Gold in the treatment of rheumatoid arthritis and its promise for other diseases

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While trying much not to preempt the coming soiree with CMA, to thank this mentor for his almost “solo”mentorship to my generation of rheumatologists, this piece has to be written before being presented in that gathering.

Did you  know that gold has a tablet form which is 29% gold by weight? This was circa 1980’s, during my first years of practice as a rheumatologist. Back then, the drug auranofin (Ridaura) was brought to the Philippines by GSK.

Apparently, the fascination with Au has not stopped with heavy ingots and delicate trinkets adorning the graceful of necks, waists, ankles and wrists. Gold in its liquid form in very tiny amounts was taken orally in those early days. One wonders if this could be out of that great desire to keep it within the body (as in hide it), or because it was so valued that other uses had to be invented to increase its worth even more.  Conveniently, the apothecary therefore, incorporated it into concoctions and salve for illnesses.

History points to the very name that substitutes for tuberculosis- Koch’s disease, as Robert Koch, in 1890, discovered that gold compounds could slow down the growth of Mycobacterium tuberculosis. This finding paved the way for  the use of gold as treatment for tuberculosis.  This use of gold for treatment of disease was termed chrysotherapy.

Chrysotherapy would soon be used in cancer therapy since gold is known to concentrate in areas of high vascularity. This was followed closely by its successful use  for rheumatoid arthritis (RA). Its use for RA as a disease modifying anti-rheumatic drug (DMARD), was promising but short-lived. By 1985, the anti-cancer agent methotrexate had become the first line DMARD for RA, till the present. And many more other ways to treat RA have flourished.

Not withstanding, the promise of gold in the realm of medicine continues to be explored, its fascination much like how the eyes would rivet toward its golden glow as light hits its surface. Currently, its use in the delivery of drugs where they are needed in the body is being investigated. Soon, if not already out, its use in HIV therapy may welcome it back to mainstream medicine as the drug to reckon.

One, it seems can never have enough of gold and so the wait continues…

Arthritis and the myth of the Mung bean (mungo, moong)

It must be something local to the Philippines.  This I yet have to hear as a significant educational gap of common (by this I mean, lay) knowledge of arthritis in other Asian countries where mung beans or moong or mungo is abundant. As one who specializes in arthritis and rheumatic diseases, it can be frustrating to hear as a matter of daily, per  patient encounter, the attribution of any joint malady to eating mungo. While it is unusual or even weird to pity food, I must admit that I have grown to “pity” the mung bean over my 35 years of practice.

The oft conjured story about mungo causing arthritis has actually no written  literature, scientific or otherwise, on review. It would therefore qualify as an old wives tale. And as old wives tales go, this belief is construed as fact and assured of its factual status and longevity as it is passed from one generation to the next. In recent years, the personal emotions that arise each time I hear the mungo “accused” of causing this painful neck or the bad knee, have grown from pity to “protective” and even defensive type of annoyance. I’d immediately counter the accusation, with a tirade of scientific facts about how the mungo is an innocent bystander during some food indiscretions that actually cause NOT just any arthritis, but only gout!  It can be surmised that since gout is the most severe of the arthritides, it is easily the one arthritis that needs a reason for being.  And the mungo, it is.

Gout is a severely disabling, painful, episodic and recurrent arthritis that affect males in their big toe, ankles and knees individually at first but in years, all together. Its episodic nature might well be timed after a generous meal of mungo served by the wife, and unbeknown to her, the man may have had a good serving of innards with alcohol earlier. The ensuing gouty attack therefore gets tagged on the mungo meal.

Whatever the source of this tale is not in Google. Philippine folklore publications carry various forms of  treatment for arthritis consisting of what is now considered as alternative or complementary medicine, others describe the “pasma” which supposedly does not have a known medical equivalent and nothing much else. Patient sites on mung beans, on the other hand, describe its medicinal value including as treatment for arthritis.  When actual patients are asked, their one universal answer is, they have been told that mung beans cause arthritis. Specifically who told them? Blank.

Going back to gout, we continue to find some internet sites listing beans as a possible cause of arthritis due to its purine content. In fact, one does NOT find the mungo listed under high purine containing food. It actually is known to contain just moderate  amounts of purine.

A patient education material produced by the Section of Rheumatology, Philippine General Hospital.  Ask your rheumatologist about it.

Foodstuff causing arthritis therefore need to be qualified to details of what food and which (of the more than one hundred types) arthritis, can be truly causally linked:

Gout can be caused by diet high in red meat (beef, pork, etc), small fishes and shell fishes, anchovy and innards, alcoholic drinks like beer and wine, and fructose based beverages like the soda and commercial juice drinks. Dehydration and physical stress are other common and immediate causes of acute attacks of gout and not just any arthritis.

Meanwhile, we urge all to leave alone the legend that the mungo or mung beans cause arthritis  and instead, eat it for it high nutritional value and perhaps even to treat arthritis if any.

 

 

It’s nice to be back; Can blog sites be hacked; The doctor is to comfort always

The Muses took a long time to prod me to open this site again. Today, a niece seemed unable to open her blog site and sought help.  And so off I went to WordPress to check out my long untended Mix trail and Arthritis. And lo, it still is here! I offered my niece some help and found out that her case was complicated, maybe, hacked. Can blog sites be hacked? What for?

Opening Mix trail and Arthritis felt weird, to say the least. I’ve forgotten the stuff I wrote, how many I did and was disappointed to see that there are less number of articles stored here than I thought. I now recall that I wrote more articles in another blog site which I had closed, and got this mixed up in my 63 year old brain.

So, today is the resurrection of this site. Apologies to the few who followed it, and have gone on to throw Mix trail and Arthritis into the trash bin. It’s time to pick up the more patient ones who did not lose hope and continued to check.

In giving a graduating class of the biggest teaching hospital of the country some inspiration to carry on, let me quote a part of my talk:

“Handling lives, counting pulses and breaths, you know how it feels to be “you the man” after you wrest a patient from the clutches of death.  And you have cowered in some inner sanctum for solace after some devastating clinical mishap.

After all is said and done, this portion of your journey has opened the reality (attributed to Hippocrates himself) that the doctor is to “cure sometimes, treat often and comfort always”. But I know you’d rather reverse the sequence – you’d really want to cure always, treat often and comfort some of the times.”

Forty years into the clinics, there is no mistaking of the wisdom of the Hippocratic adage, “the doctor should comfort always”. Years have mellowed the desire to defeat disease and deny death. Experience has finally made it clear that life is precious, to be lived fully, and death, inevitable and welcome at the opportune time.  Now there is only that sense of victory in having comforted the patients I had sent home well and healed, as well as, the  the ones who died. Yes, the doctor should comfort always.

A Graduation message

Former CNN field reporter and current CEO of Rappler, Maria Ressa is 105th Commencement Exercises Speaker of the University of the Philippines College of Medicine. “Meaning plus value equals purpose” was a statement that struck a cord in this aging parent of a graduate. Ressa’s ascendancy to speak on ethics is palpable and could only come from one who lives and breathes it. Might the excitement of all who heard her translate to just an iota of changed lives and purpose?