Arthritis Pain: When Diet Really Matters

tomatoes_are nightshades

Arthritis and Nightshade Vegetables

by Jeffrey Dach MD

Susan, a Young Woman with Rheumatoid Arthritis

Susan, a 46 year old female retired nurse arrived in my office with a chief complaint of joint pain, involving the hands. Susan was post menopausal, and had been taking prednisone (a synthetic steroid) for her diagnosis of rheumatoid arthritis.  Susan’s  blood test panel was positive for rheumatoid factor.  Above left: The Tomato is a Nightshade Vegetable, courtesy of Wikimedia Commons.

The pain in her fingers is so severe, Susan finds it helpful to immerse her hands in a bucket of ice water in the middle of the night.   Physical examination shows swollen inflamed joints of the fingers (DIP and PIP joints).  Susan brought in Xrays of her hands which showed synovial erosions along the margins of the affected joints.

SynovialErosionsRheumatoidarthritisXrayNightShadeLeft image : Xray of fingers. Red Arrows show synovial erosions, commonly seen in Rheumatoid Arthritis, courtesy of Wikimedia Commons)

Susan’s Program

Susan was started on bioidentical hormones including Bi-Est (estrogen), Progesterone, Testosterone and DHEA.  She was also given LDN (low dose naltrexone) a 4.5 mg capsule taken each night before sleep.  Once on treatment, Susan did a little better, with some improvement, yet continued to have joint pain. Susan consulted several rheumatologists, and was prescribed methotrexate, a mainstay immunosuppressive medical treatment.  This drug helped her greatly.  However, she was worried about the long term adverse effects of methotrexate, and wanted to get off the drug, if possible.

Rheumatoid Arthritis Cured with NightShade-Free Diet

A few months later, Susan came into my office, exclaiming she is pain free, and was off all the dreaded prednisone and methotrexate drugs.

I said , ” Hey that’s Great !!!  How did you do it?”

Susan said, “I eliminated Night-Shade vegetables from my diet. And now I am pain free.”

Tom, a Patient with Rheumatoid Arthritis On AZT- Recovery on Gluten Free, Nightshade Free Diet, Vitamin K, LDN and Testosterone

Tom, a 46 year old gentleman with severe incapacitating pain and swelling in the joints arrived in my office with a diagnosis of rheumatoid arthritis.  Tom had already been seen by multiple rheumatologists, and had been prescribed AZT,  the immune suppressive drug called Azathiaprine.  However, this drug was not helping his arthritis. Instead, it was causing severe muscle weakness, a well known adverse effect of the AZT drug which is a mitochondrial toxin.

On examination, Tom’s hands and knee joints were visibly swollen, and tender with active inflammation. He was able to walk and to get up from a sitting position with difficulty, indicating muscle weakness from the AZT drug.

Going Gluten Free, Nightshade Free

Tom was advised to go on a gluten-free and nightshade-free diet, and supplement with Vitamin K2 and Omega 3 Fish Oil.   Tom’s serum testosterone was low, below 300, so he was given testosterone replacement, as well.

NightShade Vegetables

My previous article discussed the connection between autoimmune diseases such as Lupus and Rheumatoid arthritis with Gluten Sensitivity, and the importance of a Gluten-free diet (wheat -free diet).  Multiple Sclerosis and Myasthenis Gravis patients also require a Gluten-Free diet, as well, since these are autoimmune diseases linked to Gluten sensitivity

The “Nightshade Vegetabes” are a food group implicated in both osteoarthritis and rheumatoid arthritis.

What Are the Night-Shade Foods, and How Do They Cause Arthritis?

The nightshades are a group of vegetables including Tomatoes, Potatoes, Eggplant, Peppers and Tobacco.

Nightshade Foods Contain Drug-like Substances

These plants have pharmacological activity and actually contain four types of alkaloid drugs:

(1) the steroid alkaloids including solanine (solanum-type glycoalkaloids)
(2) the tropane alkaloids. (atropine, scopolamine and cocaine)
(3) the pyrrolizidine alkaloids. (highly toxic to animals and livestock)
(4) the indole alkaloids.(various drugs, psychoactive,  anticancer, anti-malarial and anti-arrhythmic agents)

AtropabelladonnaAtropineBelladonnaPlantNightshadeSolanacea1Left Image:  Red Arrow points to Atropa belladonna, Solanaceae, Deadly Nightshade. This poison plant is native to Europe and North Africa and contains the tropane alkaloids, scopalamine and atropine, courtesy of Wikimedia commons.

