Tips About Arthritis

Rheumatologist says maintaining flexibility can prevent arthritis

2006-01-04T14:21:00.000-08:00

The Pak Tribune reports findings from a study by Tim Spector, a professor of rheumatology at St. Thomas� Hospital in London, who claims his study shows that flexibility in women is associated with reduced risk of arthritis.

It's not clear from the study if women were born with extra-flexible joints or obtained them through a lifetime of exercise and stretching, according to Tim Spector, a professor of rheumatology at St. Thomas' Hospital in London.
"Our research suggests that both the innate or the exercise route (to flexibility) both seem to help prevent arthritis -- so exercise and stretching should be encouraged," said Spector.
"In our study we only tested the women once and can't really separate hypermobile women who remained flexible from normal women who exercised and stretched to become more flexible than their sedentary peers," said Spector.
It's the looseness of the structures surrounding the joint that allow it to have more motion, similar to a hinge on a door that allows it to swing open and closed.
In some cases, hypermobility is a sign of inherited connective tissue or bone disease, and some studies had suggested it might actually increase the risk of osteoarthritis.
Osteoarthritis occurs when the cartilage that cushions joints breaks down, often leading to pain, swelling and loss of mobility.
In the ongoing study, predominantly middle-class white women have received regular x-rays and bone mineral density measurements since 1988.
Spector and his colleagues found that bone mineral density was three percent higher in the hips of the hypermobile group compared with other women.
There was no difference in spine bone mineral density between the two groups of women, according to the study in the current issue of the Journal of Rheumatology.
The researchers also looked for osteoarthritis in the hands, knees, spine and hips of hypermobile women.
The American Academy of Orthopedic Surgeons and the American Geriatrics Society recommend that adults engage in 30 minutes of moderate physical activity every day.

Dear Doctor: Causes, complications of neck arthritis

2006-01-04T14:20:00.000-08:00

By Gerard Werries, M.D., Orthopedic Surgery

Q. Will I become paralyzed from my neck arthritis?

A. Arthritis of the neck is the leading cause of spinal cord dysfunction in patients 55 years and older. It affects men twice as much as women and can consist of bone spurs, disc bulges/herniations or thickened ligaments of the spine. Risk factors include frequent lifting, excessive driving and genetic and autoimmune factors.

Symptoms of neck arthritis can be neck pain, decreased motion, arm pain, numbness and weakness. Patients with significant spinal cord compression caused by severe neck arthritis often develop leg weakness, experience difficulty writing and walking and develop bowel and bladder difficulties.

If you have neck arthritis, you should have a thorough history taken and a physical done by a trained spinal surgeon. Routine X-rays of the neck should be done, after which additional imaging tests may be required to check the severity of spinal cord compression. Nerve conduction studies also may be required.

Patients with mild neck arthritis and minimal symptoms often respond well to physical therapy, anti-inflammatory medications and steroid injections. When conservative treatment fails or severe spinal cord compression from neck arthritis develops, surgery may be required to make room for the spinal cord and nerve roots. It is important for patients with severe spinal cord compression and significant neurological problems to seek immediate consultation with a spinal surgeon to avoid permanent damage to the spinal cord.

Osteoporosis drug fights knee arthritis

2006-01-04T14:16:00.000-08:00

Risedronate preserves underlying bone to delay collapse of the joint

A drug that treats brittle bones may also help people with worn out knees.

British researchers have found that high doses of risedronate (brand name Actonel), an osteoporosis drug called a bisphosphonate, can preserve the underlying bone in the knee joints of people with osteoarthritis, the wear-and-tear form of arthritis.

"It has been known for some time within the literature that bisphosphonates could actually do this but nobody actually had the data to show it and so we are the first group to be able to do that," says Christopher Buckland-Wright, the senior study investigator and a professor of radiological anatomy at King's College London. He says the treatment slows the collapse of the joint and could potentially delay the need for knee replacement surgery.

Buckland-Wright and his colleagues studied 100 people who had knee osteoarthritis and were taking inactive pills or several different doses of risedronate. Over the next two years, X-rays showed that study participants with more advanced arthritis who were taking the higher medication doses experienced a halt or reversal in the loss of underlying bone in their knee joints.

People with advanced arthritis on the low-dose risedronate or inactive pills did not show any benefit, and those with less advanced arthritis had a modest loss of bone regardless of treatment.

Buckland-Wright says the drug was well tolerated even at high doses, and there is no reason to believe that other bisphosphonates would not also be effective.

Dr. Eric Matteson, professor of medicine at the Mayo Clinic in Rochester, Minn., says this study marks a new approach to slowing the progress of arthritis. "We now have a very good tool for slowing down this process, other than weight loss."

Arthritis patients denied drugs

2006-01-04T14:14:00.000-08:00

By Nigel Hawkes

MANY patients with a form of arthritis that mainly affects young men are not being treated with drugs that could help them back into work.

Ankylosing spondylitis (AS) affects about 60,000 people in Britain, and is most common among men in their late teens and early twenties. It impairs mobility and causes fatigue.

The Arthritis Research Campaign (ARC) said that many patients were denied anti-TNF therapy, a new class of drugs that combat the inflammatory tumour necrosis factor, because of its high cost. Although it has been licensed for AS since 2003, the National Institute for Health and Clinical Excellence (NICE) is not expected to review its use in AS patients until February 2007.

The ARC said that funding was patchy throughout the country and NHS trusts in England and Wales were not making the drugs available. It said that making the drugs more widely available would enable more patients to return to work. Professor Paul Wordsworth, of the ARC, said: “We urge NICE to speed up its approval process so that other people can benefit from the extraordinary transformation that these drugs can bring.”

New evidence to support combination therapy for achieving remission of early rheumatoid arthritis

2006-01-03T14:31:00.001-08:00

Two-year study of patients with early, aggressive disease demonstrates significantly superior results of anti-TNF plus DMARD therapy over either therapy alone

A chronic and potentially crippling inflammatory disorder, rheumatoid arthritis (RA) progressively wears away the cartilage and bone. Joint erosions are routinely seen within 6 months of RA's onset, and occur more rapidly earlier in the course of the disease. Moderate disability within 2 years of diagnosis is not uncommon. While conventional DMARD (disease-modifying antirheumatic drug) therapies have been shown to slow joint destruction, they are powerless to stop RA's progression or reverse joint damage.

As researchers widely agree, early intervention offers RA patients the most promise for preventing irreversible joint damage and avoiding severe disability. In addition to early treatment, combination treatment, with DMARDs as well as with biologic agents, has been shown to yield more favorable outcomes than a single treatment. The January 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis) presents the first study to compare the effectiveness of DMARD therapy alone, anti-TNF (tumor necrosis factor) therapy alone, and a combination of DMARD and anti-TNF therapy. The compelling results affirm the long-term benefits of early combination therapy for women and men afflicted with aggressive RA.

The study was sponsored by Abbott Laboratories and conducted at 133 sites throughout North America, Europe, and Australia. It focused on patients with active RA for less than 3 years who had never been treated with the DMARD methotrexate (MTX). A total of 799 patients were enrolled in the study. The majority were women. The mean age was 52 years. 57 percent of the participants had RA for 6 months or less. The subjects were randomly divided into one of 3 treatment groups: MTX, in pill form, starting with 20 milligrams weekly; the anti-TNF adalimumab, administered by injection, starting with 40 milligrams every other week; and a combination of adalimumab plus MTX, starting at the same dosage levels as the single treatment groups. For all groups, treatment effectiveness was thoroughly evaluated after 6 months, 1 year, and 2 years. 539 of the participants completed 2 years of their assigned treatment.

In all outcome measured, the combination of treatments was clinically and statistically superior to both adalimumab and MTX alone. Following 1 year of treatment, 62 percent of patients in the combination therapy group had 50 percent improvement in disease symptoms, according to the standard American College of Rheumatology criteria, compared with 41 percent of patients in the adalimumab only group and 46 percent of patients in the MTX only group. In addition, there was significantly less radiographic disease progression at 6 months, 1 year, and 2 years among patients in the combination treatment group than among those in either single treatment group. What's more, after 2 years of treatment, nearly half the patients in the combination therapy group exhibited a major clinical remission, rates approximately twice those found among patients receiving either single therapy.

The combination of DMARD and anti-TFN therapy proved safe and well tolerated by patients. The incidence of infections and other adverse events were low and comparable in all 3 treatment groups. What's more, increasing the dosages of either adalimumab or MTX alone failed to yield the improvements experienced by patients receiving both treatments in relatively low dosages.

As spokesperson George T. Spencer-Green points out, the study's participants had an unusually high level of radiographic damage present at baseline for their average disease duration of under one year. Early RA patients with milder forms of the disease may benefit from early DMARD therapy under a clinician's supervision. "For the patient with early, aggressive and erosive, RA," he notes, "treatment with combination therapy is superior to treatment with MTX alone."

Canadian study focuses on pain management for arthritis sufferers

2006-01-03T14:31:00.000-08:00

Mary-Ann Fitzcharles, M.D., of Montreal General Hospital, McGill University, led a study of pain management for arthritics that incorporates diet, exercise, topical applications and opioid analgesics in its treatment of the ailment.

Long treated as a side effect, pain is now widely recognized as an integral part of patient care.
While the last decade has brought extraordinary advances in the unravelling of pain mechanisms at the molecular level, evaluating and alleviating pain remains an ongoing challenge for physicians, particularly rheumatologists.
The December 2005 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis) offers a timely examination of pain as it pertains to rheumatology practice.
"Pain management is no longer simply a quick fix with a single pill, but rather an approach to the patient as a whole biopsychosocial being."
Drawing on the latest research into this complex factor, Dr. Fitzcharles and her collaborators demystify both the process and the experience of pain for patients with rheumatoid arthritis (RA) and related diseases.
Because rheumatic pain travels through small, slow-conducting fibers, it is perceived as a pervasive aching rather than as acute, localized stabs.
Inflammation also plays a role in activating pain pathways that usually lie dormant -- comprising as many as one-third of the total number of pain-transmitting nerves.
What's more, molecular evidence suggests that stress and depression may increase a rheumatic patient's production of pain-provoking inflammatory agents.
In addition to using time-honored tools -- namely, the visual analogue scale of pain severity and patient questionnaires -- in real-life practice, the rheumatologist must take cues from the patient during the interview and examination, heeding spontaneous movement, musculoskeletal structure, and verbal complaints, as well as consider the patient's psychosocial history and coping strategies.
Beyond the prescription of a pill, what works to relieve rheumatic pain?
According to studies, regular physical activity not only maintains muscle tone and helps to improve function, but also induces the production of endogenous opioids -- endorphins and other natural painkillers.

The impact of smoking and genes on rheumatoid arthritis

2006-01-03T14:29:00.000-08:00

Researchers offer new insight into specific autoimmune triggers among smokers with shared epitope genes

Rheumatoid arthritis (RA) is one of the most common systemic autoimmune diseases, and one of the least understood. Smoking is the major known environmental risk factor for RA, though little is known about the mechanisms involved. HLA-DR shared epitope (SE) genes are a widely recognized genetic risk factor for RA, though little is known about how these genes affect autoimmune reactions that lead to chronic inflammation and progressive joint and organ damage.

To better understand the interactions between smoking and HLA-DR SE genes in RA, a team of researchers in Sweden focused on the disease's distinctive autoimmune hallmark: citrulline, an amino acid not normally present in protein. While extremely rare in healthy individuals and relatively rare in other inflammatory conditions, citrulline-modified proteins are common in about two-thirds of RA patients and may be an underlying factor in the development of the disease. To investigate whether smoking and SE genes trigger immune reactions to citrullinated proteins, the team conducted a case-control study involving patients with recent-onset RA. The results, featured in the January 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), suggest that smokers with SE genes are more susceptible to anticitrulline antibody-positive RA.

The study's 930 early RA patients, drawn from the Epidemiological Investigation of Rheumatoid Arthritis Study Group, ranged in age from 18 to 70 years. 383 healthy controls, drawn from the blood bank of northern Sweden, were matched for age, gender, and residential area. All participants completed questionnaires about their past and present smoking habits, as well as genotyping profiles. In addition, bronchial fluid was obtained from a representative sample of RA patients, including both current heavy smokers and lifelong non-smokers, and tested with immunostaining for the presence of citrullinated protein in cells.

Based on their series of experiments and comparisons, the researchers found that a history of smoking increases the risk for RA, but only for individuals who test positive for anticitrulline antibodies, regardless of the presence of SE genes. Similarly, inheriting HLA-DR SE genes in a single copy, as well as in double copies, increases the risk for RA, but only for individuals who test positive for anticitrulline antibodies, including individuals who have never smoked. Yet, for individuals who test positive for anticitrulline antibodies, the interaction of smoking and carrying 2 copies of the SE gene dramatically increases the risk for developing RA--by 21 times.

"The remarkable gene-environment interaction observed in the case-control study, together with the immunostaining for citrullinated proteins, might now provide a clue to the molecular mechanisms of importance for disease development in a subset of RA patients," notes team spokesperson Dr. Lars Klareskog of Karolinska Institutet, Stockholm. "We may thereby be given some new opportunities to both predict and understand the onset of RA and to interfere with RA-inducing events before clinical symptoms are apparent."

2006-01-02T15:01:00.000-08:00

Could knee stem cells offer new hope on arthritis?



Tom Perks has been an enthusiastic football player ever since he could kick a ball. But from about the age of 14, one of his knees would regularly give way during a game. It progressively grew worse and, eventually, got so bad he had to give up the game he loved. Now aged 23, Perks has just taken part in a trial for a radical new technique in which patients with injuries to the cartilage in their knee joints are injected with new cartilage grown from their own stem cells. At the moment, it is available only to relatively young, otherwise fit people, whose knee joints have been damaged, usually from a sports injury or accident. However, the technique offers new hope of preventing the pain and disability of arthritis in later life as a result of knee damage. Tom Perks is one of increasing numbers of people in Britain who have undergone autologous chondrocyte implantation (ACI). It requires two operations, one to remove cartilage cells (chondrocytes), which are then grown in the laboratory. Three or four weeks later they are re-implanted in the damaged area, where they are held in place by a patch either taken from the membrane covering the shin bone or by a manufactured collagen patch. Articular cartilage is a tough, smooth, elastic tissue which covers the ends of bones that form joints. It enables the bones to move smoothly over one another and performs the vital function of a shock absorber, cushioning the bone from forces of more than five times the body's weight. Damaged articular cartilage in knees can cause the joint to be painful, swollen and difficult to move, restricting once-swift athletes to a hobble. A line-up of foot-ballers' knees is testament to how much damage contact sports can do to the delicate engineering of the knee joint. Unlike skin, cartilage does not have the ability to repair itself. Instead, the damage tends to spread, allowing the bones to rub against each other. Any repair tissue that does form is not like the original cartilage and doesn't work very well. Royal Alexandra Hospital in Paisley is conducting a trial of ACI along with 14 other hospitals in the UK and two in Norway. It is the only one in Scotland so far. Dr Heather Smith, the trial manager, based at the orthopaedic hospital in Oswestry, Shropshire, has so far recruited 60 patients for the trial as opposed to more traditional treatments. "We hope to have 600 patients eventually and there will be a long-term follow-up," she says. "We plan to analyse the results after five years and 10 years. The procedure was pioneered in Sweden in the mid-1990s by Lars Petersen, who treated Ole Gunnar Solskjaer, the injured Manchester United player, and is being used in the US and in Germany, with promising results so far. It is not available in this country on the NHS except as part of a trial." ACI is a more expensive technique, requiring two surgical procedures rather than one and therefore an increased risk as well as a longer rehabilitation period than other techniques. Dr Smith's trial is therefore part of an evaluation which will decide whether it should be available to NHS patients. Like Tom Perks, patients must have a very specific form of cartilage damage to take part in the trial. "You need stable knees – sometimes the cartilage we are trying to repair may be so damaged there is almost nothing to get hold of." Perks has no doubt the operation has been a success: "I had the operation at the end of August and my leg is now quite a lot better," he says. "It is still a bit swollen but I have no discomfort when walking, although I'm not up to a run. I have been back at work for four weeks. I am on my feet all day, because I repair roads and footpaths. "They look inside your knee with a camera to see how bad it is, then they make a couple of incisions to take out the cartilage. After four weeks the cells are grown and you have the second operation. For that, I was in hospital for three days. "I was attached to a machine which automatically bends and straightens your knee to keep everything moving. Then I went on to crutches and now I am walking normally. You have to keep up with the physio – it takes about two months for the leg to become weight-bearing and the rehabilitation programme continues for 12 months." To be eligible to take part, patients must have had a standard treatment which failed. There are several alternatives to ACI. The traditional one is debridement, which involves sucking or washing away loose and damaged pieces of cartilage via keyhole surgery. Abrasion or drilling takes this a step further until bleeding points are seen. The theory is that the underlying bone produces primitive blood cells which are then reformed into cartilage cells which cover the damaged area. Microfracture is a modification of the drilling technique. Debridement is carried out to form a stable perpendicular edge of healthy cartilage. Then multiple holes are made in the defect. Blood from the defect is washed away until a clot forms. This "super clot" is believed to be the optimal environment for tissue to regenerate within the lesion. The questions with these techniques, says Dr Smith, are whether the right type of cells are released, whether there are enough of them and whether they stay in the right place, whereas ACI is possibly a more accurate way of achieving regeneration of the cartilage. The great hope for ACI is that it results in permanent improvement. Patients for whom other treatments have failed, have only the alternative of a knee replacement, but these do not last for more than 15 years, so are not a good option for younger people. So far, ACI patients have reported continued improvements for up to two years, suggesting the transplanted cells may continue to form new cartilage for that length of time. It gives great hope to Tom Perks. He has been told to avoid contact sports for a while, but he hopes he might soon be able to have a kickabout with his five-year-old son and get back to the game he adores. "It would be great to get back on the pitch with the lads," he says.

FDA OK's Bristol Myers' arthritis drug

2005-12-31T07:54:00.000-08:00

The Food and Drug Administration has approved Bristol-Myers Squibb's rheumatoid-arthritis drug Orencia.

Orencia works by slowing the progression of structural damage in patients with rheumatoid arthritis and improves physical function in RA patients who have had inadequate responses to other drugs, the company said.

"Bristol-Myers Squibb is committed to discovering and developing innovative medications that address areas of significant unmet need," said CEO Peter Dolan. "There is clearly a need for more therapies for rheumatoid arthritis, and Orencia has the potential to help many people with this serious disease. Orencia is our first internally-discovered biologic and it further diversifies our pharmaceutical portfolio."

Orencia is the first in a new class of agents for the treatment of RA that selectively modulates a co-stimulatory signal required for full T-cell activation, the company said, and is also the first RA therapy proven safe and effective for patients for whom tumor necrosis factor (TNF) antagonists don't work.

Australian man convicted for growing marijuana for elderly arthritis patients

2005-12-22T18:59:00.000-08:00

Craine Lucas Wattam, 37, has been found guilty of growing marijuana at his residence in Darwin, though the Court found that the man was cultivating the medicinal plant at the request of elderly citizens living in Palmerston.

A Darwin court has heard that a man who has pleaded guilty to growing marijuana intended to supply it to elderly people suffering arthritis.
Craine Lucas Wattam, 37, pleaded guilty in the Northern Territory Supreme Court to unlawfully cultivating a commercial quantity of cannabis.
Police discovered the 45 plants when they visited his Darwin River property on an unrelated matter in January this year.
The court heard that Wattam had been approached to grow the plants by a group of elderly people in Palmerston who used the drug to relieve symptoms of arthritis.
Their own backyard plants had been persistently raided by thieves.
The court heard Wattam had simply scattered seeds in pots and did not intend to grow that number of plants.
Nor did he intend on profiting from them.
He has been sentenced to nine months' jail suspended immediately.

Light at the end of the tunnel for arthritis sufferers

2005-12-21T18:13:00.000-08:00

There is at last a light at the end of the tunnel for Arthritis sufferers.

The disease which can cause severe pain, leaves many incapacitated with a reduced quality of life.

Osteoarthritis is a form of rheumatic disease, and it affects as many 2 million people in the UK alone.

But now British scientists say they have made a significant step towards finding a new treatment for osteoarthritis, a disease that can leave people unable to walk.

Apparently researchers at Bristol University have successfully grown new cartilage from a patient's own stem cells and are hopeful that the technique will allow them to eventually carry out transplants.

But they do warn it could take over a decade to perfect the technique.

The scientists grew a piece of cartilage using stem cells, which are self-renewing and have the ability to grow into blood, bones or organs.

The cells were taken from the bone marrow of people undergoing hip replacement operations because of the disease.

They were then placed in a solution to help them develop and then grown into a scaffold made up of polyglycolic acid, which is the same material used to make dissolvable, surgical stitches.

Once the cartilage is transplanted, the scaffold should melt away.

Because the patient's own cells are used to create the cartilage, the new technique is expected to surmount problems of transplant rejection, as well as avoiding the ethical concerns over using human embryos.

Many experts are encouraged by the success but see it as a milestone rather than a breakthrough.

Although there is no single cause of osteoarthritis, several factors increase the likelihood of getting it, including being over 40, female, overweight or having an existing injury to a joint.

Osteoarthritis means that the smooth cartilage that takes the strain in a normal joint becomes rough, brittle and weak and in order to compensate, the bone beneath it thickens and spreads out, forming knobbly outgrowths.

The membrane surrounding the joint also thickens and the fluid-filled space within it becomes smaller.

As the disease progresses bits of cartilage may break away from the bone, causing the bone ends to rub together and the ligaments to become strained.

This causes a great deal of pain and changes the shape of the joint.

Osteoarthritis is most common in the hands, knees, hips and feet but some people also develop it in the back and neck.

Stem cells give new hope to arthritis sufferers

2005-12-20T14:45:00.000-08:00

Scientists in England predict they will have a "cure" for osteoarthritis within the next decade, with the help of stem cell technology.

Researchers at the University of Bristol successfully grew new human cartilage from stem cells taken from the patient's own bone marrow -- a first.

The development paves the way for cartilage transplant operations for people who suffer from osteoarthritis, one of the most severe forms of arthritis, which can leave people unable to walk.

This technique is promising because it overcomes the problems of transplant rejection, since the patient's own stem cells are used to make the cartilage.

As well, the fact that it uses the patient's own stem cells, rather than human embryos, avoids ethical concerns.

In this experiment, scientists took the stem cells from the bone marrow of people undergoing hip replacement surgery, because of osteoarthritis.

The cells were placed in a special solution to help them grow, and in just over a month, experts ended up with a half-inch piece of cartilage.

Experts warn that the technique could take up to 10 years to perfect.

"I think we should be encouraged but not overly excited. At the moment this is a milestone but not really a breakthrough," professor George Nuki, from the British Society for Rheumatology, said, the BBC website reported.

Osteoarthritis is one of the most common forms of arthritis. It involves the breakdown of a joint's cartilage, which cushion the ends of bones, and allows for easy movement.

It commonly affects older people. Men are more likely to have osteoarthritis than women under the age of 55. Over the age of 55, it becomes more common in females, according to the U.S.-based Arthritis Foundation.

While a single cause of osteoarthritis isn't known, risk factors include age, weight and having a previous injury at a joint. Genetics can also play a part.

The disease typically affects major joints, such as the hips, knees and lower backs. It can also affect the neck, small finger joints, the base of the thumb and the big thumb.

Supplements help mend, not mask, pain

2005-12-20T14:43:00.000-08:00

I'm 75 years old and play softball, volleyball and jog. I take glucosamine and chondroitin for my arthritis pain. Is this good?

R.G., Summerfield, Fla.

Yes. The human body produces glucosamine and chondroitin, which in turn produce the cushion between your joints. The more squishiness you have between your joints, the less pain you feel. So supplements (which are often derived from animals or shellfish) are not "painkillers," like prescription drugs, but actually help mend the underlying cause of pain.

Not all studies on glucosamine and chondroitin show positive results, but at least these dietary supplements don't cause fatalities. When top prescription pain relievers (like Vioxx or Bextra) are pulled from the market because of fatalities, and serious doubts shroud Celebrex and other nonsteroidal anti- inflammatory drugs, called NSAIDs (like naproxen and ibuprofen), clinicians become open-minded for the sake of their patients in pain. Almost 70 million people in the United States live with some form of arthritis, and the excruciating cost of that is more than $80 billion a year.

One study recently compared glucosamine to the painkiller acetaminophen, sold under brand names such as Tylenol and Excedrin.

For 24 weeks, 318 patients with knee osteoarthritis took either glucosamine (1,500 mg), acetaminophen (1,000 mg three times a day) or a placebo. People taking glucosamine reported the most benefit for their discomfort and immobility. And there is no risk to the liver with glucosamine, as there is with acetaminophen.

More recently, findings from a study by the Glucosamine/Chondroitin Arthritis Intervention Trial proved that the combination of glucosamine and chondroitin was effective in treating moderate to severe knee pain from osteoarthritis; and, the kicker is, these two naturally derived substances outshined our fabulous pharmaceutical, Celebrex, over the course of six months. There were 1,538 people in this notable study. It was funded not by a supplement manufacturer but, rather, the National Institutes of Health, in Bethesda, Md. A total of $14 million was spent on this project - the largest placebo-controlled, double-blind clinical trial ever conducted for glucosamine and chondroitin.

Go for reputable brand names or generic equivalents.

2005-12-19T17:53:00.000-08:00

Freer joints will ease pain of arthritis

Q: I suffer from arthritic pain and stiffness in my knees and fingers and I would like some help with that. Also, I have recently been experiencing some gastric upset and would like your recommendations for that as well.

A: Try the remedy Knotgrass Complex at a dose of 20 drops, twice a day before meals in a little water to help with the knees and fingers. This has a cleansing effect on the joints and will help to reduce inflammation and pain. For the gastric problems, I would recommend Gastronol at a dose of 2 tablets, two to three times a day, 15 minutes before meals.

It would also benefit both problems if you reduce or avoid acid-forming foods in your diet, such as pork, tomatoes and citrus fruit

2005-12-19T17:52:00.000-08:00

Selenium: Low selenium linked to osteoarthritis risk
People with low levels of selenium in their bodies face a higher risk of knee osteoarthritis, according to researchers from University of North Carolina at Chapel Hill Thurston Arthritis Center. The study compared x-ray evidence of knee osteoarthritis in 940 study participants with how much selenium was in their systems. Study participants who had less of the trace mineral than normal in their systems faced a higher risk of the osteoarthritis in one or both knees.

