Does eating fish help treat rheumatoid arthritis?

March 27, 2018

Does eating fish help treat rheumatoid arthritis? This is the question we will try to answer in this edition of RheumDoctor Journal Club. Rheumatoid arthritis is a common autoimmune condition that affects about 1% of the population. This disease can cause joint pain, swelling, and stiffness, as well as inflammation throughout the body. Disease modifying antirheumatic agents (DMARDs) are the standard of care for the treatment of rheumatoid arthritis. These medications help slow and stop the progression of the disease. Some of these medications include methotrexate, hydroxychloroquine, sulfasalazine, as well as biologic medications such as etanercept, tofacitinib, tocilizumab, etc.

We know from research from the 80s, that omega-3 fatty acids also help to decrease rheumatoid arthritis inflammation. We learned from the studies that supplementation with 3 g of omega-3 fatty acids is effective in decreasing inflammation. However, the studies focused on supplementation, not the consumption of whole natural fish.[1] [2]

Relationship between fish consumption and disease activity in rheumatoid arthritis[3]

The objective of the study was to determine whether people who ate fish frequently tend to have lower rheumatoid arthritis disease activity. The researchers conducted a cross-sectional analysis from a large group of patients evaluating cardiovascular disease. Their outcome was the disease activity score known as the DAS28, as well as C-reactive protein (CRP). CRP measures inflammation throughout the body.

Patients completed a 120 item food questionnaire. Because we think long-chain fatty acids degrade when exposed to high heat, fried fish, non-fried shellfish, and fish in mixed dishes, the research did not count them. It could be boiled, steamed, baked, or eaten raw.

Results

176 people were included in the analysis. The majority of these people were middle-aged, college-educated white women, who are taking DMARDs and who were seropositive, and had rheumatoid arthritis for a long time.

19.9% of the people reported infrequent fish consumption (never to <1/month), 17.6% were frequent consumers (≥ 2 times/week). People who supplemented with fish oil were more likely to eat fish infrequently (20%). Interestingly, people who smoked cigarettes, were more likely to eat more fish

After adjusting for age and sex, people who consumed fish more than two times per week compared to those who ate fish infrequently, had lower disease activity scores and had lower CRP levels. Moreover, each additional serving of fish per week decreased both the disease activity score and the CRP. In a sensitivity analysis, the researchers found similar results after adjustments for biologic DMARDs and fish oil supplements. Further adjustment for smoking produced similar results.

What does this mean?

Simply put, eating fish two or more times per week may decrease rheumatoid arthritis activity as well as systemic inflammation. Although supplementing with fish oil also decreases inflammation in rheumatoid arthritis, there is something about eating fish as a whole natural food. One serving of fish almost certainly includes less than 5.5 g of omega-3 fatty acids given that an 8 ounce serving of fatty fish generally provides 2 to 4 g of omega-3 fatty acids. Whole natural fish has various macronutrients and micronutrients including omega-3 fatty acids that could be beneficial.

Then again, maybe people who regularly eat fish tend to have a healthier lifestyle. This could be the case, however, in this particular group, people who ate fish more regularly tended to smoke more. I think we can all agree that this isn’t the healthiest of lifestyle choices!

What we learned today

People who eat fish two more times per week compared to those who never eat fish or those who eat fish less than one time per month, tend to have lower rheumatoid arthritis, disease activity as well as systemic inflammation.

Eating non-fried fish on a regular basis is an important part of eating to beat rheumatoid arthritis.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

References

[1] Kremer JM, Bigauoette J, Michalek AV, Timchalk MA, Linenger L, Rynes RI, Huyck C, Zieminski J, Bartholomew LE. effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet. 1985 Jan 26;1(8422):184-7.

[2] Kremer JM, Lawrence DA, Petrillo GF, Litts LL, Mullaly PM, Rynes RI, Stocker RP, Parhami N, Greenstein NS, Fuchs BR, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal anti-inflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995 Aug;38(8):1107-14.

[3] Tedeschi SK, Bathon JM, Giles JT, Lin TC Yoshida K, Solomon DH. Relationship between fish consumption and disease activity in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018 Mar;70(3):327-332.

