Do you take your arthritis meds with fruit Juice?

November 23, 2012

Do you take your arthritis med with fruit Juice?

If yes, think again. Fruit juice may not let you achieve remission…..
And why is that So?

Many fruits, especially grapefruit juice & possibly orange, starfish, Seville apple juice affect the absorption of methotrexate from the intestine.

Methotrexate is absorbed in the intestine by a pump called OATP. These juices contain chemicals that block this pump & decrease absorption of methotrexate. Grapefruit also blocks CY 350 which affects other meds.

So now that we know about this, what can we do?

1) Avoid taking methotrexate with any fruit juice.
2) Keep a gap of at least 2 hours between methotrexate fruit & any fruit juice.


Rheumatoid Arthritis: The journey from ‘no treatment’ to ‘drug free remission’

November 15, 2012

Not bothered about me crying in pain,
That Physician with great name & fame,
Gave the disease he cannot cure,
A name!

Is this what Rheumatoid Arthritis treatment all about?
Are Rheumatologists just giving name to a disease for which they do not have any treatment & cure?
Mind you, these lines were penned almost 150 years back.

We have come a long way since then.
In the early years, symptomatic therapy (pain control & patient’s feeling of well being) was all that was available. We had aspirin & steroids. Slowly multiple other anti inflammatory meds became available; but the treatment concept remained the same.

Slowly, the destructive potential of rheumatoid arthritis was realised. This stimulated the search for means to modify the disease course. This is when DMARDs (Disease Modifying Anti Rheumatic drugs) came into the picture. Armed with evidence, Rheumatologist shifted gears from the ‘conservative wait & watch’ approach to the much more aggressive ‘early diagnosis, early aggressive targeted treatment’. This literally translated into ‘will not tolerate any harm’ approach. Biologics came in handy for Rheumatologists to achieve this goal.

The change in mindset coupled with effective medicines enabled us to aim for remission in a disease that was thought to be the one without effective treatment.  Recent studies have already shown that even ‘drug free remission’ is possible.

The existence of ‘drug free remission’ was discussed at length at this year’s American College of Rheumatology Conference. Doubts about its real world definition, longetivity, recurrence of RA definitely do exist.

Nevertheless, we have come a long way; from ‘no effective treatment’ to ‘drug free remission’ Collateral damage in the form of cardiovascular events, osteoporosis is also well recognised & prevention strategies are getting refined. Patients be rest assured that better things are in store for them.

Few years from now & you may find me tweeting & blogging about sustained drug free remission. All the very best & wish everyone remission……


Is twitter the best place to know what’s happening at ACR 2012?

November 12, 2012

The annual conference of the American College of Rheumatology (ACR) is a  mega conference with thousands of delegates from across the globe &  multiple lectures running simultaneously. It is an annual pilgrimage for all the Rheumatologists with the aim of updating themselves.

However, even if one attends the conference, it is practically impossible to attend all the lectures. ACR has done a great job in solving this problem with ‘Session Select’. With ‘Session Select’ one can view the recorded lectures on the net. However, after the conference is over; once the daily grind starts; this rarely happens.

In recent times, a better solution seems to be brewing – Twitter. A bunch of Rheumatologists & intelligent patients have been tweeting ‘important take home messages’ from various lectures & abstracts. You can get a highly refined & ‘ready to use’ from all over the conference on twitter.

Media coverage of the conference does not seem to have started yet. Google yields a single relevant Medscape  page ‘what’s hot at ACR 2012?’  Media coverage may also be biased towards reporting about newer drugs & trials rather than clinical pearls.  Just follow #ACR2012 on twitter & I’m sure you will not miss out on anything.


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