Hocus-Pocus As Applied To Arthritis

                            by Annabel Hecht

                           [Graphic Omitted]

                              FDA CONSUMER

                  A REPRINT FROM FDA CONSUMER MAGAZINE

                DEPARTMENT OF HEALTH AND HUMAN SERVICES
                         PUBLIC HEALTH SERVICE
                      FOOD AND DRUG ADMINISTRATION
              OFFICE OF PUBLIC AFFAIRS. 5600 FISHERS LANE
                          ROCKVILLE, MD 20857



You can sit in an abandoned radium mine, hang a Vryllium tube on your
lapel, bury yourself up to the neck in horse manure, swill Dr. Fenby's
Formula X, or take a dose of "Chuifong Touku-Wan," but you will not be
able to cure your arthritis.

It is a distressing fact of life that although there are drugs to
relieve the pain and reduce the inflammation of arthritis, there are no
cures for most of the more than 100 types of this painful and sometimes
crippling disease.  Yet many people with arthritis turn to unproven
devices and "miracle" cures, such as those mentioned above.  They do no
good and in some cases can do considerable harm.  However, the peddling
of these unproven cures is a big business, with more than a billion
dollars a year spent on them.

It is not too surprising that this business flourishes. There are plenty
of people to prey on-over 37 million Americans suffer from arthritis and
related disorders.  Arthritis is a chronic condition. Once you develop
it, it often stays with you the rest of your life, bringing pain and
sometimes disability. Not only are there few cures, but also scientists
don't know for sure what causes most types of the disease.

Arthritis apparently has been around as long as man.  Bones of the Java
Ape Man and Egyptian mummies show signs of arthritic damage.  The word
arthritis literally means inflammation of a joint.  Like many medical
words, it is taken from Greek, combining the Greek words arthron for
joint and itis for inflammation.

The various types of arthritis have different causes, symptoms, and
types of treatment.  Medication, rest, heat or cold, special exercise,
and surgery are all used to relieve symptoms.  What's best for a person
with arthritis depends on an accurate diagnosis of the type of disease
that person has. Treatment programs are tailored to fit the individual
because the disease varies from person to person, and people themselves
vary in the way they react to therapies.

Promoters of unproven remedies don't take such factors into
consideration when they peddle their wares.  All forms of arthritis are
the same to them: One drug or one device cures all. Unfortunately,
quacks persist even in this age of enlightenment. In part, that's
because arthritis has a way of coming and going unpredictably, an aspect
of the disorder known as spontaneous remission.  The pain and swelling
can simply disappear for days, weeks, months, or even years.  People who
experience such a remission are easily convinced that whatever they were
taking or doing brought relief.

The Food and Drug Administration has long been concerned about
fraudulent drugs and devices and has, over the years, taken legal action
to get many of them off the market.

One of the earliest gadgets to make its appearance in this country was
"Perkins Tractors," two pointed rods about three inches long-one
gold-colored, the other silver.  A number of conditions-especially gout,
pleurisy, rheumatism, violent insanity, "inflammatory tumors," and
yellow fever-resulted from a surcharge of an electric fluid in the body,
inventor Elisha Perkins claimed.  This electricity could be released
through drawing the tractors over the affected area.  Perkins and his
"tractors" were the biggest thing going-in 1796.

In the 20th century, people with arthritis have been lured by an
astounding variety of quack devices, ranging from simple copper or
magnetic bracelets to complex "electronic" mechanisms, such as the
Palorator device seized by FDA in 1954.  It had two electro-magnetic
coils that vibrated a couple of knobs on the front of a box.  Another
was the Gonsertron.  Billed as "A New Concept in the Field of
Electrotherapy," it was a cabinet filled with various electrical
components connected to a chair and, not coincidentally, to the house
current.  Still another was the Magnetron, a 6,000-volt transformer
hooked up to a homemade condenser; the claim was that it provided an
adequate and effective treatment for diabetes, tumors, varicose veins,
and rheumatoid arthritis.  Other such devices are still turning up
despite FDA efforts to get them out of circulation.

Things that vibrate-chairs and mattresses for example-also have been
"hot" items in the arthritis quack's bag of tricks. The vibrators may
produce interesting sensations, but they certainly are not harmless
since they can further aggravate already inflamed joints.  So too could
the Slim-Twist Exerciser, two pieces of wood connected by a ball-bearing
swivel joint. Stand on the top piece, pretend to dance the "Twist," and
you could lose weight, cure heart and vascular problems, or relieve
arthritis, asthma and diabetes, the promoters claimed.