Overcoming Inflammation

Exercises to help hand osteoarthritis

November 21, 2017

Osteoarthritis is the most common joint disease. Unlike rheumatoid arthritis, osteoarthritis is not an autoimmune disease. Osteoarthritis mainly affects the fingers, knees, hips, as well as the spine. Today, I would like to talk about hand osteoarthritis, which is much more common in women and particularly women above the age of 50.

We like to think of osteoarthritis as a wear-and-tear arthritis, however, this is somewhat adopting a limited view. Osteoarthritis certainly has to do with wear-and-tear, however, there are several biochemical and genetic factors that play a crucial role in the pathogenesis of the condition.

Because osteoarthritis is not an autoimmune disease, medications that we use for rheumatoid arthritis that deal with the immune system like methotrexate, are generally not effective in either alleviating pain or stop progression. Currently there are no disease modifying medications that significantly alter the progress of the disease. Typically, treatment relies on analgesic medications, both topical and oral, splinting, steroid injections, and surgery.

Although there are no medications that alter the progress of osteoarthritis, hand exercises play a major role in improving function and alleviating pain. The aim is to strengthen the muscle surrounding the joints to act as cushion to reduce the pressure on the joints. This will have the effect of improving grip strength, range of motion, and help with pain.

Here’s some evidence.

Hand anatomy

First let’s refresh our anatomy.

First of all, here we have a picture that illustrates the various bones that make up your hand.

Carpals
Metacarpals
Proximal phalanges
Intermediate phalanges
Distal phalanges

And then we have the joints that make up your hand.

Midcarpal joint
1^st carpometacarpal (CMC) joint
1^st interphalangeal (IP) joint
Metacarpophalangeal (MCP) joints
Proximal interphalangeal (PIP) joints
Distal interphalangeal (DIP) joints

Finally, your hand needs to adapt to do everyday tasks. Below you will find a picture that demonstrates the arches of the hands. Basically, these are the different ways your hand can move – range of motion.

Improved hand function, self-rated health and decreased activity limitations – results after two month hand osteoarthritis group intervention

A recent study aimed to study the effect of exercise and paraffin wax therapy on osteoarthritis. They wanted to see if their intervention would improve hand function, activity limitation, and self-rated health in people suffering from hand osteoarthritis.[1]

This was a prospective cohort study which consecutively recruited people in a primary care clinic in Sweden. They included people who were symptomatic or had radiographically verified and osteoarthritis. Finally, they excluded people who had other types of hand diseases, like rheumatoid arthritis or had undergone hand surgery.

Intervention

The intervention consisted of both an educational and exercise component. People received two group sessions lasting an 1 ½ each. During the educational piece, they discussed osteoarthritis in general, as well as guides to treatment. They also discussed why exercise is important for rehabilitation and how to perform exercise as well as how to modify exercise due to pain.

The exercise component started after two educational sessions. They were held twice weekly over a six-week period. These were spearheaded by occupational therapists. Each session started with 20 minutes of paraffin wax therapy followed by 25 minutes of hand exercises. Typically these included 14 different types of exercises performed at least five times during the 25 minute.

Assessment

Everyone who participated in the study saw one of three occupational therapists at baseline, after three months (after the end of the intervention), and after 12 months (long-term follow-up). During each visit, the occupational therapist measured hand function, activity limitation, as well as self-rated health.

Hand function

Range of motion
Grip force
Hand pain
Grip ability

Activity limitations

The Patient Specific Functional Scale (PSFS), – people were asked to define three limiting activities caused by osteoarthritis
The Quick Disability of the Arm, Shoulder and Hand (Quick DASH)

Self-rated health

EuroQol VAS

Results

A total of 49 people participated in the study: 5 were men and 44 were women. There weren’t any significant differences between the participants who completed study versus those who dropped out, except that the people who dropped out were more likely to be working and the people who completed the study were more likely to be retired.

