN'T TAKEN A HISTORY OR EXAMINED YOU, SO I CAN'T ANSWER ALL OF THE QUESTIONS IN DETAIL, BUT WHAT I CAN SAY IS IT'S NOT UNUSUAL, IF SOMEONE HAS A CAR ACCIDENT AND INJURIES THEIR NECK AND BACK FOR PAIN TO BECOME WIDESPREAD. AND THERE IS A CONDITION WHICH WE CALL WIDESPREAD SORT OF PAIN ALL OVER SYNDROME WHICH MEANS THAT YOU DON'T SLEEP WELL AT NIGHT, YOU HAVE POOR ENERGY, YOU HAVE FATIGUE, THE WEATHER BOTHERS YOU AND IT'S GENERALLY PAIN EVERYWHERE. IT DOESN'T MEAN IT'S ARTHRITIC BUT IT'S CERTAINLY PAIN FROM ALL OVER AND USUALLY STEMS FROM THE PECK AND BACK. THE NECK CAN CAUSE PAIN INTO THE SHOULDERS AND ARMS, BACK PAIN CAN CAUSE PAIN INTO THE LEGS AND THEN IT GENERALIZES. YOU DON'T SLEEP WELL, YOU HAVE MORE PAIN, MORE PAIN, DON'T SLEEP WELL, AND IT'S A VICIOUS CYCLE AND I THINK YOU NEED A RHEUMATOLOGIST OR A FAMILY PHYSICIAN TO DIAGNOSE WHETHER THIS IS TRULY ARTHRITIS AND IT MAY BE SOME WEAR AND TEAR CHANGES OR WHETHER IT'S AS A CONSEQUENCE OF THE ACCIDENT YOU'VE TRIGGERED THIS WIDESPREAD PAIN PROBLEM. AND THERE ARE... YOU TAKE A HISTORY, YOU EXAMINE YOU, YOU FIND OUT IF ANY OF THE JOINTS ARE SWOLLEN OR WHETHER IT'S ALL MUSCLE AND BACK AND NECK. AND THEN THE IDEA IS TO PROVIDE BETTER SUPPORT FOR YOUR NECK, BETTER SUPPORT FOR YOUR BACK, AND REALLY TO IMPROVE YOUR SPINE. BECAUSE ONCE THE "SPORTS INE'S" IMPROVED, ONCE YOUR SLEEP IS BETTER, THEN THINGS TEND TO SELT DOWN. I CAN'T SAY YOU'RE GOING GET RHEUMATOID FOR AN ACCIDENT BECAUSE I DON'T BELIEVE THAT FOR SECOND. WHAT I DO BELIEVE IS AN ACCIDENT LIKE THAT CAN TRIGGER THIS PAIN ALL OVER PROBLEM.

Maureen says RHEUMATOID IS DIFFERENT FROM OSTEOIN THAT RHEUMATOID IS WHAT, I GUESS CONGENITAL, WOULD YOU CALL IT? YOUR BORN WITH IT?

Ed says WELL YOU'RE BORN WITH A PREDISPOSITION. YOU HAVE THE GENETIC PREDISPOSITION. SO WE KNOW PATIENTS ARE BORN WITH THE GENES FOR IT AND THEN SOMETHING ELSE, A BUG, BACTERIA, VIRUS, TRIGGERS THE PROCESS THERE. IS A HEREDITARY ELEMENT ALSO IN OSTEOARTHRITIS BUT NOT QUITE THE SAME AS IN RHEUMATOID BUT WE KNOW THERE ARE HEREDITARY ELEMENTS. THE KEY DIFFERENCE BETWEEN OSTEO AND RHEUMATOID IS THAT RHEUMATOID IS A LOT OF INFORMATION, CELLS COMING IN, RERELEASING ENZYMES, COMING IN AND INVADING CHEWING UP THE TISSUES. OSTEOARTHRITIS IS A MORE OF A WEAR AND TEAR PROBLEM BUT WE DON'T UNDERSTAND THE WEAR AND TEAR AND WHERE IT OCCURS. IT'S NOT JUST AGE-RELATED. YES IT OCCURS IN A HIGH PROPORTION OF PEOPLE OVER 65 BUT NOT EVERYBODY GETS IT. AGE IS A FACTOR. WE KNOW HORMONES... ESTROGENS MAY BE PROTECTIVE IN SOME WAY AS A FACTOR, AND NOW WE'RE BEGINNING TO ASK THE QUESTION THAT THERE IS SOME INFLAMMATION THERE. NOT AS MUCH AS RHEUMATOID, THERE ARE SOME ENZYMES RELEASED, SOME CELLS THERE. SO IT'S MILD INFLAMMATION IN THE CONTEXT OR THE IN... IN THE CONTEXT, I WOULD SAY, OF A WEAR AND TEAR PROCEDURE. WE STILL DON'T UNDERSTAND WHY THAT WEARING TAKES PLACE.

Maureen says OKAY, THANKS JENNY FOR YOUR CALL. WAIN IN SARNIA. HELLO WAYNE.

The Caller says HI, THANKS FOR TAKING MY CALL. I WOULD LIKE TO SAY I WAS ON A TEST FOR REMICAID, AT TORONTO GENERAL HOSPITAL, SEVEN OF US WERE AND FIVE OF US GUYS WERE DOING SUPER AND TWO OF US WEREN'T DUE TO OUR LENGTH OF DURATION WITH THE S. ONDRLITIS. I MYSELF HAVE HAD IT 30 YEARS AND I WOULD LIKE TO AND THE DOCTOR WHAT HIS COMMENTS ARE FOR THE REMICAID AND THE TIME HAVING IT WITH ANKYLOSINGSPONDILITS.

Ed says GOOD QUESTION. THIS IS A CONDITION OF THE SMALL JOINTS AT THE SPACE OF THE SPINE AND FUSES OVERTIME, THE INFLAMMATION CAUSES STIFFNESS AND THE SPINE CAN FUSE, LITERALLY FUSE, NEW BONE FORMATION CAN OCCUR AND YOU CAN ACTUALLY ALMOST HAVE A CEMENTED SPINE OVER MANY YEARS. IT OCCURS IN MEN PREDOMINANTLY. AT LEAST IT'S CLINICALLY SEEN IN MEN YET WOMEN HAVE IT AS WELL BUT THEY HAVE A MIRLD CONDITION SO IT'S OFTEN MISSED. IT STARTS USUALLY IN THEIR 20s, GOES THROUGH THE REST OF YOUR LIFE BUT USUALLY BY THE MID-40s YOU TEND TO BURN OUT TO SOME EXTENT. REMECAID, AN ANTITNF ANTIBODY, IT'S AN ANTIBODY, WE ALL HAVE ANTY BODIES, A GENETICALLY ENGINE EARED ANTIBODY, PART MOUSE, PART MAN, 75 percent MOUSE, 75 percent MAN, THAT'S THE MOL MOLECULE, GIVEN INT VENUESLY TO PATIENTS AND LOWERS THE. A TNF IN PATIENTS. NOW IT DOESN'T WORK IN EVERYONE AND WE DON'T UNDERSTAND WHY THAT IS AND THERE COULD BE TWO REASONS. ONE, THERE MAY NOT BE ENOUGH INFLAMMATION SO THAT THE TNF MAY NOT BE THERE A LOT BECAUSE THE DAMAGE HAS OCCURRED AND THE INFLAMMATION HAS SETTLED SO YOUR SPINE COULD BE TUSD, YOU DON'T HAVE A LOT OF INFLAMMATION BUT YOU HAVE A LOT OF JOINT DAMAGE FROM PREVIOUSLY THEREFORE WITHOUT MUCH TNF AROUND THE ANTI-TNF MAY NOT WORK WELL. NUMBER TWO, WE KNOW 25 OR 30 percent OF PATIENTS PARTICULARLY WITH RHEUMATOID ARTHRITIS, NO MATTER WHAT ANTI-TNF AGENT OR BLOCKER YOU ADD, THEY DON'T GET BETTER SO THE QUESTION IS WHY NOT? AND IT'S A VERY IMPORTANT QUESTION, AND YOU RAISE AN IMPORTANT ISSUE RIGHT NOW, IS IT BECAUSE THERE ARE OTHER HORMONES OTHER THAN TNF PLAYING AN IMPORTANT ROLE? AND WE DON'T KNOW THE ANSWER. BUT IF TNF ISN'T IMPORTANT IN SOME PATIENTS AND IT IS IN OTHERS, CLEARLY IF TNF IS IMPORTANT IN CAUSING DISEASE IN CERTAIN PATIENTS THEN A TNF BLOCKER WILL WORK. IF THERE'S SOME OTHER HORMONE PLAYING AN IMPORTANT ROLE TNF IS NOT, AN ANTI-TNF AGENT OR ANTAGONIST WILL NOT WORK. THERE ARE STUDIES ONGOING AS WE SPEAK TO UNDERSTAND WHAT'S GOING ON, PARTICULARLY KEY QUESTION RIGHT NOW, WHAT'S GOING ON PARTICULARLY IN THOSE PATIENTS THAT DON'T RESPOND? IS IT BECAUSE TNF ISN'T THERE? IS IT BECAUSE ANOTHER HORMONE IS DRIVING THE INFLAMMATION? SO YOU ASK ALL THE RIGHT QUESTIONS. WE DON'T KNOW THE ANSWERS BUT IT'S A MAJOR AREA FOR RESEARCH RIGHT NOW.

