Question of the month


This month we are able to respond to 2 of our readers questions.

For this months answers we turn to Dr. Monique Camerlain who has more than 30 years of experience in rheumatology. Dr. Camerlain is the author of approximately 100 articles and some 200 medical presentations.

Question #1
from S. Attwater, United States...
"My mother has RA and has been put on the waiting list for a double hip replacement. The wait is about one year long and she is suffering with a lot of pain. Can you suggest anything for the pain?"
It is unfortunate that the medicare system permits a person in your mother's condition to suffer so long in pain. Furthermore the delay leads to other problems such as muscle wasting, osteoporosis, excess stress and possible damage to other joints compensating for the hips, clots in leg veins, skin ulcers, psychological distress and depression and care-giver burn-out.

Request that your mother be put on a waiting list for the surgery. Get any help you can to move her up on the list. Write your health minister and local MP and MPP to voice your concerns.

Physiotherapy will teach joint protection, muscle strengthening and range-of-movement exercises, pool therapy and use of walking aids such as forearm crutches. Occupational therapy will help modify environment to protect hips eg raised chairs and toilet seat, dressing and washing aids

The most effective and best tolerated nonsteroidal antiinflammatory drug should be used on a regular basis. They may be more effective in a suppository form overnight. Analgesics should also be used--sometimes regular doses of long-acting narcotics are needed. Acupuncture may help. Injection of the hip joints  with cortisone under radiological or ultrasound guidance may be effective and may need to be repeated. Maximum control of the rheumatoid arthritis is also important because some of the hip joint pain may be due  not only to damage but to inflammation. Measures to counteract osteoporosis are also advisable.

Question #2
from M. Ginger, New Zealand...

"I find that cutting out dairy helps reduce the frequency and severity of pain. Do dairy and other foods play a role in Sjogren's syndrome? "

It is estimated that up to 5% of patients with various forms of arthritis may worsen with certain foods. There is nothing specific about Sjogren's Syndrome. The commonest foods implicated in worsening rheumatoid arthritis-like conditions include dairy products; wheat, corn, beef; and tartrazine dyes. There are few good studies on this subject and they are difficult to do in a rigorous scientific manner.
A good study in an individual patient with rheumatoid arthritis worsened by dairy products is described in the following article: Panush RS, Stroud RM, Webster E: Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk. in the journal called "Arthritis and Rheumatism" , Volume 29, pages 220-226 in the year 1986.This article describes a patient diagnosed with rheumatoid arthritis who worsens after eating dairy products. The patient was better off dairy products but worsened on 4 blind challenges with milk products but not with other foods or placebo. Symptoms peaked 24 to 48 hours after each dairy challenge and then resolved by 3 days. These flare-ups were associated with immunologic hypersensitivity to milk as measured by tests of cellular and antibody immunity.
If eliminating dairy products definitely helps and ingesting them definitely worsens your joint symptoms, then avoid eating them. However, make sure you supplement your diet with adequate amounts of calcium and vitamin D.

Wishing you great health & good fortune,

 Peter Ballantine


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