The Nightshade Book by Norman Childers

Dr Norman Childers is the most vocal and dedicated Anti-Nightshade researcher.  Childers has authored many scientific articles and published the definitive book:

Arthritis– Childer’s Diet That Stops it.
by Norman F Childers- The cause of most arthritic problems, including osteo- and rheumatoid arthritis, is the so-called nightshades. The book contains over 100 years of research on nightshades (drug plants) which are closely related to the Solanaceae family of plants, some of which are highly toxic as the deadly nightshade.  The book gives case histories based on over 50,000 people  who have been on the NO-NIGHTSHADES Diet for years.   These people following a Nightshade Free Diet have recovered completely or shown marked improvement, some leaving canes, walkers, and wheelchairs. No dangerous drugs are used.  (Paraphrased and Quoted from Dr Childer’s web site) (5)

arthritisLeft image: Book cover, Arthritis-Childers’ Diet That Stops It!: The Nightshades, Ill Health, Aging, and Shorter Life 8th Edition
by Norman F. Childers (Editor)    c
ourtesy of Norman Childers.

Two Health Problems with the NightShades:

1) Muscle Spasm, Pain Tenderness Inflammation

The NightShades contain drug-like substances including  solanine in potato and eggplant, tomatine in tomato, nicotine in tobacco, and capsaicin in garden peppers.  These drugs may cause paralytic-like muscle spasm, aches, pains, tenderness, inflammation, and stiff body movements.

2) Soft Tissue Calcification Around the Joints

The second problem is the ability of the Solanaceae (Nightshades) to develop naturally the very active metabolite of vitamin D3 (1-25 dihydroxycholecalciferol) that results in calcinosis of soft tissues, ligaments, and tendons, mineralization in walls of major arteries and veins in livestock. Above Quoted From Dr. Norman Childers Web Site: (5)

Garrett Smith on Nightshades, From Weston Price Web Site(8)

“If you suffer from inflammation, joint pain and cracking, avoiding nightshades will lessen your pain, whether or not the nightshades are the true source of the pain.  Muscle pain and tightness, morning stiffness, poor healing, arthritis, insomnia and gall bladder problems—these can all be caused by nightshades.

Nightshades can also cause heart burn or GERD—a lot of people already know they react this way when they eat peppers or tomatoes…”(8).”

The Drug in Nightshades is Calcitriol – a Highly Active Form of Vitamin D that Causes Soft Tissue Calcifications

Nightshades contain calcitriol, a highly active form of Vitamin D, (Five times more effective than D3).  This highly potent calcitriol causes hypercalcemia, and soft tissue calcification.(8)  Over-consumption of calcitriol from nightshade foods can  lead to calcium deposits in tendons, ligaments, cartilage, cardiovascular tissues, kidneys and skin.

One such Nightshade plant commonly found in Florida contains 1,25 hydroxy-cholecalciferol (calcitriol), and causes soft tissue calcification.

ZCestrumdiurnumNightshadesofttissueCacificationJeffreyDachRheumatoidArthritisThis is Cestrum Diurnum (see above image, courtesy of Wikimedia Commons).

Consumption of nightshade calcitriol drug can cause chronic hypercalcemia which leads to generalized soft tissue calcification.  If this occurs in the joints, it results in arthritis.  Osteoarthritis, under this hypothesis, is caused by deposition of calcium in the soft tissues of joints.    If calcium is deposited in the wall of the arteries to the heart, this is called coronary artery disease.

High Coronary Artery Calcium Score ?

If you have a high calcium score in your coronary arteries, it is advisable to avoid Nightshade Foods, and supplement with extra Vitamin K2.(15-19)  Vitamin K2 (and not K1) prevents and reverses the soft tissue and arterial calcification caused by Nightshade Foods.(15-19)  The other form of Vitamin K, namely the K1 form, is not effective, however.

Rheumatoid Arthritis ?