Hand function

Grip ability improved significantly from baseline to three months, p<0.001. There was no difference between three months and at 12 months.
Range of motion improved significantly from baseline to three months, p= 0.011. There was no difference between the results at three months and 12 months.
Grip force improved significantly from baseline to three months, p<0.001 in the right-hand as well as in the left-hand, p=0.008. The left-hand continued to improve between three months and 12 months but not the right hand.
Hand pain at rest also significantly reduced after 3 months, p<0.001. There was no difference between the results at three months versus 12 months.

Activity Limitations

Activity limitations in all three activities improved significantly from baseline to three months, p=0.008, p=0.001, p=0.004. There was no change between three months and 12 months.
Activity limitations using the Quick-Dash improved significantly from baseline to three months, p=0.001.

Self-rated health

Self-rated health also improved significantly between baseline and three months, p=0.039, and the results remained stable at long-term follow-up.

Limitations

The study had multiple limitations:

Small sample size
Based on the study design, it was impossible to tell whether the improvement in activity and self-rated health leads to improve hand function or vice versa.
This was not a randomized control trial.
Unable to distinguish the results of the separate parts of the intervention.

Conclusion

People who suffer from osteoarthritis appeared to improve when it comes to hand function, activity limitations, as well as overall self-rated health when they combine education as well hand exercises. The improvements were also sustained at 12 months!

In this study, the participants also started their exercise program with a paraffin wax bath. The European league against rheumatism (EULAR) recommends local application of heat, light, paraffin wax therapy, for the treatment of osteoarthritis as a short-term treatment option to decrease pain and to support muscle strength. There is ample evidence supporting that hand exercises independently improve pain and function in osteoarthritis. That being said, it’s safe to say that the improvement seen during the course of this study were not solely caused by paraffin wax therapy. Although, who would ever say no to a nice relaxing paraffin wax bath?

Hand osteoarthritis program

Now that we have evidence that exercise supporting the role of exercises to improve hand osteoarthritis, it’s time to start the healing process. Now not all of us either has resources or the time to see an occupational therapist twice a week, but here are a few interventions that you can do in the comfort of your home.

Remember, hand exercises for osteoarthritis should include flexion and extension of the DIP, PIP, and MCP joints, opposition of the index and middle fingers, and well as an opening grip movement – like opening up a door handle.

Please leave your comments below!

References

[1] Bjurehed L, Brodin N, Nordenskiold U, Bjork M. Improved hand function, self-rated health and decreased activity limitations – results after a two month hand osteoarthritis group intervention. Arthritis Care Res (Hoboken). 2017 Oct 3. doi: 10.1002/acr.23431. [Epub ahead of print]

Scheme human hand bones, Mariana Ruiz Villarreal (LadyofHats); retouches by Nyks

Human-Hands-Front-Back, by Evan-Amos

Hand-arches, Drawn freely (OK, crappy) from Physiology of the Joints, I.A. Kapandij 1982, p. 169. Made in Inkscape. |Source={{own}} |Date=January 2013 |Author= [[User:Fama Clamosa|Fama Cl…

Medical Disclaimer

Overcoming Inflammation When to see a rheumatologist

How to prepare for your rheumatology consultation

October 3, 2017

Rheumatologists treat well over 100 different types of diseases. These diseases are complex and affect many organ systems. Diagnosing a rheumatic disease is like solving a complex puzzle. Every first consultation includes a detailed history, a physical examination, and a review of past blood work, x-rays, and documentation from your other doctors. All these help your rheumatologist solve the puzzle.

Preparing for a rheumatology consultation is a bit like preparing for a meeting with your accountant. You want everything organized in advance: W-2, investment income statements, IRA/pensions distributions, child care costs, etc. You want everything neatly laid out in advance, so that your consultation is as productive as possible.

Laying the groundwork

Make sure your rheumatologist has all the information at his or her disposal well before your appointment.

The progress note from your referring physician. What is the question that’s being asked?
Your primary care physician’s (PCP) last progress note.
The results of any blood tests.
The results of any x-rays or any other imaging.
If you had a biopsy that relates to your symptoms (e.g., skin biopsy, kidney biopsy, lung biopsy), your rheumatologist will want to see the pathologist’s interpretation.
If you are transferring care from another rheumatologist, your current rheumatologist will definitely want to see that information.