Future studies may focus on whether selenium supplements may help reduce the risk of osteoarthritis. Selenium can be toxic, so supplements are not being recommended. A healthy diet is recommended. According to the American College of Rheumatology, "food distribution patterns in the U.S. ensure most people get the low doses of selenium needed, particularly if they eat a variety of foods from several sources."

Health Watch: Juvenile Arthritis

2005-12-18T14:19:00.000-08:00

When we think of arthritis, we tend to think of the elderly, not young children. However, thousands of youngsters live with juvenile rheumatoid arthritis everyday. Some get better over time, and others continue to have problems well into adulthood. Here is more about this condition, found in tonight's Health Watch Report.

You would not know it by looking at her, that 7-year-old Kaylee Adams suffers from juvenile rheumatoid arthritis.

"When she was about 20 months old she had fallen and sprained her finger. We thought it was just a sprain and nine months later we got a diagnosis," said Kaylees mom Kim Adams.

Juvenile rheumatoid arthritis affects about one in every thousand children. The good news is most of the cases are mild. According to Dr. Barry Myones, a pediatrician, it can affect one or more joints, as well as the eyes, and the pain is usually at its peak in the morning.

"They can't move if the weather changes, if the barometric pressure changes, or if it gets cold. Sometimes the stiffness can last all day long," said Myones.

Not only does the disease put a damper on certain activities for kids, but it can also affect them emotionally because they are not like all the other kids.

"Kids will become depressed, and that causes problems with their development and interaction with their peers, as well as interaction within the family, and there's a lot of family stress," said Myones.

A new generation of biological modifier medications that block specific immunological signals with regards to the disease have made living with juvenile rheumatoid arthritis much easier for patients.

Kaylee's daily dose of medication not only allows her to be active with her little sister, but it also puts her mother's mind at ease.

"My first thought after we got the diagnosis we went to a seminar and there were people my age in wheelchairs, and crippled, and we thought was going to be our future. But the medications nowadays are amazing," said Adams.

Between 80 to 90 percent of children will eventually grow out of their condition, however, the small percentage that do not, can sustain long-term problems, such as permanent cartilage damage or joint deformities.

If you would like more medical news, visit our health partners Web sites:

M.D. Anderson Cancer Center:http://www.mdanderson.org/

The Mayo Clinic: http://www.medicaledge.org

Baylor College of Medicine:http://public.bcm.tmc.edu/

Increased Risk of Rheumatoid Arthritis by eating Red Meat

2005-12-18T14:18:00.000-08:00

red meat higher risk

A study conducted by British researchers found that high levels of red meat in a person’s diet may increase the risk of developing inflammatory arthritis.

A team of British researchers found that dietary habits were part of the cause of the onset of rheumatoid arthritis, along with genetics. Lifestyle choices can account for about 40% of the risk. Cigarette smoking has also been a contributor in developing rheumatoid arthritis. Nutritional factors are still not clear, but some studies have shown that eating fish is beneficial, drinking coffee is bad, and drinking in moderation for women is good.

The researchers found vitamin C from not eating fruit also increased the risk of inflammatory arthritis. This lack of vitamin C increase risk as much as 3 x’s. The study was first published in Arthritis & Rheumatism Journal, back in December 2004. The interesting finding was that the researchers also discovered that eating a high level of red meat also increased the risk for inflammatory arthritis.

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The University of Manchester, with lead researchers, Alan Silman and Deborah Symmons, started with a combination of 25,000 men and women ages 45 through 75. Within this sample there were 88 patients that were newly diagnosed with inflammatory arthritis of more than 2 joints. Also there was approximately 40 percent that were considered by the American college of Rheumatology for rheumatoid arthritis baseline. Each participant took extreme care in keeping a 7 day food diary that included measuring food portions to report more accurately amount of food that was eaten, as well as what was eaten. They also answered whether or not they were smokers

The lack vitamin C intake was not as significant in this study, but what they found was the ones who ate the highest amount of red meat had a 2 x’s higher risk for developing rheumatoid arthritis. Those patients that consumed high levels of red meat with other meat products had the similar showings. The dietary fats did not seem to have an increase in risk.

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Because there is a genetic factor to rheumatoid arthritis, it may not cause everyone the same risk for developing the inflammatory disease. “It may be that the high collagen content of meat leads to collagen sensitization and consequent production of anticollagen antibodies, most likely in a subgroup of susceptible individuals,” the authors for the studies say. “Meat consumption may be linked to either additives or even infectious agents, but, again, there is no evidence as to what might be important in relation to RA.”

“A high level of red meat consumption may represent a novel risk factor for inflammatory arthritis or may act as a marker for a group of persons with an increased risk from other lifestyle causes,” Dr. Pattison and colleagues report. “It is unclear whether the association is a causative on

Health officials won't revive arthritis drug

2005-12-17T20:29:00.000-08:00

Bextra, an anti-inflammatory drug for arthritis sufferers, will not be allowed back on the Canadian market.Based on recommendations from an expert safety panel, Health Canada said yesterday the cardiovascular risks of the drug, including heart attack and stroke, outweighed its benefits. Officials said it also causes rare but severe and potentially fatal skin reactions more often than other drugs in its class."We concluded that there is insufficient evidence to establish the safety of the drug for its recommended use," said spokesperson Jirina Vlk.Bextra was withdrawn voluntarily from the market in April by drug giant Pfizer after severe skin reactions affected seven people in Canada.The drug falls into the same controversial class of drugs as Vioxx and Celebrex, known as cox-2 inhibitors. Vioxx, once the most popular painkiller in Canada, was pulled from the worldwide market in September 2004.New warnings of cardiovascular risks have subsequently been issued for Celebrex.In a written release, Pfizer Canada said "Bextra is an important treatment option ... (and) it should continue to be available for those patients who could benefit from it."A Health Canada expert safety panel issued a report last summer recommending Vioxx be allowed back on the market. However, panel members in an 8-5 vote said Bextra should not be. Bextra was approved for sale in December 2002 and 665,783 prescriptions were filled in Canada last year.

`Good science' to study pain pills and heart woes

2005-12-16T17:28:00.000-08:00

Should the millions of North Americans who are at risk of heart problems take painkillers for arthritis?That's what a huge international study by The Cleveland Clinic hopes to find out. With an unusual mix of industry, academic researchers and government oversight, the study also aims to restore public confidence in the wake of the Vioxx debacle. "There's only one way — through good science," said Dr. Steven Nissen, the Cleveland cardiologist who will lead the study. "We know the burden is upon us to do this right." Drug safety and the credibility of research have been concerns in recent months since Vioxx and Bextra were pulled from the market because of evidence they can raise the risk of a heart attack or stroke. That left Pfizer Inc.'s Celebrex as the only available cox-2 inhibitor available. The drugs became blockbusters because they were gentler on the stomach than older pain relievers. Many people who switched to over-the-counter pain relievers called non-steroidal anti-inflammatory drugs, or NSAIDs, then had a new worry when the U.S. Food and Drug Administration ordered stronger warning labels earlier this year. The new study will test Celebrex and two types of NSAIDs — ibuprofen (sold as Motrin, Advil and other brands) and naproxen (Naprosyn, Aleve). About 20,000 people throughout the United States, Eastern Europe, Canada, Australia and South America will be randomly assigned to get one of the three — neither they nor their doctors will know which — and a drug to prevent stomach irritation so each pain reliever's true effectiveness can be assessed. Drugs and follow-up medical monitoring will be free. To be eligible, participants must have had a heart problem in the past, such as a heart attack, blocked arteries or chronic chest pain, or diabetes, stroke or clogged vessels in the neck or legs. "The idea here is if you know what happens in the highest-risk individuals, you will know how to use the drugs in people at lower risk," Nissen said. "We will have 10 times the statistical power of any trial ever done of these drugs." Pfizer will fund the study, expected to cost more than $100 million, but independent researchers will collect and control the results and have offered to make all of them public, not just bottom-line conclusions. No top researchers can have financial ties to any pain-drug manufacturers. "This is a very interesting model" for a public-private partnership to do medical research, said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which will appoint a representative to serve on the study's executive committee. "We believe this is an effective and appropriate way to conduct this study," said Pfizer spokeswoman Mariann Caprino. The study will be called PRECISION, for Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen. Results are expected in about four years. Dr. Alastair Wood, a Vanderbilt University physician who heads the FDA's non-prescription drug advisory panel, called the study "a good idea." "One of the underlying assumptions is that naproxen is safest," but that has not been rigourously tested, he said. Nissen also has served on FDA drug advisory panels and chaired one on the cox-2 drugs. He and another Cleveland Clinic cardiologist, Dr. Eric Topol, were among the first to publish warnings about Vioxx's safety.

2005-12-16T17:26:00.001-08:00

'India Lacks Multidisciplinary Approach For Juvenile Rheumatoid Arthritis Patients’

It is said that 60 out of 1,00,000 children in the US and the UK are affected with juvenile rheumatoid arthritis. With as many as 12,000 children in Mumbai estimated with paediatric rheumatoid arthritis, the formation of Juvenile Arthritis Support group at Mumbai's Jaslok Hospital signifies an important milestone. And that is why Canada-based Dr Ross Petty, Head of the Division of Rheumatology in the Department of Pediatrics at BC's Children's Hospital and the University of British Columbia, was at Jaslok Hospital, invited by Dr Raju Khubchandani, a pediatrician with special interest in Paediatric Rheumatology. Dr Petty is credited with theestablishment of The Arthritis Society, the first comprehensive programme in paediatric rheumatology in Canada. He is the recipient of the Ross Award, a prestigious honour given by the Canadian Paediatric Society for contribution to the care of children and youth. Both the rheumatologists spoke to Rita Dutta about various aspects of the disease.


Dr Ross Petty	Dr Raju Khubchandani

Please brief me about the Juvenile Arthritis Support group started at Jaslok Hospital.

Dr Khubchandani: Jaslok hospital was the first to launch paediatric rheumatology services in the city of Mumbai, three years ago. Besides patient care, the department has done its bit in spreading awareness about children with joint diseases amongst patients, parents and physicians. In the last few years, we realised that joint/muscle and connective tissue diseases in children can devastate families and that such families are often in need of educational inputs, emotional support and empowerment to cope. So while 'juvenile arthritis' refers to a specific disease entity, the scope of JAS would be to provide such inputs to families and kids with joint, muscle and connective tissue diseases in general. It is important to note that JAS is not a facility, which provides financial aid or arranges subsidised care.

Which other Indian hospitals have such support groups for juvenile arthritis? Do most hospitals in the western countries have such support groups?

Dr Petty: This is the first one I know of. Many Western countries do have active support groups for various chronic illnesses. Arthritis support groups in the UK and Europe are very active and function independent of hospitals as voluntary organisations.

What are the most prevalent forms of juvenile arthritis? What is the incidence of its various forms?

Dr Petty: Many childhood illnesses, like systemic lupus erythematosus, dermatomyositis, leukemia, and infections, can cause symptoms of arthritis. It is important that these diseases be identified and appropriately treated. If there are 400 million children in India, it is likely that one-quarter of of million children have some kind of arthritis. This represents an enormous disease burden, well beyond the capacity of the current number of rheumatologists and paediatric rheumatologists to care for optimally. I understand from colleagues in India, that there is also a very severe shortage of physical therapists, occupational therapists and nurses, who are trained and experienced in helping in the care of children with arthritis.

Dr Khubchandani: There are no incidence or prevalence figures available for India. If one goes by the UK or North American data of a prevalence of 60 per 1,00,000 children and assumes a 20 million Mumbai population with about 40 per cent as children, an assumed number of 12,000 kids at any point in time in Mumbai would be suffering from juvenile rheumatoid arthritis. Add to this, other diseases like lupus and dermatomyositis Kawasaki disease and many more diseases with joint manifestations and we have a huge burden. One important point to be noted is that with the eradication of polio this group of disorders will emerge as the largest cause of physical handicap.

What are the various forms of juvenile rheumatoid arthritis? What are the symptoms of juvenile rheumatoid arthritis? Can a child affected with juvenile rheumatoid arthritis lead a normal life?

Dr Petty: In general, children with arthritis have pain and swelling in one or more joints. Young children sometimes do not complain of pain, but they may limp, be stiff in the morning, or alter their play patterns. Activities which were formerly easy for the child to perform, become difficult. The symptoms are often most severe in the morning ("morning stiffness"), and may improve with activity. In some children, many joints, including those of the hands, are affected. Such children have severe pain, stiffness and lose range of motion in the affected joints. Any joint, including those of the neck, spine and jaw may be affected.

Children with a particularly severe form of disease (systemic arthritis) have fever, rash, enlarged lymph nodes, spleen, liver, and anemia in addition to arthritis. With the passage of time, if the child is untreated, the joints become chronically swollen, lose range of motion, and eventually may be destroyed. Severity of disease, and its effects on the child depends on at least two factors. First, there are many types of juvenile arthritis, and some types (like polyarthritis: many affected joints, or systemic arthritis) are more severe than other types (like oligoarthritis: few affected joints). The second factor that determines the severity of the effects of the disease on the child is treatment. Children who are untreated, or who are treated late in the course of disease have the worst outcome than those who are treated early. In the hands of a physician, who is expert in the management of children with arthritis, even children with severe forms of the disease can have an excellent outcome.

How does one diagnose juvenile rheumatoid arthritis? Are all the diagnostic methods available in India?

Dr Petty: Juvenile arthritis and various other joint diseases involve clinical or bedside diagnosis. Investigations are often required to access activity, detect complications or monitor therapy. All such modalities should be available at any medium or large hospital in India.

What should be the first line of treatment for juvenile rheumatoid arthritis?

Dr Petty: As of now, there is no cure for childhood arthritis as administration of drugs does not cure the disease. However, medicines available today are very effective at controlling the disease and that may seem like the disease has gone away entirely. Initial treatment usually begins with one group of drugs, called non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen.

If these drugs fail to completely control the disease, other medications are used. These depend on the type of disease, its severity, the patient's preferences, and other factors. They include cortisone-like drugs as a pill prednisolone) or injections into the affected joints (triamcinolone hexacetonide). Other important drugs used to control the disease include methotrexate, hydroxychloroquine, sulfasalazine and the new biologic agents such as etanercept and infliximab. With careful use of these drugs, the disease can be controlled in most children, although they usually require medications for many years.

What are the hindrances to the treatment?

Dr Petty: Geographic distance plays an important role, but the most important barrier to care is limited awareness on the part of parents and primary care physicians (general practitioners, paediatricians) about the signs of the disease. Too often, arthritis is thought not to occur in a child, or symptoms are ascribed to other causes (usually trauma). There is still a wide-spread belief that nothing can be done about arthritis. Nothing, could be farther from the truth. The advances made in understanding arthritis in the last decade have revolutionised the outcome for children with these diseases.

What are major breakthroughs in the treatment of juvenile rheumatoid arthritis in the recent past?

Dr Petty: The drug methotrexate, which is very cheap, represents one important breakthrough and recently the biological agents, which are yet very expensive the world over, have changed the complexion of the disease.

Are there enough experts in juvenile rheumatoid arthritis in India and worldwide?

Dr Petty: There is a world wide shortage of paediatric rheumatologists. It is estimated that there are about 700 qualified / trained specialists, of which about 500 would be in North America and Europe. Canada has the largest number when one uses the doctor to population ratio. I learnt from this trip that there are about half a dozen centres in India. The arthritis care model that we have in Canada is centered around the child and family, and includes the expertise of paediatric rheumatologists, physical and occupational therapists, nurses, social workers and nutritionists, all of whom make important contributions to the care of children with arthritis. That model has not yet been developed in India, although there is considerable interest in doing so.

Please tell me about the research chairs constituted on Dr Petty’s name back at Canada.

Dr Petty: With the possibility of finding a cure for arthritis, The Arthritis Society, BC and Yukon Division (TAS) has launched a USD 10.5 million campaign in June 2004 to fund two research chairs in arthritis research. The two research chairs, held at the University of British Columbia will focus on research into paediatric rheumatology, proteomics and genomics to understand the fundamental mechanisms of the disease.

Anti-arthritis drug stirs action

2005-12-16T17:26:00.000-08:00

A CLASS action has been launched on behalf of hundreds of Australians who suffered heart attacks and strokes after taking the anti-arthritis drug Vioxx.

Lawyers Slater and Gordon yesterday filed a writ in the Supreme Court of Victoria seeking damages for at least 400 victims, including relatives of up to 50 people who died while using the drug.

They are seeking compensation against US drug manufacturer Merck & Co Inc and its Australian subsidiary Merck Sharp & Dohme Australia, who assembled, marketed and distributed the tablets.

The class action comes after Vioxx was withdrawn from sale under a global recall on September 30, last year.

About 250,000 Australians used the drug before it was recalled.

Slater and Gordon lawyer Richard Meeran said the law suit was a “compelling legal case” because the product was defective, a fact he said the companies were aware of almost from the outset of its distribution to the public.

Ottawa bans arthritis drug

2005-12-16T16:25:00.000-08:00

The federal government has banned a popular arthritis drug because it may cause a heart attack or stroke.

Sales of Bextra have been suspended since last April when the federal government approached its maker, Pfizer Inc., after concerns were raised in the United States and Europe about its possible side effects.

The drug, which racked up global sales of $1.3 billion in 2004, has now been banned permanently.

"The decision to stop the sale of Bextra is based on information submitted by the manufacturer, Pfizer Canada Inc.," Ottawa said in an announcement late Friday afternoon. "Health Canada concluded that there is insufficient evidence to establish the safety of the drug for its recommended use."

A Pfizer spokesman was unavailable for comment.

FROM DEC. 9, 2004: Heart warnings added for painkiller Bextra

Health Canada started a review of Bextra and related drugs following Merck & Co. Inc.'s withdrawal of a similar drug, Vioxx, in September 2004. Bextra was suspended in April across Canada, the United States and Europe after regulators voiced concerns over cardiovascular risks.

Vioxx remains suspended, but the federal government said in July that it would be allowed back on the market if requested.

Group sues drugs maker

2005-12-15T16:58:00.000-08:00

A GRANDFATHER who says his life was blighted by an anti-arthritis drug yesterday became the face of a class action against a pharmaceutical giant.

Graeme Peterson, 55, says he was healthy but that after taking Vioxx he devloped heart problems.

Mr Peterson suffered his first heart attack in December 2003 after taking Vioxx for almost four years to treat arthritis in his hips and neck.

"I took it for an arthritic condition," he said.

"I would have lived with that arthritic condition given the choice. I wasn't given the choice."

Law firm Slater and Gordon yesterday launched a Supreme Court class action against American maker Merck & Co and its Australian subsidiary Merck Sharpe & Dohme (Australia) Pty Ltd.

The firm represents more than 400 people who took Vioxx and suffered heart attacks and strokes but it is believed 250,000 Australians used the drug.

It was withdrawn from sale last year because of safety fears.

The writ alleges Merck failed to warn doctors, pharmacists and the public that an ingredient of Vioxx significantly increased the risk of arterial thrombosis and cardiovascular conditions.

Mr Peterson, of Mornington, said his heart condition meant he was much less active.

The grandfather of seven was global safety manager for BHP but now works only part-time.

Slater and Gordon special counsel Richard Meeran said Merck had not warned doctors and the public about possible cardiovascular risks associated with Vioxx.

Some Suffering Severe Pain Find Comfort In Dietary Supplements

2005-12-15T16:56:00.000-08:00

BOSTON -- For the 21 million Americans who suffer from arthritis, safe and effective pain relief is hard to find.NewsCenter 5's Heather Unruh reported Wednesday that when a major study by the National Institutes of Health found the dietary supplements Glucosamine and Chondroitin eased the pain for people with moderate to severe osteoarthritis, it should have been cause for celebration. Instead, it has sparked debate.In Europe they have been sold as drugs for decades, but in the United States Glucosamine and Chondroitin are dietary supplements and are not regulated by the government. Still, the combination is widely promoted in the United States as pain relief for osteoarthritis of the knee."It's one of the top selling supplements, certainly because it's effective," Johnson Drug's Stephen Bernardi said.But, no scientific evidence existed to back up claims of its effectiveness -- until the NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) study. Researchers followed more than 1,500 people with knee osteoarthritis over six months.They found that for the entire group, a combination of Glucosamine and Chondroitin had no more effect on pain than a placebo.But, when researchers narrowed the findings to the participants with moderate to severe pain, the results were much different. Seventy-nine percent of participants who took the supplements reported pain relief compared to 69 percent who took Celebrex and 54 percent who took a placebo."Unlike pain relievers, which just cover up the symptoms, taking Glucosamine and Chondroitin actually improves the health of the joints," said Dr. Jason Theodosakis, author of "The Arthritis Cure."But many doctors say the narrowed findings don't tell the whole story."The results just really weren't that impressive -- not impressive enough for me to suggest another pill to a patient who probably, given the population that has arthritis, is already on a lot of pills," Brigham and Women's Hospital Dr. Elinor Mody said.Years of running left Dr. Ronda Rockett with knee arthritis at a young age. Six months ago her doctor recommended she give up jogging, strengthen her muscles and take Glucosamine and Chondroitin."I definitely think this medication has helped me but the reality is, I've also had to do those other things in order to help my symptoms. So, I think it's a combination of the different therapeutic interventions," Rockett said.

Major Painkiller Trial to Start

2005-12-15T16:55:00.000-08:00

The Cleveland Clinic will direct a large-scale clinical trial to determine the cardiovascular safety of three painkillers commonly used by arthritis sufferers.

The trial will focus on three drugs -- ibuprofen (Advil/Motrin), naproxen (Naprosyn or Alleve) and celecoxib (Celebrex) -- all of which belong to the class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). Celebrex is a cox-2 inhibitor, a member of a newer class of NSAIDs that avoided the gastrointestinal problems of the older drugs. Two other cox-2 painkillers, Vioxx and Bextra, have been pulled off the market because of documented heart risks.

The Cleveland Clinic trial, which will enroll 20,000 at-risk heart patients, is an attempt to figure out whether the NSAIDS that remain on store shelves pose any cardiovascular risks.

"We've desperately needed this. The entire public confidence in terms of what is safe for pain has been eroded," said lead investigator Dr. Steven Nissen, who is the director of the clinic's Cardiovascular Coordinating Center.

"This is the trial that we've all been waiting for," added Dr. Mark Fendrick, an internal medicine professor at the University of Michigan. "It examines commonly used pain relievers at dosages frequently used in primary care, in patients at risk for cardiovascular events."

But the trial is also being funded by Pfizer Inc., which makes Celebrex, and experts worry that the integrity of the results could be called into question.

"I think the National Institutes of Health should take responsibility for conducting this type of clinical trial, where controversy and potential harm to the population are at stake," said Adil Shamoo, a professor of bioethics at the University of Maryland and co-founder of CIRCARE, a nonprofit dedicated to the protection of people used in research and medical treatment.

There is also the fact that the Cleveland Clinic itself was the subject of a lengthy expose published Monday by the Wall Street Journal. The article highlighted extensive ties between the institution and AtriCure, a company that makes equipment used in surgeries performed at the clinic.

According to the Journal article, a venture-capital partnership that the Cleveland Clinic helped found and invested in owns about 4.1 percent of AtriCure's stock. Patients were not told of these ties.

"In light of the problems they just had, I'm surprised they're doing this," Shamoo said. "What I would like to see are conflict-of-interest statements and complete financial disclosures for all involved, and the patients should be told that. This will affect what they're doing and the integrity of the research."

Nissen, who is also the president-elect of the American College of Cardiology, noted that special measures have been taken to guard the integrity of the trial's findings.

Pfizer will basically stay out of the trial, which has been dubbed the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety vs. Ibuprofen or Naproxen) trial, he stressed.

"We've done some very unusual things," Nissen added. "The executive committee to run the trial does not have a Pfizer person on it. It's all academic. I have asked the academic participants to all agree that they will accept no honoraria, speaking fees, etc. from any manufacturers of drugs in this class."

In addition, Nissen intends to place the trial's database into the public domain by giving it to the National Heart, Lung, and Blood Institute.

"We're going to make this trial so transparent that everybody will believe it," he said. "We're committed to doing this in a way that, for patients and physicians, answers the questions using the best scientific methods and integrity."

Nissen, along with Dr. Eric Topol (also of the Cleveland Clinic), was one of the first to reveal the potential risks associated with Vioxx. Since then, several studies have pointed out similar risks, and Vioxx manufacturer Merck & Co. is now immersed in litigation over whether the drug caused heart deaths.

The Vioxx saga took a new twist last week, when the editors of the prestigious New England Journal of Medicine published a rare "Statement of Concern." It charged that the authors of a major study called VIGOR, published in the journal in 2000 and subsequently used as a strong argument for the drug's safety, withheld information on three heart attacks and other cardiovascular events among participants taking Vioxx. Executives of Merck were among that study's authors.

The unusual accusation was released last Thursday afternoon, as jurors in Houston began deliberations in the first federal trial against Merck. On Monday, a mistrial was declared after the jury declared it could not reach a unanimous verdict.

Topol, who testified against Merck during the latest Vioxx trial, is not on the executive committee of the Cleveland Clinic study that is about to get underway. However, he is advising Nissen. "We didn't want to have more than one individual from any single center," Nissen said. "He has been very generous with advising us. I will keep him engaged."

The trial participants are expected to be enrolled over 18 months and will be followed for an average of two years. In addition, the researchers will be collecting information on pain relief and on gastrointestinal bleeding.

The study will end when 700 of the participants have died or suffered a heart attack or stroke, according to a New York Times report. That's a number consistent with what would be expected in such a group even without use of painkillers, the newspaper said.

apanese study confirms impact of seasonal change on rheumatoid arthritis

2005-12-12T18:01:00.000-08:00

Dr. Noriko Iikuni, of the Institute of Rheumatology, Tokyo Women's Medical University, issued a statement summarizing the findings of new research, saying that climate and weather do indeed affect the condition of rheumatoid arthritis.

