1,000-year-old potion shows promise against MRSA

MRSA has become one of the deadliest bacteria of modern times. The cause of more than 80,000 severe infections in the US every year, the "superbug" has evolved to develop resistance to many antibiotics that once killed it. But researchers from the University of Nottingham in the UK say they may have uncovered a new treatment for MRSA: a 1,000-year-old remedy for eye infections taken from a manuscript found in the British Library.

The ancient potion - made of garlic, onion or leek, wine and cow bile - proved effective against the superbug MRSA.

Dr. Christina Lee, associate professor in Viking studies and a member of the Institute for Medieval Research at the University of Nottingham, and colleagues say the remedy killed up to 90% of MRSA (methicillin-resistantStaphylococcus aureus) in vivo.

What is more, studies in mouse models of MRSA conducted by researchers from Texas Tech University in Lubbock found the ancient potion presented "astonishing" results against the superbug.

The researchers are due to present their findings at the Annual Conference of the Society for General Microbiology in Birmingham, UK.

MRSA is a type of Staphylococcus, or "staph," bacteria that can be spread through skin-to-skin contact. It can cause skin infections and - particularly in health care settings - bloodstream infections, pneumonia and surgical site infections.

The Centers for Disease Control and Prevention (CDC) estimate that in 2011, MRSA was the cause of 80,461 invasive infections and was related to 11,285 deaths in the US. Most MRSA infections occur in health care settings.

MRSA infections are becoming harder to treat. Many antibiotics that were once effective against the bacteria - including methicillin, oxacillin and nafcillin - no longer work. As a result, researchers across the globe are trying to find new ways to kill the superbug.

Now, Dr. Lee and colleagues believe a 10th century Old English manuscript may hold a remedy for MRSA infections.

Ancient potion requires cow bile, garlic, onion and wine

The manuscript was found in Bald's Leechbook, which is believed to be one of the earliest ever medical textbooks. The book contains an array of Anglo-Saxon remedies for a number infections, and a potion for an eye infection caught Dr. Lee's attention.

"Medieval leech books and herbaria contain many remedies designed to treat what are clearly bacterial infections," says Dr. Lee. "Given that these remedies were developed well before the modern understanding of germ theory, this poses two questions: How systematic was the development of these remedies? And how effective were these remedies against the likely causative species of bacteria?"

"Answering these questions will greatly improve our understanding of medieval scholarship and medical empiricism," she continues, "and may reveal new ways of treating serious bacterial infections that continue to cause illness and death."

Dr. Lee translated the recipe for the ancient eye infection potion. The recipe requires garlic, onion or leek, wine and bile from a cow's stomach, called oxgall. The potion must be brewed in a brass vessel, strained for purification and left for 9 days before being applied to the infected site.

Following the recipe's strict instructions, Dr. Lee and her colleagues made four batches of the potion using fresh ingredients for each batch.

Researchers 'blown away' by the potion's effectiveness against S. aureus

The team created artificial wounds infected with S. aureus by growing the bacteria in collagen. They then exposed the wounds to each potion ingredient individually or the full potion.

Applying each separate potion ingredient to the wounds appeared to have no effect against S. aureus. When the full potion was applied, however, they found it killed almost all of the bacteria, with only around one bacterial cell in every 1,000 surviving.

Next, the researchers diluted the potion and applied it to the infected wounds to determine how much of it would be needed to treat a real infection.

They found that diluting the potion to the extent that it is unable to kill S. aureus interrupts communication between bacterial cells. Dr. Lee and colleagues say this is an important discovery because bacterial cells have to communicate with each other in order to cause tissue damage, and many scientists believe halting such behavior could treat infection.

Study leader Dr. Freya Harrison, also of the University of Nottingham, says the team was surprised by the findings:

"We thought that Bald's eyesalve might show a small amount of antibiotic activity, because each of the ingredients has been shown by other researchers to have some effect on bacteria in the lab - copper and bile salts can kill bacteria, and the garlic family of plants make chemicals that interfere with the bacteria's ability to damage infected tissues. But we were absolutely blown away by just how effective the combination of ingredients was."

Dr. Harrison says the potion even proved effective in harsher conditions, killing S. aureus in "biofilms" created from extended growth of artificial infections. Biofilms occur when each bacterial cell clumps together, creating a sticky coating that can stop antibiotics from reaching them.

"When we found that [the potion] could actually disrupt and kill cells in S. aureus biofilms, I was genuinely amazed," says study co-author Dr. Steve Diggle.

"Biofilms are naturally antibiotic resistant and difficult to treat so this was a great result. The fact that it works on an organism that it was apparently designed to treat [an infection of a stye in the eye] suggests that people were doing carefully planned experiments long before the scientific method was developed."

The researchers explain their findings further in the video below:

Effectiveness of ancient remedy on par with previously used antibiotics

The ancient potion was also tested on mice with MRSA-infected skin wounds by Dr. Kendra Rumbaugh from Texas Tech University, and she found it was highly effective against the superbug.

"We know that MRSA infected wounds are exceptionally difficult to treat in people and in mouse models," says Dr. Rumbaugh. "We have not tested a single antibiotic or experimental therapeutic that is completely effective; however, this 'ancient remedy' performed as good if not better than the conventional antibiotics we used."

The researchers are now looking for further funding to test the effectiveness of this potion and other ancient remedies that may be effective against modern-day bacterial infections.

Dr. Harrison says further research into alternative treatments for such infections is crucial if we are to tackle the increasing problem of antibiotic resistance.

"There is a pressing need to develop new strategies against pathogens because the cost of developing new antibiotics is high and eventual resistance is likely," she explains. "This truly cross-disciplinary project explores a new approach to modern health care problems by testing whether medieval remedies contain ingredients which kill bacteria or interfere with their ability to cause infection."

Medical News Today recently reported on a study published in the Proceedings of the National Academy of Sciences, in which researchers claim an increase in the use of antibiotics in livestock over the next 15 years may fuel drug resistance.

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Salt May Play Role In Autoimmune Disease

A healthy immune system is a finely balanced system: too little activity and we fall prey to disease, too much, and it attacks our own tissue, triggering autoimmune diseases like multiple sclerosis. Now three studies published online this week in Nature suggest the amount of salt we eat may influence this balance by indirectly encouraging the overproduction of immune cells.