Bring an updated list of your medications and allergies

It’s always a good idea to have a written updated list of all your medications and allergies. Make sure you bring this along to your first consultation. Do not assume that your PCP’s updated medication list is up-to-date. Some people see more than one doctor and they’re all making changes independently.

Anticipate questions your doctor may ask

Rheumatologists certainly have access to high specialized blood tests and imaging, but the medical history is by far the most important part of the consultation. Before your visit, try to expect some questions your doctor may ask and then write them down. Here are a few that may help you get started.

When did you first notice something was wrong or had changed?
Describe your symptoms.
Has this ever happened before? If so when?
Do the symptoms come and go or are they continuous?
Is there a particular time of day where they are worse?
What makes your symptoms worse? What makes them better?
Have you taken any over-the-counter medications for your symptoms? If so, which ones and did they help?
Do you think you have other symptoms besides joint or muscle pain that seem connected?
Have your symptoms caused you to make changes to your daily routine?

Anticipate questions you may have for your doctor

Based on what you know, what could be causing my symptoms?
What tests do I need to have done to help decide what my diagnosis is?
Are there any symptoms that I should be looking out for?
What kind of interventions could I do now, to help ease some of my symptoms?
What kind of activities should I avoid at this time? (e.g, get pregnant, run a marathon, prolonged travel, etc.)

Actively listen and participate

You may feel overwhelmed when your doctor is giving you a new diagnosis, let alone giving you a complex set of recommendations. You’re not alone. A study looked at how much information (when prescribing a new medication) patients retained after their doctor’s appointment. They found that only 64% of people were able to recall all the information that they discussed during the visit[1]. Not bad, but not great.

We know that recall of information improves health outcomes in people suffering from chronic diseases like rheumatoid arthritis and lupus. Another study looked at aspects of doctor-patient communication that lead to higher recall. They found that active patient engagement and explicit conversations about medications improved recall.[2] Here are a few tips about becoming a better active listener.

Pay attention
Show that you’re listening
Provide feedback
Defer judgement
Be candid, open, and honest in your response.

You may also want to write things down in a journal (highly recommended) or maybe you may want to bring an advocate to your consultation. This could be a trusted friend or family member.

Conclusion

Being ready for your appointment, active listening, and asking questions to understand your symptoms is central to not only making the most of your rheumatology consultation but also, becoming an empowered patient.

Please follow this link to request a rheumatology consultation.

[1] Tarn DM, Flocke SA, New prescriptions: How well do patients remember important information? Fam Med. 2011 Apr; 43(4): 254–259.

[2] Richard C, Glaser E, Lussier MT. Communication and patient participation influencing patient recall of treatment discussions. Health Expect. 2017 Aug; 20(4): 760–770.

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Overcoming Inflammation

Flu vaccines and autoimmune diseases

September 19, 2017

Should people with autoimmune diseases get a flu vaccine? If so which ones?

Have you received your annual flu vaccine? Flu season is just getting started. People who suffer from autoimmune diseases, like rheumatoid arthritis, lupus, and Sjogren’s syndrome, often have a weakened immune system, either from the disease itself or from the medications used to treat their disease. Today I’d like talk about the flu also known as influenza, and discuss what steps you can take to protect yourself this season.

What is the flu or influenza?

The medical word for the flu is influenza. Influenza is a type of virus that mainly attacks the respiratory system. There are two general types of influenza: influenza A viruses and influenza B viruses. Different components make up the flu virus: one hemagglutinin (H1, H2, H3) and one neuraminidase (N1, N2). There are many different strains of influenza and to make matters worse, it tends to mutate.

The stomach flu is NOT caused by influenza. The stomach flu is a general word used to describe a gastrointestinal infection caused by other types of viruses like Norovirus, the most common cause of gastroenteritis in the United States.

What are some of the signs and symptoms of the flu?