Many rheumatoid arthritis (RA) patients believe changes in the seasons trigger fluctuations in their symptoms, and now a study out of Japan appears to support that view.
Specifically, the study found that the pain of RA rises as seasonal temperatures fall.
"Physicians can easily dismiss seasonal changes as having an impact on patients with rheumatoid arthritis yet, in reality, the differences in weather and climate are having an impact," researcher Dr. Noriko Iikuni, of the Institute of Rheumatology, Tokyo Women's Medical University, said in a prepared statement.
Her team reviewed data collected from more than 1,800 RA patients between October 2001 and April 2004.
The volunteers averaged nearly 58 years in age and had suffered from RA for an average of over 10 years.
The study looked at the patients' disease activity, score, tender joint count, swollen joint count, health assessment questions, pain scale, laboratory test results that indicated amount of pain and inflammation, and response to treatment.
Both subjective and objective results indicated that the RA patients experienced a significant decrease in RA activity from spring to fall, and an equally marked increase from fall to spring.
"For the majority of rheumatoid arthritis sufferers, the period between fall to spring will give rise to more problems whereas symptoms will ease between the spring and fall.
Awareness of this very real influence on these patients should play a role in more effective treatment management," Iikuni said.
The findings were to be presented Monday at the annual scientific meeting of the American College of Rheumatology, in San Diego.

Orange juice could protect you against arthritis

2005-12-12T18:00:00.000-08:00

Dr. Alan J. Silman, from The University of Manchester in the UK, has led a study of 25,000 subjects, and the findings suggest that arthritis may be defended against considerably by daily consumption of orange juice, which contains carotenoids that Silman and colleagues have found helpful in preventing arthritis.

The researchers' findings appear in the American Journal of Clinical Nutrition.
Eighty-eight subjects developed arthritis during follow-up and they were matched to 176 healthy comparison subjects.
Average daily intakes of the carotenoids beta-cryptoxanthin and zeaxanthin were 40 and 20 percent lower, respectively, for arthritis patients compared with healthy subjects.
By contrast, consumption of two other well-known carotenoids, lutein and lycopene, did not seem to protect against arthritis.
Further analysis showed that subjects with the highest beta-cryptoxanthin and zeaxanthin intake were about half as likely to develop inflammatory polyarthritis than those with the lowest intake.
"These data add to a growing body of evidence that some dietary antioxidants, such as the carotenoids beta-cryptoxanthin and zeaxanthin as well as vitamin C, may be protective against the development of" arthritis, the authors conclude.

2005-12-12T17:59:00.000-08:00

Arthritis Therapy May Help Ease Some MS Symptoms
by John C. Martin	Article Date: 12-12-05

A natural product that some medical experts claim may be able to ease some symptoms of arthritis^1,2 might do the same for some people with multiple sclerosis (MS). That's the conclusion of a new study using animals to test the product's effectiveness.³

Does it Work in People?
A group of neurologists at Thomas Jefferson University and the Jefferson Hospital for Neuroscience in Philadelphia used a group of mice to test the product's efficacy against a disease similar to MS. Doses of the product, known as glucosamine, dramatically postponed the symptoms of the disease, experimental autoimmune encephalomyelitis (EAE), and improved the animals' ability to move and walk.

The important question that still remains is whether these benefits can be replicated in people. "It would be fantastic if glucosamine works in humans because we have a product that has a long track record for safety, and most importantly, can be given orally," said Abdolmohamad Rostami, MD, PhD, professor and chairman of Neurology at Thomas Jefferson University and one of the study's chief researchers.

Most current therapies for MS are given by injection.

Easing Symptoms in Diseased Mice
Glucosamine is a natural substance in the body that is believed to increase levels of substances that experts believe are deficient in the origins of osteoarthritis. It also is believed to repair destructive enzymes that play a role in the disease.⁴ In MS, it's believed glucosamine fends off destructive immune system cells.

In this animal trial, Rostami, Guang-Xian Zhang, MD, PhD, an assistant professor of Neurology, and others gave some mice doses of glucosamine, while other rodents did not receive the product. In the intervention group, mice received glucosamine either orally, intravenously, or intraperitoneally, in which the product is infused in the animals' abdominal region. They also tested the effect of the product in a group of animals before symptoms appeared and in a second group in which symptoms had already begun to appear.

In each case in which glucosamine was used, the onset or progression of symptoms was significantly delayed, the study team wrote. That is, the mice that received the product took longer to become ill, and when they did become ill, the disease was much less severe, the study found. Glucosamine was as effective when given early in the disease or after the mice became ill.

Blocking Immune Cells
It's believed glucosamine works by suppressing the ill-effects of the immune system. MS (and EAE) is believed to be an autoimmune disease. For an unknown reason, the body's immune system begins to attack normal body tissue. Specifically, a fatty substance that insulates nerve fibers in the central nervous system is damaged, as are the nerve fibers themselves in some cases. When this occurs, communication between the nerve fibers is disrupted, causing the neurological impairment that is seen in the disease.⁵

In this case, glucosamine affects the production of specific immune system cells known as T cells. There are two types of T cells: TH1 promotes inflammation as part of the immune response and TH2 cells suppress it. "We've shown that glucosamine modulates the immune response by producing more TH2 responses, suppressing brain inflammation," explained Rostami, who is also head of the Neuroimmunology Laboratory in the department of Neurology at Thomas Jefferson University. "At the same time, it suppresses TH1 response."

When the rodents' spinal cords were examined for this research, the study team found less inflammation and myelin damage in those given glucosamine.

Combination Therapy Possible?
"As a therapy, it might be used in combination with other proven treatments, such as beta-interferon and Copaxone," Rostami explained. He and his colleagues are currently studying the feasibility of such a therapy combination in the same group of mice to search for any possible adverse effects. They're also trying to determine if glucosamine can hinder the relapses that occur in the relapsing/remitting form of EAE, similar to what occurs in MS.

"As glucosamine is able to effectively suppress acute EAE, has low or absent toxicity, and has been safely used in humans orally, our study suggests a potential use for this drug alone or in combination with other disease-modifying immunotherapies to enhance their efficacy and reduce their doses in MS and possibly other autoimmune disorders," the researchers wrote.

Conflicting Information
In clinical trials involving people with osteoarthritis, glucosamine hasn't always shown that its effective at reducing symptoms. In one study last year,⁶ more than 200 patients with symptoms of osteoarthritis of the knee were enrolled to test the product's safety and efficacy. The patients were assigned at random to receive either doses of glucosamine or a placebo, an intervention that has no therapeutic effectiveness, as a comparison.

The researchers tested the effectiveness of the product for its ability to reduce pain and ease stiffness. However, they wrote, "There was no difference between treatment and control groups [the group taking a placebo] in terms of change in pain score, stiffness, physical function … and analgesic use."

Acupuncture could prove effective in reducing arthritis pain

2005-12-12T17:58:00.000-08:00

Dr. Brian Berman, from the University of Maryland School of Medicine in Baltimore, led a trial study that observed the effects of acupuncture on arthritis victims, and the results were that pain was reduced 40 percent.

They were randomly assigned to one of three treatments - genuine acupuncture, "sham" acupuncture, or a self-help course that teaches patients to manage their own condition.
Throughout the 26 week trial, participants continued to receive their normal standard medical care, including anti-inflammatory drugs and pain relievers.
By the eighth week, genuine acupuncture patients showed a significant increase in function compared with both the sham treatment and self-help groups.
Overall, pain was reduced by about 40% and function improved by almost 40% in the volunteers receiving acupuncture.
The trial, led by Dr Brian Berman, from the University of Maryland School of Medicine in Baltimore, was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Muscoloskeletal and Skin Diseases (NIAMS).
NCCAM director Dr Stephen Straus said: "For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee.
NCCAM has been building a portfolio of basic and clinical research that is now revealing the power and promise of applying stringent research methods to ancient practices like acupuncture."
Dr Berman said: "This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis."
Sham acupuncture, which has been employed in a number of other trials, has been criticised for not providing a fool-proof control condition.
It is claimed that even if needles are not placed in the correct treatment points they might trigger a response in the patient.
Because of the difficulty of faking needle insertion, designing acupuncture trials is notoriously difficult.
In the United States, about five million people a year receive acupuncture treatment.

Nine-Year-Old With Arthritis Inspires On The Ice

2005-12-10T14:05:00.000-08:00

Darcy Pohland

It's a disease often associated with the elderly. But 1,100 Minnesota children age 16 and younger have rheumatoid arthritis, the most serious kind.

"Sometimes I'm sad because I can't do everything that everyone else is doing," said Allie Ray, a nine-year-old fighting the disease.

But Allie isn't letting arthritis keep her on the bench. Instead, she's inspiring others through sports.

"I have good days and I have bad days," Allie said.

For a child who suffers from arthritis, putting on snow pants and boots without stiffness or pain can be a huge accomplishment.

"It's usually in my knees or ankles, fingers or wrists," she said.

Allie was just six when she was diagnosed with arthritis. Her mother noticed a swollen ring finger.

"We were dumbfounded," said Allie's mother, Leslie Ray.

"I thought only old people got arthritis," Allie said.

Despite her limitations, Allie perseveres physically. She dances, figure skates, plays soccer and loves hockey.

"It's quite unusual for children to be that active with arthritis," Leslie said.

Allie helps manage her pain and stiffness with medications and common sense.

"When I hurt out there I go in right away," Allie said of her time on the ice.

But, that's not always easy.

"I feel sad that I have to sit out," she said.

Even so, Allie wants to inspire other children now and in the future. She is a junior ambassador for the Arthritis Foundation and helps other kids cope with the disease.

"I want to be a pediatric rheumatologist," she said. "That's the kind of doctor that helps kids with arthritis."

Edinburgh Researchers bring hope to arthritis sufferers

2005-12-10T14:02:00.000-08:00

THOUSANDS of arthritis sufferers could benefit from a new pill being developed by scientists at Edinburgh's Western General Hospital.

The researchers are aiming to produce a mass-market tablet which would provide rheumatoid arthritis sufferers with a more powerful treatment than is currently widely available.

The most effective treatment available for patients at the moment is known as anti-TNF therapy. However, the treatment is so expensive only 750 patients in Scotland receive it, and patients have to undergo the discomfort of a series of injections.

The Western General scientists believe they can develop a tablet which would replace the existing anti-TNF therapy.

Dr Rob van't Hof and his team at the hospital's rheumatic diseases unit have been awarded £100,000 to develop the treatment over the next three years.

The grant has come from the Arthritis Research Campaign (ARC) which was responsible for pioneering anti-TNF drugs.

The drugs work by blocking the action of TNF (tumour necrosis factor), a molecule responsible for increasing levels of inflammation in rheumatoid arthritis sufferers.

Dr van't Hof said his laboratory had spent the last two years attempting to find a way the medication could be developed as a tablet - something which would save patients repeated trips to hospital for injections.

"We think we have now hit on the first generation of drugs that could be really useful," said the senior scientist.

"We are getting to the stage we could give it as a tablet and that would be extremely useful and a cheaper alternative to current therapy."

The medical scientists are now stepping up their laboratory tests but hope to begin clinical trials in patients within three years. If successful, the new medication could become widely available within the next decade.

"Rheumatoid arthritis is a pretty widespread disease and if we are successful, this would be of benefit to hundreds of thousands of people," said Dr van't Hof.

"You could never claim to have found a cure for rheumatoid arthritis because it is something which would return as soon as you stopped taking the treatment.

"But what we are hoping for is to control the disease and make people have a decent life, a good quality of life, without the pain and without the crippling side effects."

Rheumatoid arthritis is a disease in which the lining of the joints become swollen, causing damage to the bone in the joint.

Almost 400,000 people in the UK have the disease and there are more than 6000 sufferers in the Lothians, 175 of which receive anti-TNF treatment. About three times as many women as men are affected.

People with the degenerative disease often begin to complain of stiffness between the ages of 40 and 50. In severe cases, it can impede walking to the extent that victims need to use a wheelchair.

The Arthritis Research Campaign raises funds to promote medical research into the cause, treatment and cure of arthritic conditions and currently funds £3 million of research in Edinburgh.

A spokeswoman said: "Dr van't Hof's research, while in its early stages, has great potential and could lead to more people with rheumatoid arthritis being able to get on to therapies that may transform their lives.

"At the moment the high cost of anti-TNF drugs means that not all patients who need them get them and producing a cheaper alternative could make a real difference to a very large number of people."

Professor of rheumatology at the Western General Hospital, Stuart Ralston, said if Dr van't Hof's work was successful it would be welcomed.

He said: "Anti-TNF therapy is a very effective treatment, probably the most effective, but the production costs are high. Obviously in the NHS this is an issue so we have to limit its use to the most severe patients. We think this is a fantastic project and certainly worth pursuing."

Wonder drug 'gave me my life back'

FORMER factory worker Isabella Inglis was wheelchair-bound and in excruciating pain because of arthritis until doctors gave her what she believes is a wonder drug.

Miraculously, after spending nine months in hospital, unable to move without help, she can now walk again and has an active social life.

The grandmother said thanks to weekly injections with anti-TNF drug therapy, she can now walk again and enjoy an active social life.

She said: "I have got my life back. It's amazing. I am still sore but I can walk and I can go out and do so much more than I have been able to do in the past. It's brilliant."

Mrs Inglis, 68, of Bo'ness, was finally able to leave hospital five years ago after doctors at the Western General Hospital decided she would benefit from the treatment.

The first signs of rheumatoid arthritis set in when she was only 28 and from there her condition degenerated rapidly. Since then, she has endured an ankle and two knee replacements.

Recalling life before the treatment, she said: "I just couldn't move and I was so sore I had to get lifted in and out of bed, showered, washed and dressed.

"I couldn't do anything for myself. I was so sore that anytime anyone touched me I would cry - it was excruciating.

"I am still sore but now I can put up with it and I can take painkillers. I can go to the bingo and I no longer have to rely so much on my husband. I am so lucky because I had a good doctor and I have got my life back."

The role of Type II Collagen in rheumatoid arthritis

2005-12-09T16:45:00.001-08:00

Rheumatoid arthritis ( RA ) is an autoimmune disease characterized by chronic inflammation of the joints, which gradually erodes the cartilage and bone.
The agents of destruction include inflammatory cells, cytokines, and protein-degrading enzymes known as matrix metalloproteinases ( MMPs ).
The vicious cycle begins when inflammatory cells infiltrate the tissue lining the joints and consume excess oxygen.
In addition to unleashing MMPs, the oxidative stress provokes non-enzymatic glycation – a chemical binding of sugar molecules and proteins. Telltale signs of glycation have been found in blood, urine, and synovial fluid of rheumatoid arthritis patients.

The primary protein in cartilage, Type II Collagen ( CII ) is crucial to joint health and function. Yet, the involvement of CII in the process of joint inflammation has proven difficult to substantiate. To gain a clearer understanding of CII's role in the pathogenesis of rheumatoid arthritis, researchers at Queen Mary, University of London and others studied its behavior within an inflamed joint, when modified by oxidants linked to inflammation or by ribose, a five-carbon sugar common to all living cells.

For their investigation, the researchers collected blood serum samples from 31 rheumatoid arthritis patients. Between the ages of 65 to 93 years, the patients had disease in varying stages and were receiving different treatments.
For control purposes, serum samples were also collected from 41 patients with other inflammatory joint diseases, including osteoarthritis and lupus, as well as back pain, osteoporosis, and gout. Both rheumatoid arthritis and non-RA samples were analyzed for their ability to bind to pure and natural CII, obtained from bovine cartilage, and to CII that had been chemically modified.
The modified CII included three oxidants present in the rheumatic joint – hydroxyl radical, hypochlorous acid, and peroxynitrite – and ribose.
The results were evaluated by a state-of-the-art 3-D fluorescent profile, followed by enzyme-linked immunosorbant assay ( ELISA ) and Western blotting.

Of the 31 rheumatoid arthritis serum samples analyzed, only 3 showed antibody binding to natural CII – affirming this protein as an innocent bystander in autoimmunity and its inflammatory toll on the joints.
However, the percentage of samples that exhibited antibody binding increased 4-fold when tested with modified CII.
In fact, 45 percent of all rheumatoid arthritis samples were assessed with moderate to strong antibody binding reactions. CII treated with hypochlorous acid was the most reactive, followed by CII treated with peroxynitrite, glycation, and hydroxyl radical, respectively. In contrast, only 1 non- rheumatoid arthritis sample showed strong antibody binding to modified CII.

" The present findings support the possibility that chemical modification of self antigens, in rheumatoid arthritis in particular and in inflammation in general, is the cause of formation of neoepitopes," reflects the study's leading author, Ahuva Nissim. " We propose that the oxidative modification of CII creates a CII autoantigen." This hypothesis has important implications for the further study and enhanced understanding of the pathology of rheumatoid arthritis.

November 2000 NEJM article about VIGOR trial left out heart attack data.

2005-12-09T16:45:00.000-08:00

Merck Concealed

NEJM (The New England Journal of Medicine) has dropped a bombshell in an editorial, Expression of Concern, written by Jeffrey M. Drazen, M.D. (the journal's editor-in-chief), George D. Curfman, M.D. (executive editor), and Stephen Morrissey, Ph.D. It is alleged in the editorial that Merck & Co., the maker of Vioxx, withheld data and information that would affect conclusions drawn in the manuscript about the VIGOR (Vioxx Gastrointestinal Outcomes Research) study which appeared in the New England Journal of Medicine on November 23, 2000.

The VIGOR study compared gastrointestinal events in rheumatoid arthritis patients who were randomly assigned Vioxx or naproxen. Cardiovascular events were also monitored during the study. Three myocardial infarctions (heart attacks) which occurred in the Vioxx group were not included in data submitted for the NEJM article.

NEJM Editors Didn't Think Information Was Intentionally Concealed

NEJM editors learned about the myocardial infarctions in 2001 from updated information made public by the U.S. Food and Drug Administration (FDA). NEJM editors believed the information about myocardial infarctions which occurred in the Vioxx group during the VIGOR trial was learned too late to be included in the November 23, 2000 article published in NEJM.

However, a memorandum dated July 5, 2000 which surfaced following subpoena during the ongoing Vioxx litigation has revealed new information. At least two authors of the November 23, 2000 article knew about the myocardial infarctions before the manuscript was submitted to NEJM and 4 1/2 months before publication of the article.

The Discrepancy Which Revealed The Omission

Merck had submitted the manuscript for the November 23, 2000 article about the VIGOR trial on paper and also on a computer diskette. Editing of the manuscript was based solely on the print version. NEJM did not review the computer diskette until October 5, 2004, just days after Merck pulled Vioxx from the market. The review of the computer diskette revealed that information about the three myocardial infarctions was not included in the print manuscript.

Drazen, Curfman, and Morrissey claim in their editorial that by concealing the information about the myocardial infarctions, conclusions were drawn in the published article which were inaccurate.

Back In Merck's Court

Authors of the VIGOR article have reportedly been asked to submit a correction to NEJM. A response to the allegations is expected from Merck. Meanwhile, Merck continues to battle in court over its liability in more than 7,000 lawsuits. The legal liability which some analysts estimate to be about $50 billion caused Merck to announce the termination of 7,000 jobs and closing of eight research and production facilities just last week.

2005-12-07T17:52:00.000-08:00

Instructor uses tai chi to help others get relief from pain, relax

By Alexia Campbell

Since the moment Adele Gold saw a man practicing tai chi on the Inca Trail in Peru, she knew she had to try it. Fifteen years later, she is still learning,— and teaching it.

The circular, synchronized movements Gold shows her class not only improve the flow of chi energy, they also relieve arthritis pain. Twice a week, she teaches more than a dozen students at the Arthritis Foundation in West Palm Beach how to use motions from the 600-year-old Chinese practice to target discomfort in their joints.

"I've seen improvements in people as far as pain and even flexibility," she said. "It also takes some of the stress away from everyday life."

The controlled movements have relieved some of the arthritis soreness Gold suffered from for years. Now she says she has more strength in her legs and motion in her neck and back. Gold teaches the low-impact sun style, which avoids deep knee bending.

The ancient exercise does more than soothe physical pain.

"It's very meditative," she said. "You're thinking of nothing but what you are doing."

The concentration on breathing and fluid gestures is one of the reason's tai chi is referred to as "meditation in motion." Gold leads her students through such sequences as the "brush knee" and the "wave hands like clouds," which require complete focus and attention. Although tai chi has martial arts roots, its movements resemble a slow, graceful dance.

Gold studied the art form for several years in Stuart before receiving her teaching certificate through the Arthritis Foundation. After giving classes at a health club and at a retirement home in Palm Beach County, Gold now prefers teaching through the Arthritis Foundation, where she says students are more dedicated and likely to return.

Before her first encounter with tai chi, Gold decided to follow in her brother's footsteps and study medicine. She graduated from the University of Kentucky with a degree in medical technology.

After her first visit to West Palm Beach soon after, she decided she could not leave the area.

"I came for a vacation and stayed for 55 years," she said.

Gold worked at Good Samaritan Hospital in the medical lab.

She eventually met and married Martin Gold, a schoolteacher and coach. One of the many activities she enjoyed with him was tennis.

Now a widow, Gold plays tennis twice a week and maintains her active lifestyle.

If a few days pass without exercising, Gold says she begins to feel stiffness and aching. Yoga is another outlet for her which she says improves her balance.

"Any exercise is good, just moving makes you feel better, go and walk around the block at least," she said.

Marijuana intended for elderly arthritis sufferers, court told

2005-12-07T17:49:00.000-08:00

A Darwin court has heard that a man who has pleaded guilty to growing marijuana intended to supply it to elderly people suffering arthritis.

Craine Lucas Wattam, 37, pleaded guilty in the Northern Territory Supreme Court to unlawfully cultivating a commercial quantity of cannabis.

Police discovered the 45 plants when they visited his Darwin River property on an unrelated matter in January this year.

The court heard that Wattam had been approached to grow the plants by a group of elderly people in Palmerston who used the drug to relieve symptoms of arthritis.

Their own backyard plants had been persistently raided by thieves.

The court heard Wattam had simply scattered seeds in pots and did not intend to grow that number of plants. Nor did he intend on profiting from them.

He has been sentenced to nine months' jail suspended immediately.

Gold injections treat lion's arthritis

2005-12-07T17:42:00.000-08:00

ROME -- Veterinarians at Rome's zoo treated an elderly lion for arthritis by inserting some 50 gold pellets into the animal's muscles, officials said Wednesday.

The Asian lion, named Bellamy, had difficulty walking until the procedure two weeks ago in which 24-karat gold pellets were inserted into his spinal muscles near the joints, said the zoo's chief veterinarian, Klaus Gunther Friedrich.

He said the gold helps to relieve muscle contraction around painful areas. The technique has been used before on dogs, cats and a tiger, but Friedrich said Bellamy was believed to be the first lion to undergo the treatment.

Friedrich said he did not believe the small amount of gold used was worth much.

"The lion is getting old. If we hadn't intervened, the situation would have got worse," crippling the lion's mobility, Friedrich said.

Bellamy is nearly 13 years old, Rome's Bioparco zoo said. Life expectancy in the wild is around 16 years, but it can be longer for lions in captivity.

After the 3 1/2-hour operation, Bellamy appeared a little weak and shaky but was able to walk. Small dots along his back indicate where the injections were made.

"I think he lost his pain now. Obviously, I can't ask him but I can observe him and it looks like the pain is absolutely reduced. It's a great result," Friedrich said.

Toenails point to arthritis risk

2005-12-06T17:03:00.000-08:00

Low selenium level in nails is associated with osteoarthritis of the knees

Low levels of the mineral selenium in toenails have been linked with an increased risk for having worn out knee joints.

The finding suggests selenium supplements may someday have a role in treating or preventing osteoarthritis, the wear-and-tear form of arthritis, says Dr. Joanne Jordan, an associate professor of medicine and orthopedics at the University of North Carolina in Chapel Hill.

"These data are preliminary but they certainly clear the way for future studies to confirm these results and to examine whether selenium supplements, taken in the right quantities, can reduce the development and progression of osteoarthritis."

She says toenails, which grow slowly, provide a better estimate of selenium in the body over a longer period of time than blood testing.

Jordan and her colleagues analysed toenails for selenium in 940 people whose average age was 60 years.

"The lower the selenium level was, the more severe the osteoarthritis. Looked at another way, for every 0.1 part per million increase in the toenail selenium level, the odds of having knee osteoarthritis went down by about 15 per cent."

People with the most selenium in their toenails were 40 per cent less likely to have knee osteoarthritis than those with the lowest levels.

Jordan says this is the first study of its kind to show this, so more studies will be needed to verify the findings.

dnaJP1 appears effective for rheumatoid arthritis

2005-12-06T17:02:00.000-08:00

Researchers at the University of California, San Diego ( UCSD ) School of Medicine have announced successful completion of Phase II clinical trials of a novel drug for the treatment of rheumatoid arthritis ( RA ).

The new drug, dnaJP1, is a peptide derived from a naturally occurring protein, dnaJ, which generates inflammation in rheumatoid arthritis patients, whose inflammatory-control mechanisms are impaired. The impairment causes the body’s T cells – which trigger inflammation to kill and clear foreign pathogens in the body – to attack the body’s own tissues.

“ In essence, we re-educated the immune system T cells to be tolerant of the dnaJP1 amino acid sequence, which would usually contribute to inflammation in rheumatoid arthritis patients,” Salvatore Albani, director of the Translational Research Unit of the Clinical Investigation Institute ( CII ) at the UCSD School of Medicine, said.

DnaJP1 works by resetting the ability of the patient’s immune system to tolerate dnaJ, thus transforming a potentially damaging trigger into a tool for controlling the disease.
Oral ingestion of dnaJP1 is key, because the mucosal immune system found in the gut has the ability to “teach” the body to view a protein as one that isn’t dangerous or foreign. Much as food is ingested into the body and not rejected, the body tolerates dnaJP1.

Current medications for treating rheumatoid arthritis range from anti-inflammatory drugs, such as Aspirin, to corticosteroids and medicines that alleviate symptoms by suppressing or killing the body’s immune response, basically crippling the body’s ability to defend itself against other infectious diseases or cancer.

“ Such drugs are costly, have potentially dangerous side effects and are inconvenient to administer,” Albani said. “Our drug leaves the patient’s natural immune responses intact. This differs profoundly from what is currently available to patients.”

DnaJP1 was found effective in a double-blind, placebo-controlled trial sponsored by the National Institutes of Health, which took place between 2000 and 2005 and involved 160 patients enrolled in centers nationwide including UCSD, Stanford University, Johns Hopkins University, the Mayo Clinic, and Virginia Mason Medical Center in Seattle.

Patients received 25mg of dnaJP1 daily by mouth for six months, and the treatment was found to be safe and well-tolerated. When compared with a placebo, patients in the treatment group experienced lessening of symptoms such as swollen joints, tenderness, pain and decreased mobility.