Another popular unproven remedy is uranium.  Not only have people sat in
abandoned mines to soak up the "curative" powers of this dangerous ore,
but they have been hoodwinked into buying mittens, gloves, mattresses,
and pads of assorted sizes supposedly filled with radioactive material.
What they receive is crushed rock with less radiation than a radium
watch dial emits.

According to the Arthritis Foundation, there are some scientific reasons
to think that diet affects arthritis, but there is not enough evidence
to tell how diet helps or hurts or to recommend any specific diet as a
treatment.

Everything from cod liver oil, alfalfa, pokeberries, and black-strap
molasses to a mixture of honey, vinegar, iodine, and kelp have been sold
for arthritis diets.  At one time "immune milk" was a big item.  This
supposedly came from cows injected with streptococcus and staphylococcus
vaccines.  Seawater was highly promoted in the early 1960s by a
physician who claimed to have rejuvenated his 97-year-old father with
this treatment. Serious complications were reported in cardiac and
rheumatic patients who were swept up by what then FDA Commissioner
George Larrick called a "nation-wide seawater swindle." FDA went into
action in Texas, California, Indiana, Ohio, Pennsylvania, and Michigan
to seize about 2,000 bottles of seawater packaged by a Florida
laboratory.

Diet cookbooks for arthritics have appeared on the scene, as have
special biological health regimens.  One book, There Is a Cure for
Arthritis, recommends a treatment that includes elimination of all
drugs, therapeutic fasting, enemas two or three times a day, and a diet
heavy in fresh fruits, raw vegetables, herb teas, and other so-called
natural or whole-grain foods.  Two professors at Rutgers University
theorized that arthritis is caused by eating vegetables classed as
"nightshades."  This includes tomatoes, white potatoes, green peppers,
and eggplant.  Such treatments have not been studied scientifically.

An offbeat diet might not do too much injury, but an unapproved drug
could.  Groff's Arthra Tone, Ar-Thry-Go Tablets, Ring's Golden Herb
Tonic, Elmore's R'heumative Goutaline and Dr. Fenby's Formula X are the
names of some drugs that FDA and the U.S. Postal Service authorities put
a stop to.  Many of these "cures" were combinations of herbs, aspirin,
and alcohol.

Not so innocuous was the Tri-Wonda Treatment, a three-part concoction
consisting of one bottle of dilute hydrochloric acid and dilute nitric
acid with traces of tartaric and acetic acids; a second bottle
containing cream of tartar, senna, sulfur, and phenophthalein, a
laxative; and a third bottle containing a 44 percent alcohol solution of
fluid extract of Jamaica dogwood, thiamine hydrochloride, and wild
cherry flavoring.  It took seven years for FDA to get Tri-Wonda off the
market, because of legal maneuvering by the manufacturer.

Even more dangerous is Leifcort, a powerful drug and an unapproved
arthritis treatment.  Leifcort is a hormone compound developed and
promoted some 30 years ago by a Dr. Robert Leifmann, who fled to Canada
because he was wanted by U.S. marshals for selling a baldness cure.
Leifmann prescribed his compound in Montreal until the Canadian Food and
Drug Directorate raided his clinic.  Charged with marketing an
unapproved drug and other violations, Leifmann continued treating his
own patients while various appeals were pending.

FDA became concerned about Leifcort after the death of an American woman
who went to Canada and came back with a year's supply of the drugs on
the strength of a glowing report in a popular magazine.  The agency
issued press information alerting the public to the danger of this drug.

Leifmann has since died, but his scheme made a comeback a number of
years after his death, being sold as "Hormone Balance Treatment,"
"Holistic Balance Treatment," and "Rheumatril." Whatever the name,
Leifcort was sold in clinics often set up in hotel rooms.  There the
victim got a cursory physical examination and a six-month supply of the
drug for $640.

A more recent case of arthritis hocus-pocus involved a "magic wand" type
device imported and advertised by a Fort Worth, Texas, firm. Called an
Energy Point Stimulator, the device purported to relieve arthritis by
applying an electric energy charge to certain "energy points" in the
ear.  Literature accompanying the device implied that digestive problems
could be treated by stimulating the leg, and that migraine headaches
responded to stimulation of the lower leg and wrist. A bulk order of the
devices seized from Kansas stores was destroyed by court order in June
1988.

Still other recent examples involved unproven arthritis remedies
containing drugs or for which drug claims were made.  A Phoenix firm
agreed to stop distributing two over-the-counter products that contained
potent prescription drugs.  One, imported from Hong Kong, in tea bag
form, was called Chuifong Touku-Wan. In December 1988, the same firm was
ordered to pay the government $68,000 in court costs for a newer product
called "Earth's Magic" that contained the same two potent drugs.

