Benign Joint Hypermobility Syndrome (BJHS) and Fibromyalgia

Hypermobility of joints is seen quite often, and it needn´t always be called a disease, but in any case it describes a better than normal mobility of joints like putting legs behind the head, bending thumbs backwards to the wrists, or other features. People with hypermobility like doing yoga, gymnastics, and more, where they can use their hypermobile joints. These aren´t the people, we are concerned with here. People suffering from benign joint hypermobility syndrome complain about joint or muscle pain, with daytime pain, discomfort after exercise, or awakening during nighttime. Some symptoms are like fibromyalgia.
I´ve attended several lectures and sessions with Professor Rodney Grahame from London. He introduced me to the criteria used to diagnose BJHS, which are also know as the Brighton Criteria. The Brighton Criteria include a set of scoring hypermobile joints, known as the Beighton Score: little fingers bending backward past 90°, thumbs touching the forearm, elbow bending backward, knee bending backward, and placing flat hands on the floor with straight legs. Highest score is 9/9.
The Brighton Criteria differentiate between major and minor criteria. “The BJHS is diagnosed in the presence two major criteria, or one major and two minor criteria, or four minor criteria. Two minor criteria will suffice where there is an unequivocally affected first-degree relative.” “BJHS is excluded by presence of Marfan or Ehlers-Danlos syndromes (other than the EDS Hypermobility type (formerly EDS III) as defined by the Ghent 1996 (8) and the Villefranche 1998 (9) criteria respectively).”
With arthralgia, back pain, epicondylitis we come to the vicinity of fibromyalgia. Though both diseases can be distinguished, they might be coexistant in an individual. I have diagnosed both diseases in a few patients, with needs special consideration concerning therapy.
A basic therapeutic principle is to exercise as strong muscles help to stabilise joints; walking, skating, cycling, swimming can be recommended. Trying to avoid overstretching helps, too. Medication is´t ussually necessary. There are lots of tips on the Hypermobility self help page: http://www.hypermobility.org/  


If you suffer from both the benign joint hypermobility syndrome (BJHS) and fibromyalgia syndrome, see that both are diagnosed correctly. Both need to be addressed seperately, when it comes to treatment recommendations, though some may be exactly the same.

Fibromyalgia at the EULAR 2012

There have been more than 70 studies/abstracts on fibromyalgia at the EULAR 2012 in Berlin. It´s impossible to evaluate all of them.


W. Häuser and colleagues gave a very good overview on "comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia". I have already used some of these results in treatment and shall later introduce them in detail.


[OP0192] COMPARATIVE EFFICACY OF PHARMACOLOGICAL AND NON-PHARMACOLOGICAL INTERVENTIONS IN FIBROMYALGIA
W. Häuser1, E. Nüesch2, P. Jüni2. 1Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany; 2Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Conclusions: We deem the small advantages of GABA-analogues and SNRIs over placebo of questionable clinical relevance. Our results do not necessarily support EULAR-recommendations, which currently favour drug therapy over other treatment options. (2). We found a potentially important benefit of aerobic exercise and multicomponent therapy in the management of FMS, which is in line with the recommendations of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) in Germany (3).


Additional large scale randomised trials of high methodological quality of promising non-pharmacological interventions, such as aerobic exercise and multicomponent therapy, are warranted.


S. Metyas an colleagues looked at drug combination therapy. More drugs more effects. Nothing is said concerning adverse events or the fact that people are drugged. The authors could show a reduction in symptoms. So in their conclusion the authors ask for larger, prospective trials to test their conclusion and to assess safety and tolerability of combination therapy.


[THU0355] MONOTHERAPY VERSUS COMBINATION THERAPY IN THE TREATMENT OF FIBROMYALGIA
S. Metyas1, M. Ibrahim1, E.C. Ortiz2, S. Maher2, D. Arkfeld1. 1University of Southern California, Los Angeles, United States; 2Rheumatology, University of Southern California, Los Angeles, United States
Conclusions: Treatment with combined pharmacotherapy significantly improved fibromyalgia severity and associated symptomatology. Combination therapy is synergistic in their effects and yields greater results in multiple symptom domains compared to that of monotherapy. Larger, prospective trials should be developed to test this conclusion and to assess safety and tolerability of combination therapy.