Improvement was particularly significant at the follow up visits, indicating a lasting effect of the drug. Efficacy was quantified in data generated from physicians, patients and laboratories, measuring improvement according to standards set by the American College of Rheumatology ( ACR ) from the beginning to later points in the trial.

ACR 20 response was in the 50-55% range; ACR 50 in the 30-40% range; and ACR 70 in the 15-20% range of patients completing the trial.

Rheumatoid arthritis, or inflammation of the joints, is a chronic, painful disease affecting one percent of the U.S. population, or more than 2 million people. It occurs three times more often in women than men, targeting people of every age. The condition simultaneously strikes joints on both sides of the body, such as the hands or feet or knees but can also affect the skin, eyes, lungs, heart, blood, nerves or kidneys. It is an incurable disease, with most therapies focusing on symptom relief.

“ Although the current available drugs pose risks to patients, the first two trials of dnaJP1 have not raised any significant safety concerns and offer an improved treatment option for patients with rheumatoid arthritis,” said Albani.

Arthritis sufferers misusing painkillers�

2005-12-06T17:01:00.000-08:00

ISLAMABAD: Thousands of patients with severe arthritis are adding over-the-counter medication to prescribe drugs because GPs are limiting their doses amid safety fears.

The effectiveness of conventional painkillers is being hamstrung by concerns about their side effects, such as bleeding and other severe intestinal problems which can be fatal, according to researchers including Martin Green, chief executive of the charity Counsel and Care for the Elderly.

They report that GPs are not always prescribing to appropriate levels, meaning the drugs are not controlling pain as they should, and that doctors seem reluctant to use a new generation of drugs which have fewer side effects. Patients, therefore, are often turning to other pain-relieving drugs and creams instead.

Work by Mr Green and Brian Crichton, a GP and GP trainer in the West Midlands, suggests that a quarter of patients take over-the-counter medications as well as their prescriptions, and a quarter of doctors order low doses for drugs they prescribe, hoping they can control pain without side effects.

The pair report the findings from an electronic poll of 2,000 doctors and questionnaires returned by more than 3,100 patients with osteoarthritis in the journal Current Medical Research and Opinions. The research was funded by the drug company Merck Sharpe and Dohme.

It is thought that 2,000 people a year might die from complications linked to conventional treatments, still small compared with the millions suffering from osteoarthritis - many of whom are not on prescription drugs at all.

The research suggests patients are four times more likely to be dissatisfied with the poor pain relief caused by the drugs than by side effects such as stomach upsets.

The government's national institute for clinical excellence, which monitors the cost-effectiveness of treatments, last year endorsed the new generation of drugs only in those patients who might be at high risk of developing stomach side effects.

These included people over 65, those with gastrointestinal problems, and those already taking other medicines that could cause ulcers. The drugs themselves cost more money, but their supporters argue they more than make up for that by preventing return visits to GPs, hospital treatment and the need for other drugs to counter side effects.

Dr Crichton said: "If you are on a prescription painkiller and it is not working for you don't add another painkiller you have bought yourself. Always ask the advice of your doctor or local pharmacist."

Long protest brings arthritis relief

2005-12-06T17:00:00.000-08:00

A self-employed gardener from Lyttelton is celebrating after taking on the Government and winning.

Devoted dad Richard Crowe spent months protesting after discovering a subsidised drug – TNF alpha inhibitor drug adalimumab (Humira) – which helped his young daughter cope with debilitating rheumatoid arthritis, was not available to other sufferers in New Zealand.

"I was pretty angry about it," Crowe said.

"It seemed as if people (who) were too ill to stand up for themselves weren't getting a good deal."

Crowe had seen his 13-year-old daughter, Rebecca, respond to the drug – described as a miracle cure – by resuming active life and going to school full-time, having had to rely on a wheelchair beforehand.

The drug, which costs up to $30,000 a year, is subsidised by government drug-buying agency Pharmac for sufferers who begin using it as children, but not for those diagnosed as adults – despite being just as effective for older patients.

Crowe, who is the spokesman for Arthritis Action, came into contact with up to 300 sufferers who were prevented from receiving the drug except by paying for it privately, including young people unable to have children or continue university studies because of their illness.

Crowe spent 20 hours a week for six months on the campaign, and took the fight to the Human Rights Commission on the grounds of age discrimination.

The hard work paid off in May, when the commission accepted Pharmac's policy was discriminatory.

On Monday, the agency announced that from January 1 it was releasing funding so the drug could be subsidised for anyone with severe rheumatoid arthritis.

Crowe said members of his group were "over the moon" on hearing of the decision.

"For some of these people it's as dramatic as getting up from their wheelchairs and walking. Certainly, for my daughter, she couldn't even sit up. Now she's going to school full-time."

Pharmac said the investment was worth $35 million over the next five years, with up to 1000 people expected to be prescribed the drug by the end of that period.

Rheumatoid Arthritis, Role Of Type II Collagen, Study

2005-12-05T16:34:00.000-08:00

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints, which gradually erodes the cartilage and bone. The agents of destruction include inflammatory cells, cytokines, and protein-degrading enzymes known as matrix metalloproteinases (MMPs).

The vicious cycle begins when inflammatory cells infiltrate the tissue lining the joints and consume excess oxygen. In addition to unleashing MMPs, the oxidative stress provokes non-enzymatic glycation - a chemical binding of sugar molecules and proteins. Telltale signs of glycation have been found in blood, urine, and synovial fluid of RA patients.

The primary protein in cartilage, Type II Collagen (CII) is crucial to joint health and function. Yet, the involvement of CII in the process of joint inflammation has proven difficult to substantiate. To gain a clearer understanding of CII's role in the pathogenesis of RA, researchers at Queen Mary, University of London and others studied its behavior within an inflamed joint, when modified by oxidants linked to inflammation or by ribose, a five-carbon sugar common to all living cells.

Featured in the December 2005 issue of Arthritis & Rheumatism (interscience.wiley.com/journal/arthritis), their findings support CII's potential contribution to antibody binding and RA's devastating progression.

For their investigation, the researchers collected blood serum samples from 31 RA patients. Between the ages of 65 to 93 years, the patients had disease in varying stages and were receiving different treatments. For control purposes, serum samples were also collected from 41 patients with other inflammatory joint diseases, including osteoarthritis and lupus, as well as back pain, osteoporosis, and gout. Both RA and non-RA samples were analyzed for their ability to bind to pure and natural CII, obtained from bovine cartilage, and to CII that had been chemically modified.

The modified CII included three oxidants present in the rheumatic joint - hydroxyl radical, hypochlorous acid, and peroxynitrite - and ribose. The results were evaluated by a state-of-the-art 3-D fluorescent profile, followed by enzyme-linked immunosorbant assay (ELISA) and Western blotting.

Of the 31 RA serum samples analyzed, only 3 showed antibody binding to natural CII - affirming this protein as an innocent bystander in autoimmunity and its inflammatory toll on the joints.

However, the percentage of samples that exhibited antibody binding increased 4-fold when tested with modified CII. In fact, 45 percent of all RA samples were assessed with moderate to strong antibody binding reactions. CII treated with hypochlorous acid was the most reactive, followed by CII treated with peroxynitrite, glycation, and hydroxyl radical, respectively. In contrast, only 1 non-RA sample showed strong antibody binding to modified CII.

"The present findings support the possibility that chemical modification of self antigens, in RA in particular and in inflammation in general, is the cause of formation of neoepitopes," reflects the study's leading author, Ahuva Nissim, Ph.D. "We propose that the oxidative modification of CII creates a CII autoantigen."

This hypothesis has important implications for the further study and enhanced understanding of the pathology of RA - a complex autoimmune disease.

Article: "Generation of Neoantigenic Epitopes After Posttranslational Modification of Type II Collagen by Factors Present Within the Inflamed Joint," Ahuva Nissim, Paul G. Winyard, Valerie Corrigall, Rewas Fatah, David Perrett, Gabriel Panayi, and Yuti Chernajovsky, Arthritis & Rheumatism, December 2005; 52:12; pp. 3829-3838.

Powerhouse Duo Eases Arthritis Pain

2005-12-05T16:33:00.000-08:00

Cartilage, the body's shock absorbers, is subject to the ravages of age, injury, and genetics. This can result in arthritis, also known as osteoarthritis, for tens of millions.

Here is the story about new government research on two nutrients for arthritis.

Doctors and consumers have been awaiting this study on nutritional supplements for common arthritis, and the first phase of the study is out. The GAIT study (The Glucosamine/ Chondroitin Arthritis Intervention Trial) was sponsored by the National Institutes of Health.

The study’s chief researcher is Dr. Daniel Clegg, who says, "A primary problem in osteoarthritis seems to be premature failure of cartilage that normally provides smooth, almost frictionless movement of our joints."

The GAIT study looked at how glucosamine and chondroitin helped the cartilage heal enough to reduce pain. The study showed they decreased pain in moderate to severe arthritis better than any of the study's alternatives.

The glucosamine-chondroitin combination was better than each substance alone and better than the painkiller Celebrex.

CBN News first investigated glucosamine and chondroitin 10 years ago, when almost no one in the U.S. had heard of these natural compounds.

That has changed. Today, consumers spend $700 million for glucosamine and chondroitin products.

Times have changed in those 10 years since we first spoke with pharmacist Dr. Bob Henderson and his son, veterinarian Dr. Todd Henderson. They head NutraMax, the only company that is been producing drug-grade glucosamine and chondroitin in the U.S.

They are now advertising nationally. Their TV commercial goes, "...the only brand that contains the exact pharmaceutical grade chondroitin sulfate used in the study performed by the National Institutes of Health."

Another blast from the past is nutritionist Dr. Luke Bucci. We also talked to him 10 years ago, when he was a pioneer in analyzing the European research on glucosamine and chondroitin. He was also a leader in advocating the benefits of the combination before the medical field caught on.

Bucci said, "It was literally, I think, caught with its pants down on these compounds--they missed it, they blew it. Instead they were giving analgesics, painkillers, that now we know have tremendous toxicity."

He is now the head of research for Schiff Nutrition, a supplement company that produces a variety of arthritis products with glucosamine and chondroitin. Bucci was a proponent of the substances even before he was in the supplement industry.

With hundreds of millions spent for these nutrients, there are many companies with products -- supplements that can be found in drugstores, grocery stores, and discount warehouses.

Leading orthopedic surgeon Dr. Thomas Vangsness said the new research backs up what he has found in patients.

"Oh, I think it's absolutely good news,” Vangsness said, “I think we finally have some scientific evidence that glucosamine and chondroitin can relieve pain and improve motion in arthritic joints."

Though certainly no cure-all, the use of these two substances is likely to increase as a medical option -- if not a preference -- as benefits are explored and additional research on arthritis is completed.

Arthritis medicine to be fully funded

2005-12-05T16:31:00.000-08:00

A new subsidised treatment for people with severe rheumatoid arthritis will be available in the New Year following a decision by government drug-funding agency Pharmac.

The new generation arthritis treatment adalimumab (Humira), one of the TNF alpha inhibitor drugs, will be fully funded from January 1.

Pharmac chief executive Wayne McNee said TNF alpha inhibitors can make a significant difference to the quality of life for people with arthritis.

"For some people with rheumatoid arthritis this can have enormous benefits in enabling them to become more active again," Mr McNee said.

Pharmac estimated that initially a small number of patients would be prescribed adalimumab, but that the group would grow to nearly 1000 people a year after five years.

UNC Thurston Arthritis Research Center receives $100,000 gift for lupus research

2005-12-05T16:29:00.000-08:00

CHAPEL HILL – A private foundation in Charlotte has donated a major gift to support lupus research at the University of North Carolina at Chapel Hill.

The L. Jack and Ella Shaw Spiers Foundation contributed $100,000 to the UNC Thurston Arthritis Research Center to explore the causes and mechanisms of lupus.

"The center is tremendously grateful to the foundation for this very important contribution, as it will help provide much-needed resources in our efforts to understand lupus," said Dr. Dhavalkumar Patel, director of the research center.

Lupus is one of many immune system disorders known as autoimmune diseases. In these diseases, the immune system turns against parts of the body it was designed to protect, leading to inflammation and damage to various body tissues.

"This is a very important time for lupus research," Patel said. "While we have had tremendous successes in our fight against autoimmunity with the development of effective biologic agents, we still have a long way to go."

Autoimmune diseases such as lupus have a common mechanism in that the immune system is fighting against itself, Patel added. However, its manifestations vary from person to person due to genetic and environmental influences leading to different responses to medications.

"Our goal is to define in a systematic, unbiased manner the differences and similarities between autoimmune diseases and the individuals who are afflicted by them. We would like to be able to define which individuals will best respond to which therapeutics," Patel said.

The L. Jack and Ella Shaw Spiers Foundation was established in 1995 in honor of Jack and Ella Shaw Spiers of Charlotte, who died in 1984 and 2002, respectively.

Its mission is to fulfill a wide range of socially useful purposes, including grant-making to colleges and universities and support for medical health organizations and special-project needs serving orphaned children.

Jack Spiers was a businessman in the Charlotte real estate market and, with his wife, Ella, was a lifelong supporter of philanthropic endeavors statewide. A common room where lupus researchers carry out their studies in the Thurston Arthritis Research Center will be named in honor of the Spiers family.

The gift counts toward the university’s Carolina First campaign goal of $2 billion. Carolina First is a comprehensive, multi-year, private fund-raising campaign to support Carolina’s vision of becoming the nation’s leading public university.

Protein Linked To Accelerating Rheumatoid Arthritis

2005-12-04T16:19:00.000-08:00


A new study published in the December issue of Arthritis and Rheumatism
says that a protein called Type II Collagen (CII) could have a vital
role in the pathogenesis of rheumatoid arthritis (RA), a very painful
inflammatory joint condition.


This protein was found by a team of researchers at the Queen Mary's
School of Medicine and Dentistry at the University of London. It
appears that the protein modifies itself and then proceeds to
systematically destroy the body's immune system and concurrently
increases inflammation of the joints. These findings could be a pointer
towards the development of new drugs to combat the disease.


Type II Collagen (CII) is a major protein found abundantly in
cartilage, bone and tendons. The team felt that CII could trigger RA
when it is stressed by inflammation. They say that when inflammatory
cells enter normal tissue they tend to overuse the oxygen supply. This
means that proteins are deprived of this vital element and consequently
undergo some modification. To prove this point they took blood samples
from 31 male and female RA patients and from 41 patients who had other
inflammatory conditions like osteoporosis, back pain and gout. All of
these samples were subjected to exposure by CII protein taken from cows
as well as a modified CII. This is typically present in rheumatic
inflammation. The researchers found that CII did not bind in the blood
samples of RA patients. But 45 percent of the RA blood samples formed
immune complexes with the altered form of the protein. The researchers
say that CII serves to accelerate and already worse condition in RA.
"Our study has important implications for the further study and
enhanced understanding of the pathology of RA," said study author Ahuva
Nissim. "In the future, understanding of this process will help us
develop specific therapeutics which will target only the inflamed
joints."

Too Much Red Meat May Boost Rheumatoid Arthritis Risk

2005-12-04T05:09:00.000-08:00

ISLAMABAD: If you like to eat hamburgers, steak and other red meat, you might be at increased risk for rheumatoid arthritis, claims a British study in the December issue of Arthritis & Rheumatism.

The University of Manchester study included 88 people newly diagnosed with rheumatoid arthritis (RA) in at least two major joints and 176 control subjects without RA.

The study found that people who eat a lot of red meat have twice the risk for RA and that people who eat lots of red meat and other meat products had similar high risk levels.

High levels of protein intake from all dietary sources were also associated with increased risk for RA. However, higher levels of dietary fats, including saturated fat, didn�t appear to affect risk.

"A high level of red meat consumption may represent a novel risk factor for inflammatory arthritis or may act as a marker for a group of persons with an increased risk from other lifestyle causes. It is unclear whether the association is a causative one," the study authors wrote.

They said that high consumption of red meat may only affect people with a predisposition for RA.

"It may be that the high collagen content of meat leads to collagen sensitization and consequent production of anti-collagen antibodies, most likely in a subgroup of susceptible individuals. Meat consumption may be linked to either additives or even infectious agents, but again, there is no evidence as to what might be important in relation to RA," the authors wrote.

Fighting Rheumatoid Arthritis Pain on Many Fronts

2005-12-03T03:56:00.000-08:00

Experts delve deep into the origins and treatment of pain linked to rheumatoid arthritis in an article in the December issue of Arthritis & Rheumatism.

"Rheumatologists are increasingly required to address pain as a specific symptom. Pain management is no longer simply a quick fix with a single pill, but rather an approach to the patient as a whole biophysical being," lead author Dr. Mary-Ann Fitzcharles of Montreal General Hospital, McGill University, said in a prepared statement.

"There is no gold standard regarding the ideal management of chronic pain in rheumatic disease. Ideal pain management should encompass a wide range of both pharmacological and nonpharmacological interventions," she said.

The article offers a review of complementary treatments for pain in people with RA:

Exercise. Regular activity maintains muscle tone, improves function and induces production of natural painkillers in the body.
Herbal and dietary supplements. For example, RA patients recorded decreased pain after taking supplementation with an omega-3 enriched diet for 12 months. This approach reduced the need for anti-rheumatic drugs.
Topical medications. Healing ointments have been used as home remedies for centuries, and have shown clinical promise in treating rheumatic conditions.
Opioid analgesics. Widely used for treating pain in cancer patients, opioids are increasingly being prescribed for people with musculoskeletal pain. However, there is only limited data on the long-term effects of opioids in people with rheumatic pain, and it isn't clear whether opioids provide sufficient benefit to possible harmful effects.

"Rheumatologists will need to become familiar and comfortable with the use of newly developed strategies for pain management to ensure optimal treatment. Improved function and rehabilitation, and not simply palliation, should be the main goal of pain management in rheumatologic practice," Fitzcharles concluded.

Protein Helps Spur Rheumatoid Arthritis

2005-12-03T03:55:00.000-08:00

Adding another piece to the rheumatoid arthritis puzzle, a team of British researchers believe they've discovered the role a key protein plays in the painful inflammatory joint condition.

The protein, Type II Collagen (CII), appears to be modified at the onset of rheumatoid arthritis (RA). It then morphs into a destructive anti-immunity weapon that weakens the body's immune system while promoting the chronic inflammation of joints.

The finding might someday point to new drug targets against the disease, the scientists said.

"Our study has important implications for the further study and enhanced understanding of the pathology of RA," said study author Ahuva Nissim, of the Queen Mary's School of Medicine and Dentistry at the University of London.

A chronic, painful and often disabling autoimmune disease that affects more than 2 million Americans, rheumatoid arthritis is defined by severe inflammation of the lining of the joints. This inflammation leads to a slow degeneration of bone and cartilage over time. According to the Arthritis Foundation, women are two to three times more likely to be stricken with the illness then men.

Nissim's team set out to better understand the disease, which to date has no clear cause and no known cure.

To do so, they honed in on RA's effect on Type II Collagen (CII) -- a major protein component of cartilage, bone and tendons.

The team theorized that CII -- normally a key player in healthy joint function -- might also help spur RA when stressed by inflammation.

They noted that when inflammatory cells enter joint tissue they over-consume oxygen. In turn, oxygen depletion undercuts the function of otherwise healthy proteins by modifying them in such a way as to encourage binding with sugar molecules.

This binding further encourages inflammation. The result: a vicious biochemical cycle that results in chronic RA pain.

To determine whether CCII was, in fact, one of the principle culprits in this process, the researchers first obtained blood serum samples from 31 male and female RA patients between the ages of 65 and 93.

Blood specimens were also taken from 41 patients suffering from other inflammatory joint diseases, such as back pain, osteoporosis and gout.

All the samples were exposed to normal CII protein taken from cows, as well as CII modified with one of three oxidants or a common sugar -- all of which are present during the inflammation typically found in a rheumatic joint.

Reporting in the December issue of Arthritis and Rheumatism, the authors say the normal form of the CII protein rarely bound with antibodies from blood samples taken from RA patients.

However, 45 percent of the RA blood samples showed evidence of antibody binding when exposed to the altered form of the protein. In fact, the binding rate was four times higher than that seen with non-modified CII.

Modified CII did not bind as often with blood drawn from non-RA patients , they added.

Based on these findings, the researchers believe RA alters CII proteins to further upset the immune response and perpetuate the disease.

According to the researchers, these early results could lead to practical treatment benefits, both through new clinical insights into how RA works and by highlighting novel targets for intervention.

"In the future, understanding of this process will help us develop specific therapeutics which will target only the inflamed joints," Nissim said.

Others expressed doubt the findings will have that great of an impact, however.

"It's nothing that blows your socks off," commented Dr. Stephen Lindsey, head of rheumatology at Ochsner Clinic Foundation Hospital in Baton Rouge, La.

"It's is a promising avenue of research in trying to develop further what's making RA such a chronic disease," he added. "They're looking at why the body forms immunological reactions against itself, which it's not supposed to do. But I think it's interesting, more than it is leading to any promise of new therapies."

Researchers Link Selenium Levels, Knee Arthritis

2005-11-30T18:37:00.000-08:00

CHAPEL HILL, N.C. -- University of North Carolina researchers have found a link between a mineral found in the soil and osteoarthritis.Nearly 1,000 people in Johnston County are part of a study tracking arthritic knees and analyzing the levels of selenium in their bodies.Selenium is a trace mineral that's essential to good health. People get it through foods like beef, tuna and oatmeal -- over-the-counter supplements also are available -- but the amount absorbed into the body depends on the soil the food is grown in, and people who grow their own foods are often found to be selenium-deficient."We definitely have shown in this sample having low amounts of selenium does seem to be associated with being more likely to have osteoarthritis and being more likely to have more severe condition in both knees rather than one," said Dr. Joanne Jordan, a UNC rheumatologist who is leading the study.Judy Rose, of Princeton, is participating in the study and has answered lots of questions about her diet and has had blood drawn, X-rays taken and toenails clipped for analysis."If they can help other people -- younger generations -- to cope with arthritis and then possibly cure it, that would be wonderful," Rose said.Osteoarthritis is the most common form of arthritis -- it affects about 1 million North Carolinians -- and Jordan hopes the study will lead to a way to prevent or limit the pain from the disease."The next step is to look at some other joints to see if this (relationship between selenium and arthritis) bears out as well," she said. "Wouldn't this be a wonderful thing if we could test to see if a selenium supplementation would prevent arthritis or stop it from getting worse?"

Wrist splint can help rheumatoid arthritis patients

2005-11-30T18:36:00.000-08:00

NEW YORK - Using a wrist splint can improve performance of some daily activities in patients with rheumatoid arthritis, according to Canadian researchers, but for some tasks splints can be a hindrance.

In a study published in The Journal of Rheumatology, the researchers examined the influence of wearing a wrist splint on performance of daily activities in 30 rheumatoid arthritis patients with wrist involvement. The subjects were an average of 57 years old and had rheumatoid arthritis for about 9 years.

Dr. Ada Pagnotta, of Jewish Rehabilitation Hospital, Quebec, and colleagues assessed pain, work performance, endurance and perceived task difficulty with the splint on and off.

Using a work simulator, the subjects performed 14 tasks -- 10 that assessed work performance and four that assessed endurance. The subjects rated pain, task difficulty and perceived splint benefit.

Pain was significantly lower in five tasks with the splint on, including three work performance tasks and two endurance tasks. There was no significant difference in work performance with the splint on versus off.

Endurance scores were always better with the splint on, according to the researchers. However, the differences were statistically significant on only one task - "pulling an electric cord."

On a 10-point scale, the average perceived splint benefit on the endurance and work performance tasks ranged from 3 to 5. The task with the highest perceived splint benefit was "chopping with a knife."

Overall, "17 percent reported less pain when using the splint, while 79 percent reported no difference," the team reports.

"When exploring the effects of the splint on work performance, 24 percent of participants had better work performance with the splint on, 62 percent had no difference in work performance, and 14 percent were worse," they note. "Forty-eight percent had improved endurance with the splint on and 20 percent had poorer endurance."

Pagnotta and colleagues conclude that "wrist splint prescription is not a simple process; clinicians and clients need to work together to determine the daily wear pattern that maximizes benefit and minimizes inconvenience."

2005-11-30T18:31:00.001-08:00

New unit to help arthritis patients

ARTHRITIS patients in Glasgow will be able to
get treatment without being admitted to hospital
with the opening of a new day unit.

MSP Wendy Alexander officially opened the Rheumatology
Day Unit at the Southern General Hospital yesterday.

More than half of the patients treated at the centre are
expected to be under 50 with treatment designed to

cause minimum interference in their daily lives.

Ms Alexander, who is expecting twins in February,
said the unit would make a huge difference to people's
lives.

She said: "The new Rheumatology Day Unit will make
a real difference in the lives of hundreds of people.

"Hundreds of sufferers will now be able to have the
best of treatment without having to stay in hospital.
That in turn means they can hold down jobs and
bring up families.

"It's been a real team effort to make this vision a
reality and I think it's a fantastic example of what
can happen when people pull together."

Despite the perception that arthritis is an older
people's disease, many sufferers are actually
younger people and the average age for onset
is about 40.

Around £15,000 of the cash for the project was
raised by the public and one former patient Kathleen
Donaldson left several thousand pounds in her
will to the unit.

Mrs Donaldson's nephew, Robert Bruce, attended
the opening ceremony.

He said: "I can't tell you how glad we are that the
new unit is coming to fruition today, and how
proud we are that my aunt, who suffered greatly
from arthritis could make such a difference.

"As a family, we know the quality of care at the
Southern General is excellent, and we hope very
much that the new unit will help make it even better."

Enbrel, Humira to dominate TNF-alpha market

2005-11-29T13:29:00.000-08:00

Enbrel, Humira to dominate TNF-alpha market

By Steve Mitchell

An analyst firm predicts that Amgen/Wyeth/Takeda's Enbrel and Abbott Laboratories/Eisai's Humira will dominate the market of tumor necrosis alpha inhibitors for the next ten years.

"Enbrel and Humira are going to continue to grow," Cynthia Mundy, an analyst with Decision Resources in Waltham, Mass., and author of a new report, told United Press International.

TNF-alpha inhibitors are used to treat a variety of auto-immune diseases, including psoriasis, Crohn's disease, and rheumatoid arthritis. Decision Resources estimates the market for TNF-alpha inhibitors in the United States, Western Europe and Japan will grow from $7.1 billion this year to almost $12 billion in 2014.