Maureen says ALL RIGHT. THANK YOU, WAYNE.

She reads from the laptop and says
NANCY IN NIAGARA-ON-THE-LAKE WONDERS WHAT INFORMATION YOU CAN OFFER ON THE STUDIES THAT ARTHRITIS CAN BE TREATED AND SOMETIMES CURED BY GOING ON MILD ANTIBIOTICS FOR SIX MONTHS TO A YEAR. HAVE YOU HEARD OF THIS?

Ed says OH I HAVE. I'VE HEARD THIS A LOT AND IN FACT I MUST SAY I HAD SOMETHING TO DO WITH THIS BECAUSE A NUMBER OF YEARS AGO WE ACTUALLY DID STUDIES TO SHOW IN EARLY RHEUMATOID ARTHRITIS THE IMMUNE CELLS IN PATIENTS WITH RHEUMATOID ARTHRITIS SEEMED TO RECOGNIZE BACTERIA, E. COLI BACTERIA, THE KIND THAT YOU HAVE IN YOUR GUT AND THEY HAD AN ABNORMAL RESPONSE TO IT AND WHAT'S HAPPENED FROM THAT STUDY IS THAT A COLLEAGUE OF MINE IS ACTUALLY DOING A VACCINE NOW AND INJECTING VACCINE INTO PATIENTS TO ALTER THEIR IMMUNE SYSTEM AWAY FROM THESE BACTERIA IN SOME RESPECTS WHICH THEY THINK COULD BE IN FACT DRIVING THE INFLAMMATION. SO YES THERE IS EVIDENCE BACTERIA MIGHT PLAY A ROLE BUT IT COULD BE BACTERIAL PIECES, THAT IS DEAD BACTERIA, NOT LIVE BACTERIA, IN WHICH CASE ANTIBIOTICS AREN'T GOING TO DO ANYTHING. IF THE LITTLE PIECES OF BACTERIA COME IN, THEY GET LODGED IN YOUR JOINT AND THEY'RE NOT LIVING, THEY'RE JUST SORT OF FRAGMENTS, THEN AN ANTIBIOTIC ISN'T GOING TO WORK. I REMIND YOU OF TWO THINGS. NUMBER ONE, ANTIBIOTICS HAVE THE CAPABILITY, SUCH AS MINICYCLINE TO ACTUALLY PREVENT INTHRAMMATION. NOT JUST KILL BUGS BUT ACTUALLY IS AN ANTI-INFLAMMATORY. THERE IS EVIDENCE MINISYCLINE CAN PREVENT CARDIAC AND... CARTILAGE AND JOINT DAMAGE. SO WHEN YOU TAKE IT YOU MIGHT THINK YOU'RE TAKING IT TO GET RID OF THE BUG FOR BACTERIA THAT'S CAUSING THE PROBLEM BUT YOU MAY IN FACT BE TAKING A MORE POTENT ANTI-INFLAMMATORY SUPPRESSING THE IMMUNE SYSTEM AND PREVENTING ENZYMES FROM BEING RELEAD. AT THE PRESENT TIME WE DO NOT HAVE STRONG DATA TO SAY LIVE BACTERIA ARE CONTINUING TO CAUSE OR PERPETUATE RHEUMATOID ARTHRITIS. WE THINK THEY PLAY A ROLE, THE FRAGMENTS MAY PLAY A ROLE, THE DEAD BUGS OR PIECES OF BACTERIA, WE HAVE NO IDEA YET WHETHER AN ANTIBIOTIC PER SE IS DOING IT BECAUSE IT'S KILLING BUG AS OPPOSED ANTI-INFLAMMATORY. THERE IS SOLID DANGER IN THE LITERATURE THAT SAYS MINICYCLINE DOES WORK IN RHEUMATOID ARTHRITIS. THERE'S DATA THAT SAYS IT REDUCES SWELLING, PAIN AND MAY EVEN PREVENT JOINT DAMAGE. THEY'RE BONA FIDE TRIALS, HAVE A PLACE BOW AND REAL. ALL THE SCIENTIFIC CREDIBILITY. MY BELIEF IS, PERSONAL BELIEF ONLY, IS THAT THEY WORK BEST IF THEY'RE GOING TO WORK, WITHIN THE FIRST-YEAR OR TWO OF DISEASE AND BY THE TIME YOU HAVE TWO OR THREE YEARS OF DISEASE I'M NOT CERTAIN THEY WORK VERY WELL. I'VE USED THEM A BIT. I DID A TRIAL OF IT ABOUT TEN YEARS AGO IN ABOUT 13 PATIENTS. THEY WERE LATE DISEASE IT DID NOT WORK. MY ADVICE IS IF YOU WERE GOING TO DO IT, AND I WOULD SAY WITH A RHEUMATOLOGIST... BY THE WAY, THESE MEDICATIONS, THE ANTIBIOTIC HAD SIDE EFFECTS, DIARRHEA, PROBLEMS WITH THE BOWL, NAUSEA, ET CETERA. WITH THE HELP OF A PHYSICIAN SUCH AS A RHEUMATOLOGIST, I THINK IT'S WORTH A TRY, PARTICULARLY IN THE FIRSTIER OR TWO OF DISEASE. AFTER THAT, I'M NOT CONVINCED IT WORKS THAT WELL.

Maureen says OKAY, THANK YOU NANCY. BONNIE IN KITCHENER. HI BONNIE.

The Caller says HI, HOW ARE YOU?

Maureen says GOOD THANKS. AND WHAT'S YOUR QUESTION?

The Caller says MY QUESTION IS THAT MY MOM WAS ON VIOX. THEY TOOK HER OFF BECAUSE SHE ONLY HAS ONE KIDNEY AND IT SEEMS TO BE SHUTTING IT DOWN BECAUSE THEY'RE ALSO BLASTING HER WITH MANY ANTIBIOTICS BECAUSE SHE HAD A REREPLACEMENT OF A HIP AND IT WAS VERY INFECTED AND THEY HAD TO GET OUT AND THEY'LL HAVE TO REREPLACE THE HIP LATER ON AND AT THIS POINT THEY'VE TAKEN HER OFF THE VIOX AND IN FOUR DAYS HER ARTHRITIS IS SO PAINFUL AND PROGRESSING THAT WE'RE TRYING TO DECIDE WHAT WE CAN PUT HER ON IN PLACE OF IT THAT'S NOT GOING TO INTERFERE WITH THE KIDNEYS SO BADLY. IS THERE SOMETHING THAT WE CAN TRY?