S.L.K. Yuan and colleagues looked at shiatsu in patients with fibromyalgia. The group size is much too small (N=17 per group) and the shiatsu group received 16 sessions of shiatsu lasting 50 minutes, twice a week, while the control group simply received educational guidance through a booklet. If the authors conclude, that staitsu "is effective in improving pain, tenderness and sleep quality in fibromyalgia patients", I must disappoint them. With this kind of study design you proof anything. The control group didn´t receive as much attention as the stiatsu group. A acceptable, not good control group would have received a sham shiatsu (not double blinded!).


[THU0492-HPR] THE EFFECTIVENESS OF SHIATSU ON PAIN, SLEEP QUALITY AND BALANCE CONFIDENCE OF FIBROMYALGIA PATIENTS: A CONTROLLED CLINICAL TRIAL
S.L.K. Yuan, A.A. Berssaneti, A.P. Marques. Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of Sao Paulo, Sao Paulo, Brazil+
Conclusions: The results indicate that the Shiatsu technique is effective in improving pain, tenderness and sleep quality in fibromyalgia patients.


E. Choy gave a lecture on "How to treat: fibromyalgia". I´ll comment some of his ideas. And as he is a good presenter, I´ll also attend one of his next lectures. Even if I disagree in some parts, his lectures give stimulus to test where you stand yourself.


[SP0071] HOW TO TREAT: FIBROMYALGIA
E. Choy. Department of Rheumatology, Cardiff University School of Medicine, Cardiff, United Kingdom


"These subgroups of patients with FM are likely to respond differently to different treatment strategies, ..."
But is hasn´t been shown that the proposed subgroups have an impact on treatment strategies. That is still to come.
"... treatment should be tailored to the individual, addressing their particular needs and targeting their most distressing symptoms."
I fully agreee, but wouldn´t agree if it comes to drugs.
"Patient education is a key aspect of management as for any chronic medical condition."
Yes and No. Yes, by all means patients need to be educated about their condition. No, education alone doesn´t chance anything. So, education is a needed basis, but then you have to structure other approaches on this basis.
"Explaining underlying pathophysiology reduces frustration and promote coping as well as self-management."
Yes. This is what I do in the educational part of therapy.
"FM patients are equally able to carry out exercise as healthy people, at levels tailored to each individual."
Exercise can help to overcome fear avoidance. It should be an integral part of therapy. But it needs individual tailoring as E. Choy also said. Depressive avoiders are to be addressed differently than happy endurers.
"Cognitive behavioural therapy has been shown to improve pain and function in FM either as sole therapy or in combination with exercise."
Cognitive behavioural therapy shows better results in combination with exercise.
"Tramadol has been shown to reduce pain in FM. It acts centrally and inhibits norepinephrine and serotonin re-uptake ..."
So tramadol works more in the anti-depressive region. It comes with lots of adverse events, to name the most common: nausea.
"Non-steroidal anti-inflammatory drugs, corticosteroids and opioids appear less effective in FM."
What a pharma friendly statement! NSAIDs, corticosteroids, and opiods as well as a long list of drugs have shown to be not effective in fibromyalgia.
"Pregabalin, duloxetine and milnacipran have been licensed by the Food and Drugs Administration in the US for the treatment of FM although none has been licensed in Europe."
And I hope it stays this way as F. Wolfe has shown that effect sizes of these drugs are small or even non existant. Adverse events outreach effects.
"Recent positive trial of sodium oxybate in FM suggests that impaired sleep may be of pathogenic importance in FM[3], therefore improving sleep quality in FM will be an important treatment strategy for future research."
In the ancient beginnings of fibromyalgia research Modolfky has shown that impaired sleep is important in fibromyalgia. Sodium oxybate is a drug designed for the treatment of narcolepsy. Patients with narcolepsy have other needs than patients with fibromyalgia.