Drug claims, including arthritis cures, were made for 40 items sold
over-the-counter in 1988 by a Utah firm.  The items were for treatment
of a variety of maladies.  The arthritis treatment products were called
AR-ALL and ARTHO-Pak.  The firm, Nature-All Inc., has agreed to abide by
a court injunction against the products.

While no one would consider aspirin an unproven remedy, a number of
medical writers have labeled the "glorification" of the more expensive
forms of aspirin a kind of medical misrepresentation.  Special
arthritis-strength formulas are nothing more than plain aspirin with
small amounts of caffeine or antacid added.  The tablet may be bigger
than an ordinary aspirin, but so is the price.

A few years ago, a panel of nongovernment experts evaluating aspirin and
other pain relievers for FDA said that terms such as "arthritis
strength" or "arthritis pain formula" should not be included in the
labels or advertising of aspirin products.  Ads suggesting arthritis is
a minor disease or that alleviation of pain with "extra strength
aspirin" will control the disease could delay proper diagnosis and
treatment, the group said.

Arthritis is not a minor disease, but its pain can be relieved and its
crippling effects can be prevented in many cases by prompt and proper
treatment.  People with the disease should be wary of products that
offer "special" or "secret" formulas that promise quick or easy cures,
and that are promoted by case histories and testimonials.  Such products
should be shunned or left capped-there are no genies in those bottles,
and the products can do more harm than good.


The Many Guises of Arthritis

The most common forms of arthritis are osteoarthritis, rheumatoid
arthritis, and gout.  Osteoarthritis is the most prevalent, and its
prevalence increases with age.  It involves the breakdown of tissue that
allows the joints to move smoothly. Some 16 million Americans are
afflicted with it, according to the National Institute of Arthritis and
Musculoskeletal and Skin Diseases.

The common systems of osteoarthritis are pain and stiffness. Pain is
usually felt when certain joints are used, especially finger joints and
those that bear the body's weight-namely knees, hips and spine.
Disability most often occurs in these weight- bearing joints.

Rheumatoid arthritis generally starts between the ages of 20 and 45 and
affects almost three times as many women as men. Rheumatoid arthritis
involves many joints, but most commonly the small joints of the hand.
Inflammation and thickening of tissue around the joints may cause
destruction of the bones, deformity, and eventually disability. In some
cases the disease may be mild; in others it can be crippling. While the
cause is unknown, some scientists believe rheumatoid arthritis may be
sparked by a virus and linked to a disruption of the body's defense, or
immune, system.

Gout is the easiest form of arthritis to diagnose and treat, and it is
the best understood.  It most commonly affects the joints of the feet,
particularly the big toe, although other joints may be involved. Most
cases of gout occur in men.  Gout gets its start when too much of a
certain body chemical, uric acid, is deposited in the tissues.  Crystals
of uric acid form in the joints, causing inflammation and severe pain.
Attacks of gout may follow minor injury, excessive eating or drinking,
overexercise, or surgery, or may occur for no apparent reason.

Arthritis in children can take many forms.  The most common is juvenile
rheumatoid arthritis.  It affects primarily those under 8, causes growth
disturbances, and can produce high fever and skin rash. It can be
controlled with proper treatment.

Psoriatic arthritis affects about 10 percent of the people who have
psoriasis, a common but sometimes severe skin disease.

Systemic lupus erythematosus, an uncommon form of arthritis, affects the
skin, joints, and internal organs.  Like rheumatoid arthritis, women
suffer more often than men from this variation of the disease, and it
usually crops up between the ages of 20 and 40.

Ankylosing spondylitis, also known as rheumatoid spondylitis or
Marie-Strumpell disease, affects mostly males in late adolescence or
young adulthood.  Back pain, stiffness, and loss of spinal mobility are
the main symptoms.

Bursitis is inflammation of a bursa, a small sac containing fluid that
lies between a tendon and the bone over which the tendon moves. Popular
names for bursitis are "tennis elbow" and "housemaid's knee."

Fibrositis involves pain, stiffness or soreness of the fibrous tissue,
especially in the coverings of the muscles.  It does not affect joints
directly.

A disease of the body's connective tissue with accompanying symptoms of
arthritis in the joints is called scleroderma.  This disease causes
thickening and hardening of the skin and sometimes inflammatory and
other changes in internal organs, including the esophagus, intestinal
tract, heart, lungs, and kidneys. Scleroderma strikes more woman than
men and can occur at any age, although it most often starts in the 40's
and 50's.

For more information about arthritis, write to:

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Building 31, Room 4C05
Bethesda, Md. 20892


Therapies for People With Arthritis

Therapy for arthritis depends on the type of disease being treated, its
severity, and patient response.  Here are some common forms of
treatments being used to treat the major types of arthritis.