Mundy's reasoning for the predicted success of Enbrel and Humira is that both drugs will continue to get approvals for and be increasingly used for new indications. In addition, they have the advantage over other drugs in this market of being self-administered agents that provide ease of use.

"Basically, these are drugs that are really treating indications that are underserved ... and they're fairly convenient," Mundy said.

Another agent, Remicade, which is marketed in the United States by Centocor and elsewhere by Schering-Plough, will do well over the next decade but "its going to be little bit flatter" than Enbrel and Humira, Mundy said. One reason for this is that Remicade has to be administered by a physician, making it less convenient, she said.

Other drugs that could make a showing in this field include UCB's certolizumab pegol, which is in late phase clinical development but is expected to launch for Crohn's disease and rheumatoid arthritis in late 2006 or 2007, and Centocor/Schering-Plough's golimumab, which is in phase 2 trials.

However, these drugs are likely to run into the same problems that other new entries will face in this field, Mundy said. They will need to offer characteristics that distinguish them from the approved agents used to treat these diseases and they lack the long-term efficacy and safety data of Enbrel and Humira.

The long-term data is "a big issue for all the specialists that treat these chronic disease, because these drugs are used for long-term chronic administration," Mundy said.

Looking several years ahead, Mundy thinks novel cytokine inhibiting agents, such as interleukin-12 inhibitors, could also have an impact on this market. Drugs in this class are "on the horizon as the next wave of biologics for this set of immune disorders," she said.

Mundy added that it's too early to know if these agents will offer sufficient efficacy to allow them to compete head-to-head with the TNF-alpha inhibitors, but she noted that all the companies with TNF-alpha inhibitors also have other cytokine inhibitors in development.

"They're definitely agents to watch," she said.

Matthew Murray, senior biotechnology analyst with Rodman and Renshaw in New York City, agreed that Enbrel and Humira will dominate the field for the foreseeable future.

"Enbrel's primary competition going forward will be from Abbot's Humira, not Johnson and Johnson's Remicade," Murray told UPI.

One issue that previously hindered Enbrel was manufacturing limitations, but Amgen has now resolved that and expanded its production capacity, Murray said. This should enable Enbrel to capture more of the market, but the drug will have to overcome the fact that it requires more frequent dosing than Humira, he noted.

"Now that Amgen has addressed the manufacturing issues that limited Enbrel's market share competitiveness against Remicade in the past, I think its challenge going forward will be to use the larger amount of clinical data available for Enbrel to counter-balance Humira's advantage on dosing frequency," he said.

Juvenile idiopathic arthritis

2005-11-27T14:12:00.000-08:00

Joint in pain

Juvenile idiopathic arthritis (JIA) is a persistent or recurring inflammation of the joints similar to rheumatoid arthritis, but in occurs in children, usually those below the age of 16. Though uncommon, it can be a crippling condition.

HIS fingers are crooked and gnarled, awkwardly bent at the joints. These hands are unable to hold a pencil or a spoon, or do up the buttons of a shirt.

These are not the hands of an elderly man. They belong to a seven year-old boy with juvenile idiopathic arthritis. But this seven year-old cannot copy notes in class, grip a badminton racket or tie his shoelaces.

Inflamed joints

Juvenile idiopathic arthritis (JIA) is persistent or recurring inflammation of the joints similar to rheumatoid arthritis in adults, but beginning before the age of 16,� says consultant rheumatologist Dr Chow Sook Khuan.

Children as young as six months can develop JIA, an uncommon disease that is believed to affect one in every thousand children around the world.

Doctors are still at a loss to explain what causes JIA, which is why the term idiopathic exists in the name (meaning the cause is unknown). However, we do know that it is not caused by an infection, eating the wrong types of food, events during pregnancy, injury or the weather.

JIA can affect children in different ways, for example the number of joints involved, and the symptoms can vary. This has given rise to three main classifications of JIA: pauciarticular JIA, polyarthritis and systemic disease (see table).

Western data shows that pauciarticular JIA is more common, forming up to 40-50% of all JIA cases. About 30% have polyarthritis and 10-15% have systemic disease,� says Dr Chow, although in practice, she sees more patients with the more severe forms of the disease.

Most children with JIA feel well, are fully active and have normal growth, although some may feel run down during flare-ups. More severe forms of the disease may cause problems with activities like walking, getting dressed, bathing and eating.

Juvenile idiopathic arthritis should be treated as early as possible to prevent joint deformities as seen in this picture.

Getting the diagnosis right

Diagnosis of JIA is a tricky thing, as there is no foolproof test and the symptoms are wide-ranging, fluctuating and vague.

Curiously, joint pain or swelling is not always the most obvious symptom, particularly in infants and very young children.

Fever, fever, fever! Dr Chow exclaims. Unexplained fever in a child and failure to grow, she says, are the main features that should alert parents and doctors.

Fever and rashes, often seen in systemic JIA, is a response from the immune system to the disease. Parents may also notice that their child stops growing or starts losing weight, although these features are not immediately obvious and will only be apparent after a few months.

The parents' or caregivers' observations of the child are crucial. An infant does not know how to explain (the symptoms), Dr Chow cautions, so parents need to keep their eyes peeled for unexplained behaviour, such as if the infant stops using a particular joint.

A baby may refuse to reach for the milk bottle, or a toddler may suddenly not want to get out of bed or walk, she describes.

Sometimes, blood tests are carried out to test for rheumatoid factor and antinuclear antibodies, which are present in some people with rheumatoid arthritis and related diseases. However, up to 80% of children with JIA do not have rheumatoid factor or antinuclear antibodies in their blood, while children with other conditions may have it.

What's the cure?

There is no cure for JIA, but there are ways to control the disease so that the symptoms will not limit the child's daily activities, or cause joint deformity and damage. This can only be achieved if proper treatment comes in as early as possible.

Dr Chow Sook Khuan...'Unexplained fever in a child and failure to grow should alert parents and doctors to the possibility of JIA.'

Polyarthritis and systemic disease have to be treated early and aggressively, Dr Chow stresses.

If you don't treat them early with special drugs like DMARDs (disease-modifying anti-rheumatic drugs), they will develop irreversible deformities and will need joint replacements. They may even develop life-threatening complications.�

DMARDs like methotrexate and sulphasalazine are very effective in controlling the progression of the disease. However, these drugs take several months to show any benefits.

Parents and doctors are worried about using DMARDs, as they are chemotherapy drugs, says Dr Chow. But if you delay using these drugs, joint deformities will set in.

Dr Chow assures parents that there is a lot of evidence to back the use of DMARDs in children with arthritis.

Other medications also have a role in controlling the symptoms of pain, stiffness and swelling. These include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Steroids are fast acting medications that are prescribed in low doses for a short period to control the inflammation. However, the child will not grow if you use too much steroids and do not know when to stop, cautions Dr Chow.

The good news is, most children will not grow up to have active adult arthritis. About two-thirds of children will outgrow JIA when they reach adulthood, says Dr Tang Swee Ping, consultant paediatrician and paediatric rheumatologist.

JIA usually follows a pattern where the disease flares up, then goes into remission, then flares up again. Some children are lucky, they may have only one or two flares. But some may have many flares, says Dr Tang.

On the other hand, there may also be children who just have chronic, low-grade activity for a prolonged period of time.

The ultimate aim of treatment is for JIA to go into remission, so that the child will be able to do everything that normal children can do, she says. But in reality, this can be a frustrating journey.

As is usually the case, up to four or five different types of medications and supplements are prescribed for an indeterminate period of time. The lack of an endpoint makes it difficult for children to weather it out.

A lot of patients have no problems taking the medication initially, but when they get older, they start refusing,� Dr Tang shares her experience.

She has a suggestion for parents: We compromise. We tell them, 'If you don't want to take all five medications, you take at least three. So you decide whether you want to take three or four today.'

This tactic makes the children feel like they have some sort of control, and compliance then becomes better.

Parents also need to realise that the treatment of JIA is a slow process, especially with the use of DMARDs that take several months to show any benefit.

A lot of parents end up frustrated, especially those whose children have difficulty controlling the disease. They will ask why the child is not getting any better, even though they keep bringing the child for treatment.

However, Dr Tang assures that although there is no cure, there is always hope that we can control the disease.

Note: Juvenile idiopathic arthritis is a relatively new term. Older terms used to describe this disease were juvenile chronic arthritis or juvenile rheumatoid arthritis.

Natural combo helps in severe arthritis

2005-11-27T14:09:00.000-08:00

As painkilling arthritis drugs prove increasingly unsafe, the largest study ever done of popular, natural alternatives - glucosamine and chondroitin - shows they can significantly reduce moderate to severe joint pain.

Used widely in recent years to battle osteoarthritis - the "wear and tear" form of arthritis afflicting more than 20 million Americans - the glucosamine-chondroitin combination of over-the-counter nutritional supplements is coming under heavy scientific scrutiny.

However, this latest study - involving patients at the University of Arizona - is proving highly controversial, with some evidence suggesting the supplements actually did no better than inactive placebos for arthritis sufferers.

"The primary outcome of the study was negative - it was not a ringing endorsement of glucosamine and chondroitin," said Dr. Jeffrey Lisse, interim director of the Arizona Arthritis Center, where some 30 patients were enrolled in the nationwide study.

"But when you look only at those patients with the worst pain, in the moderate to severe range, then glucosamine and chondroitin did better than placebo, or even Celebrex. So it's a confusing trial, depending on how you spin it."

But because glucosamine and chondroitin - dietary supplements containing natural substances found in the cells of joint cartilage - are known to be safe, with very few side effects, Lisse will continue to advise his arthritis patients to give them a try.

"It takes awhile, two to three months, for them to work, and the response is varied," he said. "But you can take them without the fear now linked to many arthritis drugs, and you may get a good response."

Glucosamine-chondroitin therapy burst on the medical scene in the late 1990s, when a Tucson-based sports medicine physician, Dr. Jason Theodosakis, wrote the best seller "The Arthritis Cure." In it, he argued that these easily obtained supplements were far more effective, and safe, than prescription painkillers for osteoarthritis.

Taken together, they not only ease pain, but actually repair damaged, thinning cartilage that causes the pain, according to Theodosakis.

At first, most physicians derided these claims as unproven "snake oil." But as a series of scientific studies began to demonstrate effectiveness, doctors gradually joined the glucosamine-chondroitin bandwagon, with many - including specialists at the Arizona Arthritis Center - now routinely recommending them.

The supplements have become increasingly popular as prescription painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs) - most notably Vioxx - were yanked off the market, blamed for causing heart attacks, strokes and death in regular users.

Those left on the market - mainly prescription Celebrex, also over-the-counter pain relievers such as Advil and Motrin - must all now carry "black box" warnings of dangerous side effects.

That is why the results of the largest study ever done of glucosamine and chondroitin - the nationwide Glucosamine/ Chondroitin Arthritis Intervention Trial - have been so eagerly awaited by patients and physicians wanting to know what really works on this painful disease that affects so many.

Launched two years ago, the trial tested the effects of the two supplements alone and in combination, comparing them to Celebrex and inactive placebo, when used for six months in nearly 1,600 patients suffering arthritis of the knee with various levels of pain.

Funded by the National Institutes of Health, the $16 million study was conducted at 16 U.S. medical centers, including the UA, where some 30 arthritis patients were tested.

Across the whole spectrum of arthritis patients, glucosamine and chondroitin, either alone or together, did no better at relieving pain than placebo pills, while Celebrex did show a response.

But in what some say is the study's key finding, those results changed dramatically among patients with greater pain. In that smaller group - about 20 percent of patients - nearly 80 percent of those taking the glucosamine/chondroitin combination experienced significant pain relief, compared with 69 percent who took Celebrex, and 54 percent taking placebo.

"Given the fact that the combination of supplements blew away Celebrex in those people who actually needed intervention (the high-pain group), it's clear that it may become malpractice to use anti-inflammatory drugs as first-line therapy, unless the patient has failed six months of (glucosamine-chondroitin) therapy," said Theodosakis in a statement on the trial results.

Considerably more cautious, the American College of Rheumatology - where the results were announced this month - said only that the supplements "may be an effective combination in reducing pain associated with osteoarthritis of the knee," in a statement.

The group pointed out that the glucosamine and chondroitin used in the NIH study was specially formulated, and is not the same as what is available to consumers in drugstores.

Also, the study findings are considered preliminary at this point, because they have not yet been reviewed and published in a medical journal, said the NIH, refusing to comment on the results until they are.

Treating Hindfoot Arthritis

2005-11-25T18:33:00.000-08:00

Rheumatoid Arthritis Rheumatoid arthritis is a type of arthritis in which the lining of a joint (synovium) becomes inflammed, causing warmth, tenderness, swelling and pain. The inflammation eventually damages the cartilage and bone in the joint. The condition is an autoimmune type disease, caused when the body's immune system inappropriately attacks its own tissue.According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, rheumatoid arthritis affects about 2.1 million Americans. It can develop at any age, but is most commonly diagnosed in people of middle age and older. Women are affected two to three times more often than men.Arthritis of the Foot The foot is made of 28 bones and 30 joints. Ligaments support the joints and muscles, and tendons help it move.Patients with rheumatoid arthritis of the foot may experience foot pain, swelling and stiffness. Sometimes the foot feels warm. Patients may have a hard time fitting into their shoes or walking. Some people may develop corns, bunions or foot deformities.About 90 percent of patients with rheumatoid arthritis eventually develop symptoms in their feet. Usually arthritis starts in the joints of the toes and the forefeet. Over time, the symptoms spread to the hindfeet and finally the ankles.Treating Hindfoot Arthritis The hindfoot consists of three joints: (1) the talocalcaneal (subtalar) joint, where the bottom of the talus (ankle bone) connects with the calcaneus (heel bone), (2) the talonavicular joint, where the talus meets the inner midfoot bone (the naviculus), and (3) the calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (the cuboid).Initially, doctors may try to treat the arthritis symptoms with pain medications, braces or canes and physical therapy. When conservative treatments don't help, or when the patient has severe deformity, surgery may be recommended.One type of surgery for severe rheumatoid arthritis of the hindfoot is called triple arthrodesis. Arthrodesis is a fusion surgery, where the bones of the joint are permanently welded together. Ideally, the procedure eliminates pain and provides stability for the affected joints. In triple arthrodesis, the three joints of the hindfoot are fused.Traditionally, triple arthrodesis is performed through two incisions, one on each side of the foot. Surgeons at Mercy Medical Center are now using a single incision approach to minimize trauma to the foot (there is only one incision to heal). Once the incision is made, the surface of the bones are cleaned and any remaining cartilage is removed. The bones are properly positioned and then held in place with screws. The procedure realigns the heel with the body and improves the patient's step. Since foot deformity can also cause hip and knee pain, the surgery may also improve those symptoms as well.The single incision triple arthrodesis is a technically difficult procedure and carries a higher risk of injury to nerves and blood vessels. So patients who are considering the surgery should make sure their physician has training and experience with the technique. Doctors say the procedure is ideal for patients with hindfoot arthritis who need surgery, but have problems with wound healing. For those patients, the single incision enables the body to concentrate its resources on healing just one incision. Besides rheumatoid arthritis, triple arthodesis may also be beneficial for those who have traumatic arthritis in the hindfoot (arthritis that has developed from an old injury).For general information arthritis or foot problems: American Academy of Orthopaedic Surgeons, public website, http://orthoinfo.aaos.org Arthritis Foundation, http://www.arthritis.org, or contact your local chapter National Institute of Arthritis and Musculoskeletal and Skin Diseases, http://www.niams.nih.gov

The FDA Kills

2005-11-23T14:33:00.000-08:00

by Bill Sardi
by Bill Sardi

More than twenty years after four controlled studies showed that glucosamine and chondroitin supplements allay the symptoms of wear-and-tear (osteo) arthritis, the National Institutes of Health finally backs two studies to confirm what was known two decades ago. [November 2005 American College of Rheumatology meeting]

It’s not just that millions of arthritics endured pain while modern medicine drug its feet over acceptance of these dietary supplements, it’s that the delay actually cost many thousands of people their lives. Oh, arthritis is not life threatening, but the pain relieving drugs arthritics take are. Had modern medicine embraced these safe and natural remedies two decades ago, relatively unsafe drugs like Vioxx, Bextra, and Celebrex, as well as aspirin and ibuprofen, would have never been used so widely.

Dr David Graham, an official at the U.S. Food and Drug Administration, independently reported that the use of painkillers known as Cox-2 inhibitors since 1999 resulted in between 89,000 and 139,000 premature deaths from heart attacks or strokes. [Lancet 365(9458):475–81, 2005] Both the COX-2 inhibitor drugs (Vioxx, Celebrex, Bextra) and ibuprofen increase the risk for a mortal heart attack. [British Medical Journal 330:1366, 2005] The heart attacks and strokes emanate from an increased risk for blood clots caused by the COX-2 drugs. [Annals Rheumatic Diseases June 7, 2005]

“Whistleblower” Dr. Graham had to travel outside the country to disclose the mortal risks associated with these drugs. His superiors at the Food & Drug Administration were covering up the problem. What goes unreported is that since the 1980s the FDA was also abrogating its duty to educate the public that safer and more appropriate remedies for osteoarthritis are available – namely glucosamine and chondroitin.

The FDA did more than just approve problematic pain relievers, it promoted them over glucosamine and chondroitin. The May-June 2000 issue of FDA Consumer Magazine, reported on arthritis remedies and under the sub-headline “unproven remedies” said the following:

“Two controversial nutritional supplements, not approved by the FDA, have catapulted into the spotlight because of claims that they rebuild joint tissues damaged by osteoarthritis – or halt the disease entirely. But at this time, the use of glucosamine and chondroitin sulfate supplements warrant further in-depth studies on their safety and effectiveness, according to the Arthritis Foundation. … The Arthritis Foundation says there's no evidence that swallowed chondroitin is absorbed into the body and deposited into the joints. (Author’s note: this is untrue) The Arthritis Foundation urges anyone considering using these supplements to become fully educated about potential positive and negative effects. In addition, people are encouraged to consult their physicians about how the supplements fit within their existing treatment regimens. Above all, do not stop proven treatments and disease-management techniques in favor of the supplements.”

The newly published studies involved 1800 patients, the earlier studies nearly 1300 patients. [Pharmatherapeutica 3: 157–68, 1982, 2: 504–08, 1981; Current Medical Research Opinion 8: 145–49, 1982; 7: 110–14, 1980] How could the FDA say glucosamine and chondroitin were unproven?

Not only were there four more recent studies that confirmed glucosamine and chondroitin were safe and effective [Osteoarthritis Cartilage 6: A39–46, 1998; 6: A25–30, 1998; 12: 269–76, 2004; Journal American Medical Assn 283: 1469–75, 2000], the FDA knew that use of pain relieving drugs like aspirin, ibuprofen and acetaminophen result in thousands of avoidable hospitalizations, liver transplants and death. In 1997 there were 107,000 hospitalizations and 16,500 deaths from drugs like ibuprofen and aspirin. [Current Topics Medicinal Chemistry 5: 517–25, 2005] Add these morbidity and mortality figures to the problems caused by the COX-2 inhibitors like Vioxx to fully realize the misdirection by the FDA.

Improve your arthritis with exercise

2005-11-23T14:31:00.000-08:00

Kenneth Gardner

PHYSICAL EXERCISE is recommended for individuals who have arthritis to help preserve muscle strength and joint mobility. Exercise will also improve their functional capabilities, relieve pain and stiffness. Exercising prevents further deformities, improve their overall physical conditioning and re-establish neuromuscular co-ordination, and mobilise stiff or contracted joints.

Exercise prescription needs to be developed on the basis of the functional status of the individual. Based on the stage of the problem, some persons can perform most activities that the typical healthy individual can. Weight-bearing activities such as cycling, warm water exercises and walking can be managed comfortably by others.

Exercise should be avoided during an acute arthritic flare. Arthritic individuals often report fatigue and some discomfort as common complaints following exercise. Exercise programmes need to balance the levels of immobilisation of affected joints and exercise to reduce the severity of the inflammatory joint disease.

Research has confirmed that many persons with arthritis can safely participate in appropriate regular exercise programmes and achieve better aerobic fitness. Low-impact exercises such as swimming and water aerobics can be well tolerated by persons with arthritis. Improved strength, endurance, flexibility, and better ability to walk or perform daily tasks are all benefits of exercise. A comprehensive exercise programme for persons with arthritis include flexibility, strengthening and aerobic activities. The content and progression of the programme depend on individual needs and capabilities.

Persons with long-standing or severe arthritis, or multiple joint ailments, should undertake exercise in collaboration with trained personnel. A successful exercise programme can be worked out with the support of a rheumatologist who is experienced with both arthritis and exercise.

Risk of Skin Cancer Increased in Rheumatoid Arthritis Patients

2005-11-22T17:46:00.000-08:00

Risk of Skin Cancer Increased in Rheumatoid Arthritis Patients

By Will Boggs, MD

NEW YORK NOV 21, 2005 (Reuters Health) - The risk of non-melanoma skin cancer is increased in rheumatoid arthritis patients, especially those that use prednisone and tumor necrosis factor (TNF) inhibitors, according to a report in the November issue of The Journal of Rheumatology.

"We hope that studies like these will not only help physicians and patients to be aware of possible risks so that they may institute appropriate surveillance measures, but will also begin to help us understand the biologic effects of systemic cytokine inhibition," Dr. Eliza F. Chakravarty from Stanford University School of Medicine, Palo Alto, California told Reuters Health.

Dr. Chakravarty and colleagues investigated the incidence of non-melanoma skin cancer (NMSC) in rheumatoid arthritis patients compared with osteoarthritis patients and sought to evaluate the role of several immunosuppressive medications in the development of NMSC.

After adjustment for known risk factors for the development of NMSC, patients with rheumatoid arthritis had a 19% higher risk of NMSC than did patients with osteoarthritis, the authors report.

In a multivariate model, the diagnosis of rheumatoid arthritis, increasing age, male gender, Caucasian ancestry, being married, and a history of NMSC were associated with an increased risk of NMSC.

Among patients with rheumatoid arthritis, the use of prednisone was associated with a 28% increased risk of NMSC, the researchers note, and the use of any TNF inhibitor was associated with a 24% increased risk (the latter did not reach statistical significance).

Rheumatoid arthritis patients using both methotrexate and any TNF inhibitor had a twofold risk of developing NMSC, the report indicates.

"To our knowledge, this is the first large cohort study of the associations between NMSC, rheumatoid arthritis, and immunosuppressive medications," the investigators write. "The increased hazard for the development of NMSC in patients with rheumatoid arthritis is in concert with that found in other studies of European populations."

"Currently, there are no clear recommendations for routine skin cancer screening in the general population," Dr. Chakravarty said. "If it is confirmed that rheumatoid arthritis itself and/or immunosuppressant medications do confer an increased risk, it may be prudent to recommend annual screening in these high-risk groups."

"The important thing will be to educate patients about this possible increased risk so that they are empowered to perform self-skin examinations, as well as being more attentive to protecting their skin from sun damage including regular use of sun screen and protective clothing," Dr. Chakravarty added.

Rheumatic disease increases risks in pregnancy

2005-11-21T18:54:00.000-08:00

Women with rheumatic disease experience greater pregnancy risks and longer hospital stays than the average pregnant woman.

The findings from the Stanford University School of Medicine provide women who have these conditions with a better understanding of the risks they face if they become pregnant and underscores the need for physicians to monitor closely their care.

Tina Chambers, at the University of California-San Diego, who was not involved in this study, said the findings fill a troubling gap in what is known about pregnant women who suffer from these autoimmune conditions. " Intuitively, you would think that it would be easy to access [such] data," she said, "but there is little to nothing in the literature about rheumatoid arthritis or lupus in pregnant women.".

In this study, Eliza Chakravarty aimed to see how the pregnancy outcomes for these women would compare with the outcomes for healthy women and women with diabetes. "Nobody knew these numbers," she said.

In autoimmune diseases such as lupus or rheumatoid arthritis, the immune system turns against parts of the body it is designed to protect, leading to inflammation and damage to joints.
More than 2 million Americans have rheumatoid arthritis, while another 500,000 suffer from lupus. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, rheumatoid arthritis and lupus affect far more women than men, leading researchers to believe that hormonal factors may prompt their onset.

Chakravarty was able to determine the incidence of lupus and rheumatoid arthritis pregnancies by sifting through records of pregnancies and deliveries using the Nationwide Inpatient Sample, a database of hospital discharge summaries from the entire country. In 2002, the latest year in which data was available, she found that at least 4,000 of the approximately 4 million total deliveries occurred in women with lupus or rheumatoid arthritis. By comparison, about 13,000 women who delivered in 2002 had diabetes.

" Women with rheumatoid arthritis are typically somewhat older when they become pregnant," said Chakravarty. " However, even after adjusting for maternal age, they run a higher risk for adverse outcomes and generally experience longer hospital stays than other women." On average, hospital stays increased from about two days for the general population to between three and four days for the rheumatoid group.

Chakravarty's findings also show that, compared with the general population, women with lupus or rheumatoid arthritis are three times as likely to develop hypertension and one-and-one-half times as likely to have cesarean deliveries or deliver prematurely.

In a previous study, Chakravarty had gathered evidence on the effects of lupus in 63 pregnant women at Stanford. Her results revealed that more than half of the deliveries were premature, and one-fifth suffered from pre-eclampsia - a condition characterized by a sharp rise in blood pressure during the third trimester of pregnancy.

Taking action in managing your arthritis

2005-11-20T18:16:00.000-08:00

Arthritis affects about 21 million Americans. Because of the concern for negative side effects from many of the pain medications used for arthritis, many people are seeking other ways to manage their symptoms.

There are two major forms of arthritis - osteoarthritis and rheumatoid arthritis. The first increases in incidence as we age. It results from a breakdown of cartilage, allowing bones to rub together, which causes pain. Rheumatoid arthritis is an autoimmune disease that affects about 2 million Americans. With this form, the body begins attacking its own bone tissue, which causes inflammation and pain.

Since extra body weight puts additional stress on already painful joints, weight loss can be a good goal for overweight individuals (in addition to all the other health benefits it provides). Even losing a few pounds can make a big difference. Losing one pound of weight reduces the load on your knees by four pounds. Being at a healthier body weight can also reduce the risk of developing osteoarthritis in the first place.

Regular exercise is another action you can take. This not only can help with weight control, but it allows for improvements in joint function. Range of motion exercises keeps joints more flexible and allows for continued exercise. In the research, weight loss paired with exercise appears to be a winning combination to reduce pain.