B. Hamnes and colleagues looked at "effects of a one week multidisciplinary inpatient self-management programme for patients with fibromyalgia". The background for this study is that self-management programs with or without exercise showed benefits in some outcome parameters for more than 6 months. This study shows only short term effects. It refelects the educational aspect of the intervention. Education itself is important but doesn´t chance itself. We have looked at this issue in 1999-2001 [Valentin, Th., L.M. Kirsch, A. Clasen, G. Bender, B. Kahlfuß, K. Koch: Was taugt die Patientenschulung „Fibromyalgie“ in der Rheumatologie? Die Ergebnisse einer Langzeitstudie. Zeitschrift für Rheumatologie (61), Supplement 1, 2002, S. I/123.].


[OP0079-HPR] EFFECTS OF A ONE WEEK MULTIDISCIPLINARY INPATIENT SELF-MANAGEMENT PROGRAMME FOR PATIENTS WITH FIBROMYALGIA: A RANDOMISED CONTROLLED TRIAL
B. Hamnes1, I. Kjeken2, P. Mowinckel2, K.B. Hagen2,3. 1Hospital for Rheumatic Diseases, Lillehammer; 2National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; 3Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
Conclusions: This study shows that in patients with fibromyalgia the SMP has a small short-term effect on skills and behavior that are important for managing and participating in health care (EC-17).


There are lots of other studies and I might find the time to work through these and present them here.

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Kadosh
Kadosh! Kadosh! Kadosh! Adonaj Zewaoth! Melo khol haArerez Kewodo!
Übersetzt: Heilig! Heilig! Heilig! Herr Zewaoth! Voll ist die ganze Erde von seiner Ehre!
Oder in der evangelischen Liturgie: Heilig, heilig, heilig ist Gott, der Herr Zebaoth! Voll sind Himmel und Erde seiner Herrlichkeit!

Daisy
Wieso trägt dieser Sturm den Namen Daisy, wie das Hündchen von Mooshammer?

Hermeneutischer Zirkel
Sinnentwürfe gelten bis neue Informationen neue Sinnentwürfe notwendig machen. Es entsteht aus Annährung durch Kreisen um den den heißen Brei, nein durch eine Spirale. So kann eine nicht intendierte Charakterisierung von Personen im Sprachkurs entstehen. (Oder soll ich dieses profane Beispiel zurückziehen? Nein!)

Invalidität
Die InvaliditätsKonstrukte NichtInvalider, also RentenBegehrern, steht im diametralen Gegensatz zu Hannah Arendts Begriff vom tätigen Leben (Vita activa). Arbeit befriedigt die Grundbedürfnisse, Herstellen schafft dauerhafte Gegenstände und Handeln stellt Bezüge her (wie 关系 bei den Chinesen). Der Erhalt der Arbeit heißt auch Erhalt des Lebens. Die RentenFalle schnappt früh genug zu.

Wer folgte mir da
Wer folgte mir da für eine Weile? Ein Chinese mit einem blitzBlanken TwitterAccount. Wahrscheinlich war es der GeheimDienst, ein Agent provocateur. Macht nichts, haben wir halt harmlos geplaudert.

Antiquariate
Schade, dass so viele aufgegeben haben. Ich fand immer noch was und jetzt müßte ich ins Internet. Ist aber nicht so wie in Regalen stöbern.