Ed says YOU YOU ASK A VERY IMPORTANT QUESTION. VIOX IS ONE OF THE SAFE, NON-STEROIDAL ANTIINTHRAM TREE DRUGS THAT WORKS TO HELP PREVENT ULCERS IN THE STOMACH. BUT THERE ARE OTHER THINGS NON-STEROIDALS CAN CAUSE. THEY CAN CAUSE FOR EXAMPLE THE PLATELETS, WHICH ARE THOSE STICKY CELLS IN THE BLOOD TO BE LESS STICKY. THEREFORE THEY CAN INCREASE THE RISK OF BLEEDING. THAT'S WHAT ALL NON-STEROIDALS CAN DO AND ALSO AFFECT THE KIDNEY BLOOD FLOW. ALL NON-STEROIDALS CAN DO THAT. WHEN THE OXY-2 CAME ON THE MARGE KET WE HOPED NOT ONLY WOULD THEY PREVENT ULCERS WHICH THEY HAVE DONE VERY WELL, BUT THEY WOULD HAVE LESS EFFECT ON CAUSING THIS PROBLEM IN THE BLOOD AND LESS PROBLEMS WITH THE KIDNEY. IT TURNS OUT IT IS NOT SO. ALL OF THE NEW COX-2s AND THE TRADITIONAL NON-STEROIDAL ANTI-INFLAMMATORY DRUGS HAVE THE SAME PROBLEM. WE HAVE A RISK OF CAUSING KIDNEY FAILURE SO I MUST TELL YOU RIGHT NOW IF WHAT YOU'VE TOLD ME ABOUT, I WOULD NOT PUT YOUR MOTHER ON ANOTHER ANTI-INFLAMMATORY BECAUSE THERE IS NO SAFE ANTI-INFLAMMATORY FOR THE KIDNEYS. THERE IS NO SAFE ANTI-INFLAMMATORY. SO WHAT CAN YOU DO? UNFORTUNATELY YOU HAVE TO USE PAIN RELIEVERS. YOU HAVE TO USE THINGS LIKE TYLENOL, MAYBE CODEINE, DARVON. THESE ARE A NUMBER OF ANTI-INFLAMMATORIES... THESE ARE A NUMBER OF PAIN RELIEVERS. JUST REMEMBER THOUGH PEOPLE THINK OVER THE COUNTER THEY CAN TAKE A PAIN RELIEVER, FOR EXAMPLE, LIKE MOTRIN. IT TURNS OUT MOTRIN, OR ALEEVE WHICH IS NAPRISIN, ADVIL IS MOTRIN, ALEEVE IS NAPROSIN, CALLED PAIN KILLERS, BUT THEY'RE NON-STEROIDAL.

Maureen says SO THAT WOULDN'T BE GOOD FOR THE KIDNEY.

Ed says SO DON'T THINK WHEN YOU GO OVER THE COUNTER AND SAY I'M GOING TO TAKE A DOSE OF ADVIL OR A DOSE OF ALEEVE AND I'VE GOT A KIDNEY PROBLEM THAT YOU'RE GOING TO DO OKAY. THE TRUTH IS THOSE ARE NON-STEROIDALS THAT CAN HAVE A PROBLEM WITH YOUR KIDNEY. WHAT CAN I SAY? STAY AWAY FROM FIGURE THAT'S A NON-STEROIDAL USE AN ANALOGIES SICK OR PAIN KILLER AS BEST YOU CAN. IT'S A DIFFICULT PROBLEM AND I ADMIT IT.

Maureen says DOES THIS MEAN CELEBRANTS OF VIOX HAVEN'T LIVED UP TO... I DON'T WANT CALL IT HYPE, WHEN THEY WERE FIRST RELEASED.

Ed says WELL LET'S ASK WHAT THE HYPE WAS. THE HYPE WAS WERE THEY BETTER IN TERMS OF MORE EFFECTIVE? IN TERMS RELIEVING PAIN AND STIFFNESS? NO THEY'RE EXACTLY THE SAME. THEY NEVER SAID THEY WERE GOING TO BE MORE EFFECTIVE, THEY SAID THEY WERE GOING TO BE SAFER. THE GUT OR THE BOWL, THE STOMACH WAS THE KEY AREA, BECAUSE WHAT THEY DO IS THEY PROTECT THE STOMACH AGAINST ULCERS. THEY LIVED UP TO THAT. THEY'VE REDUCED ULCERS BY AT LEAST 50 percent OR 60 percent AND WE'RE UNCLEAR RIGHT NOW BUT THEY MAY BRING RIGHT DOWN TO THE LEVEL, LIKE A PLACE BOW LEVEL AS IF YOU NEVER HAD A NON-STEROIDAL. SO WE DON'T KNOW IF IT TAKES IT DOWN TO 500 BECAUSE YOU AND I AREN'T ON NON-STEROIDALS BUT MAY DEVELOP AN ULCER. WHAT WE DO KNOW IS THEY SUBSTANTIALLY REDUCE THE RISK OF ULCERS PARTICULARLY IN THE HIGH RISK GROUP AND LET ME REMIND YOU WHO THE HIGH RISK GROUP IS. ANYBODY OVER 65 ON A NON-STEROIDAL, NO MATTER IF THEY HAD ULCER OR NOT IN THE PAST ARE HIGH RISK. BEING OVER 65 IS HIGH RISK. ON PREDNISONE AND A NON-STER RAIDAL IS HIGH RISK. TAKING TWO NONE STEROIDALS, ADVIL PLUS ANOTHER ANTI-INFLAMMATORY, TWO NON-STEROIDALS, HIGH RISK. ANYBODY WITH SERIOUS LUNG OR HEART DISEASE RVELT AND THERE'S EVEN A RISK OF ONE BABY ASPIRIN A DAY FOR HEART DISEASE PLUS ANOTHER NON-STEROIDAL. THOSE ARE TWO NON-STEROIDALS. SO WE KNOW THAT EVEN ASPIRIN INCREASES YOUR... THAT ONE ADAY TO PROTECT YOUR HEART INCREASES YOUR RISK. SO IF YOU'VE EVER HAD AN ULCER AND THEN YOU TAKE ONE ASPIRIN A DAY TO PREVENT HEART ATTACKS AND STROKES, THAT'S A PROBLEM. YOU BETTER MAKE SURE THAT YOU ARE PROTECTED EVEN AGAINST THAT ONE ASPIRIN A DAY.

Maureen says BUT THE KIDNEY THING WAS LESS COMMON? THE KIDNEY PROBLEM WAS LESS COMMON...

Ed says WELL YOU ASK A KIDNEY SPECIALIST, HE SAYS HEY, YOU GUYS ARE KNOCKING OFF MY KIDNEYS. C? BECAUSE THEY SEE ONLY THOSE PEOPLE WITH KIDNEY PROBLEMS. WE SEE SOME KIDNEY PROBLEMS BUT WE SEE IT PARTICULARLY IN THE ELDERLY. WHEN DO WE SEE IT? PEOPLE DEHYDRATED, LOSING FLUID IN THE SUMMER. PEOPLE, FOR EXAMPLE, THAT ARE IN HEART FAILURE. PEOPLE IN LIVER FAILURE ARE PARTICULARLY PRONE AND PEOPLE THAT HAVE UNDERLYING KIDNEY DISEASE ALREADY ARE PRONE TO HAVING PROBLEMS WITH THEIR KID MES WITH NON-STEROIDALS. ANYBODY DEHYDRATED, LOSING FLUID, RUNNERS IF THEY'VE GOT A KIDNEY PROBLEM, YOU TAKE A NON-STEROIDAL, YOUR KD KNEE FUNCTION COULD BE DRAMATICALLY ALTERED. SO THE KIDNEY HAS NOT LOVED UP TO THE EXPECTATION BUT WE NEVER NOW FOR SURE. WE KNEW THE STOMACH BUT KIDNEYS AND BLOOD VESSELS SO FAR ARE IN AN AREA WE HAVE TO HAVE RESEARCHED.