Vitamin K2 (MK7) was also found beneficial for Rheumatoid Arthritis. (20)   Studies find Fish Oil Omega 3 useful in reducing inflammation. (Click here for more studies on Omaga 3 Fish Oil for Rheumatoid Arthritis).

DHEA for arthritis

Nightshades Cause or Worsen Inflammatory Bowel Disease

study from Patel published in 2002 showed that glycoalkaloids in fried potatoes caused inflammatory bowel disease in an animal model in mice.  Any patients with Crohn’s or Ulcerative Colitis are advised to avoid the Nightshades.

Dr Dach’s Online Supplement Store:

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Conclusion:

Treatment Program for Rheumatoid Arthritis:

1) Gluten-Free and Nightshade-Free  Diet (may need Dairy-Free Diet as well)
2) Food Allergy Testing.

ALCAT or
Cyrex Arrays

3) Low Dose Naltrexone 4.5 mg caps QHS.
4) Bioidentical Hormone Program if postmenopausal female, or male with low testoisterone.
5) Supplement with Vitamin K2, and Omega 3 Fish Oil.
6) Supplement with Probiotics and Digestive Enzymes.
7) Complete Quest Blood lab panel.
8) Low Level Laser treatments for the affected joints.

Articles with Related Interest:

Gluten Sensitivity and Autoimmune Disease Part One

Bioidentical Hormones Prevent and Reverse Arthritis

Glucosamine and Chondroitin for Arthritis Pain

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
www.jeffreydachmd.com
www.drdach.com
www.naturalmedicine101.com
www.bioidenticalhormones101.com
www.truemedmd.com

Links and References

1) Excellent Overview article
What are nightshades and in which foods are they found?
Overview – the basics about nightshade foods -The George Mateljan Foundation

2) What are nightshades? As a botanical family, the Solanaceae comprise some ninety-two genera with over two thousand species. Its members include many stimulating, medicinal, or poisonous plants, such as tobacco, henbane, mandrake, and belladonna (also known as the deadly nightshade). The food plants of the nightshade family include some of our most popular vegetables: tomatoes, potatoes, eggplant, and peppers of all kinds (green, red, chili, paprika, cayenne, hot and sweet, except for black and white pepper.) Research has found that when people with joint pains stopped consuming all varieties of nightshades, their condition improved dramatically.

3) www.livestrong.com/article/298430-no-nightshade-diet/#ixzz25gw4mNhp
No Nightshade Diet – The most common foods in the nightshade family are white fleshed potatoes regardless of the color of the skin, tomatoes, eggplant, bell peppers of any color, cayenne pepper, chile peppers and hot peppers. The leaves of eggplant are highly toxic and never should be eaten. Pimento and paprika are also nightshades. Black and white pepper are not nightshade plants, nor are yams and sweet potatoes.

Dr Norman Childers

4) noarthritis.com/
The Arthritis Nightshades Research Foundation has been established to research why and how usage of these crops is causing arthritis in humans, and the relation they may have to other serious problems such as: heart aliments, cancer, circulatory problems, stroke, fast aging, Alzheimer’s, high blood pressure, crippling, and deterioration of major organs in the body. If you would like to contribute to these tax-free studies, please contact Dr. Childers. Unfortunately, there are so many important industries (drug, medical, agricultural, and marketing) adversely affected by these studies that about the only source of research funds is through devoted private contributors. Only the sufferers are happy with the program and the results. Dr. Norman F. Childers 3906 N.W. 31st PL. Gainesville, FL 32606   Phone 1-888-501-8822 or 352-372-5077

5) noarthritis.com/research.htm
Journal of Neurological and Orthopedic Medical Surgery (1993) 12:227-231  An Apparent Relation of Nightshades (Solanaceae) to Arthritis N.F. Childers, Ph.D.1,2, and M.S. Margoles, M.D.3 1Rutgers University, New Brunswick, NJ 08903, USA, 2Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611, USA, and 3Arthritis Nightshades Research Foundation, 177 San Ramon Drive, San Jose, CA 95111-3615, USA.

Diet appears to be a factor in the etiology of arthritis based on surveys of over 1400 volunteers during a 20-year period. Plants in the drug family, Solanaceae (nightshades) are an important causative factor in arthritis in sensitive people.