Arthroxon von Scitec

Wenn Sie bei Google suchen, finden Sie zunächst über Arthroxon von Scitec zunächst nur Angaben des Herstellers oder der Vertreiber des Präparates, also Jubelpresse. Aber es lohnt schon da hinein zu schauen. Es wird geworben mit: „Mit neuen Inhaltsstoffen in einer 6-Komponenten-Matrix“ – das bedeutet, dass sechs Inhaltstoffe miteinander vermengt wurden. Neue Inhaltsstoffe? Bei Hyaluron, Kollagen Typ II, Glukosamin, Chondroitin und MSM handelt es sich um Stoffe, die bereits in dieser oder ähnlicher Kombination seit Jahren, als Einzelstoffe schon seit Jahrzehnten im Handel sind. Sie haben es bislang veräumt, eine Wirksmkeit nachweisen zu können – Zeit genug ist da gewesen. Einzig neu und mir unbekannt ist die Eierschalenmembran. Wahrscheinlich ist aber die Eierschalenmembran die Quelle für Kollagen, da sie reich an diesem Eiweiß ist. Nun ist Kollagen gar nichts Besonderes, etwa 30% des menschlichen Eiweißes ist Kollagen, das sich aus den Aminosäuren Prolin, Glycin und Hydroxyprolin zusammen setzt. Prolin, Glycin und Hydroxyprolin zählen zu den nicht-essentiellen Aminosäuren; die sind in jedem Eiweiß drin und können vom Körper aus anderen Aminosäuren hergestellt werden! http://de.wikipedia.org/wiki/Kollagen  Vielleicht kennen Sie es besser als Gelatine. Oder noch besser: Sie kennen den Inhaltstoff vielleicht aus Gummibärchen: http://blaue-gummibaerchen.blogspot.de/2009/05/die-inhaltsstoffe-des-gummibarchens.html  
Für die Inhaltstoffe Chondroitin und Glucosamin wird immer wieder postuliert, dass sie eine Verbesserung der Arthrose bewirken, ohne dass entsprechende Studien vorgelegt werden könnten.
Die Hyaluronsäure wird über den Magen-Darm-Trakt zumindest angedaut und es kommen höchstens sehr kleine Moleküle in die Blutbahn, geschweige denn in die Gelenke. Immerhin gibt es eine experimentelle Tierstudie, die eine Aufnahme nachwies: http://pubs.acs.org/doi/pdf/10.1021/jf8017029  Eine Studie über die Aufnahme von Hyaluronsäure bei Ratten und Hunden heißt allerdings noch nicht, dass dies auch beim Menschen so ist und damit ist auch überhaupt nicht die Frage eines Nutzens bei Arthrose beantwortet worden.

Methylsulfonylmethan (Interesssanterweise steht in der Zusammensetzungsliste die englische Bezeichnung Methylsulfonylmethane) ist bei uns besser bekannt als Dimethylsulfon und kommt in vielen tierischen und pflanzlichen Organismen vor. „Die höchsten, natürlichen Konzentrationen wurden in Kuhmilch (3,3 ppm) und in Kaffee (1,6 ppm) gemessen.“ http://de.wikipedia.org/wiki/Dimethylsulfon  

Gout and other crystal diseases at the EULAR 2012

Gout and other crystal diseases have been a hot topic at the EULAR meeting 2012 in Berlin.


M. Doherty has given a superb lecture on gout and other crystal diseases. Gout is well understood in pathogeneis and can even be cured. The pathogenesis of calcium pyrophosphate (CPP) or basic calcium phosphate (BCP) crystal associated diseases is less well understood. For acut gout or pseudo-gout (CPP) best practice "is to aspirate and inject the joint with corticosteroid (this is safe, quickly effective and allows confirmation of diagnosis) and then apply ice-packs." Alternatives are: " oral steroid; intramuscular injection of steroid or ACTH; oral colchicine (0.5mg 2-4 times daily); oral NSAID/coxib (with PPI); or IL-1 inhibition using a biologic (e.g. anakinra, canakinumab - though currently not licensed for gout)." I must say, I don´t use intramuscular steroids. Without constructing the prerequisites of a patient, who would be considered for intramuscular steroids, I´d say it´s obsolete. I´ll come back to it later. And I don´t see "many" patients, who would not tolerate low dose colchicine. And M. Doherty mentioned colchicine useful: "Low dose colchicine may be helpful for patients with frequently recurring acute CPP crystal synovitis, with or without OA, but there is no long-term treatment to eliminate CPP crystals." If we can lower urate levels, we can "cure" gout. We can do so with: " allopurinol, febuxostat, sulphinpyrazone and benzbromarone - each has its own advantages and disadvantages." Gout has a lower profile than other forms of arthritis, which is to be addressed. " Successful management requires full patient discussion and explanation concerning gout and its treatment". " The key challenge therefore is to raise the profile of gout and to improve training, interest and knowledge of doctors so they can impart correct information to their patients." All in all time spent on this lecture has been time well spent!



