Magnets and Arthritis?

Pain causes many arthritis sufferers to seek new treatments. Some are driven to look for odd or extreme alternatives for pain relief. Recently, there was a rise in magnetic straps and bracelets as a pain reliever for arthritis patients. Essentially, these magnetic straps are supposed to increase blood flow or cause an increase in our natural painkillers. These straps are generally considered safe and a natural way to alleviate the pain. In a New York Times article the author points delves into this new-found popularity with the magnetic straps and bracelets.

While many people may claim the magnetic bracelets and straps help them, there have many studies to look at their effectiveness. As this article points out, there is little evidence that these bracelets provide any type of benefit. One study claimed they couldn’t exclude the evidence of the magnetic therapy, but more research was needed. Another study claims there is no effectiveness to this type of therapy.

So with these claims of no real benefit by numerous studies, why do arthritis patients continue to buy these bracelets? Is it a type of placebo effect where patients buy the bracelets and they feel better just thinking that the magnet is helping out? While these studies point out the lack of benefit for arthritis, I think this just shows that arthritis patients are willing to use anything to help with the pain.

http://www.nytimes.com/2009/11/10/health/10real.html?_r=1

Immunogenetics, Transplantation and Crossmatches

Several weeks ago, J.J. Cohen lectured about Immunogenetics and Transplantation. We discussed how outcomes of grafts of living tissues between two individuals are dependent upon whether or not the individuals are histocompatible or histoincompatible. In humans the strongest histocompatibility antigens are called the Human Leukocyte Antigens (HLA). Under current UNOS (United Network of Organ Sharing) listings, not only is the HLA-A, HLA-B and HLA-DR loci of interest for the transplant surgeons, but the DQ locus as well. Under UNOS guidelines, prospective crossmatches are typically run to see the compatibility between a donor and a prospective recipient. I say typically because it is the standard with kidneys (a kidney has a cold ischemia time of about 48 hours) and yet a prospective crossmatch is usually not possible for a heart or lung (in which case the cold ischemia time is much shorter). Needless to say, I am talking about a deceased donor. To run a crossmatch (XM), T and B cells are isolated from the donor (using blood, lymph nodes or spleen) and then incubated with the sera of prospective recipients. If antibody binding to both the T and B cells is seen (measured by flow cytometry as a positive XM), we know there is antibody to the donor’s MHC Class I antigen(s) present. Remember that Class I is on all nucleated cells. If a positive XM is seen with only the B-cells, then we know the recipient has antibody to the donor’s Class II antigen(s). Typically, we can predict in advance the outcome of a XM before the XM is even run because both the donor and recipient have been phenotyped and the recipient has been screened not only for antibody specificity, but levels of antibody at each specificity as well. Transplant surgeons have the task of determining what level (if any) of a positive crossmatch they are willing to accept before going to surgery. Many factors come into play in this decision including their patient’s wait time on the UNOS list, how common their patient’s HLA typing is (the more common, the higher chance of another donor coming up again in the future), the health of their patient and how good of a match the donor is for this patient – just to name a few.

Sex Hormones and Rheumatoid Arthritis

Autoimmune diseases such as rheumatoid arthritis are more prevalent in women, and many studies have suggested that estrogen’s pro-inflammatory action may contribute to this phenomenon. An article by Cutolo et al. from 2003 discussed that while estrogen levels in synovial fluid of arthritis patients were not significantly elevated compared to healthy patients, they saw a significant decrease in androgen levels (testosterone/dihydrotestosterone, dehydroepiandrosterone). They speculated that it might be this imbalance of estrogen to androgens (high ratio of estrogens to androgens) that might play a role in arthritis incidence, since androgens have an anti-inflammatory role.

So why are androgen levels lower in RA patients? Inflammatory cytokines such as TNF-α, IL-1 and IL-6 stimulate aromatase activity, the enzyme that converts androgens to estrogens. Since arthritis causes an increase in the production of inflammatory cytokines, the conversion of androgens to estrogens are also increased. This causes an imbalance of the sex hormones, creating a low anti-inflammatory, high pro-inflammatory environment that may be ideal for arthritis development.

Furthermore, estrogens have been shown to play a part in activating the NF-κB pathway, an inflammatory pathway in arthritis. Estrogen also increases cell proliferation and growth, which could lead to synovial tissue hyperplasia. An imbalance of the sex hormones may be the cause of higher incidences of autoimmune diseases in women, and research looking at hormone replacement therapy to treat or prevent arthritis are underway.

(Clin Exp Rheum, 21:687-690, 2003)

You smell..... and it's your MHC alleles

Researchers from the University of Chicago performed a study regarding human body scents and "preference" . Interestingly enough, this was due to association of MHC allele matches.....

In the first study in preliminary tests, women were allowed to choose between boxes with body scents on fabric, and were asked which they preferred or would avoid. Women preferred scents of men with whom they shared some MHC alleles and avoided boxes with which they shared no MHC alleles. Beyond this, scientists tested the hypothesis that choice was mediated by emotions, and not familiarity of smell. So women rated boxes from male donors (plus controls). They rated familiarity and intensity, pleasantness and spiciness. Women were blind from knowing these scents were male derived. Results indicated that women preferred donors with HLA alleles which match paternal alleles and avoided scents with no match, and this was based on pleasantness of scent and not familiarity, intensity and spiciness.