Maureen says ALL RIGHT, LET'S JUST RECAP WHAT WE'RE DOING THIS AFTERNOON. OUR GUEST IS RHEUMATOLOGIST Dr. ED KEYSTONE. IF YOU HAVE QUESTIONS ABOUT ARTHRITIS, GIVE US A CALL.

The phone numbers and email reappear briefly.

Maureen says ANOTHER ONE ABOUT HUMAN I HAD TO.

She reads from the laptop and says
I'M 37 YEARS OLD. MY MOTHER IS 60. SHE HAS AN EXTREME CASE OF RHEUMATOID, SEVEN REARLY DEFORMED, POOR IMMUNE RESULTING IN BLOOD INFECTIONS. I HEARD YOU SAY INDIVIDUALS ARE PREDISPOSED AND A BUG MAY TRIGGER IT. COULD IT BE SOMETHING AS SIMPLE AS THE FLU? IS THERE A TEST I CAN TAKE TO FIND OUT IF I HAVE THAT GENE?"

Ed says THE ANSWER IS RHEUMATOID ARTHRITIS IS HEREDITARY. WE DON'T KNOW THE TRIGGER FOR RHEUMATOID ARTHRITIS SO WE DON'T KNOW WHAT ACTUALLY CAUSES IT. WE THINK IT'S A VIRUS BUT WE DON'T KNOW. YOU COULD DO A TEST, AND WE COULD FIND OUT WHETHER YOU ARE THEN PREDISPOSED TO RHEUMATOID ARTHRITIS. BUT THE PROBLEM IS CARRYING THAT GENE DOES NOT MEAN YOU'RE GOING TO GET RHEUMATOID ARTHRITIS BECAUSE ABOUT 25 percent OF THE POPULATION CARRY THE RHEUMATOID ARTHRITIS ANDEEN THEY'RE FINE THE REST OF THEIR LIFE BUT ANOTHER PROPORTION OF PATIENTS WILL CARE RIGHT GENE AND THEN IT WILL TRIGGER, SO TRULY, I WOULDN'T WANT TO KNOW THAT I'M CARRYING A GENE THAT I'LL HAVE NO IDEA WHETHER I'M GOING TO GET IT OR NOT. IF YOU SAY AM I MORE PREDISPOSED TO GET RHEUMATOID ARTHRITIS? YES, BECAUSE YOUR MOTHER HAD IT YOU ARE MORE PREDISPOSED. SIGNIFICANTLY MORE PREDISPOSED? NOT THAT MUCH MORE. EXAMPLE, IF YOU HAVE RHEUMATOID ARTHRITIS AND YOU HAVE CHILDREN, YOU'VE GOT ABOUT A 5 percent CHANCE OF YOUR CHILDREN GETTING RHEUMATOID. SO YOU YOU IN FACT HAVE TO HAVE ABOUT 20 CHILDREN TO HAVE ONE THAT WILL DEVELOP RHEUMATOID ARTHRITIS SO IT'S HEREDITARY IN A ABOUT A FIVE TO TEN PERCENT PASSING DOWN THE LINE BUT IT'S NOT SOMETHING THAT I WOULD WANT TO HAVE ALL MY PATIENTS HAVE, IS THESE TESTS TO SEE IF THEY'RE SUSCEPTIBLE, BECAUSE ALL THEY DO THEN IS WALK AROUND SAYING "OH, MY GOD, I WONDER IF I'M GOING GET IT."

Maureen says EVERY COLD OR VIRUS...

Ed says EXACTLY, AND I CAN'T TELL THAT YOU A COLD OR VIRUS CAN TRIGGER THIS, WE HAVE NO IDEA BUT WE DO KNOW THERE ARE LOTS OF PEOPLE WALKING AROUND WITH THE RHEUMATOID ARTHRITIS GENE THAT NEVER GET IT.

Maureen says WHAT IF GENE THERAPY MOVES ALONG AND SOME DAY YOU CAN MANIPULATE THAT gene SOMEHOW.

Ed says DIFFERENT STOREROOM. WHEN YOU CAN DO THAT AND YOU CAN ALTER THE GENE, THEN I HAVE NO PROBLEM SAYING NOW LET'S FIND OUT. AND WE SHOULD GET INTO GENETICS FOR A MINUTE WITH YOU TO APPRECIATE THAT GENETICS ARE REALLY GOING TO CHANGE THE WAY WE THINK ABOUT THERAPY IN THE NEXT 10 TO 15 YEARS. AND THE REASON INTO IS THEY HAVE NEW TECHNOLOGIES, BECAUSE OF THE GENOME PROJECT, THEY HAVE NEW TECHNOLOGIES WHICH ARE CALLED GENE CHIPS WHERE I CAN TAKE... YOU KNOW, THERE ARE ABOUT 30,000 GENES IN THE BODY, RIGHT? THAT CAN BE SWITCHED ON OR OFF AT WILL AT ANY TIME. SOME SWITCH ON, SOME OFF. AND THE PATTERN OF WHETHER THEY SWITCH ON OR OFF DETERMINES HOW YOU ARE. WEATHER YOU HAVE TOO MUCH HORMONE, TOO LITTLE HORMONE, GET INFLAMMATION OR NOT. IT TURNS OUT THERE ARE THESE GENE CHIPS WHERE I CAN TAKE 10,000 OF YOUR GENES, PUT THEM ON A LITTLE CHIP ABOUT THIS BIG LIKE TEENY TINY AND SEE WHAT GENES ARE TURNED ON AND TURNED OFF. AND THE REASON WHY IT'S IMPORTANT IS THE PATTERN WE BELIEVE... NOT PROVEN YET, BUT THE PATTERN OF THOSE GENES SWITCHING ON AND OFF WILL TELL US ONE, WHO'S SUSCEPTIBLE TO DISEASE, TWO, WHO'S SUSCEPTIBLE TO BE WORSE THAN BETTER, IF YOU HAVE RHEUMATOID, BECAUSE YOU HAVE GOOD RHEUMATOID, WHICH IS MILD DISEASE, AND SEVERE DISEASE. SO WE'LL BE ABLE TO DO A GENE PROFILE AND TELL YOU WHETHER YOU'RE GOING TO DO WELL OR POOR POURLY, AND THEN HOW AGGRESSIVE TO TREAT YOU, AND EVEN MORE IMPORTANT, EVERY MAJOR COMPANY, PHARMACEUTICAL COMPANY NOW ARE LOOKING AT WHAT'S CALLED PHARMACO GENOMICS AND THEY WILL DO THE TEST AND TELL YOU HOW YOU RESPOND OR DON'T RESPOND, YOUR GENES DUE TO A PARTICULAR AGENT. MY BELIEF, TEN YEAR FROM NO WE'RE GOING TO DO A GENE SCREEN ON YOU ON THIS CHIP, IF YOU'VE GOT RHEUMATOID ARTHRITIS AND IT WILL TELL US YOU SHOULD TAKE THIS DRUG BECAUSE THIS ONE WILL WORK. THIS ONE WILL NOT. THIS WILL AND THIS WILL NOT SO WE WILL SCREEN HOW YOU ARE TREATED BASED ON YOUR GENETICS AND IT'S MOVING FORWARD, IT'S MOVING VERY QUICKLY.

Maureen says ALL RIGHT. OKAY, LET'S SEE WHAT Sylvie WOULD LIKE TO KNOW, SHE'S IN OTTAWA. HI SYLVIE.

The Caller says HI. I HAVE FIBROMYALGIA AND MY MOTHER HAS SEVERE RHEUMATOID ARTHRITIS. I WANTED TO KNOW HOW CLOSELY THEY ARE RELATED AND IF WE CAN SEE THE DIFFERENCE TO SEE IF LATER I CAN HAVE RHEUMATOID ARTHRITIS OR NOT.