[SP0096] GOUT AND OTHER CRYSTAL DISEASES
M. Doherty. Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
Citation: Ann Rheum Dis 2012;71(Suppl3):24
Session: How to manage 5




In the next study K. Reiter and colleagues looked at "comparative effectiveness and health economic evaluation of systemic anti-inflammatory therapies for acute gout flares". See for yourself at conclusions and limitations. I see a problem for canakinumab as it is extreme expensive compared to other alternative and moreover it´s off-label.



[FRI0430] COMPARATIVE EFFECTIVENESS AND HEALTH ECONOMIC EVALUATION OF SYSTEMIC ANTI-INFLAMMATORY THERAPIES FOR ACUTE GOUT FLARES
K. Reiter1, E. Krishnan1, J. Goldhaber-Fiebert2. 1Deapartment of Medicine; 2Health Policy, Stanford University, Palo Alto, United States
Conclusions: When priced as an unbranded product, colchicine is cost effective for the treatment of acute gout flare. In the US, where colchicine is sold as a branded product, systemic corticosteroids provide a more cost effective alternative. At current prices, biologic therapy does not provide additional benefits commensurate with the cost.
Limitations: These results apply to patients with gout who do not have absolute contraindications to any of the treatment options, such as allergies to the drugs, advanced liver or renal disease, or heart failure. Our models did not take into account the drug half-life of parenteral corticosteroids. Our assessment of biologic therapy may not be applicable to non-canakinumab therapies currently in development.


The next studies all come from the same set or nearly the same set of authors. The first is by R. Alten and colleagues, who compared canakimumab to intramuscular triamcinolone. Serious adverse events occurred more often in the group of patients treated with canakinumab (8.5% vs. 3.4%). Look for yourself!


[AB1081] EFFICACY AND SAFETY OF CANAKINUMAB VS TRIAMCINOLONE ACETONIDE IN PERSISTENT OR ELDERLY GOUTY ARTHRITIS PATIENTS
R. Alten1, M. Bloch2, T. Bardin3, A. So4, A. Shpilsky5, J.M. Nebesky6, T. Kiechle6, N. Schlesinger7. 1Charité Univ Medicine, Berlin, Germany; 2Holdsworth House Medical Practice, Sydney, Australia; 3Hôpital Lariboisière, Paris, France; 4CHUV, University of Lausanne, Lausanne, Switzerland; 5Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States; 6Novartis Pharma AG, Basel, Switzerland; 7Umdnj-Rwjms, NJ, United States
Conclusions: Canakinumab provided superior pain relief and reduced the risk of a new flare vs TA in this subgroup of pts with persistent GA or elderly pts with GA. Thus it may represent a treatment alternative given that these pts are at a higher risk of comorbidities and may have more limitations to currently available treatments.


In the next study N. Schlesinger and colleagues studied the "effect of canakinumab vs triamcinolone acetonide for treatment of gouty arthritis in patients who are unable to use NSAIDs and colchicine or with severe gouty arthritis". I wondered where they recruited 312 of 454 patients, who are unable to use NSAIDs and colchicine, but severity does the trick. The authors conclude that canakinumab "may represent a potential treatment alternative for this subpopulation." That would be a large subgroup if defined like the authors did.

[FRI0369] EFFECT OF CANAKINUMAB VS TRIAMCINOLONE ACETONIDE FOR TREATMENT OF GOUTY ARTHRITIS IN PATIENTS WHO ARE UNABLE TO USE NSAIDS AND COLCHICINE OR WITH SEVERE GOUTY ARTHRITIS - POSTER TOURS
N. Schlesinger1, R. Alten2, T. Bardin3, M. Bloch4, A. Shpilsky5, G. Krammer6, T. Kiechle6, A. So7. 1Umdnj-Rwjms, NJ, United States; 2Charité Univ Medicine, Berlin, Germany; 3Hôpital Lariboisière, Paris, France; 4Holdsworth House Medical Practice, Sydney, Australia; 5Novartis Pharmaceuticals Corporation, East Hanover NJ, United States; 6Novartis Pharma AG, Basel; 7CHUV, Univ of Lausanne, Lausanne, Switzerland
Conclusions: Pts unable to use NSAIDs and colchicine or with severe GA when treated with CAN had significantly reduced risk of new flare and better pain relief compared to pts treated with TA. CAN may represent a potential treatment alternative for this subpopulation.


