I recently posed a few questions to Dr. Siegel regarding my recent blood tests
and x-rays. I also asked him a question about MSM, but I think because of what
Joe is doing with DMSO, he is confusing the two as they are different although
similar chemically. My understanding is that MSM is a benign substance. I
thought I had explained that in my note but sometimes everyone doesn't read as
carefully as you would like them to read. I've written him a followup pointing
him towards further info on the web about MSM and we shall see what that reply
brings.
Dr. Siegel noticed my chat room signature and found that to be interesting, so
he indicated that I could post his response to me to the group, so I am. (I've
deleted a few unimportant items). Unfortunately, my x-rays taken in February
indicate some small erosions of bone (which despite him telling me not to panic,
sort of scares the hell out of me). I have written to him asking him to explain
those in greater detail. I wonder if these happened in the early stages of
taking mino - since my labs are trending downwards, I am hoping that means less
pressure of synovial fluid on cartilage and bone and thus hopefully a
discontinuation of this erosion. You will note that if my hands keep flaring,
that he wants me to take something else in addition. I've asked him what that
might be in my followup (anyone want to guess? :))
So here's my note and his answers (sorry for the length - he quotes some
lengthy articles on DMSO - note that he does include a Russian study which
exhibited the following:
("It was found that DMSO and dimethyl sulfone lessen the destructive changes in
the joints, while DMSO also inhibits the manifestation of immune disorders, i.
e. produces a"basal" effect on the course of spontaneous chronic arthritis in
experimental animals. " Dr. Siegel states that those tests have not been
repeated elsewhere. Wonder why that is?)
Sorry - his answers follow!
Dear Mr Holmes
Thanks for your notes. Another patient last week asked me
about DMSO and I did some reading on the subject. See the articles appended
to my note . DMSO applied topically appears to have pain releiving
properties, somwehat like Flex-all or Zostrix, but the evidence for actual
immunomodulating properties is scarce. The only studies on oral use are from
Russia in the 1980's and have not been repeated elsewhere. As for systemic
use note the study on rats in which there was significant toxicity. The
medically accepted use of DMSO is based on its properties as powerful
solvent that can dissolve toxic compounds such as bladder irritants and
amyloid. IT IS ALSO USED AS A PRESERVATIVE IN BONE MARORW FOR INFUSIONS INTO
CANCER PATIENTS.
I encourage you to look through the NIH pubmed database where I
found these articles. Searching is pretty straightforward and the abstracts
are often less technical than the article. The site is
www.ncbi.nlm.nih.gov/PubMed/medline.html.
We reviewed your X rays at our clinical conference, and in
comparison to August there is definite evidence of small erosions in the
metacarpal bones. I will forward this information to Dr Kempf. I do not
think this is anything to panic about but if you still are having frequent
flares and inadequitely controlled symptoms in your hands it may be time to
start thinking about adding another agent to your therapy.
Answers to your other questions are in capital letters (see below)
Hope the winter is not too severe in the mountains - it's snowing
like crazy at the NIH right now!
Richard
Richard M. Siegel M.D., Ph.D.
Fellow, ARB NIAMS
NIH Bldg 10 Rm 11N311
Bethesda MD 20892
301-496-6753
FAX 301-480-7352
HERE ARE SOME REFERENCES
Rev Clin Basic Pharm 1985 Jan-Jun;5(1-2):1-33 Medical use of dimethyl sulfoxide
(DMSO).Swanson BNDMSO is a clear odorless liquid, inexpensively produced as a
by-product of
the paper industry. It is widely available in the USAas a solvent but its
medical use is currently restricted by the FDA to the
palliative treatment of interstitial cystitis and to certainexperimental
applications. Cutaneous manifestations of scleroderma appear to
resolve (albeit equivocally) following topicalapplications of high
concentrations of DMSO. A limited number of small
clinical trials indicate that intravenous DMSO may be ofbenefit in the treatment
of amyloidosis, possibly by mobilizing amyloid
deposits out of tissues into urine. Dermal application ofDMSO seems to provide
rapid, temporary, relief of pain in patients with
arthritis and connective tissue injuries. However, claimsfor antiinflammatory
effects or acceleration of healing are currently
unwarranted. There is no evidence that DMSO can alterprogression of degenerative
joint disease, and, for this reason, DMSO may be
considered for palliative treatment only and not tothe exclusion of standard
antiinflammatory agents. The safety of DMSO in
combination with other drugs has not been established;neurotoxic interactions
with sulindac have been reported. In experimental
animals, intravenous DMSO is as effective as mannitoland dexamethasone in
reversing cerebral edema and intracranial hypertension.