Ed says THAT'S AN EXCELLENT QUESTION. THERE IS NO RELATIONSHIP DIRECTLY BETWEEN HAVING RHEUMATOID ARTHRITIS AND THEN SOMEONE ELSE DEVELOPING FIBROMYALGIA IN THE FAMILY BUT FINE BRA MALL A GENTLEMAN IS A PROBLEM WITH PAIN ALL OVER. WE MENGHTSED THAT BEFORE. NECK, BACK, MUSCLES. RHEUMATOID ARTHRITIS CAN TRIGGER FIBROMYALGIA. SO YOU CAN HAVE TWO CONDITIONS. RHEUMATOID ARTHRITIS AND THEN BECAUSE YOU HAVE ACHES AND PAIN IN YOUR NECK AND BACK AND JOINT YOU DON'T SLU SLEEP WELL. YOU DON'T SLEEP WELL, YOU START GETTING PAIN ALL OVER. IN OTHER WORDS, IT'S THIS WIDESPREAD PAIN PROBLEM. BUT EVEN IF YOU HAD WIDESPREAD PAIN PROBLEMS, SUCH AS WE JUST TALKED ABOUT, OR FIBROMYALGIA, IT DOES NOT MEAN YOU'RE PREDISPOSED TO HUMAN ROID ARTHRITIS. PEOPLE WITH RHEUMATOID CAN GET SECONDARY PAIN ALL OVER BUT PEEB HE WILL WHO HAVE FIBROMYALGIA ARE NOT NECESSARILY PREDISPOSED TO GETTING RHEUMATOID ARTHRITIS.

Maureen says SIMILAR IN THAT NOBODY'S SLEEPING WELL WHEN YOU HAVE THOSE.

Ed says YOU GOT IT. THEY DID A STUDY... IF YOU WEREN'T IN THE STUDY YOU WEREN'T HAPPY. THEY TOOK MEDICAL STUDENTS, KEEP THEM UP, PUT LITTLE ELECTRODES ON THEM AND GAVE THEM A LITTLE STILL LUTZ JUST AS THEY WENT INTO THE DEEPEST SLEEP SO IT KEPT THEM JUST AT A LOW LEVEL OF SLEEP AND COULDN'T GET DEEP, THEY STARTED TO WAKE UP TIRED, FATIGUED AND DEVELOPED MANY OF THE SYMPTOMS YOU SEE WITH fibromyalgia OF COURSE IT WAS ETHICAL, THEY SIGNED CONSENTS AND EVERYTHING AND THEY DIDN'T GO ON AND GET LONG-TERM FIBROMYALGIA BUT THEY COULD REPRODUCE SO FINDINGS OF FIBROMYALGIA SIMPLY BY NOT GIVING YOU A DEEP ENOUGH SLEEP.

Maureen says WOW SO THE CHICKEN AND EGG THING.

Ed says YEAH, YES.

Maureen says A QUESTION...

Maureen reads from the laptop and says "I HAVE BROTHER WHO IS 38 YEARS OLD AND BEEN DIAGNOSED WITH SCORIATIC ARTHRITIS. HE'S PRESENTLY ON METHITREXAID AND TOOK QUITE SOMETIME FOR HIM TO BE DIAGNOSED. HE HAS A LOT OF PAIN AND HAS HAD LITTLE IMPROVEMENT. ARE THERE ANY OTHER MEDICATIONS EFFECTIVE FOR THIS TYPE OF ARTHRITIS?

Ed says AN EXCELLENT QUESTION. A QUESTION ABOUT PSORIATIC ARTHRITIS. REMEMBER PSORIASIS, THE SCALEY LESIONS, SKIN CHANGES ON THE ELBOWS, KNEES, AND SCALP AND WE KNOW 5 percent OF PATIENTS WITH BONA FIDE PSORIASIS WILL DEVELOP ARTHRITIS SO YOU HAVE THE PSORIASIS AND THEN CAN GET ARTHRITIS. IT CAN BE JUST LIKE RHEUMATOID ARTHRITIS, VERY SIMILAR BEING OR THERE VERY PATTERNS OF THE ARTHRITIS THAT ARE A LITTLE BIT DIFFERENT. THE IMPORTANT FACTOR IS THIS, TUMOR NECK CROWS SIS FACTOR PLAYS A ROLE IN THIS ARTHRITIS. THEREFORE, IF METHITREXAID FAILED, GIVE NOT NECESSARILY BY MOUTH, BECAUSE HE AT THE HIGHER DOSES YOU LIKE TO GIVE IT UNDER THE SKIN OR IN THE MUSCLE BUT IF IT FAILS AT HIGH DOSE MY THOUGHT WOULD BE WHY NOT CONSIDER ONE OF THE TUMOR NECROSIS FACTOR OR BLOCKING EIGHTS? BECAUSE THERE'S NOW GOOD DATA TO SAY THEY WORK QUITE WELL IN THIS ARTHRITIS AS WELL AS RHEUMATOID.

Maureen says AND YOU WERE SAYING THE GREAT THING EARLIER ABOUT THOSE IS THEY DON'T HAVE THE SIDE EFFECTS. JUST BECAUSE IT DIDN'T WORK IN HIM DOESN'T MEAN THE OTHER WON'T WORK?

Ed says NO, IN FACT THE STUDIES SHOW IN A TOP LAIGS OF PATIENTS WITH SEVERE DISEASE, IF YOU ADD REMICAID OR EMBRILL YOU WILL HAVE A SUBSTANTIAL NUMBER OF PEOPLE CONTINUE TO IMPROVE BEYOND THE LEVEL OF IMPROVEMENT ALREADY WITH METHITREPAID AND IN ONE STUDY WITH EMBRILL, 90 percent OF THE PATIENTS FAILED WITH METHITREXAID AND WENT THEY WENT ON EMBRILL 72 percent OF THE PATIENTS DID WELL, HAD A CLINICAL RESPONSE. AND 50 percent IN THE SKIN, THE SKIN LESIONS GOT 50 percent BETTER. SO THE PSORIATIC LEAGUES IMPROVED BY 50 percent ON AVERAGE IN PATIENTS THAT WENT ON THESE TNF BLOCKING AGENTS.

Maureen says AND THE PAIN?

Ed says SAME, IMPROVE. REMEMBER WHAT I SAID. IT DOESN'T WORK IN EVERYBODY. A PROPORTION OF PATIENTS DON'T SPOON. IT TURNS OUT... AS I SAID, 70 percent OF PATIENTS WHO WERE ON EMBRILL DID VERY WELL BUT 25 OR 30 percent OF THE PATIENTS DIDN'T RESPOND SO IT'S NOT ALL OR NONE. IT'S A PROPORTION OF PATIENTS WILL DO WELL. SOME BETTER THAN OTHERS, BUT IF THEY'RE NOT DOING WELL ON METITREXAID, IF IT MY SISTER, BROTHER, COUSIN, UNCLE OR CHILD, I WOULD SERIOUSLY CONSIDER THE POSSIBILITY OF REMICAID OR EMBRILL. SHOULD I REMIND YOU, THERE'S ANOTHER NEW MEDICATION ON THE MARKET, LAFLUDIMIDE, IT'S A VERY GOOD, DOES PROTECT AGAINST JOINT INPANELMATION, HAS MORE SIDE EFFECTS I BELIEVE THAN REMICAID OR EMBRILL BUT IT IS ALSO A NEW AGENT. I WANT TO BE BROAD, TO RECOGNIZE THAT WILL IS A MULTIPLICITY OF NEW MEDICATIONS. AREBA IS A CHEMICAL, RATHER THAN A BY LOGIC, THAT IS IT'S NOT CREATE FROM LIVING TISSUE AS REMICAID AND EMBRILL-DRRB

Maureen says HOW DO YOU TAKE THAT ONE?