Anti-Inflammatory Drugs

These are widely used to treat the symptoms of many types of arthritis,
as well as other conditions, including muscular pains and fever.

Salicylates-The most widely prescribed medications to reduce swelling,
fever and pain, they include:

* Aspirin (acetylated salicylates).  For arthritis, this most commonly
  used salicylate is prescribed in doses higher than those allowed for
  over-the-counter use.  Because of potential side effects, their use
  should be monitored by a physician.

* Non-acetylated salicylates (choline salicylate, magnesium salicylate,
  sodium salicylate).  These drugs are similar in structure to aspirin
  and are an alternative.

* Coated and time-release salicylates.  Aspirin and the newer non-
  acetylated salicylates also are available in forms that may increase
  the body's tolerance to them or allow taking fewer doses.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)- Structurally related
compounds that have similar benefits and side effects.  They work much
as aspirin does to block a biochemical pathway that produces
prostaglandins, which promote inflammation.  NSAIDS include: Carprofen,
diclofenac, fenoprofen, flurbiprofen, ibuprofen, indomethacin,
ketoprofen, meclofenamate, naproxen, piroxicam, phenylbutazone,
tolectin, and sulindac.

Corticosteroids

These potent drugs are similar to a naturally occuring hormone,
cortisol.  They can very quickly reduce inflammation. However, because
of the possibility of significant side effects, corticosteroids are used
only in carefully evaluated circumstances.  They may be given orally or
injected directly into muscles, veins or joints.  Corticosteroids
include: Hydrocortisone, prednisone, prednisolone, methylprednisolone,
and triamcinolone.


Slow-Acting and Disease-Modifying Agents

Most commonly used to treat advanced forms of rheumatoid arthritis,
these drugs normally take longer to act than corticosteroids and NSAIDS,
but have been found to have a lasting benefit for some arthritis
sufferers.  They include: *Gold-used for at least 50 years, brings
significant improvement to some people.  Its use is limited due to
potentially severe side effects.  It is given orally or by injection.

* Penicillamine-sometimes produces the same benefits as gold and is
  prescribed as an alternative to it.  Significant side effects are
  possible.

* Antimalarials-originally used to treat malaria, they have sometimes
  been found to be of benefit in early treatment of some forms of
  rheumatoid arthritis.  Use is limited primarily because of side
  effects involving the eyes.


Immunosuppressive Drugs

These drugs control inflammation by suppressing the immune system.
Because of their potency, they must be used under close supervision.

* Methotrexate-effective in low doses to treat rheumatoid arthritis and
  psoriatic arthritis.

* Azathioprine-used in treating severe rheumatoid arthritis.

Gout

Gout occurs when output of uric acid, a normal waste product in the
body, becomes excessive.  Uric acid can form crystals that collect in
and around the joints, causing inflammation and pain. Drugs effective in
treating gout include:

* Allopurinol-blocks the formation of uric acid.

* Colchicine-may relieve swelling and help prevent the frequency of
  attacks.

* Indomethacin and other NSAIDS-relieve pain and swelling.

* Probenecid-decreases the frequency of attacks of gout by increasing
  the kidney's excretion of uric acid.

Treatment Without Drugs

Medication at times is not the best or only choice of treatment for
arthritis.  Physical therapy or surgery may be indicated, or prescribed
in combination with drugs.  A decision should be made by the patient,
physician, and any other members of the treatment team.

* Physical therapy-can be performed at home or with professional
  supervision.

* Rest-important in treatment of painful, inflamed and fatigued joints,
  but it can lead to temporary stiffening of diseased joints.

* Moist heat or cold-often reduces pain and increases the range of
  motion.  A shower, a bath, heat packs, hydrotherapy, and paraffin
  treatments are examples.  Occasionally, for acutely inflamed joints,
  ice packs are an initial treatment.

* Exercise-helps maintain range of motion in affected joints. Special
  daily exercises also can strengthen the muscles that surround an
  arthritic joint.

* Devices-splints, braces and crutches may give relief by resting or
  supporting painful joints.  Aids for daily activity can help by
  supporting a joint that is painful, weak or impaired.

Surgery

Sometimes orthopedic surgery is indicated.  Surgeons can correct some
deformities, remove inflamed tissue, repair ligament damage associated
with arthritis, or replace a diseased joint.



A REPRINT FROM FDA CONSUMER MAGAZINE

Printed September 1993.

This article originally appeared in the September 1980 FDA Consumer.
Updated August 1989.

PUBLICATION NO. (FDA) 90-1080



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