In the three studies the researchers focused on a group of immune cells known as T cells because they play an important role in clearing disease-causing pathogens and also in autoimmune disease. They were particularly interested in how T cells develop.

TH17 Cells Have Been Implicated In a Number of Autoimmune Diseases

Previous research has suggested that some types of autoimmunity may be tied to overproduction of a type of immune cell called TH17, a type of helper T cell that protects against pathogens.

However, Th17 cells have also been implicated in diseases like multiple sclerosis, psoriasis, rheumatoid arthritis, and ankylosing spondylitis. Treatments for some of these diseases, such as psoriasis, involve manipulating T cell function.

Until now, scientists have struggled to pinpoint the molecular machinery behind the overproduction of TH17 cells, partly because the usual way of activating native immune cells in the lab, such as RNA interference (RNAi) to manipulate genes, either harms them or disturbs their development.

First Study: Using Nanowires to Manipulate Genes in TH17 Cells

But, by using a new method based on nanowires to manipulate genes in immune cells without altering the cells' functions, the authors of the first study, led by Aviv Regev, a biologist at the Massachusetts Institute of Technology, in Cambridge, in the US, were able "systematically" to assemble and validate a model of how TH17 cells are controlled in mice.

Regev got the idea for the new approach after attending a lecture given by co-author, Hongkun Park, a physicist at Harvard University, also in Cambridge, on how to use silicone nanowires to disarm single genes in cells without disturbing the way the cells operate.

She says in a report by Nature NEWS that without such a model they would probably have been only "guessing in the dark".

Co-author Vijay Kuchroo, an immunologist at Brigham and Women's Hospital in Boston, Massachusetts, says in a statement that until they got the new technology using the nanowires, every time they downregulated a gene (with the previous technology), the cell would change.

The team identified and validated 39 "regulatory factors" altogether, uncovering the most important points in the network and untangling their biological meaning.

They conclude that their findings highlight "novel drug targets for controlling TH17 cell differentiation".

Second Study: Discovering Key Role of SGK1 Signal

In the second study, Regev and another team, this time led by Kuchroo, took snapshots of how immune cells were produced over a three day period.

One protein in particular grabbed their attention, SGK1 (short for serum glucocorticoid kinase 1), a well-studied signaling protein that had not been described in T cells before, but is known to regulate how salt is absorbed in cells of the gut and in kidneys.

By manipulating salt levels in cultured mouse cells, the researchers found SGK1 expression was stronger the more salt there was, causing more TH17 cells to be produced.

Kuchroo says:

"If you incrementally increase salt, you get generation after generation of these TH17 cells."

Third Study: Confirming Findings in Mouse and Human Cells

In the third study, researchers led by David Hafler, a neurologist at Yale University in New Haven, Connecticut, confirmed the findings in mouse and human cells.

Hafler says this was easy to do, "you just add salt".

They also found that mice fed with a high-salt diet developed a more severe form of experimental autoimmune encephalomyelitis (EAE), "in line with augmented central nervous system infiltrating and peripherally induced antigen-specific TH17 cells".

EAE is an animal model of brain inflammation that is used to study autoimmune disease in the lab.

Hafler and colleagues conclude that " ... increased dietary salt intake might represent an environmental risk factor for the development of autoimmune diseases through the induction of pathogenic TH17 cells".

Implications

The researchers do not wish people to go away from these findings assuming that high salt diets alone cause autoimmune diseases.

In their studies they had to induce autoimmune disease, the salt played an additional role. And there are other factors too, as Kuchroo explains:

"It's not just salt, of course. We have this genetic architecture - genes that have been linked to various forms of autoimmune diseases, and predispose a person to developing autoimmune diseases. But we also suspect that environmental factors - infection, smoking, and lack of sunlight and Vitamin D - may play a role."

"Salt could be one more thing on the list of predisposing environmental factors that may promote the development of autoimmunity," says Kuchroo.

Regev also says it is far too early to say people shouldn't eat salt because it leads to autoimmune disease.

"We're putting forth an interesting hypothesis - a connection between salt and autoimmunity - that now must be tested through careful epidemiological studies in humans," she explains.

Hafler adds, "As a physician, I'm very cautious."

He says people should be on a low-salt diet anyway, for general health reasons.

The researchers now plan to apply the new model and build on the results to identify and follow up on potential drug targets.

Support for the research came from the National Human Genome Research Institute, the National Institutes of Health, National Multiple Sclerosis Society, the Klarman Cell Observatory, Guthy Jackson Foundation, and the Austrian Science Fund.

A study published in 2012 finds that the the prevalence and incidence of autoimmune diseases is on the rise in the US and researchers at the Center for Disease Control and Prevention are unsure why.

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What Is Inflammation? What Causes Inflammation?

Inflammation is the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body's response to it.

The word inflammation comes from the Latin "inflammo", meaning "I set alight, I ignite".

Inflammation is part of the body's immune response. Initially, it is beneficial when, for example, your knee sustains a blow and tissues need care and protection. However, sometimes inflammation can cause further inflammation; it can become self-perpetuating. More inflammation is created in response to the existing inflammation.

According to Medilexicon's medical dictionary, Inflammation is:

"A fundamental pathologic process consisting of a dynamic complex of histologically apparent cytologic changes, cellular infiltration, and mediator release that occurs in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent, including the local reactions and resulting morphologic changes; the destruction or removal of the injurious material; and the responses that lead to repair and healing.

The so-called cardinal signs of inflammation are rubor, redness; calor, heat (or warmth); tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added. All these signs may be observed in certain instances, but none is necessarily always present."

Plaque in coronary artery disease linked to inflammation - scientists from Stanford University, California, linked 25 new genetic regions to coronary artery disease. They found that people with coronary artery disease, the leading cause of death globally, are most likely predisposed to the disease because they have gene variants linked to inflammation.

Inflammation helps wounds heal

Our immediate reaction to a swelling is to try to bring it down. Bearing in mind that inflammation is an essential part of the body's attempt to heal itself, patients and doctors need to be sure that the treatments to reduce swelling are absolutely necessary and to not undermine or slow down the healing process.