This family includes
potato (Solanum tuberosum L.),
tomato (Lycopersicon esculentum L.),
eggplant (Solanum melongena L.),
tobacco (Nicotiana tabacum L.), and
peppers (Capsicum sp.) of all kinds except the black pepper (family, Piperaceae).

A buildup of cholinesterase inhibiting glycoalkaloids and steroids from consumption and/or use (tobacco) of the nightshades and from other sources such as caffeine and some pesticides (organophosphates and carbamates) may cause inflammation, muscle spasms, pain, and stiffness.

Osteoarthritis appears to be a result of long-term consumption and/or use of the Solanaceae which contain naturally the active metabolite, vitamin D3, which in excess causes crippling and early disability (as seen in livestock). Rigid omission of Solanaceae, with other minor diet adjustments, has resulted in positive to marked improvement in arthritis and general health.

6) macrobiotics.co.uk/articles/nightshades.htm
Nightshades Norman F. Childers, PhD, Foundation Chairman of Arthritis Nightshades Research Foundation

7) www.gloriagilbere.com/health-conditions/choose-a-category/pain-a-inflammation/93-avoiding-the-invisible-flame-of-pain-a-inflammation.html

Avoiding the Invisible FLAME of Pain & Inflammation Avoiding the Invisible Flame of Pain and Inflammation by Gloria Gilbère, N.D., D.A.Hom., Ph.D., D.S.C., EcoErgonomist, Wholistic Rejuvenist –

Excellent Article Summary on Nightshades, calcinosis, vitamin D , Vitamin K

8) www.livingfoodvillage.com/features/36-general/199-nightshades-peppers-eggplant-potatoes-etc-and-inflamation www.westonaprice.org/food-features/nightshades
Nightshades (tomatoes, peppers, eggplant, potatoes, etc…) and Inflammation by Garrett Smith

pdf poster on nightshades

9) www.balancedbites.com/PDFs/BalancedBites_Nightshades.pdf
Chili Peppers – active ingredient is Capsaicum – found to cause arthritis

10) www.arthritistrust.org/Articles/Chemicals%20in%20hot%20Chili%20Peppers%20Confirmed%20to%20be%20Cause%20of%20Arthritis.pdf

Chemicals in ‘hot’ Chili Peppers Confirmed to be a Cause of Arthritis!
Professor Jack Abel, Ph D “Harvard Medical School researchers have now found that the receptor activated by chemicals in ‘hot’ chili peppers is also responsible for the ongoing, burning pain associated with inflammation, tissue damage and arthritis!”

Dr Clifford Wolf HArvard Nature 449, 607-610 (4 October 2007) | doi:10.1038/nature06191; Received 21 June 2007; Accepted 28 August 2007 Inhibition of nociceptors by TRPV1-mediated entry of impermeant sodium channel blockers

Alexander M. Binshtok1, Bruce P. Bean2 & Clifford J. Woolf1 Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129, USA Department of Neurobiology, Harvard Medical School, 220 Longwood Avenue, Boston, Massachusetts 02115, USA

12) www.henriettesherbal.com/archives/best/2003/solanaceae.html

testimonial from message board of lady who recovered once eliminating nightshades Potato arthritis.Solanaceae Arthritis Musculo-skeletal Toxicity .

——————
13) www.organicfoodee.com/inspiration/craig/nightshadefoods/
Nightshade Foods by Craig Sams

Systemic Lupus

14) www.lifescholarship.org/lupus-nutrition/
Lupus Inspiration Foundation for Excellence News & Announcements A Caution Regarding Other LIFE Sites LIFE Announces 10th Anniversary Featured Winner: Bianca Augusto Nutrition and Lupus JENNA K. LARSEN Columbia University, Institute of Human Nutrition, New York, NY

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Vitamin K

vitamin K and Coronary artery calcification, soft tissue calcification

15) http://www.ncbi.nlm.nih.gov/pubmed/8698544
Int J Vitam Nutr Res. 1996;66(1):36-8.
Effect of vitamin K2 on experimental calcinosis induced by vitamin D2 in rat soft tissue.Seyama Y, Horiuch M, Hayashi M, Kanke Y.
Source  Dept. of Clinical Chemistry, Hoshi College of Pharmacy, Tokyo, Japan.Abstract  The effect of vitamin K2 on calcium (Ca) and inorganic phosphorus (P) levels in the aorta and kidney obtained from experimental calcinosis induced by vitamin D2(2.5 x 10(5) I.U./ kg b.w.) of male rats was investigated.