A lack of regular exercise can almost guarantee decreases in joint function and increased pain. Plan an exercise program that includes range-of-motion exercise (stretching and flexibility), strengthening exercises (helps muscles and bones), and endurance (cardiovascular) exercises. Work with a physical therapist who can guide you through exercises that are just right for you. It is important to exercise safely. Drinking enough water is necessary for the health of all body tissues and the amount consumed should increase as exercise increases.

There are some dietary approaches to reducing the risk of inflammation. Omega-3 fatty acids (such as those found in fish oils), are known for their anti-inflammatory properties. Specifically, fish oils have been shown to decrease joint pain and stiffness, delay fatigue, and improve overall mobility. Higher levels of these can be consumed by eating fish or by taking supplements. Some other sources include ground flax seed/flax seed oil, canola oil and walnuts. If you choose to take a supplement, take about 3 grams of EPA/DHA. A diet high in omega-6 fatty acids can increase inflammation, so decrease your intake of the fats found in animal products and many processed foods. The current American diet contains a much higher level of these fats than in past decades.

A recent study has also suggested that a substance in olive oil is also anti-inflammatory. Previous studies had shown a benefit to people following a Mediterranean diet - high in fruits, vegetables, beans, olive oil, whole grains and fish, with limited amounts of saturated fats (animal-based fats).

Some researches found that a diet high in colorful fruits and vegetables (red, orange, and yellow) - which contain carotenoids and zeaxanthin - were less likely to develop rheumatoid arthritis. Vitamin C is another important nutrient in the arthritis picture. Drinking orange juice daily would help you to get both these benefits.

Numerous supplements are touted to help with arthritis. Of these, glucosamine and chondroitin appear to have the most potential for osteoarthritis. Anecdotally, many people state these two supplements, used alone or together, have shown benefit. To date, however, the National Arthritis Foundation claims it wants to see more concrete evidence before it can recommend taking these supplements. If you choose to take these supplements, the recommended doses are glucosamine sulfate (1200 mg/day) and chondroitin (1500 mg/day).

Vitamin D is another nutrient that may help. Some studies have shown that osteoarthritis progresses much faster in people who are deficient in vitamin D. The bone pain that results from a vitamin D deficiency can also be mistaken for arthritis. Older adults should try to get at least 600-800 IU of vitamin D per day. This can also help maintain bone density.

Remember that dietary changes and supplements generally work more gradually than medications. Do not expect immediate results. The benefit to including these dietary changes, is that they also help to reduce the risk of other medical concerns - so you can’t lose. As in treating many other medical conditions, there are a number of action steps that can choose to take.

So the bottom line is to maintain a regular habit of exercise, eat meat and poultry less often and replace them with oily fish or plant sources of protein such as beans, nuts, or seeds. Use olive or canola oil. Make fruits and vegetables a large part of your day. Add supplements as needed, such as vitamins C and D or fish oils, and drink plenty of water.

Pamela Stuppy is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and at Whole Life Health Care in Newington. She is also the nutritionist for Phillips Exeter Academy.

Lupus and its varied symptoms hide behind mistaken diagnoses

2005-11-20T18:15:00.000-08:00

BY MICHAEL GRANBERRY

Allison Koeninger has had symptoms of lupus since childhood. (DARNELL RENEE/KRT)

What is lupus?

Lupus is a chronic autoimmune disease that causes the immune system to attack the body's own tissue and organs, including the joints, kidneys, heart, lungs, brain, blood or skin.

Researchers do not know what causes lupus. It is not infectious, rare, cancerous or AIDS-derived. Scientists believe there is a genetic predisposition to lupus, but it is known that environmental factors also play a role in triggering the disease.

The Lupus Foundation of America estimates that about 1.5 million Americans have a form of the disease. Men and women of all ages can be affected, but lupus occurs 10 to 15 times more frequently among adult females than adult males.

Source: American Lupus Foundation Source: American Lupus Foundation

DALLAS -- For Allison Koeninger, symptoms began as early as age 7. She felt aches and pains "and a lot of fatigue," and no one could figure out why.

"They would X-ray me, and nothing would show up," she says. "I even began to think I was imagining things."

Now 44, Koeninger failed to get the answer she was seeking until 1990, when she went to a dermatologist for a rash that began on the bridge of her nose and spread to her cheek. She remembers him saying, "I think you have lupus." He was right.

An archivist at the University of Dallas, Koeninger lives in Dallas and suffers from lupus, for which there is no cure. In her case and those of millions of others, lupus is often misdiagnosed.

About 1.5 million Americans suffer from it, and most of its victims are women. It's a chronic autoimmune disease that causes inflammation and tissue damage to almost every organ in the body, including the brain and heart. Its symptoms, which tend to arrive with devastating severity, include achy and swollen joints, fevers, fatigue and obvious skin rashes.

"Lupus is a classic example of an autoimmune disorder in which your own immune system has become imbalanced," says Dr. Edward K. Wakeland, director of the center of immunology at UT Southwestern.

Wakeland received a recent research grant from the Alliance for Lupus Research, or ALR, which was founded in 1999 for the purpose of raising money to prevent, treat and eventually cure lupus. The Lupus Foundation of America is also aggressively involved in raising funds.

"Lupus can lead to a whole variety of problems, including kidney abnormalities, rashes, photosensitivity, neurological disorders, vascular disorders ... and there's currently no good way to treat it," said Wakeland. "Oftentimes, the therapy is almost as bad as the disease itself."

In Koeninger's case, steroids caused her to gain weight and hit her with a severe case of depression and anxiety. Anti-inflammatories tore up her stomach for 10 years. "I can no longer take them, because my stomach is just shot," she says.

Dr. Nancy Olsen, professor of medicine at the University of Texas Southwestern, has treated lupus patients for years. The worst scenarios she sees usually involve kidney failure, which "is not as dire as it used to be," she said. "We've gotten a lot better at treating it." Koeninger is among the relatively fortunate who have never suffered kidney problems.

Patients "usually come in with one of several symptoms," said Olsen. "It's a very heterogenous disease, so it affects people differently. People often come in with a skin rash, which can be on their face. Others have joint pain, arthritis-like symptoms. It's usually less intense than rheumatoid arthritis, but there can be swelling or pain.

"Some patients come in with high blood pressure, then we find their kidneys aren't working. And then a biopsy will show lupus in the kidney. Most people don't have all of the symptoms."

Of the 1 in 2,000 it victimizes, it targets women at least 10 times as often as men, said Wakeland. And no one knows why. One of the men who died from lupus is famed CBS broadcaster Charles Kuralt.

"The disease tends to be much more severe in women who are reaching their child-bearing years," he says. "The frequency and severity is also much more prevalent among African Americans and Hispanics. They more commonly get it, and when they do, it's more commonly severe among those populations."

Just as no cure exists for lupus, neither is there an identifiable cause. Lupus patients often undergo the frustration of suffering swelling of the joints or bruising, only to have the symptoms subside by the time they get to a doctor's office. It's often wrongly diagnosed as arthritis.

Unpredictability, Koeninger said, makes it difficult to cope with. "You can wake up today feeling great," she says, "and wake up feeling horrible tomorrow. It's hard to make long-term plans. I always take out vacation insurance, because I never know when a vacation comes around if I'm up to going."

And one of its saddest aspects is the suspicion it sometimes arouses in others. "Most of the time, you don't look sick, and people just don't realize how much you're suffering. But believe me," she said, "you are suffering."

Arthritis Drug May Ease Another Joint Disease

2005-11-19T13:53:00.000-08:00

-- Robert Preidt

FRIDAY, Nov. 18 The drug adalimumab (Humira) -- commonly used to treat rheumatoid arthritis -- may also help reduce the signs of symptoms of ankylosing spondilitis (AS), a painful and disfiguring autoimmune disease, according to an international study.

AS, which affects about one in 2,000 people in the United States, occurs when a protein called tumor necrosis factor (TNF) attacks certain spinal joints and causes inflammation those joints. Adalimumab is an anti-TNF agent.

This study included 315 AS patients in the United States and Europe who had no success with at least one other form of therapy. Patients were randomly assigned to receive either 40 milligrams of adalimumab or a placebo for 24 weeks.

Researchers used five assessment methods to measure the patients' clinical responses treatment. The goal was a 20 percent improvement in AS signs and symptoms.

At 12 and 24 weeks, more than twice as many patients taking adalimumab had achieved the 20 percent improvement goal, compared to those taking the placebo. Some of the patients showed improvement as early as two weeks into the study.

The findings were to be presented this week at the annual scientific meeting of the American College of Rheumatology in San Diego.

Arthritis awareness: Speakers touched by disease share 'Commitment to Cure'

2005-11-19T13:50:00.000-08:00

By COLLEEN JOHNSON

As if speaking in front of a room full of people is not tough enough, Doug Young had to discuss his personal struggle with a painful disease.

"I was pleased to speak so people will be aware," said Young, a local businessman whose daughter was diagnosed with rheumatoid arthritis when she was just 23 years old. "The Arthritis Foundation is not new in the country, or to Middle Tennessee, but it is relatively new to Murfreesboro."

Modern medicines enabled Young's daughter to earn a diploma, become a teacher, marry a supportive husband, and have a child. However, many arthritis patients are not as fortunate.

Arthritis is a painful disease that causes stiffness and sometimes swelling in and around joints. For arthritis patients, everyday movements can become extremely difficult. There is no known cure for arthritis.

This past Wednesday, the Arthritis Foundation hosted a "Commitment to a Cure Breakfast" for the first time in Rutherford County. The event was held at the Stones River Country Club, and many members of the community attended.

One by one, arthritis patients stood before the audience and spoke about their personal struggles and accomplishments.

Melinda Poff, a former track star who was diagnosed with severe rheumatoid arthritis when she was just 25, described how the disease ended her ability to run, to finish college, and to have children. Teaching Sunday school at church will have to satisfy her childhood dream of one day teaching kindergarten, she said.

"I didn't think it was a disease I should have," said Poff as she described having to be carried around the house by family members when the disease was at its worst. "I thought it was an old person's disease."

Poff is not alone in thinking arthritis is a disease that only afflicts the elderly. This is a stereotype she and other patients are trying to change.

Arthritis appears in more than 100 different forms, and the cause of all of them remains unknown. There may be a genetic link, but doctors still do not know for sure.

According to the Arthritis Foundation, arthritis affects one in three adults, is the No. 1 cause of disability in the United States, and costs more than $86 billion a year. The Arthritis Foundation estimates that approximately 66 million adults are living with arthritis in the United States, and about 300,000 children have some form of arthritis.

Ashley Carpenter was just 16 months old when doctors diagnosed her with juvenile rheumatoid arthritis. Her condition is described as "onset systemic," which means she has a very active form of the disease. This form affects her five major joints as well as her five major organs.

Ashley's mother, Tammy Carpenter, fought back tears as she stood before the crowd at the recent breakfast and described their family's personal struggles. Ashley, now 6, comforted her mom and occasionally gave the audience huge smiles.

"As you can see, she looks like a normal child," said Tammy, her voice quivering. "But she is on all sorts of different medicines. We buy ibuprofen by the pint. It costs $3,000 a month just to pay for her medical needs."

When it comes to medication, little Ashley may be luckier than the arthritis patients who came before her. Improved treatments keep patients more comfortable than in previous years.

"There has been more improvements in the drugs in the last 10 years," said Tammy. "But we still need more research, so we can find a cure and the (next generation) will have hope. You feel so helpless and hopeless when this happens to your family."

Ashley takes an injection every morning, and Tammy said "right now she is doing pretty good."

Doctors predicted Poff would be wheelchair-bound by the age of 25. She is now 35 and still standing.

"Because of medications, I don't have the deformities in my hands," said Poff, as she held up her hands for the audience to see. "Just think of how much better the medications will be for future patients."

"As I understand it, the biggest improvements have been in pain management in the last 10 years," said Ronnie Shaw, a member of the Rutherford County Arthritis Advisory Council. "And in the medications that help to stop disfigurement."

In the past, many patients suffered severe disfigurement, especially in their hands. In a video titled "Faces of Arthritis," an elderly gentleman who was diagnosed more than 30 years ago described how he had become completely dependent on other people. His hands and fingers were permanently swollen, disfigured and almost useless.

"You don't really see that anymore," said Shaw. "Medicines have improved, but what we really need is a cure, and there is no cure."

The Arthritis Foundation is just one of many research foundations in need of support, but patients such as Poff, Carpenter and Young's daughter serve as living proof the research being done is producing results.

"When you take in account the number of caregivers as well as patients, it really affects a very large percentage of people," said Young. "And it can't be vaccinated or treated. It is going to take research to get it done."

Arthritis Supplements

2005-11-18T13:17:00.000-08:00

The popular supplements glucosamine and chondroitin may not offer much benefit for people with mild arthritis pain, but could help people with more severe arthritis. Those are the findings of two studies presented at the American College of Rheumatology meeting in San Diego this week. The first study looked at about 1,600 people with knee osteoarthritis for six months. Most of the patients had mild arthritis; about 20% had more severe disease. The patients were treated either with glucosamine, chondroitin, the drug Celebrex, or a placebo. The patients were also allowed to take daily doses of acetaminophen along with the other treatment. The researchers found that Celebrex relieved pain, but the supplements did no better than the placebo at relieving pain. However, the findings suggested that glucosamine and chondroitin together could help people with moderate to severe osteoarthritis, The New York Times News Service reports. However, the second study by European researchers, which looked at about 300 women treated with acetaminophen, glucosamine or a placebo, suggested that glucosamine might work better than acetaminophen at relieving knee arthritis pain.

Arthritis pill discounted

2005-11-17T14:53:00.000-08:00

Study shows no proof glucosamine, chondroitin ease knee pain, but they don't do any harm either.

What they are

Glucosamine and chondroitin sulfate are substances found naturally in the body.

� Glucosamine is a form of amino sugar that is believed to play a role in cartilage formation and repair.

� Chondroitin sulfate is part of a large protein molecule (proteoglycan) that gives cartilage elasticity.

� Both glucosamine and chondroitin sulfate are sold as dietary or nutritional supplements.

� Both are extracted from animal tissue: glucosamine from crab, lobster or shrimp shells; and chondroitin sulfate from animal cartilage, such as tracheas or shark cartilage.

A clinical trial of the popular dietary supplements glucosamine and chondroitin found no evidence that they're better than placebos in easing arthritic knee pain, the study's lead investigator said Tuesday.

The good news: like placebos, the supplements aren't harmful, either.

The government-sponsored trial involving 1,600 arthritis sufferers at 16 medical centers across the country was designed to see if the supplements lived up to their billing as potent weapons against arthritis. Sales of the two supplements topped $700 million in 2004, according to the Nutrition Business Journal.

Dr. Daniel O. Clegg, speaking at a rheumatology convention in San Diego, said the supplements -- taken separately or in combination -- didn't fare any better than placebos, pills with no active ingredients. Some study highlights:

� Remarkably, about 6 in 10 patients reported that their knees felt better after six months of therapy -- whether they took supplements or the dummy pills. Psychology may have played an important role in how participants felt. "Patients really believe in dietary supplements, and I think patients wanted to do better," Clegg said.

� Patients taking the glucosamine-chondroitin combination fared slightly better than those on placebos, but not enough to qualify as statistically significant.

� Patients taking the prescription drug Celebrex did better than those on placebos -- by a 70 percent to 60 percent margin.

"It's a very confusing time right now," said Clegg, noting that some previous studies showed the supplements worked better than placebos, while others did not.

An estimated 21 million people in the United State suffer from osteoarthritis, a condition caused by the breakdown of cartilage that cushions the ends of bones in joints throughout the body.

Tackling arthritis ... gently

2005-11-16T19:37:00.000-08:00

By MERYL NAIDOO

ARTHRITIS Tasmania will introduce a range of new prevention and management programs thanks to a $298,000 Federal Government grant.

The funding boost was welcomed yesterday by the organisation's chief executive Jackie Slyp.

She said the statewide Living Well with Arthritis project had a strong emphasis on better practical management of arthritis and osteoporosis.

Ms Slyp said gentle, ongoing physical activity was an important tool to help manage both conditions, which affected thousands of Tasmanians.

The healthy lifestyle and self-management programs aim to better control symptoms and improve quality of life for sufferers.

New programs include activities like Tai Chi, warm water exercises, chair-based exercises, and strength training.

The six-week Get the Most Out of Life course also offers emotional support for people with a chronic condition.

Arthritis Tasmania volunteer Carolyn Price, 61, first heard about Tai Chi about two years ago.

These days, she instructs weekly classes for beginners and swears by the ancient Chinese practice.

She said Tai Chi might not make people look younger, but it certainly made them feel it.

She believes it has improved her mobility, is a great relaxant and a fantastic way to meet new people.

Liberal Senator Eric Abetz, who announced the program funding, said it would be of great benefit to arthritis sufferers in the state.

Key Underwrites ‘Working Successfully with Arthritis’: New Educational Program Offered by Arthritis Foundation

2005-11-16T15:31:00.000-08:00

CLEVELAND, November 16, 2005 – Helping employers and employees learn more about arthritis and its impact on the nation’s workforce is one of the goals of the Arthritis Foundation. Working Successfully With Arthritis – a new, free arthritis education program offered by the Arthritis Foundation, Northeastern Ohio Chapter and underwritten by a $15,000 Key Foundation grant – will bring this important information to the worksite.

“As more Americans are diagnosed with arthritis at younger ages (in their 20s, 30s and 40s), this disease is affecting an individual’s health and quality of life,” said John T. Petures, Jr., Chapter President. “As medical costs increase and younger, working-age people are diagnosed, issues of employability, income and economic self-sufficiency become paramount. There are many lifestyle changes that can improve functioning and minimize the impact of this disease.”

Working Successfully With Arthritis features a presentation designed for executives, managers, human resource specialists and employees. Perfectly suited for a brown bag lunch event, the 60-minute presentation includes information on arthritis diagnosis, treatment options and simple lifestyle changes that will help attendees function better and work more productively. For more information, contact Eileen Moeller at 800-245-2275, ext. 155, or email moeller@gwis.com.

Working Successfully With Arthritis is the next generation of the Northeastern Ohio Chapter of the Arthritis Foundation’s economic self-sufficiency project established in 2003, with support from the Key Foundation and KeyCorp (NYSE: KEY). Since that time, more than 750 individuals with arthritis, and their families, have benefited from educational programs led by a panel of volunteer experts including KeyBank representatives among professionals addressing medication access; financial planning; employment issues and, for those who can no longer work, the disability application process.

Why should employers care about this condition? Arthritis is the leading cause of disability in the United States, costing our economy more than $86 billion annually in lost wages, lost productivity and medical expenses. A staggering one in three Americans (70 million people) has arthritis, including 1.5 million individuals of all ages in Northeastern Ohio.

Arthritis Patients Missing Out on Aspirin Therapy

2005-11-16T15:29:00.000-08:00

By Randy Dotinga

As preventive measures go, it's a pretty simple one: People with rheumatoid arthritis are more likely to develop heart disease, so they should take a low-dose aspirin once a day.

But new research suggests many patients aren't getting the message, potentially putting them at risk.

Researchers found that just 18 percent of rheumatoid arthritis patients are on aspirin therapy, widely considered an effective and inexpensive way to prevent heart attacks. Meanwhile, a similar group of people with other types of arthritis are significantly more likely to take aspirin each day -- 25 percent of them do so, the study found.

The reason for the oversight isn't clear, but it may have something to do with rheumatologists and primary-care doctors failing to consider a patient's overall health, said Dr. Eric Ruderman, an associate professor of medicine at Northwestern University's Feinberg School of Medicine. "Maybe we're not looking at the rest of the picture as much as we should," he said.

Rheumatoid arthritis is caused when the immune system begins attacking the body itself, causing pain and inflammation in the joints. It's one of the most serious and disabling types of arthritis, is most common among women, and often begins when people are in their 30s and 40s.

By contrast, osteoarthritis is caused when the cartilage that covers the ends of bones in the joint deteriorates, producing pain and loss of movement as bone begins to rub against bone, according to the Arthritis Foundation.

For reasons that aren't entirely clear, people with rheumatoid arthritis are twice as likely to develop heart disease, said study co-author Dr. Lee Colglazier, a rheumatologist in Crestview Hills, Ky., who worked on the study as a rheumatology fellow at Wake Forest University School of Medicine. Some theories suggest the inflammation triggered by arthritis contributes to cholesterol buildup and artery blockages.

Colglazier and colleagues are scheduled to report their findings Wednesday at the American College of Rheumatology annual meeting, in San Diego.

For the study, the researchers surveyed 18,123 arthritis patients, most of whom -- 14,114 -- had the rheumatoid form, over a three-year period.

Of the rheumatoid arthritis patients, only 18.4 percent took an aspirin a day to prevent heart disease, compared to 25.1 percent of the patients with other forms of arthritis.

Doctors believe that a simple low-dose -- or "baby" -- aspirin once a day, which costs pennies, can reduce the risk of heart attacks.

The findings are mystifying, especially because rheumatoid-arthritis patients are hardly strangers at doctor's offices, Colglazier said. "Maybe they're seeing the doctor a lot, a lot of acute things are going on, (but) doctors don't have time to say, 'Let's address prevention.'"

Ruderman agreed, adding that primary-care doctors might not realize the heart-risk urgency facing rheumatoid arthritis patients. Perhaps "they don't view these patients with the same concern that they may view a diabetic or a patient with significant hypertension or elevated cholesterol," he said.

Raynaud's pain and blanching has many causes

2005-11-15T12:54:00.000-08:00

ALLEN DOUMA. ALLEN DOUMA spent 12 years in clinical practice. He has written, edited and advised on numerous medical publications.

For many years I've had problems with my fingers turning white and hurting whenever they get cold. Last year when I was breastfeeding, my nipples did the same thing. My pediatrician said that I had something called Raynaud's in my fingers but that the problem with my nipples was my child was latching on too tightly. But it didn't matter how hard she sucked, the same thing happened. What do you think is going on?

W.M., Harwich, Mass.

It sounds as if you may have Raynaud's, a condition in which small arteries go into spasm and prevent adequate blood flow. This causes the characteristic blanching and pain. Most commonly affected are the digits, and fingers are involved more often than toes. But Raynaud's can occur in the nipples as well. This usually happens during breastfeeding because of greater exposure and because the evaporation of moisture from the nipples causes cooling.

Raynaud's primarily occurs in young women. In men it is often the result of occupational trauma.

When the condition is related to another disorder, it is called Raynaud's phenomenon. This is the most common form. When no other underlying disease is found it's called Raynaud's disease.

Many medical conditions may cause Raynaud's phenomenon, including scleroderma, rheumatoid arthritis, atherosclerosis, decreased thyroid activity, injury and reaction to certain drugs. In a recent research study, the most common causes of Raynaud's phenomenon were the use of beta-blocker drugs (primarily used for blood pressure control and heart conditions), carpal tunnel syndrome and rheumatoid arthritis.

Episodes of Raynaud's come on quickly and are usually triggered by stress or exposure to cold. Rewarming the affected hands or feet usually restores normal color and sensation within a few minutes, but a burning pain is often felt as the tissue returns to normal.

Do what you can to keep your extremities and nipples warm. Some people with severe Raynaud's wear socks and gloves heated by battery power. Some even decide to move to warmer climates.

Even the slightest change in temperature may be enough to trigger the pain.

Avoid drugs that restrict blood vessels, including tobacco. If stress is a problem (and you certainly may be anxious about the condition of your nipples), you may want to talk to family doctor or a psychological therapist.

2005-11-15T12:53:00.000-08:00

Q: TWO years ago I was diagnosed with rheumatoid arthritis. I was only given anti-inflammatory medication and if I stopped taking it, the pain and uneasiness would return. How can I reduce the pain?

A: RHEUMATOID arthritis (RA) is a chronic inflammatory condition that can affect the entire body. It is an autoimmune disease in which the immune system attacks the joints, including the synovial membranes surrounding the lubricating fluid in the joints.

Common symptoms of RA include fatigue, low-grade fever, weakness, joint stiffness, vague joint pain and appearance of painful, swollen joints. Involved joints will characteristically be quite warm, tender and swollen.

Some herbs may be beneficial for RA. For instance, celery seed has anti-inflammatory properties and combined with guaiacum can be very helpful for those suffering from RA.

A combination of antioxidants will help to protect against degenerative diseases like RA.

Omega-3 oil has produced favourable changes in suppressing the production of inflammatory compounds and shown to be effective in reducing the problem of tender joints and morning stiffness in patients with rheumatoid arthritis.

Reduce your meat intake, especially that of beef, and vegetables such as tomato, potato, eggplant and peppers. This is due to the toxin called sotanine which people suffering from RA are highly sensitive to. RA sufferers should exercise regularly. Go for swimming, stretching and walking. Try to reduce or avoid smoking and alcohol consumption as they can cause excessive free radical formation.

Combining drugs at the start of rheumatoid arthritis may help most

2005-11-15T12:52:00.000-08:00

THE QUESTION As treatment of rheumatoid arthritis has expanded from simply relieving the chronic pain of inflamed joints to also preventing the destruction of bone and cartilage, an array of drugs has become available, for use alone or in combination. What strategy works best?

THIS STUDY randomly assigned 508 adults, mostly women, recently diagnosed with rheumatoid arthritis to one of four types of medication programs: (1) methotrexate alone, switching to a different disease-modifying, anti-rheumatic drug (DMARD) if needed; (2) a step-up program that starts with methotrexate but adds other DMARDs and the steroid prednisone; (3) an initial combination of methotrexate, sulphasalazine (an anti-inflammatory) and prednisone; or (4) a combination of methotrexate and infliximab, a drug that blocks a substance (tumor necrosis factor) that causes inflammation. After a year, the ability to function had improved in all groups, with the disease in remission in 32 percent of the participants.

But more people from groups 3 and 4 — those whose had taken a combination of drugs from the start — improved, and they improved more quickly, than the others. Compared with hand and foot X-rays taken at the start of the study, groups 3 and 4 also showed less progression of joint damage, with no progression shown for 87 percent and 93 percent of the groups, respectively, compared with 67 percent for group 1 and 73 percent for group 2.

WHO MAY BE AFFECTED BY THESE FINDINGS? People with rheumatoid arthritis, which most often begins between ages 30 and 50. Women are nearly three times more likely to get the disease, but it tends to affect men more severely.