The first stage of inflammation is often called irritation, which then becomes inflammation - the immediate healing process. Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing. Inflammation is part of a complex biological response to harmful stimuli. Without inflammation, infections and wounds would never heal.

Neuroscientists at the Lerner Research Institute at the Cleveland Clinic in Ohio found that inflammation actually helps to heal damaged muscle tissue. Their findings clash with how sportspeople with inflammation are treated - health professionals always try to control the inflammation to encourage healing. The researchers say their findings may lead to new therapies for acute muscle injuries caused by freeze damage, medications, chemicals and trauma.

Lan Zhou, M.D., Ph.D., said that patients should be very closely monitored when therapies to combat inflammation are used to make sure that the benefits of inflammation are not completely eliminated.

Inflammation is part of our innate immunity

Our innate immunity is what is naturally present in our bodies when we are born, and not the adaptive immunity we get after an infection or vaccination. Innate immunity is generally non-specific, while adaptive immunity is specific to one pathogen:

Whooping cough vaccine - example of immunity being specific to one pathogen

After being vaccinated for whooping cough (pertussis), we develop immunity to Bordetella pertussis or Bordetella parapertussis, types of bacteria that cause pertussis. This is an example of adaptive immunity - the immunity was not there before receiving the vaccine.

Inflammation is seen as a mechanism of innate immunity.

What is the difference between chronic inflammation and acute inflammation?

Acute inflammation - starts rapidly (rapid onset) and quickly becomes severe. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks.

Examples of diseases, conditions, and situations which can result in acute inflammation include: acute bronchitis, infected ingrown toenail, sore throat from a cold or flu, a scratch/cut on the skin, exercise (especially intense training), acute appendicitis, acute dermatitis, acute tonsillitis, acute infective meningitis, acute sinusitis, or a blow.

Chronic inflammation - this means long-term inflammation, which can last for several months and even years. It can result from:

• Failure to eliminate whatever was causing an acute inflammation
• An autoimmune response to a self antigen - the immune system attacks healthy tissue, mistaking it (them) for harmful pathogens.
• A chronic irritant of low intensity that persists

Examples of diseases and conditions with chronic inflammation include: asthma, chronic peptic ulcer, tuberculosis, rheumatoid arthritis, chronic periodontitis, ulcerative colitis and Crohn's disease, chronic sinusitis, and chronic active hepatitis (there are many more).

Our infections, wounds and any damage to tissue would never health without inflammation - tissue would become more and more damaged and the body, or any organism, would eventually perish.

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

What happens during acute inflammation?

Within a few seconds or minutes after tissue is injured, acute inflammation starts to occur. The damage may be a physical one, or might be caused by an immune response.

Three main processes occur before and during acute inflammation:

• Arterioles, small branches of arteries that lead to capillaries that supply blood to the damaged region dilate, resulting in increased blood flow


• The capillaries become more permeable, so fluid and blood proteins can move into interstitial spaces (spaces between tissues).


• Neutrophils, and possibly some macrophages migrate out of the capillaries and venules (small veins that go from a capillary to a vein) and move into interstitial spaces. A neutrophil is a type of granulocyte (white blood cell), it is filled with tiny sacs which contain enzymes that digest microorganisms. Macrophages are also a type of white blood cells that ingests foreign material.
  
  Klaus Ley, M.D., a scientist at the La Jolla Institute for Allergy & Immunology, reported in a study published in Nature that neutrophils are the human body's first line of defense; they are the main cells that protect us from bacterial infections. Their protective function is a positive one, however, they also have inflammatory properties that may eventually lead to heart disease and several autoimmune diseases, such as lupus. Effectively manipulating neutrophils is vital in disrupting inflammatory diseases.

When our skin is scratched (and the skin is not broken), one may see a pale red line. Soon the area around that scratch goes red, this is because the arterioles have dilated and the capillaries have filled up with blood and become more permeable, allowing fluid and blood proteins to move into the space between tissues.

Edema - the area then swells as further fluid builds up in the interstitial spaces.

The five cardinal signs of acute inflammation - "PRISH"

An ingrown toenail with the five PRISH signs; pain, redness, immobility, swelling and heat



• Pain - the inflamed area is likely to be painful, especially when touched. Chemicals that stimulate nerve endings are released, making the area much more sensitive.
• Redness - this is because the capillaries are filled up with more blood than usual
• Immobility - there may be some loss of function
• Swelling - caused by an accumulation of fluid
• Heat - as with the reason for the redness, more blood in the affected area makes it feel hot to the touch

The five classical signs of inflammation

Although Latin terms are still used widely in Western medicine, local language terms, such as English, are taking over. PRISH is a more modern acronym which refers to the signs of inflammation. The traditional Latin based terms have been around for two thousand years:

• Dolor - Latin term for "pain"
• Calor - Latin term for "heat"
• Rubor - which in Latin means "redness"
• Tumor - a Latin term for "swelling"
• Functio laesa - which in Latin means "injured function", which can also mean loss of function

Dolor, Calor, Rubor, and Tumor were first described and documented by Aulus Cornelius Celsus (ca 25 BC-ca 50), a Roman encyclopaedist. Celcius is famous for creating De Medicina, which is thought to be the only surviving section of a vast encyclopedia. De Medicina was the main source of medical reference in the Roman world for pharmacy, surgery, diet and some other medical fields.

Functio laesa - it is not clear who first described and documented the fifth sign. The majority of attributions have gone to Thomas Sydenham (1624-1689) an English physician and Rudolph Carl Virchow (1821-1902), a German doctor, biologist, politician and pathologist. Virchow is seen as one of the founders of social medicine.

These five acute inflammation signs are only relevant when the affected area is on or very close to the skin. When inflammation occurs deep inside the body, such as an internal organ, only some of the signs may be detectable. Some internal organs may not have sensory nerve endings nearby, so there is be no pain, as is the case with some types of pneumonia (acute inflammation of the lung). If the inflammation from pneumonia pushes against the parietal pleura (inner lining of the surface of the chest wall), then there is pain.

