Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis.

OBJECTIVE: To review efficacy studies of antioxidant and antiinflammatory dietary supplements used to manage osteoarthritis (OA) and rheumatoid arthritis (RA) and make conclusions about their place in therapy. Glucosamine, chondroitin, and methyl sulfonyl methane were excluded. DATA SOURCES: A literature search was conducted using MEDLINE (1996 through January 2009), EMBASE, Cochrane Library, Natural Medicines Comprehensive Database, and Natural Standard, with bibliographic review of relevant articles. Cited studies from before our search range were included if they represented the only published human data available. Search words included "antioxidant," "antiinflammatory," "cat's claw," "ginger," "fish oil," "omega-3," "turmeric," "vitamin E," "vitamin C," "Baikal skullcap," "barberry," "Chinese goldthread," "green tea," "Indian holy basil," "hu zhang,""oregano," and"rosemary." STUDY SELECTION AND DATA EXTRACTION: Efficacy studies published in English were included provided they evaluated the dietary supplements in patients with OA or RA. DATA SYNTHESIS: Our search strategy yielded 16 clinical studies (11 randomized, placebo-controlled clinical trials, three crossover trials, one case-controlled study, and one open-label study) in addition to one meta-analysis and one review article. CONCLUSIONS: Three studies support cat's claw alone or in combination for OA, and two studies support omega-3 fatty acids for the treatment of RA. We cannot recommend use of vitamin E alone; vitamins A, C, and E in combination; ginger; turmeric; or Zyflamend (New Chapter, Brattleboro, Vermont) for the treatment of OA or RA or omega-3 fatty acids for OA. Whether any of these supplements can be effectively and safely recommended to reduce nonsteroidal antiinflammatory drug or steroid usage is unclear and requires more high-quality research.

The role of the pharmacist--prayer and spirituality in healing.

Are you a "spiritual" pharmacist? I define being spiritual as having an ongoing relationship with God regardless of whether one is physically healthy, "stressed out," or sick; I encourage pharmacists to pray for, and with, their patients when opportunities present themselves and patients are receptive. Spiritual healing can be as dramatic as physical and emotional healing. Holistic healing encompassing all 3 components is important for lasting, abundant wellness for professionals and patients alike. Spiritual practice, including a reliance on prayer in the healing process, demonstrates pharmacists' gratitude for the gifts and humility received through their relationships with patients. Imagine office-based and hospital employees, from accounting, to housekeeping, to pharmacy, to nurses and physicians, praying daily. Many patients and their healthcare providers believe that faith-based prayers to God are important instruments for healing, and spiritual pharmacists may wish to consider integrating prayer into their professional practice.

Correlation of the change in the International Normalized Ratio and decreasing the Coumadin dosage following total joint arthroplasty.

This retrospective pilot study determined whether a change in the daily International Normalized Ratio (INR) correlates with a decrease in Coumadin (DuPont Pharma, Wilmington, Del) dosage. Four hundred seventeen patients yielded 1167 pairs of INR values and Coumadin doses. An increase in INR > 0.4 units correlated 81% with a decrease in the Coumadin dose (P < .05). In patients aged > or = 70 years, the correlation fell to 70% compared to an 89% correlation in patients aged < 70 years (P < .05). The correlation fell to 78% in women, while men exhibited an increase to 87% (P < .05). Although this is a pilot study, when managing postoperative Coumadin anticoagulation for orthopedic patients, an increase in INR > 0.4 units correlates highly with the need to decrease the Coumadin dose. A prospective study is needed to test the usefulness of this parameter.