InsightHostRon: Hi Dr Waters
DrWaters: Hi all.
InsightHostRon: Tina is having a bit of trouble getting in to the room so yoou are stuck with me....
DrWaters: OK
bert: Has anyone heard anything on zipper?
Bug: Hi Dr Waters and Donna
Hobbles: no
DonnaM: good evening Dr Waters
Hobbles: hi Dr Waters
DonnaM: Hello Bug
DrWaters: It's anything goes night, so let's have some questions.
Hobbles: ron there was a very foul mouthed person on earlier
InsightHostRon: LOL... with this few people, I think that will work
Hobbles: hi dd
Bug: ?
DonnaM: I am doing well so I am here to listen
InsightHostRon: go ahead bug
Bug: How does Bextra compare with Vioxx? Recently changed to Bextra due to high bp.
DrWaters: In most ways they are similar. It seems to be that Bextra is a little less likely to cause edema and high BP.
InsightHostRon: Any other questions?
DrWaters: ?
Bug: OK, thanks
bert: Dr Waters, is Aspartame bad for us?
DrWaters: I have one. Do you people really find NSAID's to be effective? What do you think about the cost of the COX-2's?
InsightHostRon: do both celebrex and vioxx have a sulfa base.. I seem to get varying answers every time I ask someone..
Bug: I wish that lady who was considering Mexico and DMSO was here to ask Dr. Waters what he thinks about that move! LOL
InsightHostRon: they are too high of course
DrWaters: I believe a few people get weird stuff from aspartame, but a very tiny minority.
bert: thank you.
DrWaters: Only Celebrex contains sulfa.
Bug: All drugs are expensive for me; but fortunately BC helps.
InsightHostRon: thanks
InsightHostRon: LOL... . hiya tina
DrWaters: DMSO helps only a little, from what most users tell me.
DonnaM: I don't take the COX-2s, only Voltaren and it seems to help
ItsMeKJ: Hi Guys I hate computers!
ddaby: dr - your question for us about NSAIDS - I don't think my RA would respond completely to just DMARDS (but I did not have any success with Vioxx)
DrWaters: All COX-2's are theoretically exactly the same as non-selective NSAID's in terms of EFFICACY. The only difference is SAFETY (and cost).
Bug: Give us some examples (name brands) please.
DrWaters: I did very cool computer stuff this weekend. Go check out www.lindows.com. It's supposed to be a competitor for Microsoft's monoply.
ItsMeKJ: i'll have to check that out!
DrWaters: Motrin, Naproxen, Relafen, Lodine, Feldene and nonselective. Vioxx, Bextra and Celebrex are COX-2's. Mobic is not officially a COX-2 but in reality it's the same as the other 3.
InsightHostRon: OK folks, you have the good Dr here to answer questions....?
ItsMeKJ: Dr Waters...are any of your patients on kineret experiencing a fade?
bert: Isnt it actually a combo of drugs that help us?
Hobbles: i take .8 cc of mtx every week, my concern is how high of a dose can you take
DrWaters: COX-2's work exactly the same in the joints as non-selective NSAID's. The difference is there's no COX-2 receptors in the stomach or in platelets, so COX-2's don't cause ulcers or prolong the bleeding time.
InsightHostRon: k, hang on a bit and let him get those
DrWaters: So far my Kinerets have been holding steady. But I think all RA drugs fade somewhat, so we'll see.
ItsMeKJ: It's been 9 months since i started it and it's starting to fade....I guess i need to add another dmard?
DrWaters: 1.0 cc is usually the max. 0.8 is normal dose.
DrWaters: I thought you ran out of options.
Hobbles: thank you Dr Waters
InsightHostRon: What new treatments do you see coming down the pike?
ItsMeKJ: i can add mtx or azulfadine to it
InsightHostRon: for those of us who are about out of options
DrWaters: The big thing is probably going to be combinations of Kineret and Enbrel (and other biologics). That's why Amgen brought Imunex.
InsightHostRon: how about those of us who cannot use the enbrel,remicade kineret group?
ItsMeKJ: ron, your just screwed....lol
InsightHostRon: lol.. did i enjoy it?
DrWaters: They're researching the combo. I suspect D2E7 and other TNF's will be similar to Enbrel/Remicade, so it's either going to have to be combo's of current drugs or new interleukin inhibitors.
Hobbles: ?
InsightHostRon: go ahead hobbles
DrWaters: If you didn't live in the midwest you wouldn't have all those histoplasmosis concerns. You need to move to Florida.
Hobbles: Dr.Waters someone told me they have lukemina from taking mtx
InsightHostRon: LOL... I would love to... Know any good rheumeys there
Hobbles: is that possiable ?
DrWaters: Currently standard RX is TNF-blocker + / - MTX. If there's an issue the usuall is MTX + Plaquenil + / - Azulfadine. But that's already old news. That's why the Kineret plus Enbrel thing is interesting.
