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How do I know if I have Osteoarthritis or Rheumatoid Arthritis?

Osteoarthritis and rheumatoid arthritis are both forms of arthritis, and can cause joint tenderness and deformity. This is where their similarity stops, as they are actually very different diseases.

Osteoarthritis

Tire photoOsteoarthritis is a form of mechanical arthritis. It is caused by wear and tear of the cartilage and joint, much like the tires of a car. The more we use our joints, in activities like sports or repetitive movements, the more likely we are to get osteoarthritis.
Osteoarthritis is very common, and its prevalence increases as we get older. In fact, 35% of people over 65 and 80% of people over 75 have at least one arthritic joint.

Osteoarthritis can affect any joint, but it’s mostly seen in large joints like hips and knees. The arthritis pain is usually worse at the end of the day or after a lot of activity. Stiffness in the morning lasts a few minutes.

Rheumatoid arthritis

joints of hands photoRheumatoid arthritis is caused by an overactive immune system. The immune system actually attacks the joint, causing a lot of inflammation which can actually dissolve pieces of the bone. I sometimes think of this as pacman eating away at a joint. It can start at any age. Its prevalence is about 1% in the United States.
Rheumatoid arthritis most commonly affects small joints of hands and feet, but like osteoarthritis, can go to any joint. The pain is usually worse in the morning and after periods of inactivity. Morning stiffness commonly lasts several hours. Pain and stiffness get better as the day progresses.

 

Here are the differences between the two diseases at a glance:

OsteoarthritisRheumatoid Arthritis
CauseWear and tearAutoimmune
PrevalenceIncreases with ageAbout 1% of population
GenderWomen > MenWomen > Men
Joint sizeUsually large jointsUsually small joints
InflammationUsually littleUsually a lot
TimingPain worse at nightPain worse in morning
Morning stiffnessLess than an hourMore than an hour

 

Unfortunately, most arthritis is not this simple. For example, you can have osteoarthritis affecting small joints of the hands, or rheumatoid arthritis with not a lot of inflammation.  Or you may have one of more than 100 other types of arthritis. The diagnosis will require a trained physician. If you have arthritis pain, it is a good idea to talk to your physician or see a rheumatologist.

 

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Reumofan – a wolf in sheep’s clothing

Reumofan is…

Reumofan (or Reumofan Plus) has been called the miracle drug by many who have used it. Still, others believe Reumofan to be harmful. After my own patients reported their experience with this drug, I decided to take a closer look at the enigma that is Reumofan.

What prompted this blog

Last week I saw a young woman who was referred for evaluation of swelling in her legs. A quick exam made it obvious that her problem was not rheumatologic. “But why do I have this swelling?”, she asked through tears. Her legs had been swollen for about 4 months, and all labs and imaging studies were normal. In addition, she pointed to an annoying rash that had appeared on her entire face for the same length of time. She had already seen a dermatologist and an allergist, but nothing they gave her was working. She was clearly miserable.

We went through everything she had done and everywhere she had been before these symptoms started. “Any new medications?”, I asked, but her answer was no. When I asked if she was taking anything herbal or over the counter she replied, “well, not now, but 6 months ago I took a supplement from Mexico for plantar fasciitis, but stopped it about 3 months ago”. I was not familiar with Reumofan then, but a quick google search revealed concerns that it may contain dexamethasone, a form of steroids. Suddenly my patient’s symptoms made sense: as expected with long term steroid use, she had gained 30 lbs and developed swelling in her legs, in addition to steroid-acne on her face. In addition, she was at risk of adrenal insufficiency, a life-threatening condition that can occur if steroids are stopped abruptly.

After I saw my second patient with lower extremity swelling and weight gain- this time a middle aged man who had taken Reumofan for low back pain- I started to do a more in depth search on this drug. What I found was petrifying. “Reumofan” or “Reumofan plus” has been marketed as a “100% natural”, Mexican herbalary product to treat arthritis, tendonitis, muscle pain, osteoporosis, bone cancer, and a variety of other conditions. It has been sold not only in Mexico, but online in US and Canada.

Review on Reumofan

Blogs dating back to December of 2011 described a magical effect of this drug- aches and pains rapidly disappeared, people reported a “boost of energy”, and they were able to do things they could not previously. By March of 2012 people taking Reumofan started blogging about weight gain, leg swelling, irritability, sleep disturbance, muscle cramps, and abnormal hair growth, among others.

On June 1, 2012, the FDA, working closely with the Mexican government, issued a warning about Reumafen plus. An FDA laboratory analysis of Reumofan plus found that it contains a few hidden ingredients: diclofenac sodium and methocarbamol. The Mexican Ministry of Health discovered that at least one lot of the product contains the corticosteroid dexamethasone. Consumer adverse reports to the FDA included many of the side effects expected with these ingredients.

The FDA updated its warning on August 21, 2012, noting more reports of fatalities, stroke, severe gastrointestinal bleeding, dizziness, insomnia, high blood sugar, and problems with liver and kidney functions, as well as corticosteroid withdrawal syndrome.

Let’s take a look at what these ingredients actually are:

  • Dexamethasone– a form of steroids, it is a powerful anti-inflammatory medication with rapid efficacy but many side effects when used long term. It is one of the medications that I as a rheumatologist commonly prescribe, but would monitor the patient frequently and carefully and try to wean off as fast as possible. It should never be stopped abruptly as that can lead to adrenal insufficiency. Potential side effects include:
            -weight gain
            -water retention (which can cause swelling in the legs)
            -heart failure
            -skin thinning and easy bruising
            -osteoporosis
            -gastrointestinal ulcers and bleeding
            -cataracts
            -steroid acne
            -steroid psychosis
            -adrenal insufficiency when stopped abruptly (some of the symptoms include fatigue, nausea, low blood pressure, dizziness. It can cause death).
  • Diclofenac sodium (Voltaren)- a prescription non-steroidal anti-inflammatory drug (NSAID), similar to ibuprofen, advil, naproxen, aleve, meloxicam, etc. It may be contraindicated in people with heart disease, kidney disease, or those on blood thinners. It also should not be combined with aspirin or other NSAIDS as it can increase the risk. Potential side effects include:
            -gastrointestinal upset, ulceration, perforation, and bleeding (black box warning)
            -increased risk of cardiovascular events like heart attack, clots, and stroke (black box warning)
            -kidney failure
            -increased risk of bleeding in people on blood thinners
  •  Methocarbamol (Robaxin)- a prescription muscle relaxant, which can cause sedation, dizziness, and impaired mental status. Its use is not recommended in people older than 65.

These ingredients may also interact with other medications and result in serious adverse events.

What is the take-home message?

First, if you have taken or are currently taking Reumofan, make sure to alert your doctor. Do not stop it abruptly as it may cause serious problems. Report any side effects to the FDA (click here).

Second, let’s be more skeptical of supplements that claim to be “all natural”, especially if they come from Mexico.  This is not the first time I have seen a supplement from Mexico contain steroids.

Third, just because a product is natural, or claims to be, it may not be necessarily safe. For example, Ginko biloba can cause serious bleeding and Ginsing can interact with Coumadin (a blood thinner). Keep in mind that tobacco is also a natural product.

Finally, if you see a number of side effects listed on FDA-approved drugs, it’s because these drugs have been extensively tested and side effects are carefully reported. The side effects of many “natural” supplements are unknown. While I am a proponent of herbal supplements that have been around for a long time, like turmeric or glucosamine for arthritis, I advise judicial skepticism when considering a new product with promises too good to be true.

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