Ed says PILLS.

Maureen says SEE, I LIKE THAT ONE. RIGHT AWAY I'M ATTRACTED TO IT. I DON'T WANT TO GO TO THE HOSPITAL AND SIT THERE FOR TWO HOURS. TARA IS IN TORONTO.

The Caller says HI MAUREEN AND Dr. KEYSTONE. I REALLY WANTED TO THANK YOU. YOUR SHOWS ARE VERY VERY INFORMATIVE AND THEY HELP A LOT.

Maureen says THANK YOU.

The Caller says Dr. KEYSTONE I SUFFER INTEREST ENDOMETRIOSIS AND I'VE BEEN DIAGNOSED WITH RAYNODE SYNDROME WHERE MY FINGERS BASICALLY TURN PURPLE CAN ALSO WITH FIBROMYALGIA BUT I FEEL I HAVE THE SYMPTOMS OF RHEUMATOID, BUT ALL MY BLOOD TESTS AND EVERYTHING HAVE COME BACK AS NEGATIVE IN TERMS OF ARTHRITIS. HOWEVER WHENEVER THE WEATHER... I CAN ACTUALLY PRICK THE WEATHER, I SWEAR, AND I ACTUALLY GET VERY ACHY, STIFF, AND I FEEL LIKE MY BODY IS LEAD. AND I WANT DO GET SOME SWELLING IN MY ANKLES, BUT IT'S USUALLY AFTER SOME FORM OF WALKING, SO IT DOESN'T, IT DOESN'T SPONTANEOUSLY HAPPEN AND IT'S USUALLY AFTER I'VE WALKED. SO I DO HAVE SOME SPELLING SWELLING. SO I'M WONDERING, YOU KNOW, ARE THE BLOOD TESTS REALLY A TRUE INDICATOR OF WHETHER SOMEONE HAS RHEUMATOID OR NOT?

Ed says GOOD QUESTION. EXCELLENT QUESTION. THE ANSWER IS NO THE BLOOD TESTS MAY BE RIGHT 50 percent OF THE TIME OR LESS. IN FACT I DON'T DEPEND IN TERM THE OF MAKING A DIAGNOSIS ON RHEUMATOID ARTHRITIS ON BLOOD TESTS SO THERE IS SOMETHING CALLED THE RHEUMATOID FACTOR AND IT'S SEEN IN 75 percent OF PATIENTS WITH RHEUMATOID BUT 25 percent DON'T HAVE IT AND EARLY ON ONLY 20... EARLY ON MAYBE ONLY 50 percent OF PATIENTS WILL HAVE RHEUMATOID FACTOR. THERE'S ANOTHER TEST CALLED CES RATE, OR C.R.P., A TEST TO SEE HOW MUCH IS INFLAMMATION IN THED ABOUT DEEP. TRUTH IS MAYBE 60 percent OF THE TIME IT CORRELATES, 40 percent OF THE TIME IT DOESN'T. THE TRUTH IS TO MAKE A DIAGNOSIS IN RHEUMATOID ARTHRITIS, ALL YOU NEED TO DO... AND IT'S NOT THAT EASY, YOU HAVE TO HAVE A PHYSICIAN WHO KNOWS THE AREA, DO A HISTORY, A PHYSICAL EXAM AND IF THERE ARE SWOLLEN JOINTS AND NOT JUST TENDER JOINTS BUT IF THE JOINTS ARE SWOLLEN, AND I DON'T MEAN ANKLES THAT MIGHT BE SWOLLEN AT THE END OF THE DAY WHICH COULD BE RELATED TO VARICOSE VEINS AND IF THE JOINTS ARE PAINFUL AND SWOLLEN I WILL LIKELY CONSIDER A DIAGNOSIS OF RHEUMATOID ARTHRITIS. IF YOUR FAMILY PHYSICIAN IS UNCLEAR I WOULD SUGGEST YOU SEE RHEUMATOLOGIST AND LET THEM EXAMINE YOU. THE KEY TO MAKING A DYING KNOWS SIS OF RHEUMATOID IS A PHYSICAL EXAMINATION. BLOOD TESTS DO NOT MAKE THE DIAGNOSIS. HISTORY AND PHYSICAL EXAMPLE.

Maureen says WE SAW EARLIER IN THE PIECE THE JOINTS OF THE ONE WOMAN WHOSE HANDS YOU WERE LOOKING AT IN YOUR CLINICAL... IT WAS OBVIOUS THAT THOSE WERE ART DELIGHT PARTICULAR HANDS.

Ed says RIGHT, CORRECT.

Maureen says BUT EARLY ON IN THE DISEASE YOU DON'T SEE THAT.

Ed says NO, YOU WILL SEE SWELLING BUT YOU WON'T SEE DEFORMITY. AND IN RHEUMATOID ARTHRITIS ONE OF THE KEY THINGS ON HISTORY THAT DIFFERENTIATE FROM OSTEOARTHRITIS, RHEUMATOID, IF YOU SIT AND THEN GO TO GET UP, YOU'RE STIFF. SO IN OTHER WORDS IN THE MORNING THERE'S A LOT OF MORNING STIFFNESS, USUALLY WITHIN AN HOUR. SO THE LESS YOU DO, THEN START MOVING THE WORSE YOU ARE WITH RHEUMATOID. IT'S CALLED IMMOBILITY STIFFNESS. THE JOINTS GEL WHEN YOU'RE NOT DOING THINGS. WITH OSTEOARTHRITIS IT'S DIFFERENT. WHEN YOU'RE SITTING YOU FEEL BETTER BUT WHEN YOU GET UP AND DO THINGS, YOU'RE WORSE. OSTEO GETS WORSE WITH ACTIVITY, RHEUMATOID GETS WORSE AT LEAST FOR A WHILE AFTER YOU'VE BEEN SITTING. SO WHEN YOU TAKE THE HISTORY OF A PATIENT WITH RHEUMATOID THE CRITICAL QUESTION IS ARE YOU STIFF IN THE MORNING? NOT EVERYBODY IS. HOW LONG DOES IT LAST? IF IT LASTS MORE THAN AN HOUR OR SO, IT SUGGESTS AN INFLAMMATORY DISEASE SUCH AS RHEUMATOID AS OPPOSE ODD OSTEOARTHRITIS WHICH IS MORE WEAR AND TEAR AND HAS LESS GELLING AND STIFFNESS. THEY'RE MUCH WORSE THE MORE THEY DO, RHEUMATOID IS BETTER WHEN THEY GET MOVING.

Maureen says IS THAT TO SAY PEOPLE WITH OSTEOARTHRITIS SHOULD NOT EXERCISE? NO, I THINK THEY SHOULD EXERCISE. THEY SHOULD STRENGTHEN THE MUSCLE, PERHAPS IN THE LOWER LIMBS. STRENGTHEN THE MUSCLES OF THEIR LEG, CALVES, THIGHS, BUT ONE THING I WILL SAY, IF YOU HAVE OSTEOARTHRITIS IN THE HANDS AND HAVE KNO p.m. BLY FINGER, DON'T KNIT OR CROCHET, DON'T SQUEEZE A RUBBER BALL AND THINK YOU'RE DOING YOURSELF A LOT OF HELP BUT KEEPING THEM MOVING. THE MORE YOU MOVE THE HANDS AND THE SMALL JOINTS, THE WORSE IT IS. IN THE LOWER LIMBS, THE STRONGER THE MUSCLES ARE, AND YOU KEEP MOVING, THE BETTER IT IS. BUT IF YOU'VE GOT OST YOF THE KNEES I'M NOT GOING TO WANT YOU TO BE JOGGING. I DON'T MIND YOU TO BE BIKING, GETTING IN A POOL, BUT I WOULDN'T WANT YOU TO TO BE DOING A LOT OF IMPACT LOADING AND RUNNING ALONG WITH IMPACT THROUGH THOSE JOINTS.