CAVEATS About 41 percent of the participants, roughly divided equally among the groups, reported side effects, mainly gastrointestinal and skin problems. The study was funded in part by Centocor and Schering-Plough, which had paid fees to one author.

Halting arthritis damage

2005-11-15T12:50:00.000-08:00

By LINDA SEARING

THE QUESTION: As treatment of rheumatoid arthritis has expanded from simply relieving the chronic pain of inflamed joints to also preventing the destruction of bone and cartilage, an array of drugs has become available, for use alone or in combination. What strategy works best?

THIS STUDY randomly assigned 508 adults, mostly women, recently diagnosed with rheumatoid arthritis to one of four types of medication programs:

methotrexate alone, switching to a different disease-modifying, anti-rheumatic drug (DMARD) if needed;

a step-up program that starts with methotrexate but adds other DMARDs and the steroid prednisone;

an initial combination of methotrexate, sulphasalazine (an anti-inflammatory) and prednisone;

a combination of methotrexate and infliximab, a drug that blocks a substance (tumor necrosis factor) that causes inflammation.

After a year, the ability to function had improved in all groups, with the disease in remission in 32 percent of the participants.

But more people from the third and fourth groups - those who had taken a combination of drugs from the start - improved, and they improved more quickly, than the others. Compared with hand and foot X-rays taken at the start of the study, those two groups also showed less progression of joint damage, with no progression shown for 87 percent and 93 percent of the groups, respectively, compared with 67 percent for the first group and 73 percent for the second group.

WHO MAY BE AFFECTED BY THESE FINDINGS? People with rheumatoid arthritis, which most often begins between ages 30 and 50. Women are nearly three times more likely to get the disease, but it tends to affect men more severely.

CAVEATS: About 41 percent of the participants, roughly divided equally among the groups, reported side effects, mainly gastrointestinal and skin problems. The study was funded in part by Centocor and Schering-Plough, which had paid fees to one author.

FIND THIS STUDY: November issue of Arthritis & Rheumatism; abstract available online at |interscience.wiley.com/journal|/arthritis.

LEARN MORE about rheumatoid arthritis at arthritis.org and mayoclinic.com.

THE QUESTION: In laboratory experiments, it appears that statins - which are taken to lower cholesterol and prevent heart disease - might also prevent cancer by inhibiting the growth and spread of tumors. Has evidence of this emerged among the millions of Americans who take this drug every day?

THIS STUDY analyzed medical data on 79,994 women, with an average age in the mid-60s, who were cancer-free at the start of the study. During a 12-year period, breast cancer occurred in 3,177 of the women, including 1,727 who took statins. Those taking statins were no more - and no less - likely to have breast cancer than women not taking the drug. The length of time statins were taken did not alter the results.

WHO MAY BE AFFECTED BY THESE FINDINGS? Women who take statins. Women are more apt to be taking this type drug, as they generally have higher cholesterol levels than men.

CAVEATS: The study did not differentiate among different types of statins, and it did not consider other forms of cancer. It remains unclear whether taking the drug for longer than 12 years would affect the results.

Supplements May Help Knee Arthritis New Studies Give Mixed Signals About Glucosamine, Chondroitin Benefits

2005-11-15T12:49:00.000-08:00

Nov. 14, 2005 -- Arthritis sufferers may -- or may not -- benefit from a pair of popular dietary supplements, two new clinical trials suggest.

One supplement is glucosamine, derived from the shells of crabs and lobsters. The other is chondroitin, usually derived from animal cartilage. These supplements are said to help relieve arthritis pain. They are also said to prevent the arthritic joint narrowing that causes one bone to grind against another.

Do these supplements really work? That is what two clinical trials -- a 1,583 patient study in the U.S. and a 318 patient study in Europe -- tried to find out. Researchers reported results from both studies at this week's annual scientific meeting of the American College of Rheumatology in San Diego.

"The supplements were not better than the placebo," Daniel O. Clegg, MD, tells WebMD. Clegg, chief of rheumatology at the University of Utah in Salt Lake City, led the NIH-sponsored U.S. study.

Arthritis Foundation spokesman Erin Arnold, MD, has a different interpretation. Arnold, a rheumatologist with the Illinois Bone and Joint Institute in Morton Grove, Ill., notes that Clegg is focusing on the study's overall results. She says she is more impressed with the study's finding that patients with more severe arthritis pain got significant relief from the glucosamine-chondroitin combination.

"I am very encouraged by the results of this study," Arnold tells WebMD. "The data presented certainly does not deter me from encouraging patients to try glucosamine and chondroitin."

There is less controversy over the smaller, European study led by Gabriel Herrero-Beaumont, MD, of the Jiminez Diaz Foundation in Madrid, Spain.

"Our results confirm previous studies," Herrero-Beaumont tells WebMD. "They demonstrate clearly that glucosamine was able to control knee osteoarthritis pain."

Glucosamine + Chondroitin: For Bad Arthritis Pain Only?

Glucosamine + Chondroitin: For Bad Arthritis Pain Only?

The U.S. trial enrolled patients aged 40 and older with knee pain due to osteoarthritis. They were randomly assigned to one of five treatments:

Inactive placebo pills
Glucosamine hydrochloride at a dose of 500 milligrams three times a day
Sodium chondroitin at a dose of 400 milligrams three times a day
Combination glucosamine and chondroitin
Celebrex at a dose of 200 milligrams per day

It is common for a pain study to show that many patients report relief from inactive placebo pills. And that happened here. Nearly 60% of patients given only placebo pills said they had less pain. So did about 67% of patients treated with combination glucosamine and chondroitin. But that isn't what scientists call a significant difference -- that is, there's more than a 5% chance the findings are just coincidence.

"I really feel the study is a negative study," Clegg says. "I would say to patients that the safety data are really reassuring, the efficacy data are not."

When Clegg's team looked only at patients with moderate to severe pain. Only 54% of these patients got relief from placebo. But 79% reported relief from combination glucosamine and chondroitin. That is a significant difference. But there's a problem, Clegg says. The study wasn't designed to look at just this group. The effect here is based on only a small number of patients.

"About 20% of the study patients have moderate to severe pain," Clegg says. "Interestingly, in that subgroup, the combination of glucosamine and chondroitin appeared to be effective in relieving pain. I think this outcome is really interesting but just from a research standpoint. It is an exploratory, hypothesis-generating finding -- not a finding on which to base treatment."

Different Opinions on U.S. Study

Different Opinions on U.S. Study

The Arthritis Foundation says that the Clegg study "demonstrates that the combination of glucosamine and chondroitin may be a beneficial part of an overall treatment plan in individuals with moderate to severe knee osteoarthritis."

This conclusion did not change after conversations with Clegg, Arnold says.

"Based on the data we have had -- and on the use of glucosamine and chondroitin in clinical practice -- we think there is enough there to give glucosamine and chondroitin a try," she says. "It is safe."

The study isn't the first to show that glucosamine and chondroitin help arthritis, says Andrew Shao, PhD, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a supplement industry trade group.

"There are at least 50 published clinical trials on either one of these supplements or the combination, with various relevant health outcomes, such as improved joint pain and improved joint space," Shao tells WebMD. "It's important to keep in mind these products support joint health. It is not necessary to restrict use to osteoarthritis sufferers. Although the research is not done yet, they might be useful for arthritis prevention, too."

Glucosamine Better Than Tylenol?

A more consistently positive result comes from the European study. This clinical trial randomly treated knee osteoarthritis patients with either glucosamine sulfate (one 1,500-milligram dose daily), acetaminophen (the active ingredient in Tylenol, given at the high dose 1,000 milligrams three times daily), or inactive placebo.

After six months of treatment, patients getting either glucosamine or acetaminophen had significantly less pain than patients getting placebo pills.

But researcher Herrero-Beaumont says that patients treated with glucosamine reported more kinds of improvement than those treated with acetaminophen.

"Glucosamine showed more positive effects than placebo in 10 of 10 measures, whereas acetaminophen was more positive than placebo in only five of the 10," he says. "But there was no statistical significance between glucosamine and acetaminophen."

Things to Know

Things to Know

Herrero-Beaumont says that because glucosamine is extremely safe, he recommends it to patients with arthritis. But since there's some evidence that the supplement accumulates in the body, he says he advises patients to use it in three-month-on, two-month-off cycles.

Arnold says she has yet to see any safety concerns with either glucosamine or chondroitin. She recommends that patients give it a try -- with the advice of their doctors.

"There are things that work for certain patients that don't work for others," she says. "Based on safety, I would continue to encourage my patients to use glucosamine and chondroitin. Some of my patients who use these supplements have been able to use [fewer] anti-inflammatory and pain medications."

Arnold is quick to warn that supplements will not cure arthritis -- and that they are only a part of a multiprong treatment.

What does Arnold tell her patients?

"I recommend first of all that they try only products evaluated by Consumer Laboratories or USP to make sure they have in them what they are supposed to have," she says. "Then I tell them to take half the dose in the morning and half in the evening. And I have them do at least a three-month trial before giving up."

Industry spokesman Shao says patients should be patient.

"Glucosamine and chondroitin are very different from some drugs used to relieve arthritis pain," he says. "Rather than mask pain, they are actually fixing the joint. But that takes time. It does not kick in after a few hours or days. It takes months for the effects to manifest."

Lupus, Rheumatoid Arthritis Raise Pregnancy Risks

2005-11-15T12:47:00.000-08:00

Robert Preidt

TUESDAY, Nov. 15 -- Pregnant women with lupus or rheumatoid arthritis may experience more pregnancy complications and longer hospitalizations than other women, a new study finds.

Stanford University researchers analyzed 2002 data from the Nationwide Inpatient Sample, which contains discharge records from representative U.S. hospitals. The researchers compared delivery outcomes and hospitalizations for nearly 3,300 women with lupus and more than 1,400 women with rheumatoid arthritis to women in the general population.

Reporting at this week's annual scientific meeting of the American College of Rheumatology in San Diego, they found that women with lupus had twice the rate of hypertensive disorders, compared to women with rheumatoid arthritis. Women with either lupus or rheumatoid arthritis had higher rates of hypertensive disorders than pregnant women in the general population.

Women with lupus or rheumatoid arthritis also faced higher rates of intrauterine growth restrictions and Cesarean delivery, the study said.

"Women with either lupus and/or rheumatoid arthritis are typically somewhat older when they become pregnant," researcher Dr. Eliza F. Chakravarty, assistant professor of medicine with Stanford's division of immunology and rheumatology, noted in a prepared statement.

"However, even after adjusting for maternal age, they run a higher risk for adverse outcomes and generally experience longer hospital stays than other women. As a result, they should be monitored carefully for the length of their pregnancies," Chakravarty said.

Rheumatoid arthritis, cannabis-based medicine relieves the pain and suppresses the disease

2005-11-14T15:55:00.000-08:00

A study has found that cannabis-based medicine ( CBM ) for treating rheumatoid arthritis has a significant effect on easing pain and on suppressing the disease.

The researchers say that although the differences were small and variable in the group of 56 patients they studied, the results are statistically significant and a larger trial is needed to investigate in more detail the effects of cannabis-based medicine on the disease which affects approximately 600,000 people in the UK.

There is anecdotal evidence that cannabis can provide pain relief for people with rheumatoid arthritis ( RA ), and in a recent survey 155 (16%) of 947 people who obtained cannabis on the black market for medicinal reasons said they did so to obtain relief from symptoms of rheumatoid arthritis.

However, this study in Rheumatology journal, led by David Blake, at the Royal National Hospital for Rheumatic Diseases ( RNHRD ), Bath, and the University of Bath, UK, is the first randomised controlled trial to investigate the effect of a cannabis-based medicine on rheumatoid arthritis.

In the double-blind trial, the researchers randomised 31 patients to receive the CBM ( brand name: Sativex ) and 27 the placebo.

The cannabis-based medicine was in the form of an easy-to-use mouth spray that patients could administer themselves up to a maximum of six doses a day.
Sativex consisted of a blend of whole plant extracts, standardised for content, that delivered approximately equal amounts of two key therapeutic constituents from the cannabis plant: delta-9-Tetrahydrocannabinol ( THC ) and cannabidiol ( CBD ).

Mouse studies have shown that THC and CBD have anti-inflammatory effects, and that CBD blocked progression of RA and produced improvements in symptoms.

Ronald Jubb, at the University Hospital Birmingham NHS Foundation Trust, UK, said: " Patients had a baseline assessment at the beginning of the trial and then were randomised to receive either the cannabis-based medicine or placebo. Patients only took the doses in the evening in order to minimise possible intoxication-type reactions. The starting dose was one actuation within half an hour of retiring, and this was increased by one actuation every two days to a maximum of six doses according to individual response over a period of two weeks. Stable dosing was then maintained for a further three weeks."

The researchers found that in comparison with the placebo, patients who had taken Sativex had statistically significant improvements in pain on movement, pain at rest, quality of sleep, inflammation ( measured by a Disease Activity Score involving 28 joints – DAS 28 ) and intensity of pain ( measured by the Short-Form McGill Pain Questionnaire SF-MPQ ).

For instance, on a score of 0-10 where 0 is no pain, CBM patients on average moved from 7 to 4.8 for pain on movement ( placebo patients moved from 6.7 to 5.3 ), 5.3 to 3.1 ( placebo 5.3 to 4.1 ) for pain at rest, and 5.7 to 3.4 ( placebo 5.8 to 4.6 ) for quality of sleep. On the DAS 28 score of 0-10, the CBM patients moved from 5.9 to 5 ( placebo 6 to 5.9 ), and on the SF-MPQ score of 0-100 for intensity of pain at present, the CBM patients moved from 48 to 33, while the placebo patients remained unchanged at 50.

Adverse side effects were mostly mild or moderate ( e.g. dizziness, light-headedness, dry mouth, nausea). Of the eight patients who experienced mild dizziness, in four patients this occurred during the initial two-week period when they were gradually increasing the doses, and two occurred two days after this initial period, so these were probably due to patients getting used to the correct dose. No patients taking Sativex had to withdraw from the trial due to adverse side effects, but three did from the placebo group.

Philip Robson, at the Oxford University and Director of the Cannabinoid Research Institute within GW Pharmaceuticals ( the manufacturer of Sativex ), explained: " Withdrawals from the placebo group were probably due to a psychological effect, a spontaneous occurrence, or a reaction with another medicine."

Jubb said: " The results from the first controlled study of cannabis-based medicine in rheumatoid arthritis are encouraging, with overall improvements in pain on movement and at rest, improvement in the quality of sleep and improvement in the overall condition of the patients' arthritis. Whilst the differences are small and variable across the patient group, they represent benefits of clinical relevance and indicate the need for more detailed investigation through larger trials to see exactly where cannabis-based medicine could be best used with minimum side effects."

If further trials are run, researchers will probably extend the dosing period over the full 24-hour period. Robson said: " The beneficial effects in this study occurred in the context of a dosing regime restricted to evening dosing in order to minimise any possible intoxication-type reactions. However, 24-hour dosing with Sativex, using a self-titration regime, in trials for multiple sclerosis resulted in only minimal intoxication scores."

He continued: " The element that can cause the 'high' in cannabis – THC – also has valuable pharmacological activity. It is thought to be an essential therapeutic component and therefore it can't be removed from the medicine. However, the method of giving the doses, via the mouth spray, and the principle of self-titration, where each patient gradually determined their own optimal dose level up to a maximum of six doses a day, minimised the risk of intoxication."

Robson said that fears that the cannabis-based medicine could be abused by patients hoping to get a "high" were probably unfounded. " It seems that in practice this is a very rare event. More than 1,000-patient years of treatment with Sativex in clinical trials have been accumulated and to date there has not been a single documented case of abuse. The fact is that the motivation of medicinal users of cannabis-based medicine is entirely different from recreational users: the former simply want symptom relief and the ability to go about their normal lives, and for them intoxication would be a distinct disadvantage; for the latter, smoking marijuana is infinitely more intoxicating than Sativex and is still easily available."

Selenium 'could delay arthritis'

2005-11-14T15:54:00.000-08:00

Lack of the super-mineral selenium may cause arthritic knees, say US scientists.

A research team from the Johnston County Osteoarthritis Project found a lack of selenium - which is commonly found in foods like tuna, Brazil nuts and eggs - could explain why some people develop arthritis in their knees.

Even the tiniest amounts selenium could protect against arthritic knees, it was found in a study of 940 volunteers.

For every tenth of a part per million of selenium present in the body, individuals were found to have a 15 to 20 per cent reduction in risk from arthritis.

In addition, the research team compared the severity of knee arthritis in each volunteer with amount of selenium in their body, finding that those with the highest levels of selenium in their bodies had up to 40 per cent more protection against osteoarthritis developing in their knees.

Lead researcher Dr Joanne Jordan, from the University of North Carolina in Chapel Hill, said: "Our results suggest that we might be able to prevent or delay osteoarthritis of the knees and possibly other joints in some people if they are not getting enough selenium.

"That's important because the condition, which makes walking painful, is the leading cause of activity limitation among adults in developed countries."

Dr Jordan was first alerted to the possibility that selenium deficiency may lead to osteoarthritis when she found people in China who ate selenium-deficient diets commonly developed osteoarthritis.

Previous studies have suggested selenium can help prevent death from lung and prostate cancer.

Those with low selenium levels have also been shown to be at a higher risk of developing asthma.

Arthritis drug's death toll 'four times higher'

2005-11-14T15:53:00.000-08:00

by JENNY HOPE

Up to four times as many arthritis patients as previously estimated may have died or been harmed by the painkiller Vioxx, it has been claimed.

The drug regulator at the centre of a dispute over its safety has vowed to fight attempts to suppress claims that many thousands have died or been seriously injured as a result of taking the drug.

Vioxx was removed from the market by U.S. manufacturer Merck in September when research found that patients had more than twice the risk of cardiovascular problems after 18 months compared with those taking a "dummy" pill.

British patient action

The research by Dr David Graham, an official at the U.S. Food and Drug Administration, has sparked a debate over the entire class of painkillers known as Cox-2 inhibitors. European regulators have ordered a safety review into four similar drugs.

At the height of their popularity, Cox-2s were taken by around 1.4million Britons.

The research will also spur legal action over Vioxx - taken by 400,000 British patients - with around 100 Britons preparing to launch a group action in the High Court within weeks.

Dr Graham raised the alarm over Vioxx in August, despite warnings from his FDA bosses to "downplay" the risks.

He originally estimated that 28,000 Americans had died or suffered heart attacks or strokes as a result of using the drug since it was launched there in 1999.

But a re-analysis of data suggests that that figure is between 89,000 and 139,000.

Dr Graham hopes his updated assessment will be published in The Lancet medical journal, even though he has been threatened with dismissal by the FDA for publishing any paper on the issue.

"The FDA has suppressed the paper and maligned me in the media," he said.

Potential claims

Around 20 class actions have started in the U.S. and analysts estimate the drug company faces a $ 15billion (£7.8billion) bill from U.S. claims alone. So far 100 Britons have approached lawyers with potential claims, including the families of three patients who died, said Martyn Day, one of the solicitors advising them.

The success of the action would depend on proving that the extra risk of harm posed by the drug had emerged before it was withdrawn, said Mr Day.

A spokesman for Merck said it had "meritorious" defences to any lawsuits and had acted in the "best interests of patient safety' throughout the period in which the drug was available.

She said: "Merck conducted well-controlled randomised clinical trials.

"Merck analysed the data from those studies, discussed them with the FDA and regulatory agencies around the world, and disclosed them to the medical and scientific community."

Study Suggests Supplements Don't Help Mild Arthritis Sufferers

2005-11-14T15:51:00.000-08:00

By Randy Dotinga

MONDAY, Nov. 14 -- Thinking about taking the supplements glucosamine and chondroitin as a treatment for arthritis?

Researchers have been debating for years whether that's a good idea. Now, the largest study yet suggests you're better off saving your money unless you have a moderate to severe case of osteoarthritis. And even then it's not clear if the supplements work.

But there's some good news. Glucosamine and chondroitin -- a staple of health-food stores -- may help with moderate to severe pain, U.S. researchers were to report Monday at the American College of Rheumatology annual meeting, in San Diego.

The supplements "seem to be safe, but the bottom line for the overall patient population is that there wasn't a difference" compared to not taking them at all, said study co-author Dr. Daniel Clegg, chief of rheumatology at the University of Utah School of Medicine. He added that the findings were preliminary.

But a smaller European study came to an opposite conclusion, suggesting that glucosamine may actually work better than the painkilling ingredient in Tylenol.

An estimated 21 million adults in the United States have osteoarthritis, which is caused by wear and tear on cartilage in the joints. Some evidence has suggested that glucosamine, a natural substance found in bone, helps the body repair itself. Another natural substance, called chondroitin sulfate, has also been considered a possible arthritis reliever.

Over-the-counter and prescription painkillers can help relieve the pain of arthritis, but they don't always make it go away completely.

In the new U.S. study, researchers followed almost 1,600 patients with painful knee osteoarthritis for six months. The patients were randomly assigned to different treatments -- glucosamine hydrochloride, chondroitin sulfate, the painkiller celecoxib (Celebrex), or a placebo. Regardless of what drug or supplement they took, they were allowed to take daily doses of the painkiller acetaminophen (Tylenol).

Celecoxib relieved pain, but the supplements did not for a majority of the patients, and neither of them did a better job than a placebo, Clegg said.

However, there is a glimmer of hopeful news. The study indicated that a combination of glucosamine and chondroitin might help patients with moderate or severe osteoarthritis. Those patients made up about 20 percent of participants in the study; the other 80 percent had milder forms of the disease, Clegg said.

"From a research standpoint, these are really interesting results," he said. But the findings are only preliminary. "I think we need more information," he added.

In response to the research, the Arthritis Foundation said in a statement that it "believes that, based on the findings from this study and the supplements' safety and cost-effectiveness, the combination of glucosamine and chondroitin should be considered by patients and physicians as part of an overall treatment plan for painful knee OA. Further research is needed to determine exactly how glucosamine and chondroitin work, as well as the possible effectiveness of these supplements on limiting the progression of cartilage damage."

In the second study, also to be released at the American College of Rheumatology conference, European researchers were to report that glucosamine sulfate -- a different form of the supplement than used in the American study -- did a better job of treating pain from knee arthritis than acetaminophen. The study looked at 318 patients, mostly women, who took the supplement, acetaminophen or a placebo.

In other arthritis news, researchers were to report Tuesday at the rheumatology meeting that they've uncovered an apparent link between the mineral selenium and arthritis in patients.

Selenium is found in corn, wheat, soybeans, animal products and other foods, the researchers said. In some parts of the world, selenium deficiency has been connected to arthritis.

Researchers decided to look at an American group of arthritis patients by analyzing toenail clippings from 940 residents of Johnson County, a semi-rural region of North Carolina. Selenium builds up in toenails over time, allowing researchers to estimate the levels of the mineral.

The findings? "The lower the selenium level, the more likely you were to have more severe arthritis. And you were more likely to have it in both knees instead of one," said Dr. Joanne M. Jordan, associate professor of medicine and orthopedics at the University of North Carolina.

It's not clear if selenium supplements would help treat or prevent arthritis. Most Americans get enough in their diets, Jordan said.

Still, the study "gives us the idea of something we can go after to help people with their arthritis," she said.

Cold Seasons Boost Rheumatoid Arthritis Pain

2005-11-14T15:49:00.001-08:00

MONDAY, Nov. 14 -- Many rheumatoid arthritis (RA) patients believe changes in the seasons trigger fluctuations in their symptoms, and now a study out of Japan appears to support that view.

Specifically, the study found that the pain of RA rises as seasonal temperatures fall.

"Physicians can easily dismiss seasonal changes as having an impact on patients with rheumatoid arthritis yet, in reality, the differences in weather and climate are having an impact," researcher Dr. Noriko Iikuni, of the Institute of Rheumatology, Tokyo Women's Medical University, said in a prepared statement.

Her team reviewed data collected from more than 1,800 RA patients between October 2001 and April 2004. The volunteers averaged nearly 58 years in age and had suffered from RA for an average of over 10 years.

The study looked at the patients' disease activity, score, tender joint count, swollen joint count, health assessment questions, pain scale, laboratory test results that indicated amount of pain and inflammation, and response to treatment.

Both subjective and objective results indicated that the RA patients experienced a significant decrease in RA activity from spring to fall, and an equally marked increase from fall to spring.

"For the majority of rheumatoid arthritis sufferers, the period between fall to spring will give rise to more problems whereas symptoms will ease between the spring and fall. Awareness of this very real influence on these patients should play a role in more effective treatment management," Iikuni said.

The findings were to be presented Monday at the annual scientific meeting of the American College of Rheumatology, in San Diego.

How To Find Early Symptoms For Rheumatoid Arthritis

2005-11-11T15:38:00.000-08:00

How To Find Early Symptoms For Rheumatoid Arthritis
By Mike Herman

If you find your joints are warm, tender, or swollen, these may be early symptoms for rheumatoid arthritis.

This condition affects approximately one percent of the United States' population and generally more prevalent in women than men.

Early symptoms for rheumatoid arthritis generally occur between 25 and 50 years of age, but can show up in individuals under the age of 16.

The exact causes of rheumatoid arthritis are unknown, as is any possible cure.

There are a variety of treatments for this condition that can ease pain and suffering, as well as contribute to the overall quality of life in the patient.

If early symptoms of rheumatoid arthritis are correctly identified and treatment begins immediately, there is a greater success rate for controlling this condition before it becomes acute.

Possible examples of symptoms include a general feeling of bursitis, effusion, warmth, swelling, edema, and subcutaneous nodules found in the fingers.

Many doctors believe this condition is caused from some sort of interior trigger.

Although this condition does not cause a direct mortality in patients, sufferers tend to experience a general downward spiral in regards to their health. Much like this condition, these problems may not have a cure, but have a treatment.

Additionally, sufferers are more likely to experience an infection or some sort of secondary organ condition. As the condition becomes more acute, these additional problems are more likely to surface.

If you have identified any early symptoms, contact your primary care provider.

He or she may be able to rule out any potential causes and correctly identify the problem.

