Arthritis patients who take NSAIDs (nonsteroidal anti-inflammatory drugs) have an increased risk of developing bleeding ulcers -- one of the most serious problems associated with NSAID use. While there are many potential side effects that can occur from longterm use of NSAIDs, bleeding ulcers can be life-threatening and must be taken seriously. Bleeding typically occurs from the duodenum or stomach, but may also develop from the large intestine.

While warning signs often occur, such as stomach discomfort or bloody/black stools, some patients -- especially the elderly -- may have no warning before they develop serious bleeding. Fortunately, for those patients who need to take NSAIDs to treat their arthritis, there are ways to decrease the risk of ulcers and complications from ulcers such as gastrointestinal bleeding. We asked Scott J. Zashin, MD (a rheumatologist) and he suggested 9 Ways to Reduce Your Risk of Bleeding Ulcers from NSAID Use.

Related Resources:

• 10 Things You Need to Know About NSAIDs
• Nexium Reduces Risk of Ulcers for NSAID Users
• Voltaren Gel - What You Need to Know
• Gastrointestinal Bleeding - Don't Ignore Your Symptoms

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Unless you or a loved one have one of the over 100 types of arthritis, I doubt the word "rheumatology" is in your vocabulary. But, when arthritis enters your life, you learn quickly about rheumatology -- a subspecialty of internal medicine. Rheumatology is the medical specialty that focuses on arthritis and related rheumatic diseases. Doctors who specialize in rheumatology are referred to as rheumatologists.

Arthritis patients, especially early in the course of their disease, may question if it is necessary to go to a specialist in rheumatology. If you're already an established patient and have a good rapport with an internal medicine doctor -- can't the internist diagnose and treat arthritis? Learn when you should see a rheumatologist and why in What Is Rheumatology?

Related Resources:

• Arthritis Screening Quiz
• First Visit to the Rheumatologist
• I Think I Have Arthritis. Now What?
• Test Your Knowledge - Types of Arthritis and Rheumatic Diseases

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Rheumatoid arthritis causes bone loss but exactly how that happens has not been fully understood. It is known that TNF-alpha plays an important role in autoimmune diseases like rheumatoid arthritis. When it is overproduced, TNF-alpha signals the destruction of bone and cartilage. Human bone is continually regenerated in what could be called a biological balancing act. Osteoclasts break down bone to pave the way for new bone. Osteoblasts build new bone where osteoclasts removed it.

Researchers have known that TNF-alpha decreases the number of bone-building osteoblasts but now they know how as well. A study published in the August 22 edition of the Journal of Biological Chemistry revealed that TNF-alpha affects osteoblasts through an enzyme referred to as Smurf1 (Smad Ubiquitin Regulatory Factor 1). Smurf1 turns off two proteins that are involved in bone-building. While there are drugs that have been developed that block TNF-alpha (Enbrel, Remicade, and Humira), researchers are now focused on designing drugs that would shut down Smurf1. Interestingly, mice that are engineered to have less Smurf1 expression have been found to develop thicker bones. This suggests that focusing on Smurf1 may also lead to new ways of treating osteoporosis. The significance of these findings will be determined in future studies.

Related Resources:

• Fast Facts About Rheumatoid Arthritis
• Test Your Knowledge - Rheumatoid Arthritis
• Rheumatoid Arthritis 101 - Free E-Course Newsletter
• Rheumatoid Arthritis Prognosis - How Soon Will Symptoms Worsen

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Fruit juice may not be the best choice when taking your arthritis medications. A Canadian researcher has concluded that fruit juice can decrease or increase the effect of certain medications by affecting their absorption. Emphasizing that patients shouldn't panic and stop drinking fruit juice, researchers will continue to study which drugs are affected and by how much.

It's well-known that grapefruit juice should be avoided with certain medications. In 1991, grapefruit juice was found to boost the amount of certain drugs absorbed into the bloodstream, increasing the drug's toxicity. Now, there are nearly 50 drugs that carry warnings about grapefruit juice. But it may also be that apple juice and orange juice affect the absorption of certain medications. The researcher said in The Gazette, "Chemicals in the fruit juices appear to turn off a pump that normally helps get drugs out of the gut and into the body. The concern is that drugs essential for treating serious medical conditions might lose their benefit." Methotrexate is named in the article as one of the drugs that may be affected by fruit juice.

The best advice regarding fruit juice and medication -- ask your doctor and pharmacist how you should take your pills for optimal effectiveness. It may be best to avoid fruit juices for at least two hours so that drugs can be fully absorbed.

Related Resources:

• Arthritis Drugs - What Are My Options?
• 10 Most Popular Arthritis Drugs Prescribed by Rheumatologists
• 10 Ways to Ensure Drug Safety
• More About Drug Side Effects / Adverse Reactions

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