Maureen says DO YOU SEE A FAIR NUMBER OF BALLERINAS IN YOUR PRACTICE?

Ed says I DON'T BUT I KNOW PEOPLE WHO DO. THERE ARE PEOPLE WHO ACTUALLY SEE A LOT OF BALLERINAS AND THEIR FEET ARE THE KEY PROBLEM. KEY PROBLEM. NOT JUST THE KNEES, THEIR FEET. THE BIG TOE, THEY'RE ON POINTE ALL THE TIME. THEY HAVE SOME OF THE MOST DIFFICULT PROBLEMS WITH THEIR FEET BECAUSE OF LOADING THEIR ENTIRE BODY WEIGHT THROUGH A SMALL AREA INSTEAD OF THROUGH THE WHOLE FOOT, THEY'RE UP ON POINTE AND CREATING PROBLEMS WITH THOSE JOINTS. IT'S A COMMON PROBLEM WITH BALLERINAS IS THE TOE JOINTS, BIG JOINTS IN THE FOOT.

Maureen says LET'S GO TO THIS E-MAIL FROM MICHAEL.

Maureen reads from the laptop and says WE HAVE A CASE OF J.R.A. WITHIN OUR FAMILY.

Ed says JURVE NILE RHEUMATOID ARTHRITIS.

Maureen says OUR SEVEN-YEAR-OLD HAS BEEN DIAGNOSED WITH IT LAST MONTH. PLEASE LET US KNOW WHETHER THE ANTITNF TREATMENT WHICH YOU'RE TALKING ABOUT NOW CAN BE APPLIED TO THE CASE OF J.R.A.

Ed says ANOTHER GOOD QUESTION. EXCELLENT QUESTION. THE ANSWER IS YES. STUDIES HAVE BEEN DONE IN THE UNITED STATES TO APPROVE EMBRIL, WHICH IS THAT TNF ANTAGONIST OR BLOCKER FOR THE TREATMENT OF JUVENILE RHEUMATOID ARTHRITIS. THEY HAD QUITE GOOD SUCCESS IN PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS THAT WERE NOT RESPONDING FOR EXAMPLE TO METHITR. XAID. SO WHAT WE GENERALLY DO IS PUT THEM ON CONVENTIONAL THERAPY. IF THEY'RE NOT RESPONDING THERE'S EXCELLENT DATA SO SAY EMBRIL IN PARTICULAR, BECAUSE IT'S THE ONLY ONE THAT'S ACTUALLY BEEN APPROVED FOR USE IN JUVENILE RHEUMATOID ARTHRITIS IN FACT DOES HELP PATIENTS QUITE SUBSTANTIALLY AND AT SICK CHILDREN'S HOSPITAL AND OTHER MAJOR CENTRES, THEY ARE USING THESE TUMOR NECROSIS FACTOR BLOCKING AGENTS. REMICAID, I CAN'T THINK OF ANY STUDIES RIGHT NOW, BUT I KNOW THEY'LL BE COMING UP AND WE WILL BE SEEING DATA IN THAT REGARD.

Maureen says OKAY. NEXT IS SUSAN IN TRENTON. HI SUSAN?

The Caller says HI, THANK YOU FOR TAKING MY CALL.

Maureen says YOU'RE WELCOME.

The Caller says I WAS DIAGNOSED WITH RHEUMATOID ARTHRITIS AND FIBROMYALGIA ABOUT TWO YEARS AGO. THE ARTHRITIS THROUGH BLOOD WORK AND EXAMINATION. NOW, I HAVE BEEN PUT ON PLAQUINIL AND ALSO ENDOMESESIN AND I TAKE THAT ON A REGULAR BASIS DAILY. NOW THE QUESTION IS THE PLAQUINIL, HOW SAFE IS FOR LONG-TERM TAKING? I'VE BEEN READING A LOT ABOUT EYE PROBLEMS THAT CAN...

Ed says OCCUR. WELL LET ME TELL YOU, PLAQUINIL IS THE SAFEST OF ALL OF THE CONVENTIONAL DISEASE-MODIFYING DRUGS. IT'S THE SAFEST, USED FOR MILD TO MODERATE DISEASE. WHEN IT'S MORE MODERATE INTO THE SEVERE RANGE PLAQUINIL DOESN'T WORK AS WELL, SO WORKS FOR EARLY IN THE MORE MILD CASES AND IS EXTREMELY SAFE IF IT'S USED IN THE RIGHT DOSE AND THE DOSE HAS TO DEPEND ON YOUR IDEAL BODY WEIGHT. NOT YOUR REAL BODY WEIGHT BUT YOUR IDEAL BODY WEIGHT AND THE WAY WE LOOK AT IT NOW IS WE FIGURE OUT WHAT YOUR IDEAL BODY WEIGHT IS AND THEN WE FIGURE OUT HOW MANY MILL BRAMS PER KILOGRAM OF IDEAL BODY WEIGHT AND WHAT WE SAY IS THE DOSE SHOULD BE IN THE ORDER OF 6.5 MILLIGRAMS PER KILOGRAM OF IDEAL BODY WEIGHT. IN THE PAST, THE PEOPLE TENDED TO BE A LITTLE OVERDOSED BECAUSE THEY USED TO LOOK AT THEIR REGULAR WEIGHT AND THAT WASN'T GOOD ENOUGH BECAUSE IT CREATED PROBLEMS. IF YOU LOOK AT YOUR IDEAL BODY WEIGHT AND CALCULATE THE DOSE ON THAT BASIS, AS FAR AS I'M CONCERNED IT'S EXTREMELY SAFE. YOU HAVE YOUR EYES CHECKED EVERY SIX MONTHS, YOU CAN USE AN EYE CHART AS WELL. I HAVE NO CONCERNS... OR VERY FEW CONCERNS ABOUT THE USE OF PLAQUINIL NOW IF IT'S DOSED ACCORDING TO YOUR IDEAL BODY WEIGHT IT. DOES WORK WELL IN MILD DISEASE. IT DOESN'T WORK AS WELL IN THE MORE SEVERE FORMS.

Maureen says THANK YOU, USE IS SAVELT TINA IS IN THORNHILL. HI TINA.

The Caller says YES, I HAVE OSTEOARTHRITIS AND I ALSO HAVE OSTEOPOROSIS. FOR THE OSTEOPOROSIS I'M ON ZETHOMAX AND ALSO I HAVE A HIATIS HERNIA SO I TAKE RANITIDINE TO HELP WITH THAT CANADA. MY DOCTOR GAVE ME ARTHROTECH, 20 MILLIGRAMS A DAY AND I STILL DIDN'T TAKE IT BECAUSE I'M CONCERNED ABOUT, YOU KNOW, THE PAINS I GET IN MY CHEST FROM THE HIATUS HERNIA SO WHAT DO YOU THINK OF THE TAKING THE ARTHROTECH WITH THIS DISMN.

Ed says WELL FIRST OF ALL, ARTHROTECH IS ONE OF THE BETTER NON-STER RAIDALS THAT IS PROTECTIVE, BECAUSE IT IS VOLTERRAN, BUT IT'S GOT A PROTECTIVE COATING AROUND IT CALLED CYTOTECH. IT DOES REDUCE THE INCIDENTS OF ULCERS. SO BEFORE THE COX-2s, THESE NEW AGENTS, VIOX AND CELEBREX CAME ON THE MARKET, THEY USED IN FACT ARTHROTECH, SO I THINK IT'S ONE OF THE SAFER NONE STEROIDALS IN THE CONTEXT OF SOMEONE HAVING A PROBLEM WITH THEIR SOLVE FUSS BUT IF YOU CONTINUE TO HAVE CHEST PAIN, YOU SEE YOUR FAMILY DOCTOR EVEN THOUGH YOU ARE TAKING RANITIDNE OR AN ANT AS SID TO MAKE SURE THERE'S NOTHING MORE SERIOUS GOING ON BEFORE YOU ADD THE ARTHROTECH. I DON'T LIKE THE IDEA SOMEONE WOULD STILL HAVE HEARTBURN OR ACID INDIGESTION AT TIME WHEN I'M ADDING ANOTHER NON-STEROIDAL ANTI-INFLAMMATORY DRUG.