In the second study, scientists examined body scents from breastfeeding women and their infants. It was known from previous studies that scents from the breasts and axillae(armpit) of breastfeeding moms increase sexual motivation, and alter timing of ovulation in other women. This group wished to elucidate whether these effects were from immediate olfactory experience when the scents were wiped under her nose. Women either had control pads or compounds collected on pads from breasts and axillae of lactating women wiped under their noses. The women were asked questions about preference or strength of smell, or if it affected their moods. Results did not prove that smelling scents from women caused changes in menstrual cycle length or sexual desire.

Ladies, it looks like we prefer to smell men that smell like our dads and if we hang around pregnant women will cause us to want more sex and and change our ovulation patterns. Personally I do not know how I feel about this- but it may explain a few things......

What is IBD?

Inflammatory Bowel Disease (IBD) is a disease characterized by chronic inflammation in the bowel and intestine. There is a strong correlation between in the incidence of IBD in individuals with a history of the disease and is the largest independent risk factor for the disease. IBD is more prevalent in developed countries than in developing countries. Some reason for this is the extreme sanitation in developed countries that limits ones exposure to environmental antigens and impairs maturation of the immune system, specifically the mucosal layers in the digestive tract. Another possible link to developing IBD is excessive carbohydrate intake, though more research needs to be done to clarify and explain this correlation.

There are two major types of IBD: Crohn's disease and ulcerative colitis. Crohn's disease can affect anywhere from the mouth to the anus, but usually affects the large intestine. Ulcerative colitis mainly affects the colon and sometimes the lower sections of the small intestine. The symptoms of both diseases can be very similar, which makes a diagnosis between the two difficult at times.

To Pop or Not to Pop?!?

We have all sat next to that person, you know, the habitual knuckle cracker, the one that successfully cracks every knuckle, even knuckles you didn't even know existed and if you are like me, a non-knuckle cracker, you cringe! And we have all been warned by at least one person in our lifetime about the consequences of the knuckle pop. But does cracking your knuckles really cause damage or specifically arthritis or is it an old wives tale invented by some remarkably annoyed non-poppers?? Lets break it down!

Arthritis is" inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes not yet known. It occurs in various forms (over 100), such as bacterial, osteoarthritis, or rheumatoid arthritis."

Known risk factors of arthritis:

• Age. The risk of developing arthritis, especially osteoarthritis, increases with age.

• Gender. In general, arthritis occurs more frequently in women than in men.

• Obesity. Being overweight puts extra stress on weight-bearing joints, increasing wear and tear, and increasing the risk of arthritis.

• Work factors. Some jobs that require repetitive movements or heavy lifting can stress the joints and/or cause an injury, which can lead to arthritis.

What we know about knuckle cracking:

Where does the sound come from? Each joint is contained in a small bag of special fluid called "synovial fluid." When you stretch or pull your joint to "pop" it, you are stretching the bag of fluid. As a result, a bubble of carbon dioxide gas is released inside the bag and a cracking noise is produced.

After you '"crack" or "pop" your knuckles, or any other joint in your body, it takes 10-15 minutes for the carbon dioxide to re-dissolve into the fluid. This is the reason you might have tried to crack your knuckles again immediately and didn't succeed.

Soooooo:

Knowing all this one can deduce and the fact that there is no recorded evidence that cracking your knuckles does not cause arthritis. There is however evidence that knuckle popping can lead to other issues like fingers spontaneously falling off, just kidding! Err maybe ;) But seriously there is evidence that knuckle popping can lead to other hand issues later on in life like decreased hand strength and swollen hands.

Be kind to your joints!

The Contra-anti-vaccination Crusade?

I know this has been mentioned before in the blog, but I ran into the following article in an old copy of Wired Magazine (also a bit outdated) I picked up this weekend while traveling, and found it particularly interesting and pertinent to our class discussions:

http://www.wired.com/magazine/2009/10/ff_waronscience/

Albeit not peer-reviewed literature, the article discusses Dr. Paul Offit's "anti-anti-vaccination" crusade in the name of the science and efficacy of common childhood vaccinations. Due to his strong and vocal stances on the importance of continuing childhood vaccinations and his denial of their implication in autism, Offit has been labeled a "biostitute" trying to exploit children in order to profit from the RotaTeq vaccination he co-invented and has received mild death threats from members of groups promoting the causation of autism by vaccination.

The article discusses the recent popular anti-vaccination movements, led by celebrities like Jenny McCarthy, as someone mentioned earlier in the blog, and presents much data and history in favor of Offit and his pro-vaccination message. I don't think anyone in our class needs to hear the importance and efficacy of many of the vaccinations offered to children these days, but in case anyone needs some quick and easy arguing facts, the article offers these suggestions:

http://www.wired.com/magazine/2009/10/ff_waronscience_argument/

Enjoy!