Acute and chronic inflammation compared

The lists below show the difference between chronic and acute inflammation regarding the causative agents, which major cells are involved, features regarding onset, duration, and outcomes:

Acute Inflammation

• Causative agents - harmful bacteria or injury to tissue
• Major cells involved - mainly neutrophils, basophils (in the inflammatory response), and eosinophils (response to parasites and worms), and mononuclear cells (macrophages, monocytes)
• Primary mediators - eicosanoids, vasoactive amines
• Onset (when does the inflammation start) - straight away
• Duration - short-lived, only a few days
• Outcomes - the inflammation either gets better (resolution), develops into an abscess, or becomes a chronic inflammation

Chronic inflammation

• Causative agent - non-degradable pathogens that cause persistent inflammation, infection with some types of viruses, persistent foreign bodies, overactive immune system reactions
• Major cells involved - Macrophages, lymphocytes, plasma cells (these three are mononuclear cells), and fibroblasts
• Primary mediators - reactive oxygen species, hydrolytic enzymes, IFN-γ and other cytokines, growth factors
• Duration - from several months to years
• Outcomes - the destruction of tissue, thickening and scarring of connective tissue (fibrosis), death of cells or tissues (necrosis)

Sleep quality and duration impacts on inflammation risk

Scientists at Emory University School of Medicine in Atlanta, Georgia, found in a study that sleep deprivation or poor sleep quality raise inflammation, which in turn increase the risk of developing heart disease and stroke.

The team gathered data on 525 middle-aged volunteers who had completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire, which asked detailed questions about sleep quality and duration.

They tested the participants' levels of various inflammatory markers, and then tried to see whether they could link them to quality and duration of sleep. The authors concluded:

"The researchers concluded that: "Poor sleep quality, and short sleep durations are associated with higher levels of inflammation."

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Does Weather Affect Arthritis Pain?

With the winter weather biting hard in many parts of the country, you may be one of the many arthritis sufferers who feel that their arthritis pain is influenced by the weather -- specifically, that they experience more arthritis pain on cold, rainy days and less arthritis pain on warm, dry days.

Johns Hopkins Health Alerts reports on two recent research studies on whether climate really does affect arthritis pain, which have produced conflicting results. The Johns Hopkins Health Alerts editors have also just released a free Special Report on Arthritis Pain Relief to help arthritis sufferers with the latest news on the most effective arthritis pain relief strategies.

What the Research on Arthritis Pain Shows

One study looked for a relationship between weather and arthritis pain in 151 people with osteoarthritis, rheumatoid arthritis, or fibromyalgia (a rheumatic disorder that causes joint pain) as well as 32 people without arthritis. All participants lived in Cordoba City, Argentina, which has a warm climate. Participants kept a journal for one year recording the presence and features of any pain, and these daily reports were matched with weather conditions such as temperature, barometric pressure, and relative humidity.

Patients in all three groups experienced more pain on days when the temperature was low, while people in the control group were unaffected by any of the weather conditions. In addition, patients with rheumatoid arthritis were affected by high humidity and high pressure; osteoarthritis patients by high humidity; and those with fibromyalgia by high pressure. However, the associations were not strong enough to allow pain to predict weather, or vice versa.

Another study looked at 154 people (average age 72) who lived in Florida and had osteoarthritis of the neck, hand, shoulder, knee, or foot. Participants reported their arthritis pain scores for up to two years, then researchers matched the scores with the daily temperature, barometric pressure, and precipitation status. No significant associations were found between any of the weather conditions and osteoarthritis pain at any site, except for a slight association between rising barometric pressure and hand pain in women.

A Mild Case for Warmer Weather

Although some evidence exists that people living in warmer, drier climates experience fewer episodes of arthritis pain, climate does not affect the course of the disease. At most, it may affect symptoms of arthritis pain.

One theory holds that a drop in air pressure (which often accompanies cold, rainy weather) allows tissues in the body to expand to fill the space, meaning that already inflamed tissue can swell even more and cause increased arthritis pain. Other possibilities: Pain thresholds drop in colder weather; cold, rainy days affect mood; and during colder weather people are less likely to be outside and get the exercise that normally helps keep arthritis pain in check.

So does this possible link between cold, rainy weather and arthritis pain mean that people with arthritis should you should move to a dry, warm climate like Arizona? Not necessarily, especially if it means leaving your family, friends, doctors, and support system behind. If you are thinking of moving, first spend a considerable amount of time in your new location to see if the weather affects your arthritis pain symptoms.

But bear in mind that no environment is arthritis-proof: Even though the people in these research studies live in warm climates, they still struggle with arthritis pain. Similarly, it's possible to get relief from arthritis pain in any climate. For example, even if cold weather means you can't spend time outdoors, you can still get valuable exercise in a gym or heated pool.

Johns Hopkins Guide to Arthritis Pain Relief: A free Johns Hopkins Special Report

The free Johns Hopkins Guide to Arthritis Pain Relief is designed to give you an overview of the latest research and findings from Johns Hopkins' specialists on the dos and don'ts of arthritis pain relief.

The free Johns Hopkins Guide to Arthritis Pain Relief deals with both osteoarthritis (OA) and rheumatoid arthritis (RA), to help keep you up to date on the latest news on the most safe, effective arthritis pain relief strategies.

To download your free copy of The free Johns Hopkins Guide to Arthritis Pain Relief, please visit: Johns Hopkins Health Alerts Arthritis Pain Relief Special Report

Johns Hopkins Medicine

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FDA Approves Omnaris (ciclesonide) Nasal Spray For Allergic Rhinitis

The Food and Drug Administration (FDA) announced today the approval of Omnaris (ciclesonide) nasal spray, a new drug for the treatment of nasal symptoms associated with seasonal and perennial allergic rhinitis, commonly known as hay fever, in adults and children 12 years of age and older.

Although the precise way Omnaris works is unknown, the drug is a corticosteroid. Corticosteroids are hormone-like drugs that suppress the immune response.

Allergic rhinitis is the medical term for the inflamed, runny nose that's the main symptom of allergies. Seasonal allergic rhinitis is the most common allergic disease. About 35 million Americans suffer from this condition. The ailment's classic symptoms are watery nasal discharge, and fits of sneezing, and itching that can affect not just the nose but the roof of the mouth, throat and the Eustachian tubes which connect the middle ear to the back of the throat.