An initial clinical trial in 11 patients tends tosupport this latter
application. DMSO enhances diffusion of other chemicals
through the skin, and, for this reason, mixtures ofidoxuridine and DMSO are used
for topical treatment of herpes zoster in the
UK. Adverse reactions to DMSO are common, butare usually minor and related to
the concentration of DMSO in the medication
solution. Consequently, the most frequent sideeffects, such as skin rash and
pruritis after dermal application,
intravascular hemolysis after intravenous infusion andgastrointestinal
discomfort after oral administration, can be avoided in
large part by employing more dilute solutions. Mostclinical trials of DMSO have
not incorporated the components of experimental
design necessary for objective, statistical evaluationof efficacy. Randomized
comparisons between DMSO, placebo and known active
treatments were rarely completed. Finalapproval of topical DMSO for treatment of
rheumatic diseases in particular
will require a multi-center, randomized comparisonbetween high and low
concentrations of DMSO and an orally-active,
nonsteroidal antiinflammatory agent. [Dimethylsulfoxide (DMSO) gel in treatment
of acute tendopathies. A
multicenter,placebo-controlled, randomized study].[Article in German] Kneer W,
Kuhnau S, Bias P, Haag RFOrthopadische Gemeinschaftspraxis, Stockach. METHOD: In
a placebo-controlled double-blind study, 157 patients with acute
tenopathies (periarthropathia humeroscapularis orlateral epicondylitis) were
randomized to treatment with either DMSO gel 10%
applied three times a day (n = 77) or the gelexcipient (n = 80). The treatment
phase was 14 days long and included four
examinations. Treatment was started within 72 hoursafter the onset of the acute
symptoms. RESULTS: Pain of movement under
loading and the mobility of the joints weresignificantly improved after,
respectively, 3 and 7 days treatment with DMSO,
as compared with placebo. After 14 days onDMSO, a further improvement was
observed, and 44% of the patients were
pain-free (placebo 9%). In both groups, the substancewas well or very well
tolerated by more than 90% of the patients. No relevant
changes in laboratory results or severe undesiredevents occurred under
treatment. Undesired events were seen in 8 patients
receiving DMSO treatment, and in 3 patients in theplacebo group. CONCLUSION: The
results of this study confirm that Rheumabene
(10% DMSO gel) is suitable for topical use inthe treatment of acute tenopathy,
producing clinically relevant results with
little risk to the patient.
Analysis of dimethyl sulfoxide immunosuppression in the rat model of
collagen II
autoimmune arthritis: an effect dependent upon intraperitoneal
administration and
associated with toxicity.
Watson WC, Pucevich CL, Cremer MA, Pinals RS, Townes AS
The effect of the route of administration of dimethyl sulfoxide on humoral
immunity and arthritis was evaluated in the rat model of
collagen II autoimmune arthritis. Intraperitoneal administration of 5
g/kg/day (days 0-12) reduced serum anti-collagen II IgG levels,
delayed the onset of arthritis, but induced sterile peritonitis in all of
the treated animals. The same dose given subcutaneously did not
alter humoral or clinical parameters. Lower intraperitoneal doses (0.04 and
0.25 g/kg/day), although non-toxic, were similarly
ineffective. Subcutaneous (5 g/kg/day) or topical treatment (both hindpaws
dipped twice daily into 70% dimethyl sulfoxide) of
established disease (days 16-27) produced a mild anti-inflammatory effect
without any immunosuppression. We suggest that the
apparent suppression of autoimmunity by dimethyl sulfoxide is dependent upon
intraperitoneal administration and a toxic dose of the
agent.
Patol Fiziol Eksp Ter 1991 Mar-Apr;(2):37-9 [Effect of dimethyl sulfoxide and
dimethyl sulfone on a destructive process
in thejoints of mice with spontaneous arthritis].[Article in Russian] Murav'ev
IuV, Venikova MS, Pleskovskaia GN, Riazantseva TA, Sigidin IaAThe authors used
the blind method for evaluation of the morphological
picture of the joints and the level of circulating immunecomplexes to study the
effect of prolonged oral administration of dimethyl
sulfoxide (DMSO) and its main metabolite dimethylsulfone on the development of
spontaneous arthritis in 36 Mrl/Mn/lnr female
mice. It was found that DMSO and dimethyl sulfonelessen the destructive changes
in the joints, while DMSO also inhibits the
manifestation of immune disorders, i. e. produces a"basal" effect on the course
of spontaneous chronic arthritis in experimental
animals.