A high dose of vitamin K2 (100 mg/kg b.w.) inhibited the increase in the aortic Ca and P or in the renal Ca and P induced by vitamin D2, and a low dose of vitamin K2 (10 mg/kg b.w.) showed the same tendency, but the degree of the efficacy was small. It may be suggested that a high dose of vitamin K2 suppressed experimental calcification of soft tissues induced by vitamin D2. Therefore, a pharmacological dose of vitamin K2 might have a usefulness for the prevention and treatment of arteriosclerosis with calcification.

16)www.ncbi.nlm.nih.gov/pubmed/9414028
Jpn J Pharmacol. 1997 Oct;75(2):135-43.
Effects of vitamin K2 (menatetrenone) on atherosclerosis and blood coagulation in hypercholesterolemic rabbits.
Kawashima H, Nakajima Y, Matubara Y, Nakanowatari J, Fukuta T, Mizuno S, Takahashi S, Tajima T, Nakamura T.
Source Pharmacological Evaluation Section, Tokyo Research Laboratoires, Eisai Co., Ltd., Koishikawa, Japan.
Abstract Gamma-Carboxyglutamic acid (Gla)-containing protein, synthesized in the presence of vitamin K, has been found in atherogenic plaques, but the pharmacological effect of vitamin K on atherosclerosis is unclear.

We examined whether vitamin K2 (menatetrenone) could affect the progression of both atherosclerosis and hypercoagulability in hypercholesterolemic rabbits. Vitamin K2 in daily doses of 1, 10 and 100 mg/kg was given with a 0.5% cholesterol diet for 10 weeks to 8 rabbits each. The plasma levels of total-cholesterol in the vitamin K2-treated groups were clearly lower than that of the hypercholesterolemic control group. The excessive dose of vitamin K2, even at the high dose of 100 mg/kg/day for 10 weeks, did not accelerate the progression of atherosclerosis and did not promote the coagulative tendency in the rabbits.

In contrast, the vitamin K2 treatment (1 to 10 mg/kg/day) suppressed the progression of atherosclerotic plaques, intima-thickening and pulmonary atherosclerosis, the increase of ester-cholesterol deposition in the aorta, and both the elevation in plasma factor X level and increase in Hepaplastin test value in the rabbits. These results indicate that the pharmacological dose of vitamin K2 prevents both the progression of atherosclerosis and the coagulative tendency by reducing the total-cholesterol, lipid peroxidation and factor X activity in plasma, and the ester-cholesterol deposition in the aorta in hypercholesterolemic rabbits.

17) http://www.ncbi.nlm.nih.gov/pubmed/18722618
Atherosclerosis. 2009 Apr;203(2):489-93. Epub 2008 Jul 19.
High dietary menaquinone intake is associated with reduced coronary calcification.
Beulens JW, Bots ML, Atsma F, Bartelink ML, Prokop M, Geleijnse JM, Witteman JC, Grobbee DE, van der Schouw YT.
Source  Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. J.Beulens@umcutrecht.nl
Abstract  BACKGROUND: Dietary vitamin K is thought to decrease risk of cardiovascular disease by reducing coronary calcification, but inconsistent results are reported. This may be due to different effects of vitamin K(1) (phylloquinone) and vitamin K(2) (menaquinone, MK), but few studies included both.
METHODS: We investigated the association of intake of phylloquinone and menaquinone, including its subtypes (MK4-MK10), with coronary calcification in a cross-sectional study among 564 post-menopausal women. Phylloquinone and menaquinone intake was estimated using a food-frequency questionnaire.
RESULTS: Sixty-two percent (n=360) of the women had coronary calcification based on 1.5-mm thick slices. Phylloquinone intake was not associated with coronary calcification with a relative risk (RR) of 1.17 (95%-confidence interval: 0.96-1.42; p(trend)=0.11) of the highest versus lowest quartile. Menaquinone intake was associated with decreased coronary calcification with an RR of 0.80 (95%-CI: 0.65-0.98; p(trend)=0.03).CONCLUSION:  This study shows that high dietary menaquinone intake, but probably not phylloquinone, is associated with reduced coronary calcification. Adequate menaquinone intakes could therefore be important to prevent cardiovascular disease.

