DEAR DRS. DONOHUE AND ROACH: I have arthritis in both knees and have taken Celebrex for years for it. I am unsure how long I should keep taking it. What is your opinion of Celebrex? Also, could stem cells ever be used for joints? — L.H.

ANSWER: Celebrex is in a class of medicines called COX-2 inhibitors. It is usually used for arthritis, and was specifically intended to reduce the likelihood of gastrointestinal complications, especially bleeding from the stomach. It probably has less risk of bleeding and ulcer than other arthritis medicines, but serious bleeding can still occur.

There remains some controversy about whether Celebrex increases the risk of heart disease the way another COX-2 inhibitor, Vioxx (since removed from the market), was found to in studies. Preliminary evidence suggests it is not more dangerous to the heart than other drugs, but a study is ongoing to determine this with greater certainty.

Celebrex is very useful for many people, and if you have been taking it for years with good results and no side effects that you notice, I would recommend you continue to take it.

Stem cells may indeed be useful for arthritis in the near future. Since one of the major problems in arthritis is loss of the cartilage in the joint, it makes sense to use new cells to regenerate it. But more research is needed.

DEAR DRS. DONOHUE AND ROACH: Could you please tell me about myelofibrosis? My brother, who just turned 45, was diagnosed with it about four months ago. He has always been healthy, except for being a chronic smoker. He experienced fatigue and was found to have severe anemia, needing four units of blood. He now gets Procrit. Can you tell me more about this? Is it hereditary? I just need to know what my family is facing so we can help him as best we can. — W.S.

ANSWER: Myelofibrosis is a disease of the bone marrow. “Myelo” refers to bone marrow, and “fibrosis” is the process of replacement by scar tissue. Hence, in myelofibrosis, the bone marrow is gradually replaced with scar tissue.

It’s usually seen in people over age 50, but 45 isn’t too unusual an age.

Hindered by scar tissue, the bone marrow is unable to make enough red blood cells, causing anemia. Anemia can be treated with blood transfusion, but also with medications like Procrit, which induces the bone marrow to make more blood cells.

Similarly, the bone marrow can fail to make enough white blood cells, putting the patient at risk for infection, and platelets, which can lead to excess bleeding. Although it can be cured with a bone marrow transplant, this is a risky procedure, and only an experienced hematologist can advise whether to consider this, as many people do well for a long time with medication and blood transfusion. There is not a strong family tendency in this disease.

It is in a class called “myeloproliferative disorders,” with chronic myelogenous leukemia, and myelofibrosis progresses to leukemia in 10 percent to 15 percent of cases.

DEAR DR. DONOHUE: In a column, you commented that the vegetable drink V8 has a fairly large amount of sodium. The regular type has 290 mg per 5.5-ounce can. However, there also is a low-sodium V8 product that has only 95 mg of sodium. I have always found it available wherever the regular V8 is sold. — W.W.

ANSWER: Thank you. I appreciate the information, lovers of V8 appreciate it and the manufacturer of the product greatly appreciates it.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.

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