The signs and symptoms of the flu vary widely and are rather nonspecific. They can include:

High fever
Muscle pain
Rigors, uncontrollable shaking
Headache
Malaise
Sore throat
Nonproductive cough
Runny nose

Complicated cases

Sometimes the flu can morph into a much more serious illness. It can cause viral pneumonia and then can lead into a secondary bacterial pneumonia, sinusitis, and/or an ear infection. This tends to happen in people who have a weakened immune system like children and older adults. People with autoimmune conditions and especially people taking medications that weaken the immune system also are at high risk.

How is the flu transmitted?

The flu spreads from person-to-person by large particle droplets.

Airborne droplets: Coughing and sneezing
Skin-to-skin: handshakes and hugs
Saliva: Shared drinks and kissing
Touching contaminated surfaces: Keyboard, doorknob

What are the best ways to prevent the flu?

The best ways to prevent the flu are first, by washing your hands and second, by getting vaccinated for the flu at the beginning of each flu season. Choosing healthy lifestyle practices, like eating clean, exercising, and getting a good night’s sleep, are also important.

What are the most convincing reasons for getting vaccinated against the flu?

During the 2016 – 2017 flu season, it caused 5.1% of outpatient visits.
Pneumonia and the flu caused 2% of reported deaths.
There were at least 18,000 confirmed flu related hospitalizations, 60% of cases occurred in people aged 65 years and above.
There were 98 confirmed flu related pediatric deaths.[1]
Risks of complications, hospitalizations, and deaths from the flu are the highest among people age 65 and above, young children and people who have medical conditions that weaken the immune system.
If you end up getting the flu, the flu vaccination may make your flu illness milder
By getting the flu vaccine, you decrease the risk of passing it on to the people you love

Who should get a flu vaccine?

Everyone six months and older. This is especially important for people who have a high risk of getting flu-related complications. These include:

Children younger than five
Adults 65 years of age and older
Pregnant women, up to two weeks postpartum
People that live in a nursing home or another type of long-term care facility
People that have a medical condition that weakens the immune system, this includes almost everyone with an autoimmune disease

Medical conditions

People with weakened immune systems (autoimmune diseases, cancer, HIV or AIDS, people on chronic steroids and biologic medications)
Asthma
Neurological and neurodevelopmental conditions
COPD and cystic fibrosis
Coronary artery disease and heart failure
Diabetes mellitus
Blood diseases like sickle-cell anemia
Kidney disease
Liver disease
People with an extremely high body mass index (BMI) > 40

When is flu season and when should I get my flu vaccine?

In the United States, flu season occurs during the months of October into May. Historically, the greatest number of cases occur during the month of February. The CDC recommends that people get a flu vaccine by the end of October. If you’ve missed the deadline, no worries, better late than never!

What viruses will the 2017 – 2018 flu vaccines protect against?

Every year, manufacturers must change the structure of the flu vaccine, because the virus is constantly changing. Scientists use data from the previous year to try to guess which strains will be more problematic in the upcoming season. Flu vaccines typically have 3 to 4 specific strains of influenza. This year, the vaccinations that have three types of virus should contain the following:

A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
A/Hong Kong/4801/2014 (H3N2)-like virus
B/Brisbane/60/2008-like (B/Victoria lineage) virus

Vaccines that contain four strains should contain the above as well as the following:

B/Phuket/3073/2013-like (B/Yamagata lineage) virus

Where can I get a flu vaccine?

Most doctor’s offices carry the flu shot. Call your primary care provider or specialist to see whether they can give you your flu shot this year. If not, most pharmacies also give this service as well.

Still unsure, please follow this link to find a flu shot near you.

Which flu vaccine should I get?

According to the CDC’s of published guidelines for the 2017 – 2018 season, they recommend the use of the inactivated influenza vaccine or IIV, or the recombinant influenza vaccine (RIV). These come as injections. They recommend against vaccination with the nasal spray flu vaccine. The latter is a live attenuated vaccine. People who take biologic medications should not receive live attenuated vaccines.

Can I get a flu vaccine if I’m allergic to eggs?

The following are the CDC recommendations regarding egg allergies and the flu vaccine.