There have been more studies:


[AB1080] EFFECT OF SERUM URATE LEVEL ON PREVENTION OF FLARE IN ACUTE GOUTY ARTHRITIS PATIENTS WITH CANAKINUMAB
P. Sunkureddi1, N. Schlesinger2, T. Kiechle3, A. Shpilsky4, A. So5. 1Clear Lake Rheumatology Center, Texas; 2Umdnj-Rwjms, New Jersey, United States; 3Novartis Pharma AG, Basel, Switzerland; 4Novartis Pharmaceuticals Corporation, East Hanover NJ, United States; 5CHUV, University of Lausanne, Lausanne, Switzerland
Conclusions: Results of this retrospective exploratory analysis show that baseline SU level was not a predictor of new flares in patients receiving anti-inflammatory therapy for acute GA, suggesting that GA severity may be more closely related to the prevention of flare than the baseline SU level.


[FRI0377] EARLY RESPONSE TO TREATMENT IS A SURROGATE MARKER OF FLARE RECURRENCE IN ACUTE GOUTY ARTHRITIS
A. So1, T. Bardin2, M. Bloch3, A. Shpilsky4, T. Kiechle5, N. Schlesinger6. 1CHUV, University of Lausanne, Lausanne, Switzerland; 2Hôpital Lariboisière, Paris, France; 3Holdsworth House Medical Practice, Sydney, Australia; 4Novartis Pharmaceuticals Corporation, New Jersey, United States; 5Novartis Pharma AG, Basel, Switzerland; 6Umdnj-Rwjms, New Jersey, United States
Conclusions: These results demonstrate that a 50% pain reduction by VAS within 7 days of treatment in acute GA pts is associated with delay of new flare and can be used as a surrogate marker of time to new flare.


[FRI0402] TOPHI SPREAD, ACUTE JOINTS AND FLARE FREQUENCY PREDICT REFLARE IN GOUTY ARTHRITIS: A SPATIO-TEMPORAL MODEL
T. Bardin1, R. Alten2, N. Schlesinger3, A. Shpilsky4, T. Kiechle5, A. So6. 1Hôpital Lariboisière, Paris, France; 2Charité Teaching Hospital–Schlosspark-Klinik, Berlin, Germany; 3Umdnj-Rwjms; 4Novartis Pharmaceuticals Corporation, NJ, United States; 5Novartis Pharma AG, Basel; 6CHUV-University of Lausanne, Lausanne, Switzerland
Conclusions: Based on this spatio-temporal model the number of tophi locations, number of joints affected by acute GA, along with the number of flares is predictive of subsequent reflaring in this population of GA patients. Thus, the phenomenon of repeated acute GA is impacted mainly by the extent of advanced GA, i.e. the degree of systemic disease and frequency of flares, and not by factors immediately preceding an inflammation (CRP, urate level, etc.) thought to be contributing to the reflaring.


[AB1077] THE SPREAD OF TOPHACEOUS DISEASE STRONGLY PREDICTS TIME TO NEW FLARE IN GOUTY ARTHRITIS
N. Schlesinger1, P. Sunkureddi2, R. Alten3, T. Bardin4, A. Shpilsky5, T. Kiechle6, A. So7. 1Umdnj-Rwjms, NJ; 2Clear Lake Rheumatology Center, Texas, United States; 3Charité Teaching Hospital–Schlosspark-Klinik, Berlin, Germany; 4Hôpital Lariboisière, Paris, France; 5Novartis Pharmaceuticals Corporation, NJ, United States; 6Novartis Pharma AG, Basel; 7CHUV, University of Lausanne, Lausanne, Switzerland
Conclusions: Our results suggest that the number of locations to which tophaceous formations have spread throughout the body leading to systemic disease is an indicator of disease severity in GA. This quantitative measure is a strong predictor of delay of new flare (the higher the number of locations the less delay in reflares).


To me it looks like a massive attack to push forward the use of canakinumab in gouty attacks. Let´s stay alerted if our definitions of intolerability of certrain drugs or disease severity change!