The safety and efficacy of Omnaris nasal spray were studied in four randomized placebo controlled clinical trials ranging in duration from two weeks to a year. The studies assessed how well Omnaris treated symptoms (runny nose, nasal itching, sneezing, and nasal congestion) in patients with hay fever. The results of these trials showed that patients treated with Omnaris nasal spray had an 8-10 percent greater reduction in nasal symptoms compared to placebo. The difference between Omnaris nasal spray and placebo was significant.

The most common side effects in clinical studies were headache, nosebleeds, and inflammation of the nose and throat linings.

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Chiropractic For Arthritis - Benefits, Concerns, Side Effects, And Effectiveness

The word ARTHRITIS means inflammation of the joint. Arthritis can affect a person at any age. Sometimes the symptoms of arthritis are called rheumatism. Eight classes of arthritis and related conditions have been identified. These are:

Inflammatory - the membrane of the joint becomes irritated

Attachment Arthritis - frequently in the heels and lower back, the ligament or tendon fastened to the bone becomes irritated

Crystal Arthritis - the big toe has deposits of microscopic crystals of sodium urate

Joint Infection - bacteria contaminate the fluid inside the joint, usually found in the hip, shoulder and knee

Cartilage Degeneration - usually found in the knees, neck, lower back, hips and fingers, this type of arthritis arises when the cartilage of the joint breaks down

Muscle Inflammation - muscle tissue becomes inflamed

Local Conditions - a local injury causes pain, such as tennis elbow

General Conditions - a condition characterized by generalized muscle pain and sleep disturbance.

Chiropractic is a remedial system that centers on the structure of the body. Daniel David Palmer gave the first chiropractic treatment in 1895. He derived the name chiropractic from the Greek CHEIR meaning hand, and PRAKTIKOS meaning practice or perform. Treatment is adapted to suit the age, build, pain levels and general health of the individual. Treatment schedules depend on whether your problem is acute or chronic, and on your age and general health.

The chiropractic treatment for arthritis depends on whether the practitioner is a straight or mixed chiropractor. The body is permitted to cure itself by straight chiropractors, who treat arthritis by working with the spine to correct subluxation and other imbalances. The mixed chiropractor will probably treat arthritis and other remedies such as acpupressure mixed with manipulation.

X-rays of many people in their 20's show that arthritis is not just an old age thing. Chiropractor Dr. Lynn Kelly has identified the number one cause of arthritis as being joints that aren't moving properly because of misalignments of the bones that form them. Your spine is a group of cylinder-shaped bones with knobs on the backs and side of each bone that fit into grooves in the neighboring vertebra, and a chiropractor can evaluate these joints for you.

Chiropractic adjustments are painless for most patients. Tiny pockets of gas are relieved from the joints when your vertebrae are adjusted, making a "popping" noise. Dozens of research studies have recognized the safety and helpfulness of chiropractic care. Chiropractors are also taught to identify when damage is outside of their scope of practice and will refer patients to the proper medical specialist if needed.

The small joints of the body can be damaged by rheumatoid arthritis, as with any joint in the body. One in five to one in three patients with RA have spinal involvement. If you're an RA patient with spinal involvement, you should not have chiropractic manipulation done, as it can cause your spinal instability to worsen.

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Potassium Deficiency as a Cause of Rheumatoid Arthritis

This discussion of potassium is presented in the hope that one of its readers will consider performing an experiment establishing the effect of potassium on rheumatoid arthritis. There is no report in the literature going back to 1914 of such an experiment. Every essential nutrient should have been explored before this. In view of the way hormones which are regulated by or regulate potassium, such as cortisol and DOC are involved with rheumatoid arthritis (RA), and the low whole body potassium content in rheumatoid arthritis (RA), potassium especially should have been investigated before now.

by Charles Weber, MS

INTRODUCTION

Since the most serious aspect of the diarrheas is wasting potassium, cortisol has acquired the attribute of conserving potassium by moving it into the cells when cortisol declines. Cortisol (but not corticosterone) is reduced during a potassium deficiency, and this reduction accounts for many of the symptoms of RA.

Cortisol shuts down most of the copper enzymes when it declines so that excretion of copper is increased and Lysyl oxidase inhibited. These last two attributes are proposed to account for most of the mortality from aneurysms and infections during rheumatoid arthritis (RA). Thus the urgent necessity to survive during virulent diarrhea has set people up in the course of evolution for some of the worst symptoms of rheumatoid arthritis

For a more elaborate discussion of potassium physiology and nutrition see Arthritis as a Chronic Potassium Deficiency and for copper see this site.

DISCUSSION

Judging by the drastic decline of mortality in babies suffering from a virulent strain of diarrhea by potassium supplements,1 potassium loss in those diseases which force cyclic AMP to excrete water into the intestines2 must be the most serious effect of the diarrheas. I suggest that this is the reason why cortisol has acquired the attribute of moving potassium out of cells3 and therefore into the cells upon declining. It is also undoubtedly the reason why the adrenal's cortisol secretion is inhibited by low serum potassium in vitro (in the test tube) but not corticosterone.4 The body thus has a way of signaling for a decrease in cortisol secretion during a serious intestinal disease independently of ACTH. Thus the body inversely mobilizes its defenses. Endotoxin bacterial diseases force the body to secrete cortisol by increasing ACTH5 and this is probably an adaptation by the bacteria to force the body to inhibit the immune system. Glucosteroid response modifying factor (GRMF) secreted by T- cells then prevents the cortisol from having full effect on white cells other than suppresser cells6 and thus raises the set point, as does interleukin-I.6. Interleukin-I also stimulates cortisol secretion,7 as does cachectin (tumor necrosis factor).8 I suspect that this is an adaptation to provide some cortisol maintenance9 when normal ACTH production is later cut off during endotoxin attack.10 In other words, the immune system takes over its own regulation but at a higher set point. The role of GRMF has not yet been demonstrated for physiological processes. GRMF will probably prove to inhibit cortisol for most of those processes as well as the immune cells, surely at least for cortisol's various affects on potassium.