People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
People who have symptoms other than hives after exposure to eggs, such as angioedema, respiratory distress, lightheadedness, or recurrent vomiting; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a healthcare provider is able to recognize and manage severe allergic conditions. (Settings include hospitals, clinics, health departments, and physician offices). People with egg allergies no longer have to wait 30 minutes after receiving their vaccine.[2]

Disclaimer: I have some safety concerns about the latter. I’m simply stating what the CDC has issued. When in doubt, talk to your doctor.

Why does the flu vaccine sometimes cause flu-like symptoms?

Here are a few reasons.

You have the flu

The incubation period is between one and four days. It also takes about two weeks for your body to build immunity after receiving the vaccine. Therefore, you can get the flu after a flu shot if your body hasn’t had time to build immunity yet.

You have a cold

Rhinoviruses are a common culprit. These are the viruses responsible for the common cold. In severe cases, the common cold can feel like the flu and you can catch it the same way.

The vaccine failed

Last year, the vaccine was only 34% effective at protecting against influenza A (H3N2) and 56% against influenza B viruses. Unfortunately, over the past six seasons, vaccines have been less and less effective.[3] However, any immunity is better than no immunity.

The flu vaccine gave you the infection

This can occur if you’ve received a particular type of flu vaccine that uses a live attenuated virus. This is the vaccine that comes as a nasal spray. Live attenuated vaccines are vaccines that contain a less potent form of the real virus. The immune system reacts to the virus and develops antibodies without causing the infection. Sometimes the virus is stronger than the immune system. The real infection can occur when this happens.

The CDC advised against the use of this particular type of vaccine.

Most common cause, your immune system is reacting to the vaccine

Scientists make injectable flu vaccines with inactivated virus or without any virus at all. Therefore, by definition, these are not infectious. You cannot get the real infection from them.

Some people may experience some soreness, redness or tenderness from the shot itself. Some people actually develop a low-grade fever, headache, and muscle aches (i.e., flu-like symptoms). These typically last about 2 days and resolve without any intervention. This is your body’s way of telling you that it’s mounting an immune response to the vaccine. This means your body is responding to the vaccine and making antibodies to protect you from the real infection, which is MUCH more severe.

Final thoughts

I know vaccines have received a bad reputation over the past few years. However, when you look at the data, vaccination particularly for the flu, ultimately saves lives. Let’s take example.

During the 1918 – 1919 flu season (i.e., the Spanish Flu), 1/3 of the world population experienced a terrible flu pandemic. About 50 to 100 million died. Now this was a particularly bad season, “the mother of all flu seasons”, and the reason it was so deadly has to do with many factors that we have yet to confirm. The CDC has experimented with an influenza virus that has the genetic material from the 1918 virus. Their results suggest that our modern-day vaccines and FDA-approved antiinfluenza medications like Tamiflu, would have worked against the 1918 virus.[4]

Bottom line, flu vaccines save lives.

If you want to learn more about the flu, please follow this link.

References

Fingers smiling against flu shot message image by wavebreakmedia via Shutterstock

[1] http://www.mdedge.com/jfponline/article/145540/vaccines/latest-recommendations-2017-2018-flu-season

[2] https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm

[3] http://www.mdedge.com/jfponline/article/145540/vaccines/latest-recommendations-2017-2018-flu-season

[4] https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article

Medical Disclaimer

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Overcoming Inflammation

How to travel with medications

August 16, 2017

The other day, someone asked me how to travel with medications. In this particular instance, it had to do with a medication that comes as a prefilled syringe. I figured I’d write down some tips on how to travel with rheumatology medications.

Before you travel

Before traveling, ask your doctor for a letter describing your medical condition and the medication(s) that you are taking for that particular condition. The TSA officer may not ask you to produce such a document, but if they do you’re covered. This isn’t really an issue for oral medications but more for liquid medications. Read on to learn more about liquid medications.

Medications

The TSA allows travel with your medication in both your carry-on and your checked baggage. However, I suggest that you always carry it with your carry-on. First, you never know when you’ll need your medication. Second, you don’t want anyone tampering with your medications. As you already probably know, some medications are very expensive. E.g., 1 etanercept pen costs about $1 000. Would you put $1 000 in cash in your checked bag? Call me paranoid but I wouldn’t.