ItsMeKJ: wouldnt the infection risk be high with that combo?
DrWaters: There's no proof that MTX in RA doses causes leukemia. A lot of people have RA and swome of those will get leukemia, just like everyone else.
ddaby: ?
Hobbles: Tank You
InsightHostRon: go ahead dd
ddaby: have RA - am I supposed to be building up my immune system or are my DMARDS (plaquenil and mtx) trying to suppress it?
DrWaters: In the original Amgen study the infection risk was high; they're playing with the doses to maximize benefit and minimize risk.
DrWaters: It's not a too strong or too weak of an immune system thing, it's a confused imune system thing.
DrWaters: Your med's are supposed to clear away some of it's confusion without actually weakening it as a whole.
tinman: Do you know of any skin infections as a result of enbrel; that is can enbrel produce sideeffects of a skin rash or blood blisters appearing on the skin?
DrWaters: Let's talk about OA for a second. There's some interesting stuff. It ends up the IL-1 is very important in some OA, and Amgen is studying Kineret in the treatment and PREVENTION of OA!
ItsMeKJ: cool! so i wont get OA? Lucky Me!!
InsightHostRon: wonderful
ItsMeKJ: that is really very interesting
DrWaters: Skin infections are not a well reported complication of Enbrel. I suspect it's unrelated.
DrWaters: Of course, that's counteracted by the weight gain from prednisone.
ItsMeKJ: LOL just burst my bubble
InsightHostRon: questions?
DrWaters: There is also a big study going on using doxycycline to prevent knee OA in women.
ItsMeKJ: is there one dmard thats better than the others for treating sjogrens?
Tweet: I have a ?
InsightHostRon: go ahead tweet
tinman: Is the new psorosis medicne from Amgen going to help arthritis?
DrWaters: Do you know that just a 20%% increase in quadriceps muscle strength decreases OA progression in the knee by 50%%
ItsMeKJ: wow
InsightHostRon: wow
Tweet: My doc was telling me that the Kineret a lone doesnt seem to be helping me, is there any other combos out there that are effective that you've heard of? I cant touch NSAIDS or any immunosupressants
DrWaters: I haven't heard anything about Amgen's psoriasis drug, but I'll find out.
DrWaters: I try all kinds of stuff like Kineret and doxycycline and plaquenil. That has a low risk of infection. Sometimes I use colchicine for RA and that sometimes seems to help a lot.
Tweet: so an antibiotic and kineret is a good combo?
ItsMeKJ: what dose of doxy do you use?
DrWaters: Doxycycline inactivates matrix metalloproteinases in the joint cartilage and seems to inhibit cartilage breakdown and help arthritis that way, not as an antibiotic. Some patients respond a lot, some a little. It's a very slow acting drug, I give it 6 months before giving up.
tinman: Amgen's new drug is callede Amevive, r
DrWaters: 100 mg bid with food.
Tweet: I have OA in my knee now and i want to try something to stop any more damage before any type of surgery
Tweet: ok thank you
ItsMeKJ: hmm.....i'm gonna talk to my RD about adding that
tinman: Amevive is supposed to work on the TNF mechanism
tinman: Do you know anythging about that?
DrWaters: Then it will fight arthritis the same as Enbrel.
ItsMeKJ: i've had almost continual paratioditis for months now from the sjogrens.....they swell, they block, they get infected....vicious cycle....any ideas on how to stop it?
DrWaters: Usually use MTX and/or Imuran.
ItsMeKJ: actually it was worse on mtx....maybe i'll look at immuran
DrWaters: Have any of you been on cellcept for RA. That's what someone who's been on everything should ask there Rheum for next.
InsightHostRon: questions?
ItsMeKJ: how is cellcept side effect wise?
InsightHostRon: tell me about cellcept please
Tweet: i used to take cellcept but had bad bruises from it.. and blood count was off.. it helped but becuase of side effects i was taken off of it
ItsMeKJ: cellcept remicade and imuran are the only ones i havent tried and i cant do remicade
Texas: Are you off Kineret, KJ??
ItsMeKJ: still on it tex..but it is fading some..looking for something to add to it
rondae: hi room
Texas: Ty KJ
rondae: good grief,,, full house tonight
Tweet: KJ has the kineret faded like enbrel does for you? it hought i was the only one with that problem
ALF: hi all
rondae: hi Alf
ItsMeKJ: Hi rhondae, dr waters is answering our questions about arthritis
rondae: oh ok. greetings
rondae: I have questions about minocycline...
ItsMeKJ: well enbrel never worked enuff to fade tweet..lol....
ItsMeKJ: go ahead rhondae
InsightHostRon: what is your question rhondae
DrWaters: Cellcept is well tolerated and is less likely to lower blood counts than Imuran. It was studied in RA but the manufacturer decided not to pursue it. I have a few patients who are getting great results. Imuran works well, too, and most patients tolerate it well.
