As of right now our offices will be open March 14th, 2024. If you would like to change your appointment to telehealth or cancel your appointment, please give us a call at (720)494-4700. If a closure happens we will contact you before your appointment time.
Choosing the right Medicare plan can be a very difficult decision. There are many plans available offering a variety of benefits for different costs. When deciding on which plan to go with, it is important for an individual to understand all enrollment and usage requirements of the plan. The links below offer information that may be useful during the enrollment process:
The new American College of Rheumatology guidelines now recommend the high-dose flu shot for patients on immunosuppressive medications. Please discuss this with your CCAO provider.
We are excited to announce the opening of our new clinic in Broomfield! Our new building has an expanded clinic space, infusion room and meeting space for our growing teams. This has been a dream of CCAO’s for a long time and we are happy to see it come to life. Broomfield patients will now be seen for their appointments at our new address at 1910 Coalton Rd, Broomfield, CO, 80021. Please contact our office if you have any questions.
Ph: 720-494-4700
office@ccao.net
If you have rheumatoid arthritis and would like to participate in developing treatment guidelines, we would love your help. More information and the application can be found here.
When someone is diagnosed with osteoporosis, there is often a tendency to take more calcium. Getting enough calcium is important, but more isn’t necessarily better! The recommendation for people with low bone density is to aim for a total of 1200mg of calcium a day. It is ideal to get 1200mg of calcium from the diet (see here for the amount in certain foods) and only take calcium supplements if you need more. For example, the average American gets about 800mg of calcium a day from their diet. So taking 400mg of calcium supplements would be perfect.
(Patients with kidney disease, hyperparathyroidism, kidney stones, or other conditions that affect calcium should talk to their provider about how much calcium is right for them.)
Both weight-bearing and muscle-strengthening exercises are recommended for patients with osteopenia and osteoporosis. While muscle strength and balance training are important to reduce the risk of falling down, higher intensity loading may be necessary to stimulate bone formation and improve bone density. Studies from an Australian group with a specific training program (HiRIT) have reported a benefit in bone density in women and men. This program includes deadlift, squat, overhead press, jump drop, and balance exercises.
A recent study compared 8 months of HiRIT with a low-intensity program (similar to Pilates) in women with osteopenia or osteoporosis. It included a small number of women who were on osteoporosis medications to see if the combination of exercise and medications would be more helpful. The group who did HiRIT had a better spine bone density (about 2.5%), but neither exercise program helped with hip or forearm bone density. Unfortunately, only women on medications showed improvements in hip bone density, and doing HiRIT didn’t add anything to benefit of the medications for spine bone density.
In conclusion, women with low bone density who do not necessarily need to be on an osteoporosis medication may see some improvement in spine bone density with this high-intensity exercise program. Whether this improvement would lead to a lower risk of fracture isn’t clear, but it did lead to improved muscle strength and physical function, which is certainly important. Exercise continues to be an essential part of the prevention and treatment of low bone density, but this and other studies have shown it can only do so much for someone with osteoporosis who is at high risk for a fracture.
The FDA released a warning statement on 9/1/21 about a class of medications called JAK inhibitors, including Xeljanz, Olumiant, and Rinvoq. This was based on the results of a recent study involving people over the age of 50 who had at least 1 risk factor for heart disease (such as smoking, high blood pressure, or high cholesterol). It showed a higher risk of serious heart-related events, cancer, blood clots, and death compared to patients who were on other types of medications. The full results of this study haven’t been published yet, and we have requested this information, but it would be worth discussing this new warning with your Rheumatologist. If you are interested, please call to schedule an appointment.
A 3rd dose of an mRNA vaccine (either Pfizer or Moderna) for immunocompromised people was recently approved by the FDA. If you are taking a medication that suppresses your immune system, please contact your CCAO provider to discuss whether you are a candidate for a 3rd shot. At this time, J&J has submitted their data to the FDA, but there are no recommendations for getting a 2nd J&J shot if that was the initial vaccine.
Patients with rheumatoid arthritis who are doing well on treatments (DMARDs) often wonder how they would do on a lower medication dose. There have been many studies trying to help answer this question, and they have mostly showed that some patients can decrease or even stop DMARDs for a while, but doing this increases the risk of an RA flare. A recent study published in JAMA added important information to help patients make this decision.
This study enrolled 160 RA patients from Norway who had been in remission (doing great) for 1 year on oral DMARDs (not biologics). Half the group continued the same dose of DMARDs, and the other half decreased their DMARD dose by 50%. The most common DMARD was methotrexate, but some patients were taking leflunomide, sulfasalazine, and/or hydroxychloroquine.
Over the next year, 25% of patients in the half-dose group had an RA flare. Only 6% of patients flared if they stayed on the same DMARD dose. Fortunately, after 1 year 85% of patients in the half-dose group were still in remission compared with 92% of people on the same dose.
This study showed that decreasing the DMARD dose increases the risk for an RA flare, which can cause pain, damage to joints, and potentially lead to taking prednisone to calm the flare. Other studies have reported that some patients who stop a biologic medication and then restart it after flaring won’t get the same good response from that biologic medication, but it is reassuring that most patients who flared because of taking a lower DMARD dose can usually get the disease under control again by going back up on the dose. Siri Lillegraven, et al. Effect of Half-Dose vs Stable-Dose Conventional Synthetic DMARDs on Disease Flares in Patients With RA in Remission. JAMA. 2021;325(17):1755-1764.