Maureen says THIS LEADS TO A GOOD QUESTION. I REMEMBER I WAS ON A MUSCLE RELAXANT ONCE AND MY MOTHER SAID OH, YOU'VE GOT TO WATCH FOR STOMACH BLEEDING. HOW WOULD YOU KNOW IF YOU'RE HAVING ONE OF THOSE REACTIONS.

Ed says THAT IS A PROBLEM. DO YOU KNOW WHERE IT'S A PROBLEM? 90 percent OF PATIENTS WITH AN ULCER ARE ASYMPTOMATIC RELATED TO NON-STEROIDALS AND 60 percent OF PATIENTS BEFORE THEY BLEED OR PERFORATE OR BREAK THE BOWL HAVE NO SIM TOPICS SO THEREFORE THAT'S WHY WE'RE USING THESE NEW MEDICATIONS. NOW BLOOD IN THE STOOLS, BLACK, TARRY STOOLS, MEAN THAT THE BLOOD'S COMING HIGH UP FROM THE STOMACH AND THE SAS SID IN THE STOMACH TURNS THE BLOOD FROM RED TO BLACK AND COMES OUT AS TARRY AND THICK. AND WHEN THAT HAPPENS IT'S A PROBLEM AND OBVIOUSLY YOU DON'T WANT TO WAIT UNTIL YOUR BLOOD'S GONE DOWN ENOUGH SO YOUR LIGHT-HEADED AND DIZZY AND PAY. UNFORTUNATELY TUMMY UPSET IS A GUIDE. CRAMPS IS A PROBLEM, BLACK STOOLS IS CERTAINLY A CONCERN. GETTING YOUR BLOOD CHECKED ON A REGULAR BASIS IS A GOOD IDEA, EVERY THREE OR FOUR MONTHS. THE COMMONEST THING WE SEE FOR BLEEDING IS LOW GRADE BLEEDING WHERE THE BLOOD COUNT GOES DOWN. YOUR MIEHM GLOBE BIN DROPS AND EVERYBODY SAYS WHERE'S GONE? THE ANSWER IS IT'S LEAKING OUT THE BOWL BUT YOU DON'T GET THE TARRY STOOLS, LOTS OF BLOOD BACK THERE, IT'S JUST YOUR MIEHM GLOBE BIN'S DRIFTING DOWN. IT'S`...

Maureen says OKAY. THIS ONE'S ABOUT NUTRITION. I'VE HAD R.A. FOR A YEAR NOW AND I HAVE BEEN TAKING METHITREXAID, I KNOW TRADITIONALLY RHEUMATOLOGISTS DON'T PUT A LOT OF WEIGHT ON NUTRITION AND THE DISEASE BUT I'VE RECENTLY READ THREE DIFFERENT SOARS ABOUT HOW TO AFFECT R.A. WITH DIET. I'VE CUT OUT ALL DAIRY, CITRUS, NIGHTSHADE, EGGS AND I'VE FELT PROGRESSIVELY BETTER EACH WEEK AND HAVEN'T HAD TO TAKE VIOX FOR MORE THAN THREE WEEKS NOW. MAY SOUND LIKE QUACKERY BUT IT'S HELPED SO MUCH. I STILL TAKE MY MEDS REGULARLY. WHAT DO YOU THINK?

Ed says WELL I THINK THERE'S NOT ENOUGH RESEARCH IN THE AREA. AND I THINK THAT IF SOMEONE FEELS A LOT BETTER WITH NUTRITION BUT ARE STILL TAKING THEIR DISEASE MODIFYING DRUGS SUCH AS PLAQUINIL AND METHITREXAID, GO FOR IT. BUT THERE'S INTO THE LOT OF PROOF AND THERE HAVE ONLY BEEN A FEW STUDIES DONE ON FUTURE TRIGS THAT SAY IT DOES NOT SEEM TO MAKE A DIFFERENCE. WE'VE HAD MORE STUDIES BUT IF IT HELPS I WOULDN'T KNOCK IT, I WOULD DO IT. I WOULD JUST BE WORRIED TO SAY I'M NOW GOING TO USE NUTRITION AND DROP MY OTHER MEDICATIONS BECAUSE THOSE ARE PROVEN MODIFIERS OF JOINT DESTRUCTION. NUTRITION MAKES YOU FEEL BETTER, THERE'S NO PROOF THEY MODIFY THE DISEASE THEMSELVES.

Maureen says IS ANYONE GOING TO DO THOSE CLINICAL TRIALS IN.

Ed says GOOD QUESTION. YOU'D LIKE THE NUTRITION PEOPLE TO DO THAT THE ONES THAT SELL ALL THOSE PILLS BUT UNFORTUNATELY THERE'S NOT BEEN A LOT OF FUNDING FORTHCOMING. IF THERE WAS, WE WOULD LOVE TO DO THOSE KIND OF STUDY DS. WE'RE DOING SO MANY NEW THINGS IN RHEUMATOID ARTHRITIS IN TERMS OF BIOLOGICALS AND COME CALS, THE KEY IS THAT THAT'S SCIENTIFIC RATIONALE FOR DOING THESE STUDY, AND I CAN SAY YES, THERE IS, I'D BE DELIGHTED TO DO A STUDY WITH AN APPROPRIATE SCIENTIFIC BASIS, REAL VERSUS FAKE, SEE IF SOMETHING WORKS LIKE THAT HAPPY TO DO IT.

Maureen says WHAT WHAT IS THE BEST WAY FOR A PATIENT TO GET INVOLVED IN A CLINICAL TRIAL, THAT MAYBE RUNNING EITHER AT YOUR HOSPITAL OR OTHERS? HOW DO THEY FIND OUT ABOUT THAT?

Ed says IF IT'S OSTEOARTHRITIS, USUALLY THEY SEE THEIR FAMILY DOCTORS AND ASK IF THEY CAN BE REFERRED TO OUR CENTRE OR OTHER CENTRES. IF IT'S RHEUMATOID ARTHRITIS GENERALLY THEY'RE BEING FOLLOWED BY A RHEUMATOLOGIST, THEY SHOULD CALL THEIR RHEUMATOLOGIST AND SAY LOOK, I'VE SEEN THIS CENTRE, THEY HAVE NEW THERAPIES. AS I SAID, WE'RE DOING AN ENORMOUS NUMBER OF NEW THERAPIES IN RHEUMATOID TRYING TO PREVENT THE DAMAGE AND DESTRUCTION AND SEVERAL IN OSTEOARTHRITIS. CONTACT THE RHEUMATOLOGIST FOR RHEUMATOID ARTHRITIS. GENERALLY IF THEY'RE SEEING FAMILY DOC FOR OTH YO, THEY CONTACT THEM IF THEY SAY YES, COME DOWN, THEY SIMPLY CALL OUR UNIT OR THE FAMILY DOCTOR OR THE RHEUMATOLOGIST CAN SIMPLY REFER TO US.

Maureen says ALL RIGHT, I HOP YOU GET LOTS. THANK YOU FOR DOING THIS. GOOD TO SEE YOU.

Ed says THANK YOU.

Maureen says Dr. ED Keystone IS A RHEUMATOLOGIST AND CENTRE FOR ADVANCED therapeutics in arthritis AT MT. SINAI HOSPITAL IN ONTARIO.

A slate reads "The Arthritis Society, 1-888-321-1433, www.arthritis.ca"

Maureen says Thanks for watching this edition of More To Life. I'm Maureen Taylor, hoping you'll come back again, Monday through Friday at 1 o'clock.

A slate reads "The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances."

Watch: Arthritis