One of the most important of the cortisol controlled immune defenses is the mobilization of the availability of copper to the white cells, an attribute which probably arose because copper is crucial to an adequate immune defense.11 The primary way cortisol does this is by, inversely to its concentration, shutting down production of copper-containing enzymes such as Lysyl oxidase and superoxide dismutase.12 Lysyl oxidase catalyzes the formation of cross links in all connecting tissue including elastin.13 Since elastin makes up the main strength of normal blood vessels12 and has a rapid turnover, this is the most serious problem in arthritis. Ruptured aneurysms along with poor resistance to infection and heart disease are the chief terminal events in arthritis.14

The body uses ceruloplasmin to carry copper to the immune system during infection12. Probably the main reason for this development is that the copper in ceruloplasmin is not in equilibrium with the serum and so is not available to pathogens. However, ceruloplasmin is also used to carry copper to the bile for excretion15. Therefore I submit that the rise in serum ceruloplasmin in RA16 causes an increased excretion in members of a society who, even before this, were receiving less than the minimum daily requirement.

CONCLUSIONS

Evidence can be provided for this proposal in several ways. Arthritic people should have a lower whole body potassium content than normal people. This has been proved.17 Red blood cells have a higher potassium content than normal during RA18. This should not be taken as counter evidence because I suspect that this is an adaptation to help avoid circulatory collapse when dehydration reduces the blood volume during diarrhea.

There should be a lower concentration of potassium in blood plasma during RA. The National Health and Nutrition Survey-III has determined that of 39,695 people selected, there were 840 who said they had been diagnosed with rheumatoid arthritis. Of these, 691 had their serum tested for potassium. Of that number 7.8% had less than 3.6 milliequivalents per liter, 34.7% between 3.6 and 4.0, 40.7% between 4.0 and 4.4, and 18.1% above 4.4. Only 18% appeared to be in the normal range. The samples were refrigerated and sent out to outside contract laboratories [22c]. Refrigerating blood increases the apparent amount when it is serum that is analyzed, especially if there is a delay in the analysis. In addition to that, arthritics lose potassium from the platelets as noted above. If some were misdiagnosed, had a remission since being diagnosed, or there was a longer than usual delay in analysis, it could account for the 18% seemingly normal. So this survey showed at least most arthritics low in potassium. Many others in the survey were low in potassium also. So, unless arthritis is caused by something besides a potassium deficiency and low potassium is a symptom, those other survey people would have to have had arthritis as well. I believe many people die of a potassium caused heart disease without being arthritic, so, if so, the first part of the statement must be in order. In any case, a large proportion of arthritics at least are too low for sure, some dangerously low.

There should be a lower incidence of RA among people on potassium supplementation or who eat Morton's Lite Salt (TM) or Stirling's Half and Half (TM). I know of no epidemiological study showing this. However, people who work in potash mines have a 25% lower incidence of heart disease than the surrounding population19 and heart disease is prevalent in RA. There should be a healing of RA upon starting potassium supplements. No controlled experiment has been reported which would indicate this. However there is a case history of a single arthritic brought up to 3,500 milligrams per day in order to explore the effects of various steroid hormones on the body's mineral balance.20 A total of 3,500 milligrams is about the amount an adult would obtain from unprocessed food. The subject showed consistent improvement throughout the experiment even though potassium was the only consistent change. His total body potassium slowly but consistently rose. There should be a negative correlation between high potassium-caused muscle spasms and RA, but I have no supporting data. Neither do I know of a positive correlation with eating licorice (but not licorice candy, which is made of anise seeds) grapefruit, or potassium losing diuretics, each of which increase potassium loss. There should be a negative correlation between eating acids which have an indigestible anion and RA since the hydrogen ion interferes with potassium excretion21. I know of no good experiment or epidemiologic study. However, it has been suggested from folk custom that eating vinegar22 or cherries is efficacious. The vinegar seems doubtful since it is my understanding that acetate can be metabolized by the body22a. However, it is conceivable that people on a diet high in calories do not utilize all the acetate or even much of it. In any case. RA should not be present much in people who eat predominantly vegetables instead of grains. An experiment has been performed in which RA was healed in a group of people by switching to a vegetable diet23b. Eating bananas would increase potassium somewhat, but it is only a moderate source per calorie, about the same as potatoes.

I suspect that people with rheumatoid arthritis tend to have a poorer ability to conserve or absorb potassium than other people because of damage to their kidneys by a poison such as bromine gas (as happened to me) or long term poisons in plant foods or by a mild genetic defect or by poisons excreted by pathogenic bacteria. Some bacterial infections do trigger RA. Screening some common poisons currently in food might be enlightening. Since GRMFs inhibit cortisol, it is possible that a discordance in the immune response involving GRMF in some people or some infection types (that last does happen) may accentuate RA and thus even cause an auto immune response.

If animals are used for experiments, it is futile to use rats or mice because they rely on corticosterone to regulate the immune response, not cortisol. I suspect that this developed because they have a factor in their intestinal fluid which counteracts cholera toxin.23 They also have the ability to absorb water under cyclic AMP stimulation in part of their colon24 instead of excretion of water, unlike other animals.

Since the disturbance in copper metabolism is proposed as the most serious aspect of RA, evidence for copper's effect should be possible. Supplementing with copper should remove some of the symptoms of RA. I know of no such experiment. However, it is known that Finnish men who work in copper mines have little arthritis or susceptibility to infection.25 The high milk diet along with frequent saunas may be two reasons why other Finns have one of the highest rates of arthritis in the world,26 since milk is the poorest source of copper27, p.92 and perspiration loses potassium.28 Milk has been shown to have a high statistical correlation with cardiovascular disease, said to be as great a risk as smoking,29 which disease in turn is correlated with RA. Laplanders on a meat diet have a lower rate of RA not much further north.26 The Massai of Africa have a higher rate of RA than the surrounding tribes.30, p.768 The Masai also use a lot of milk as well as very few vegetables, which vegetables would have increased potassium intake. Men who work in copper mines must have stronger tissues than other miners because the percentage of injuries which result in lost time is significantly lower31 even though injuries like eye damage and burns which are not affected by strength are part of the data. Eating a lot of shellfish or liver should reduce those symptoms related to copper deficiency since they are the richest sources, but I know of no study. The same is true of drinking acid water out of copper plumbing.