18) http://www.ncbi.nlm.nih.gov/pubmed/19179058
Nutr Metab Cardiovasc Dis. 2009 Sep;19(7):504-10. Epub 2009 Jan 28.
A high menaquinone intake reduces the incidence of coronary heart disease.  Gast GC, de Roos NM, Sluijs I, Bots ML, Beulens JW, Geleijnse JM, Witteman JC, Grobbee DE, Peeters PH, van der Schouw YT.Source Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
Abstract BACKGROUND AND AIM: Vitamin K dependent proteins have been demonstrated to inhibit vascular calcification. Data on the effect of vitamin K intake on coronary heart disease (CHD) risk, however, are scarce. To examine the relationship between dietary vitamins K(1) and K(2) intake, and its subtypes, and the incidence of CHD.
METHODS AND RESULTS: We used data from the Prospect-EPIC cohort consisting of 16,057 women, enrolled between 1993 and 1997 and aged 49-70 years, who were free of cardiovascular diseases at baseline. Intake of vitamin K and other nutrients was estimated with a food frequency questionnaire. Multivariate Cox proportional hazards models were used to analyse the data. After a mean+/-SD follow-up of 8.1+/-1.6 years, we identified 480 incident cases of CHD. Mean vitamin K(1) intake was 211.7+/-100.3 microg/d and vitamin K(2) intake was 29.1+/-12.8 microg/d. After adjustment for traditional risk factors and dietary factors, we observed an inverse association between vitamin K(2) and risk of CHD with a Hazard Ratio (HR) of 0.91 [95% CI 0.85-1.00] per 10 microg/d vitamin K(2) intake. This association was mainly due to vitamin K(2) subtypes MK-7, MK-8 and MK-9. Vitamin K(1) intake was not significantly related to CHD.  CONCLUSIONS:  A high intake of menoquinones, especially MK-7, MK-8 and MK-9, could protect against CHD. However, more research is necessary to define optimal intake levels of vitamin K intake for the prevention of CHD.

19) http://www.ncbi.nlm.nih.gov/pubmed/22489224  FULL TEXT
Food Nutr Res. 2012; 56: 10.3402/fnr.v56i0.5329.
Published online 2012 April 2.
Vitamin K: the effect on health beyond coagulation – an overview  by Cees Vermeer* Prolonged sub-clinical vitamin K deficiency is a risk factor for osteoporosis, atherosclerosis, and cancer.

Vitamin K2 as a treatment for Rheumatoid Arthritis

20) http://www.ncbi.nlm.nih.gov/pubmed/18484089
IUBMB Life. 2008 Jun;60(6):355-61.
Vitamin K and rheumatoid arthritis. Okamoto H. Source Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan.
Abstract Vitamin K2 [menaquinone-4 (MK-4)] has been reported to induce apoptosis in hepatocellular carcinoma, leukemia, and MDS cell lines. The effects of MK-4 on the development of arthritis have never been addressed so far. In this study, we investigated the effect of MK-4 upon the proliferation of rheumatoid synovial cells and the development of arthritis in collagen-induced arthritis (CIA). We analyzed the effect of MK-4 on the proliferation of fibroblast-like synoviocytes (FLSs) using the 3-(4,5-demethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The proapoptotic effect of MK-4 upon FLS was investigated with annexin V staining and DNA fragmentation and caspase 3/7 assays. Moreover, we analyzed the effect of MK-4 on the development of CIA in female dark agouti rats. Our results indicated that MK-4 inhibited the proliferation of FLS and the development of CIA in a dose-dependent manner. We concluded that MK-4 may represent a new agent for the treatment of RA in the setting of combination therapy with other disease-modifying antirheumatic drugs.

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
954-792-4663
www.jeffreydach.com
www.drdach.com
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