Radonstollen - Therapie bei rheumatischen Erkrankungen

Die Radonstollen-Therapie ist keine anerkannte Methode und wird auch nicht weltweit eingesetzt. Das Bundesamt für Strahlenschutz weist auf Risiken hin, die in bestimmten Häusern für eine Radon Exposition bestehen. Nach dem Rauchen ist Radon das zweithöchste Risiko für die Entwicklung eines Lungenkrebses.

Seit 1912 werden in Bad Kreuznach Patienten mit Radon behandelt. Dr. Hans Jöckel, der Nestor der Radonstollen-Therapie, vergleicht die radioaktive Belastung im Stollen mit der eines Aufenthaltes im Gebirge. Also warum nicht gleich in Gebirge fahren?

Nutzen und Risken werden kontrovers diskutiert. Erhöhte Radonbelastung bedeutet eindeutig ein höheres Lungenkrebsrisiko. Die Studienlage zur Radonstollen-Therapie ist angesichts der langen Anwendung der Methode erschreckend dürftig.

Eine Studie von A. Franke und Kollegen (Long-term efficacy of radon spa therapy in rheumatoid arthritis—a randomized, sham-controlled study and follow-up) konnte zum Ende der Therapie keine Unterschiede aufzeigen [es handelt sich hierbei um Wannenbäder]. Nach einem halben Jahr will man Unterschiede auf die Intervention, die eine von mehreren war, festgestellt haben. Die Wirkungsweise wird nicht klar. Parameter für Entzündung oder Krankheitsaktivität fehlen, jedenfalls nach heute üblichen Kriterien. Andere Studien versuchen durch den Begriff der Speläologie (Höhlenkunde) ihre Arbeit aufzuwerten, z.B. speläotherapeutische Radonexposition. Wenn man sich den Stollen ansieht, dann kann der eigene Keller auch ein Ort speläologischer Mystik werden.

Und dann könnte man anstatt der Radonstollen-Therapie auch den eigenen Keller nutzen (häufiger Ort stärkerer Radon-Exposition). Aber ich meine, dass die von Patienten wahrgenommene Veränderung auf eine angenehme Wärme und das Gefühl der Geborgenheit, wie in Mutters Schoß, zurückzuführen ist. Deshalb fällt es schwer Kontrollgruppen zu definieren, die dies auch beinhalten.

Bei unklarer Wirkungsweise, unklarer Erfolgsrate und unklarem Risiko rate ich von der Radonstollen-Therapie ab.

Sammelsurium (124)

Vortrag
Gott sei Dank! Da stand wenigstens nicht mein Name dabei: "Vortrag über Gesundheit von Knochen und Gelenken".

Schnee in Holweide
"Eine rauchig-kehlige Stimme bedeutet einer Frau: "Dat isch dann och do ben."
Auf der Redwood Tanne liegt kaum Schnee, während der Boden bereits bedeckt ist, so dass sie grün und braun gegen das Grau und Weiß des schneeigen VorMittags steht.
Der Verkehr rollt wieder mit den schleimig-matschigen Geräuschen aus dem dunkel gefahrenen Schnee.

Herzhaft
Da gibt es einen Kaffee "herzhaft mild". Nun gut, warum nicht auch weiße Rappen oder schwarze Schimmel?

Arthur Seyß-Inquart
Es muss schon ein übler Bursche gewesen sein, dieser Arthur Seyß-Inquart. Sagte er nicht, als er Reichskommissar der besetzten Niederlande wurde, er können nicht alle deutschen Dialekte beherrschen?

SommerReifen
"Er hatte nur Sommerreifen: Beifahrer tot" meldete der EXPRESS. Später kam heraus, dass der Beifahrer nicht angeschnallt war. (Ich als WinterReifen Favoriseur)

KlassenTreffen
KlassenTreffen, ein KölnTatort von Kaspar Heidelbach -: von uns hat keiner versucht, den anderen wiederzusehen. Ich auch nicht. Oder erwartet man das von mir? Wen würde ich noch auf der Straße wiedererkennen? Kauz und Kaspar bestimmt.