I believe that it is unwise to give cortisol to any class of people whose immune system is weak, such as arthritic people. If it is felt that cortisol should be raised in the body, why not use something relatively safe, like potassium supplements? If potassium supplements are used, be certain that vitamin B- 1 is adequate because the "wet" heart disease of beri-beri can not materialize when potassium is deficient.32 Obviously the reverse is also true for vitamin B-1 supplementation. For this reason, If the patient has heart trouble, it is very important to determine whether it is caused by vitamin B-1 or potassium.

If potassium chloride is dissolved in fruit juice it tastes good and avoids the danger to the intestines that even slow release enteric tablets may present. The chloride is the most efficacious form33. It would be better and safer yet to provide potassium from food high in potassium such as celery or bamboo shoots as Effinger proposed34. Unboiled, unfrozen, uncanned vegetables low in starch are the richest sources35. However, removing a deficiency will be slower since the potassium is not associated with chloride and would take a few weeks or months longer.

A deficiency can arise from diarrhea, processed food, reliance on grain or fatty foods35, psychic stress stimulation of aldosterone36 p.209 (which is the main regulator of potassium)37, stress stimulation of cortisol (as in an operation, for instance38), diuretics, licorice39 as well as probably grapefruit39a, profuse perspiration28, excessive vomiting40, eating sodium bicarbonate41, hyperventilating42, laxatives43, enemas44 (especially if prolonged), shock from burns or injury45, hostile or fearful emotions36, and very high or very low sodium intake46, All of these increase excretion or decrease intake of potassium and many at once would be very dangerous. and probably even lethal if prolonged.

A chronic potassium deficiency must surely cause a degenerative disease. I believe it materializes in some people as RA. If not, then what is the name of the degenerative disease which attends a potassium deficiency ? It is not hypokalemia. This is only a word which describes low serum potassium, a marker or symptom. It is about time we found such a name.

http://members.tripod.com/~charles_W/potassium.html

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Arthritis and Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that affects the spine. Ankylosing spondylitis symptoms include pain and stiffness from the neck down to the lower back. The spine's bones (vertebrae) may grow or fuse together, resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.

Who Is Affected by Ankylosing Spondylitis?

Ankylosing spondylitis affects about 0.1% to 0.5% of the adult population. Although it can occur at any age, spondylitis most often affects men in their 20s and 30s. It is less common and generally milder in women and most common in Native Americans.

What Are the Symptoms of Ankylosing Spondylitis?

The most common early symptoms of ankylosing spondylitis include:

• Pain and stiffness. Constant pain and stiffness in the low back, buttocks, and hips that continue for more than three months. Spondylitis often starts around the sacroiliac joints, where the sacrum (the lowest major part of the spine) joins the ilium bone of the pelvis in the lower back region.
• Bony fusion. Ankylosing spondylitis can cause an overgrowth of the bones, which may lead to abnormal joining of bones, called "bony fusion." Fusion affecting bones of the neck, back, or hips may impair a person's ability to perform routine activities. Fusion of the ribs to the spine or breastbone may limit a person's ability to expand his or her chest when taking a deep breath.
• Pain in ligaments and tendons. Spondylitis also may affect some of the ligaments and tendons that attach to bones. Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel, such as the Achilles tendon at the back of the ankle.

Ankylosing spondylitis is a systemic disease, which means symptoms may not be limited to the joints. People with the condition also may have fever, fatigue, and loss of appetite. Eye inflammation (redness and pain) occurs in some people with spondylitis. In rare cases, lung and heart problems also may develop.

What Causes Ankylosing Spondylitis?

Although the cause of ankylosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, more than 75% of these people never develop the disease.

How Is Ankylosing Spondylitis Diagnosed?

The diagnosis of ankylosing spondylitis is based on several factors, including:

• Symptoms
• Findings of an physical exam
• X-rays of the back and pelvis
• Measurements of the chest when breathing
• Results of lab tests

How Is Ankylosing Spondylitis Treated?

There is no cure for ankylosing spondylitis, but there are treatments that can reduce discomfort and improve function. The goals of treatment are to reduce pain and stiffness, maintain a good posture, prevent deformity, and preserve the ability to perform normal activities. When properly treated, people with ankylosing spondylitis may lead fairly normal lives. Under ideal circumstances, a team approach to treat spondylitis is recommended. Members of the treatment team typically include the patient, doctor, physical therapist, and occupational therapist. In patients with severe deformities, osteotomy and fusion can be done.

• Physical and occupational therapy . Early intervention with physical and occupational therapy is important to maintain function and minimize deformity.
• Exercise . A program of daily exercise helps reduce stiffness, strengthen the muscles around the joints and prevent or minimize the risk of disability. Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for people with ankylosing spondylitis.
• Medications. Certain drugs help provide relief from pain and stiffness, and allow patients to perform their exercises with minimal discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen, naproxen, and aspirin -- are the most commonly used drugs for spondylitis treatment. In moderate to severe cases, other drugs may be added to the treatment regimen. Disease-modifying anitrheumatic drugs (DMARDs), such as methotrexate, can be used when NSAIDs alone are not enough to reduce the inflammation, stiffness, and pain. In addition, relatively new drugs called biologics (Enbrel, Humira, Remicade, and Simponi) have been FDA approved for treating ankylosing spondylitis. A similar drug, Humira has also been shown to improve the pain and stiffness of ankylosing spondylitis. Also, the antidepressant Cymbalta has been approved for chronic back pain as well.
• Surgery. Artificial joint replacement surgery may be a treatment option for some people with advanced joint disease affecting the hips or knees.

In addition, people with spondylitis are urged to not smoke or chew tobacco products because of the increased risk of lung problems and reduced ability to expand the rib cage. Certainly, all of the other reasons why doctors discourage smoking also apply here as well.
People with spondylitis are encouraged to sleep on a firm mattress with the back straight. Placing large pillows under the head is discouraged, since it may promote neck fusion in the flexed position. Similarly, propping the legs up on pillows should be avoided because it may lead to hip or knee fusion in the bent position. Choose chairs, tables, and other work surfaces that will help avoid slumping or stooping. Armchairs are preferred over chairs without arms.
Since those with ankylosing spondylitis could easily hurt their rigid necks or backs, special care should be taken to avoid sudden impact, such as jumping or falling.