Oral medications

When it comes to medications that come in pill form, you do NOT need to tell the TSA that you are carrying medications. You can carry as much medication as you will need for your trip. However, like any other carry-on baggage, the TSA needs to screen your medications through their x-ray machine. The TSA does not mandate that you carry your medications in the original prescription bottle, however, every state has their own set of laws regarding the labeling of prescription medications. You absolutely need to verify and comply with your own state’s laws.

Subcutaneous medications

First, you must tell the TSA officer that you are carrying liquid medications. These include medications that come in pens, prefilled syringes, and vials like subcutaneous methotrexate. Prescribed creams and eye drops are also considered liquid medications. Some examples of subcutaneous medications include etanercept, adalimumab, abatacept, golimumab, and belimumab, etc.

Unlike your usual liquids like shampoo or perfume, liquid medications are exempt from the 3-1-1 liquids rule. This means that you ARE allowed to bring more than 3.4 ounces or 100 mL of liquid medication in your carry-on bag. Moreover, you are NOT required to place the medication in a plastic zip-top bag. Like oral medications, the TSA does not require that you carry medications in their original labeling, however, it is highly suggested. Remember, you must comply with your state’s laws.

Liquid medications also go through x-ray screening. If you don’t want your medication screened by x-ray, you must tell the TSA officer. Your medication will need to undergo additional screening procedures like visual screening.

Used syringes

You had a great trip, but now it’s time to go back home. During your trip, you may have used a syringe/pen or two. It’s important to note that you can bring used syringes or pens but you must transport them in a sharps disposal container. You can put your container in your checked bag and you can also bring it on your carry-on bag.

Accessories

Some medications need to be kept cold at all times until you actually need them. Some accessories include ice packs, freezer packs, gel packs, or syringes. The TSA will screen these items. If the officer is unable to use the x-ray to clear any of your items, they also will need more screening.

Aids

These items include walkers, crutches, and canes. Like any other item, these items undergo x-ray screening. If the item does not fit into the machine, the TSA officer will do a visual screening.

Wheelchairs and scooters

Obviously, these items don’t fit through the x-ray machine. When traveling with these items, the TSA officer will screen your device, including the seat cushion.

What if you can’t walk or stand?

The TSA officer will help you sit down in a chair and you will undergo a pat-down screening.

Have a fun trip!

Now you’re ready for your big trip! If you need more information please visit the transportation security administration website. When in doubt, please contact them directly before your trip.

Safe travels!

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Diseases and Conditions Overcoming Inflammation

Can UV light trigger lupus flares?

July 12, 2017

Now that summer is finally in full swing, I’d like to remind everyone to use broad spectrum sunscreen while enjoying the sun! This is especially important for people living with systemic lupus erythematosus (SLE). Ultraviolet (UV) light is a known trigger of SLE flares BOTH involving the skin and major organs. Many people also report joint pain, weakness, and headaches. These flares can be very serious.

Although we know UV light is a trigger for SLE flares, we still don’t fully know how it happens. This is what we do know.

UV light directly damages the DNA of skin cells.
The cells release inflammatory cytokines, most notably interleukin-1α and tumor necrosis factor-α.
UV light also increases interferon-α signaling. People with high levels of interferon-α signaling often develop fevers, fatigue, and low white cell count (leukopenia). Interferon-α signaling is thought to be an important part in the development of SLE.

Take home points

So while you’re enjoying the sun remember to:

Avoid the sun when UV light is strongest, between 10 AM and 3 PM. If you use IFTTT, check out this app. You will get a notification on your phone when the UV index is high… and it’s free!
Use broad spectrum UVA/UVB sunscreen. Try to aim for a SPF higher than 30.
Try wearing clothing that have vivid colors and a tight weave. The Skin Cancer Foundation has a great article regarding this topic: “What is Sun-Safe Clothing?”
Wear a broad-brimmed hat when spending time in the sun.

Be safe and please leave your comments below!

References

Fernandez D, Kirou KA. What causes lupus flares? 2016 Mar;18(3):14. doi: 10.1007/s11926-016-0562-3.

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