ItsMeKJ: so cellcept is off label?
rondae: I've been taking it for about a month now, I can't really tell that it is doing anything but I can tell that it makes me hungry..
DrWaters: Off label.
ItsMeKJ: minocin makes you hungry?
DrWaters: Take the minocin with food. That makes it less likely to irritate the stomach and decreases the hungry feeling. Minocin, like doxycycline, ssems to help some RA's a lot and some RA's not at all It can take months to work.
Texas: ?
rondae: I have to stop arava and methotrex
rondae: liver enzymes
tinman: I have?
DrWaters: did you try 10 mg dose?
InsightHostRon: go ahead tinman
ItsMeKJ: go ahead tex........
ItsMeKJ: lol
DrWaters: It's hosts war!
ItsMeKJ: rofl
Texas: Can a peson with 13 yr RA get help on antibiotic protocol??? Only person in remission I know is on AP. He also does a lot of health supporting diet choices
Kimmy: too many cooks in the kitchen tonite... ;o)
InsightHostRon: oops.. sorry tex.. missed you
Texas: No PRob Ron Can I be next
tinman: Do you knwo anything about a drug called Rocaltrol.05? is is supposed to work on some tyopes of arthritis?
InsightHostRon: go ahead
DrWaters: I don't know if I believe in the germ thing but would definitely try mino- or doxy- cycline.
Texas: TY Dr W
tinman: sorry I interruped
Texas: No please excuse me Chuck
DrWaters: Rocaltrol is a vitamin D thing. I'm not familiar with it fighting RA.
DrWaters: We have only 10 min left so we need some very insightfull questions.
ItsMeKJ: any news on new fibro treatments?
DrWaters: substance P blocker coming out next year from Merck. Very exciting. It may put me out of business.
ItsMeKJ: what substance P?
rondae: details?
Tweet: do tell please
rondae: what is it supposed to do?
DrWaters: Ends up that fibro is REAL (I told you so) and seems to be very tied in to having too much subsatnce P which is a mediator of CHRONIC pain. Chronic pain system is different than the opoid/prostaglandin acute pain system. That's why current Rx's are not too good.
ItsMeKJ: wow
ItsMeKJ: that is exciting
tinman: Will it work on other things than fibro?
InsightHostRon: very interesting
DrWaters: Substance P turns up the volume knob on your spinal cord and brain and once it moves up a notch it can't ever go lower again.
Texas (Plays Sound: applause.wav) Thank YOu Thank you
DrWaters: It'll be good for ALL chronic pain.
tinman: thank you very helpful
ItsMeKJ: wow!
InsightHostRon: buy merck stock now......
ItsMeKJ: lol ron
bert: Good news!
ItsMeKJ: anything else you'd like to tell us about?
InsightHostRon: one final question anyone?
DrWaters: What if it causes sexual dysfunction? You know you can never win.
ItsMeKJ: pain causes sexual dysfunction
DrWaters: OK, I retract my comment.
ItsMeKJ: lol
InsightHostRon: Looks like sexual dysfunction silenced everyone
rondae: we are in mourning
rondae: ha ha
Tweet: lol
ItsMeKJ: lol rhindae
Kimmy: I thought things were just getting interesting ;o)
InsightHostRon: LOL
DonnaM: some of us have been silenced fro awhile, Ron
DrWaters: One last thing. Time management. That seems to be a big problem for arthritis Mom's. I'm working on that with my patient's husbands to accept the dirty dishes and such. Really helps.
ItsMeKJ: Wow..can i send mine down for training?
jenni: mine too
Tweet: send my father down lol
ddaby: send me a husband
rondae: Mine is great about helping...
Tweet: lol dd
Kimmy: lol ddaby...
DrWaters: You see what I mean. Everyone things it's an issue.
rondae: If I could get him to understand the "I'm so exhausted" issue
Hobbles: mine help out a lot also
ItsMeKJ: it is a big issue
tinman: We both have arthritis
Tweet: because it IS an issue.. one no one wants to talk about to be honest
ItsMeKJ: mine helps out....but he really doesnt get it
Texas: You win, Chuck!!!
Hobbles: buy paper plates tin
DrWaters: Well, speaking of time management, I got to go. Thanks for inviting for me.
tinman: I wish I cold help my wife more, but I am not able
ddaby: thanks Dr
DonnaM: thank you DR Waters
ItsMeKJ: thanks for coming dr waters..as always you are a fountain fo information
Kimmy: thank you DrWaters
jenni: thanks
rondae: thanks.
InsightHostRon: Nite Dr W. Thanks for another wonderful session
Hobbles: ty Dr. Waters
bert: Thank you Dr.
Texas: THANKS, Dr W
If you didnt get a chance to ask a question..don't forget you can always ask Dr Waters and our other advisors at
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