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NSAIDs for Rheumatoid Arthritis

NSAIDs -- or nonsteroidal anti-inflammatory drugs -- are commonly used to treat rheumatoid arthritis (RA). NSAIDS help manage the chronic pain, inflammation, and swelling associated with RA.
NSAIDs do not slow RA progression. If there is not good relief of RA symptoms with NSAIDs, your doctor may add other medications. Medications such as methotrexate or biologics help ease RA symptoms when NSAIDs aren't enough. These more potent drugs also help prevent further joint damage.

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How Do NSAIDs Treat Rheumatoid Arthritis?

When you have pain from rheumatoid arthritis, the damaged tissue releases chemicals called prostaglandins, which are like hormones.
Prostaglandins send messages to trigger inflammation that results in pain and swelling. NSAIDs block prostaglandins by blocking Cox enzymes (specifically, Cox-1 and Cox-2 enzymes). This decreases inflammation and reduces pain and stiffness.
While prostaglandins trigger inflammation, they also send a few good messages as well, for example, protecting the stomach lining and kidneys. By blocking prostaglandins entirely, NSAIDs can sometimes cause stomach ulcers, bleeding, and even kidney damage.
NSAIDs vary in their potency and how they are eliminated from the body. It seems the more an NSAID blocks the Cox-1 enzyme, the greater the tendency is to cause stomach ulcers and promote bleeding.

What Are Some NSAIDS Used for Rheumatoid Arthritis?

• Aspirin (Bufferin, Bayer)
• Celecoxib (Celebrex)
• Diclofenac (Cataflam, Voltaren)
• Diflunisal (Dolobid)
• Etodolac (Lodine)
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid)
• Ibuprofen (Advil, Motrin)
• Indomethacin (Indocin)
• Ketoprofen (Oruvail, Orudis)
• Ketorolac (Toradol)
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Salsalate (Amigesic)
• Sulindac (Clinoril)
• Tolmetin (Tolectin)

Arthrotec is an NSAID that combines diclofenac with another active ingredient, misoprostol, to help prevent stomach irritation.
Prevacid Naprapac combines naproxen with the acid blocker Prevacid to reduce the chance of developing stomach ulcers. Vimovo is a combination of naproxen and the acid blocker Nexium.

What Is a Cox-2 Inhibitor?

Cox-2 inhibitors are a newer form of prescription NSAID and work similarly to older NSAIDs. However, Cox-2 inhibitors are less likely to cause stomach problems, such as ulcers.
Cox-2 inhibitors offer the same pain relief as standard NSAIDs but have a lower risk of stomach problems.
Celebrex is the only Cox-2 inhibitor.

Do All NSAIDs Increased Risk of Heart Attack and Stroke?

All prescription NSAIDs are linked to an increased risk of heart attack and stroke.
Doctors first became aware of the link between NSAIDs and heart disease and stroke with the Cox-2 inhibitor Vioxx. Vioxx was removed from the market because of the link with heart attacks and stroke.
After much research, the FDA decided to put a strong black box warning on all prescription NSAIDs to alert consumers of this increased risk.
While the actual risk of heart attack and stroke with NSAIDs is unknown, there are medical studies in progress to help find that answer. The risk is likely greatest for people with heart disease risk factors, such as high blood pressure, high cholesterol, diabetes, and smoking.
You and your doctor can decide if NSAIDs are right for you. Many people with rheumatoid arthritis take NSAIDs for relief of pain and swelling.

What Are the Side Effects of NSAIDs?

Most people take NSAIDs with few to no side effects. However, some people do have stomach pain, and NSAIDs may cause stomach ulcers.
Side effects vary from one NSAID to another. The most common side effects include:

• Stomach problems, including pain, constipation, diarrhea, gas, nausea, and stomach ulcers
• Abnormal kidney function
• Anemia
• Dizziness
• Swelling in the legs
• Abnormal liver tests (blood tests)
• Headaches
• Easy bruising
• Ringing in the ears

NSAIDs may also increase blood pressure. If you have hypertension, be sure to keep a close eye on your blood pressure. Let your doctor know if your blood pressure goes up.

Is There a Serious Risk of Stomach Ulcers With NSAIDs?

It is estimated that more than 100,000 Americans are hospitalized each year from ulcers and stomach bleeding linked to NSAID use.
The chance of getting an ulcer or stomach bleeding increases even more if you also take corticosteroids and/or blood thinners, or anticoagulants. Also, the longer you use NSAIDs, the greater the risk of stomach bleeding and ulcers. Older adults have an increased risk of stomach bleeding and ulcers, as do those who drink alcohol and smoke cigarettes.
There are ways to reduce the risk of stomach irritation when taking NSAIDs for rheumatoid arthritis. People at high risk of stomach bleeding may need a strong stomach acid blocker to help prevent ulcers.
If you take NSAIDs to ease the inflammation, pain, and stiffness of RA, be sure to talk with your doctor about ways to protect your stomach.

Can I Take NSAIDs if I Have High Blood Pressure?

If you have high blood pressure or kidney disease, talk to your doctor. NSAIDs reduce the blood flow to the kidneys, which may cause them to not work as well. This causes fluid to build up in your body. The more fluid in your bloodstream, the higher your blood pressure.
Since NSAIDs can affect the kidneys, your doctor will likely check your kidney function from time to time. This is a simple blood test.

Can I Be Allergic to NSAIDs?

NSAIDs can cause allergies. This is most worrisome in people with asthma. Experts aren't sure why, but some people with asthma are sensitive to NSAIDs. The drugs may worsen breathing, and many specialists recommend that people who have asthma stay away from any NSAID. The risk may be even greater in people with sinus problems or nasal polyps.
If you have asthma, make sure your arthritis doctor knows. Certain NSAIDs may be safer for you. You and your doctor can determine if NSAIDs are right for you.

Are There Special Precautions for Using NSAIDs for Rheumatoid Arthritis?

NSAIDs should be used with caution if you have kidney or liver disease, heart failure, high blood pressure, diabetes, lupus, asthma, or ulcers.
Be sure your doctor is aware of all drugs and supplements you are taking. NSAIDs may interact with blood thinners, cyclosporine, lithium, or methotrexate. Be sure to let your doctor know if you are sensitive to aspirin.

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