Discover treatment options and see how you DON'T have to give up and just 'live with pain and discomfort' Arthritis Relief and Prevention & Arthritis Type of Problems

Findings Bring New Hope for Millions of Americans Suffering from Arthritis

2005-11-10T16:30:00.000-08:00

Initial Results of National Institutes of Health (NIH) Funded Study Reveal Glucosamine and Chondroitin Effective in Treating Moderate to Severe Osteoarthritis Knee Pain

CARSON, Calif., -- For 21 million Americans hobbled by osteoarthritis, new science confirms nutritional supplements glucosamine and chondroitin are the right combination for effective knee pain relief(1). The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), funded by NIH, rigorously evaluated the efficacy and safety of glucosamine and chondroitin in 1,258 people, concluding in its abstract that the "combination of glucosamine and chondroitin sulfate is effective in treating moderate to severe knee pain due to osteoarthritis."

GAIT lead researcher Daniel O. Clegg, M.D., Professor of Medicine and Chief of Rheumatology at the University of Utah, will present findings from the full study on November 14, 2005 at the American College of Rheumatology's Scientific Meeting in San Diego, California.

"GAIT brings good news to adults suffering from the wear and tear of cartilage degeneration, particularly those who cannot tolerate the side effects of taking nonsteroidal anti-inflammatory drugs (NSAIDs)," said C. Thomas Vangsness, Jr., MD, Professor Orthopaedic Surgery, Keck School of Medicine, University of Southern California. "For years glucosamine and chondroitin have been well recognized alternative solutions to pharmaceutical options in treating osteoarthritis patients in Europe, Asia and Russia. In fact, preliminary results reported in the GAIT abstract indicated glucosamine and chondroitin were found to be more effective than Celebrex® in treating moderate to severe knee pain. Clearly, the GAIT abstract suggests glucosamine and chondroitin together may be a good non-surgical pain relief choice for arthritis patients," added Dr. Vangsness.

Funded by NIH, the $14 million GAIT study is the largest placebo controlled, double blind, clinical trial ever conducted to test the effectiveness of glucosamine and chondroitin. All 1,258 patients who completed the study were over the age of 40 with knee pain and randomly assigned placebo; glucosamine 1500 mg; chondroitin 1200mg; glucosamine/chondroitin at above mentioned doses; or celecoxib (Celebrex) 200 mg daily for 6 months. The abstract published each treatment group's response rate to pain. Of note, the group taking the glucosamine/chondroitin combination experienced greater relief for the treatment of moderate to severe knee pain than the Celebrex group.

GAIT was designed to test the safety and efficacy of glucosamine and chondroitin alone and in combination in reducing knee pain associated with osteoarthritis. The study's abstract concluded that when taken together, "glucosamine and chondroitin is effective in treating moderate to severe knee pain due to OA [osteoarthritis]."

Naturally occurring in the body, glucosamine stimulates the production of cartilage, the connective tissue which cushions joints. Chondroitin is also naturally occurring in the body and like glucosamine stimulates the production of cartilage. Previous research indicates glucosamine is just as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in reducing osteoarthritis pain and has fewer gastrointestinal side effects than NSAIDs.

Store brand nutritional supplements offer consumers the highest quality product at the best value. On average, double strength glucosamine(500mg)/chondroitin(400mg) sells for 35% less than brand name double strength glucosamine/chondroitin products and triple strength glucosamine (750mg)/chondroitin (600mg) sells for about 15% less than higher priced brands. Consumers can find store brand glucosamine and chondroitin products at the nation's leading retailers.

Nearly 1 in 3 Americans (nearly 70 million) live with some form of arthritis, costing the United States $82.5 billion a year in healthcare costs related to treating the illness.(2) For arthritis knee pain sufferers who find relief in taking glucosamine and chondroitin, they will also find the supplements to be great values. Widely used in Europe for years to treat osteoarthritis, glucosamine and chondroitin are safe and effective nutritional supplements, as proven by the GAIT abstract.

Marijuana-based Medicine Helps Arthritis

2005-11-09T19:45:00.000-08:00

Doctors who tested a medicine made from a marijuana plant on people with rheumatoid arthritis (RA) found it helps ease pain and may also suppress the progression of the disease.

While noting the cannabis-based medicine (CBM) produced only small and variable benefits in this small study of 58 patients with RA, the investigators believe the treatment holds promise.

"The results from the first controlled study of CBM in rheumatoid arthritis are encouraging, with overall improvements in pain on movement and at rest, improvement in the quality of sleep and improvement in the overall condition of the patients' arthritis," says Dr. Ronald Jubb, from the University Hospital Birmingham NHS Foundation Trust in England.

People in the study self-administered the drug via a mouth spray and were instructed to use it only in the evening to avoid any intoxication effect. Researchers mention, however, it's unlikely medicinal users of cannabis would actually get high from using the medication on a regular basis, noting there has never been a documented case of abuse for this particular drug.

Researchers say cannabis was first proposed as a treatment for rheumatic diseases as long ago as 2800 BC. More studies are planned to determine the effects of the medication.

Cannabis relieves arthritis pain

2005-11-09T19:44:00.000-08:00

According to Doctors at the Royal National Hospital for Rheumatic Diseases in Bath, Cannabis could be used as a legitimate treatment for rhuematios arthritis, as well as the many other diseases it's believed to provide relief for.

Raising hope for 60'000 rhuematoid arthritis sufferers in the UK, reseaerchers have said that it could significantly reduce the symptoms of the disease, including the inevitable pain.

It's was also found to increase the quality of sleep and ease inflammation. Previous studies have found it to be an effective treatment for Crohn's disease, Multiple sclerosis, and, surprisingly, as an appetite supressant.

Researchers insist that the 'high' is a valuable part of the therapy and cannot be removed.

During the study, David Blake, professor of bone and joint medicine at the Royal National Hospital for Rheumatic Diseases, took 56 patients who were suffering from arthritis. Monitored over 49 days, half were taking leading cannabis-based medcine 'Sativex', the other took a placebo

Patients took the medicine in the evening via a mouth spray and started with one dose, gradually building up to a maximum of six doses.

On a scale of 0-100, patients in the placebo group estimated that their level remained the same at 50, whilst those who were given sativex estimated that ther pain went down from 48 to 33.

Researchers now want to conduct wider research to back up the findings

Scottish woman awarded £1.2 million for food poisoning

2005-11-09T19:43:00.000-08:00

A former midwife who was left crippled by salmonella after eating in a Chinese restaurant in Scotland was given £1.2 million in compensation today.

Margaret-Ann Reynard, 40, suffered devastating food poisoning after visiting Latours, a Chinese restaurant in East Kilbride, Lanarkshire, on her 35th birthday.

Today, the Court of Sessions in Edinburgh awarded Mrs Reynard the damages after hearing how her career and plans to start a family were left in ruins when she developed debilitating reactive arthritis as a result of the infection.

At an earlier hearing, Exquisite Quisine, the company that ran Latours, which has now closed, admitted liability for Mrs Reynard's illness.

"I’m happy about the award but I would give all the money away to have my old life back," Mrs Reynard told the Scottish Press Association. "This has robbed me of all my health, hopes and dreams. The mental and physical agony has been devastating."

"I loved my job, I lived for my work being a midwife and delivering babies but I can never do that or any work ever again. I wanted to start a family with my husband and have babies of our own but I can’t because the drugs I have to take for the rest of my life are too toxic for pregnancy," she said.

Mrs Reynard ate a meal of chicken, egg fried rice and sweet and sour sauce at Latours on October 14, 2000. In the days afterwards, she was admitted to hospital, where she suffered 17 days of diarrhoea and a terrible swelling of her joints.

After taking time off, Mrs Reynard tried to returned to her job but last year she was forced to retired from her post with Ayrshire and Arran Health Board on the grounds of ill-health.

Today, Mrs Reynard, who walks with a stick and needs full time care, was awarded £1,243,082 in damages, which included £627,730 for the loss of her earnings as a midwife until her retirement and pension rights. She was also awarded £397,304 for the cost of caring for her in the past and in the future.

Maryland-Based Device Helps Arthritis Sufferers

2005-11-08T19:16:00.000-08:00

Revolutionary technology developed here in Maryland is giving arthritis patients greater mobility.

Knee arthritis effects about 10 million people in this county. It involves the breakdown of the cushion in the knee known as cartilage. Lost cartilage can make the bones grind together causing pain, swelling and limited motion. Now, patients all over the country are benefiting from a locally created device.

The Bio-1000 looks like a leg brace - but it's actually a pulsed electrical stimulation device.

The device stimulates the cartilage cells and relieves pain, stiffness and functional problems associated with osteoarthritis.

Patients wear the battery powered device daily for six hours. Studies show the results are dramatic.

The treatment was created by Bionicare Medical Technologies - which is based in Sparks, Maryland.

The device is approved by the Food and Drug Administration. However, since it's a new technology, not all insurance companies are covering it.

Patients can rent the Bio 1000 for $37 a month.

There are no major side effects associated with the Bio system. It may not be suitable for patients who have pacemakers.

Viagra Fights Blood Vessel Disorder

2005-11-07T16:07:00.000-08:00

Viagra may ease symptoms of a circulatory disorder called Raynaud's phenomenon, a small German study finds.

Raynaud's phenomenon, which affects 3 million to 5 million people worldwide, occurs when cold temperatures or stress cause small blood vessels in the skin to constrict, resulting in numbness, tingling and pain in toes and fingers. In severe cases, there's a risk of ulcerations.

As reported in the Nov. 8 issue of Circulation, researchers at the University of Saarland compared outcomes in 16 patients (mostly women) with severe Raynaud's who did not respond to standard treatment with drugs used to help dilate blood vessels.

The patients received either Viagra or a placebo for four weeks, and were then switched to the opposite treatment for another four weeks.

Viagra reduced the frequency and duration of Raynaud's attacks, improved capillary blood flow, and helped heal chronic toe and finger ulcerations, the study found.

Patients taking Viagra had an average of 35 Raynaud's attacks compared to an average of 52 among patients taking the placebo. Total duration of attacks averaged 581 minutes among patients taking Viagra, compared to 1,046 minutes among patients taking the placebo.

During treatment with Viagra, average capillary blood flow velocity more than quadrupled, and patients taking the drug reported less pain.

This is the first evidence from a controlled study that Viagra is effective in patients with treatment-resistant Raynaud's. Viagra works by causing blood vessels to dilate, using a mechanism that's different from that of other vasodilator medications.

Lifestyle changes the key to managing arthritis

2005-11-07T16:05:00.000-08:00

Lifestyle changes the key to managing arthritis

Lifestyle changes such a regular exercise, weight loss, improved nutrition and giving up smoking are important management factors for the more than six million Australians reported to have arthritis, a musculoskeletal condition or back pain, according to a report launched by the Minister for Ageing, Julie Bishop.

The report, Arthritis and Musculoskeletal Conditions in Australia 2005, prepared by the Australian Institute of Health and Welfare, provides an overview of these conditions.

“For the first time, we have a report that provides clear information on the extent of a major health issue that impacts on the lives of so many Australians,” Ms Bishop said.

“Arthritis encompasses a diverse group of diseases and conditions that involve inflammation of the joints, causing pain, stiffness and disability. Almost 1.2 million people with arthritis are reported to have some form of disability that limits mobility and activity. One of the major preventable risk factors is obesity.

“Osteoarthritis is a problem for nearly 1.4 million Australians – mainly affecting the hands, spine and weight-bearing joints such as hips, knees and ankles. As a progressive disease, over time the pain becomes more severe and incapacitating. Yet it can be prevented with weight control and precautions to avoid sporting injuries, for example.

“Rheumatoid arthritis, the most common autoimmune disease in Australia, affects around 438,000 people – including a large proportion of women. This disease involves inflammation of the joints, most often affecting the hands.”

Ms Bishop said the number of people affected and the extent of resulting disability led to Australia’s state and federal health ministers declaring the conditions a National Health Priority Area in July 2002.

“A National Action Plan has been developed to implement relevant strategies and a National Centre for the Monitoring of Arthritis and Musculoskeletal Conditions has been established, with $500,000 in Australian Government funding, to conduct regular surveillance and monitoring of the conditions in Australia.”

Copies of the report can be obtained from the Australian Institute of Health and Welfare’s website, www.aihw.gov.au.

Bextra and Vioxx -- Tips for Arthritis Relief Without Them

2005-11-06T17:44:00.000-08:00

Bextra and Vioxx -- Tips for Arthritis Relief Without Them
By Charles Essmeier

The recent withdrawal of Vioxx and Bextra from the marketplace, due to concerns over unwanted side effects, has many arthritis sufferers concerned. These drugs, which belong to a powerful class of non-steroidal anti-inflammatory drugs known as COX-2 inhibitors, are quite effective at fighting the pain and inflammation of arthritis. Unfortunately, they have been linked to increased risk of strokes and heart attacks. Their manufacturers have voluntarily withdrawn them from the market.

There are still alternative medications available, such as Celebrex, and traditional medications, such as aspirin or ibuprofen. Aspirin and ibuprofen may not be suitable for everyone, as they can cause stomach discomfort in some people. While a good anti-inflammatory can certainly provide more comfort for arthritis pain, there are some non-medicinal steps that patients can take that may provide some relief from their pain.

Get plenty of rest. Your body works best when it’s well-rested, and it’s a well-known fact that most Americans fail to get the recommended seven to eight hours of sleep each night.

Exercise. Joints and muscles work best when they’re well toned, and that is true for arthritis sufferers as well as the public at large. Not all exercises will be appropriate, however. A patient with arthritic knees will probably not benefit from playing basketball or tennis. Low impact exercise like walking or water aerobics may help, however. Patients with arthritis are advised to discuss exercise options with their physician.

Watch your weight. Arthritic joints work best when they aren’t overly burdened. If you are overweight, you are making a bad situation worse by forcing your joints to work harder than they otherwise might. A loss of just a few pounds could make a huge difference, especially if you suffer from arthritic knees.

These tips are certainly not intended to be a substitute for medication, but with a chronic condition like arthritis, every little bit that you can do to ease the stress on your aching joints can provide a bit more relief.

©Copyright 2005 by Retro Marketing. Charles Essmeier is the owner of Retro Marketing, a firm devoted to informational Websites, including Bextra-Info.net, a site devoted to the withdrawn drug Bextra and StructuredSettlementHelp.com, a site devoted to structured settlements.

Time is critical when diagnosing rheumatoid arthritis

2005-11-06T12:11:00.000-08:00

Time is critical when diagnosing rheumatoid arthritis

A. Arthur Steele

This week's column continues the discussion of rheumatoid arthritis (RA). Treatment for RA has totally changed from 15 or so years ago. Modern management is best accomplished by the team of your primary physician, a rheumatologist and physical therapist, with occasional extra help from a nutritionist and, sometimes, a surgeon.

Treatment must be as aggressive as the individual case of RA. Bone erosion can begin within the first three months of the onset. The initial evaluation has two purposes: to be sure the arthritis is RA, and to assess how severe and progressive it is. Time is critical.

Only if there are no serious signs can doctors be content with the traditional drugs. Aspirin, ibuprofen and all the other NSAIDS may be fine if they give adequate relief and if there are no signs of early destruction. NSAIDS can be subtle in injuring the stomach, so the doctor and the patient must be very sensitive to that possibility.

Immediate use of "disease modifying anti-rheumatic drugs" (DMARDs) is the current standard of practice. These drugs work by different mechanisms. Often your doctor will use two or more simultaneously. For example, prednisone (Deltasone, and other brand names), works right away to reduce the inflammatory process. Since other DMARDs can take weeks to modify the inflammatory reaction, prednisone can stop the disease quickly, and the doctor can taper it away later.

What are the DMARDs? There are several and they often work together. They fall into groups. The first group is those drugs that interfere with the metabolism of cells. These are "immunosuppressants." They work by slowing the immune system response that is destroying the joint. First, methotrexate is the single most effective drug. Forty percent of patients will have adequate control of their RA with this. Used correctly, methotrexate has very little toxic side effects. There are several other drugs in this group.

The second group of drugs block a protein that calls more inflammatory cells into the joint. These are known as "cytokines." This group of drugs are known as "ILK blockers." ILK stands for "interleukin-1." The first of these is anakinra (Kineret). This is taken as an injection beneath the skin, twice a day.

The third group of DMARDs block "tumor necrosis factor." TNF blockers include eternacept, infliximab and adalimumab. These drugs, like the immunosuppressants, and the ILK blockers, all cause immune suppression and therefore make people more vulnerable to infections.

As you can see, the modern treatment of rheumatoid arthritis has become so complex, that a rheumatologist should be involved early in the management. Ask your primary doctor for his/her recommendation.

Miracle arthritis cure?

2005-11-04T16:21:00.000-08:00

- You may have seen the full page ads in your local newspapers, but you'll be hard-pressed to find it on store shelves. Australian Dream Arthritis Cream claims to ease your pain in 15 minutes. Medical Reporter Jessa Goddard asks, does it work?

The main ingredient in Australian Dream is emu oil. Emus are birds, similar to ostriches. The company claims the oil from these birds may help reduce joint inflammation.

Arthritis affects nearly 70 million people in the United States alone.

The pain can stop you in your tracks. So when a new product claims to lessen pain in 15 minutes, it's tempting.

But local orthopedic surgeon Dr. John Reynolds cautions, as with most products, if it sounds too good to be true... it probably is.

"Based on what I know about scientific literature pertaining to these particular ingredients in this, I would be somewhat surprised if it has that dramatic of an effect,� says Dr. Reynolds.

Still the consumer testimony is compelling, saying:

"It really works. I have terrible nerve pain and it soothes it down in about five minutes."

"I put a little on my knee each day, and can do all the things I used to do. And without pain!"

Emu oil contains linolenic acid, a pain killer and oleic acid, an anti-inflammatory.

Both are used orally to treat arthritis, but topically, Doctor Reynolds says would be the equivalent of rubbing olive oil on your skin.

"And so I don't think rubbing some on one's skin would be any more harmful than rubbing olive oil on one's skin would be, but whether it would be harmful is another question,� says Dr. Reynolds.

Australian Dream's maker, Nature's Health Connection, released this statement to Volunteer TV:

"The active ingredient in Australian Dream arthritis cream is recognized by the Food and Drug Administration as being effective for the relief of arthritis pain."

The full page ad promoting free samples of the cream lists about 70 local drug stores where you can try the product.

The ones we talked to say not only are they out of free samples, they only had a few jars of the cream left on their shelves.

Contradictory immune responses explain different therapeutic effects in rheumatoid arthritis

2005-11-04T16:19:00.000-08:00

ATLANTA -- Using a humanized mouse model that mimics the effects of human rheuma-toid arthritis (RA), researchers have discovered that protein growth factors called cytokines in the immune system have both pro- and anti-inflammatory responses to RA that help explain why some patients respond to current therapy and others don't. By pinpointing the unique immune mecha-nisms involved in different forms of RA, the scientists hope to guide physicians toward more pre-cise individualized diagnosis of RA patients and more effective therapies that target specific forms of the disease.

The findings were published online on October 20 and are reported in the November issue of the Journal of Clinical Investigation. The research was conducted at the Lowance Center for Human Immunology at Emory University School of Medicine, and was led by rheumatologists Cornelia Weyand, MD, PhD, and Jorg Goronzy, MD, PhD. The study's first author was Thor-sten M. Seyler.

Rheumatoid arthritis (RA) is a chronic and crippling inflammatory joint, bone and cartilage disease affecting more than 2.1 million Americans. An autoimmune disease, RA is characterized by an abnormal immune response in which the immune system attacks healthy tissue, causing in-flammation of the lining of the joints, called the synovium.

For the last 20 years researchers, including those at Emory, have worked to identify path-ways and molecules that play a role in RA, resulting in new therapies that target inflammatory growth factors and a marked improvement in treatment success. However, even though not all RA patients respond well to these therapies, they are applied universally, without accounting for differ-ences in disease.

"We need to become much more sophisticated as rheumatologists in understanding that RA is not all the same disease and that when we treat it we will see very diverse results," said Dr. Weyand. "Rheumatologists need to develop diagnostic tools to capture differences in patients that have meaning for the course of disease and for our therapeutic actions."

Drs. Weyand and Goronzy have helped delineate three different subtypes of RA disease over the past ten years. In diffuse RA, T and B lymphocytes seem to infiltrate tissue randomly, re-sulting in autoimmune inflammation. In aggregate synovitis, T and B cells meet each other in ag-gregates and inflame the joints. In germinal center synovitis, T cells, B cells, and other supporting cell populations go into the joints and acquire a highly complex and organized micro-architecture that resembles conditions in an inflamed lymph node.

Many therapies currently used to treat RA patients are based on new knowledge about in-flammatory cytokines �� growth factor-like proteins that stimulate the autoimmune process. Scien-tists have hypothesized that rheumatoid lesions produce excessive amounts of such growth factors, promoting lymphocyte proliferation and keeping alive the immune cells that drive inflammation and perpetuate the autoimmune disease state.

The Emory scientists set out to explore differences in immune responses by using their mouse model to study related types of cytokine protein known for helping B lympocytes survive and differentiate. Two of these proteins, known as APRIL (A proliferation inducing ligand) and BlyS (B-lymphcyte stimulator), are the targets of new experimental drugs currently in early phase clinical trials.

The researchers implanted human tissue from RA patients who had the three different types of disease into mice engineered to lack a natural immune response. They treated the mice with a soluble receptor called TACI that "plucks" the growth factors APRIL and BlyS and "mops" them away from the affected tissue.

The researchers found that in the mice carrying tissue from patients with germinal center synovitis, the inflammatory lymph-node like structures completely collapsed, effectively halting the inflammatory process. However, in the other two types of disease just the opposite happened, and the growth factors and inflammation actually increased.

"This was a very surprising result," said Dr. Weyand. "We found that these two factors do more than just support the growth and differentiation of B cells. They also can bind to T lympho-cytes. In the tissues that had worsening of disease, we found T cells binding APRIL and BLyS, telling us that these T cells had actually been suppressing the disease."

The conclusion? The factors APRIL and BlyS have multiple and complex effects in rheu-matoid arthritis. In some types of disease they are critical in keeping the inflammatory structures working and functioning, while in other types of disease they seem to do just the opposite.

"Physicians and patients already have been aware that some people respond to therapy while others do not," Dr. Weyand says. "Our research helps us explain why. These molecules have both pro- and anti-inflammatory activity, and the trial-and-error method of treatment may not be best for the patient. The goal of current RA treatment is to suppress the immune system, but we need to recognize that nature has developed anti-inflammatory pathways that we may be able to utilize."

Dr. Weyand and Goronzy say the goal of their research is to learn more about physiological ways of downregulating inflammation and strengthening them instead of destroying the entire im-mune response. They also want to develop molecular screening methods to distinguish RA pa-tients, ideally using a simple blood teest.

"We want to move away from making global, unsophisticated diagnoses and design ther-apy plans for patients that match their particular needs," says Dr. Weyand. "We can gain clues from nature about how it inhibits inflammation that will allow us to develop a whole new way of managing the auto-immune response."

Other study authors included Yong W. Park, Seisuke Takemura, from Emory's Lowance Center for Human Immunology; Richard J. Bram, Department of Pediatrics and Adolescent Medi-cine, the Mayo Clinic; and Paul J. Kurtin, Department of Pathology, the Mayo Clinic.

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Lifestyle Choices Help Control Arthritis Pain

2005-11-04T16:17:00.001-08:00

Millions of Americans live with arthritis, which occurs in more than 100 forms and in varying levels of severity.

But even among people with similar signs and symptoms, not everyone copes in the same way. Research has shown that people with a positive, proactive attitude are likely to experience less pain and fewer limitations from their arthritis than those who are more negative. And when people feel in control, they’re more likely to use medical treatment options effectively.

The Mayo Clinic Health Letter October Medical Essay provides a comprehensive look at arthritis and treatment options, including these healthy lifestyle measures that can help people with arthritis cope:

Reduce stress -- Stress increases muscle tension, which can worsen arthritis pain. This can set off a cycle of increased pain, decreased ability to function and greater stress.

Take time to relax -- Meditation, prayer and guided imagery are some ways people calm their minds. Massage, slow and deep breathing, or simply tightening and releasing different muscle groups may help relax muscles. Certain forms of exercise, such as yoga or tai chi, often emphasize relaxation.

Understand your pain -- Learn the difference between pain associated with general joint discomfort and that caused by joint overuse. When pain with a particular activity is excessive, comes on quickly and lasts for more than an hour or two afterward, chances are you’re overdoing it or doing an inappropriate activity.

Know when to rest -- The feeling of fatigued joints may be a signal to back off or change activities. Painful, inflamed joints may temporarily require total rest or even an immobilizing splint. Whole body rest also is important. If you have trouble getting a good night’s sleep, talk to your doctor about strategies to improve sleep. During the day, rest before you become too tired. Plan 10 minutes of rest for every hour of physical exertion.

Use assistive devices -- Many products, such as jar openers, specially designed kitchen knives, devices to extend your reach and aids to help you dress may make common daily tasks less harmful to your joints.

Lifestyle Choices Help Control Arthritis Pain

2005-11-04T16:17:00.000-08:00

Millions of Americans live with arthritis, which occurs in more than 100 forms and in varying levels of severity.

Reduce stress -- Stress increases muscle tension, which can worsen arthritis pain. This can set off a cycle of increased pain, decreased ability to function and greater stress.

Learning to Live with Arthritis

2005-11-03T17:16:00.000-08:00

Learning to Live with Arthritis
By Charles Kassotis

In the United States alone, more than 40 million people suffer from arthritis discomfort. Although many view this condition as a natural part of the aging process, there is no reason why it has to be debilitating. In fact, many doctors help their patients learn to manage arthritis symptoms like pain and stiffness by utilizing a variety of techniques. The first step is to see your doctor for an accurate diagnosis. Bone pain can be a symptom of other medical problems, so it is important to find out if arthritis is the true cause. If so, you can then begin the quest for proper treatment.

Depending on the degree to which you have arthritis and its impact on your lifestyle, you may need to take anti-inflammatory medications that your doctor will prescribe. Always follow the directions carefully and take the medication only as directed. Let your doctor know if you experience side effects or allergic reactions, which might include hives, itching, swelling, or difficulty breathing. Over-the-counter medications likewise may be prescribed so you can take them as needed for sporadic discomfort if the pain has not become chronic or severe.

If you are only beginning to develop arthritis, or if it presents only mild discomfort, you can try other things to help make it more bearable, as well. For example, regular physical exercise is a great way to build bone mass and to promote bodily circulation, both of which can help to control arthritic symptoms. Ask your doctor to recommend the best type of exercise for your condition. People with joint swelling or pain might need to avoid weight-bearing exercise like walking and instead go swimming at the local pool, which helps their bodies to float and thus relieves pressure from the joints and bones.

In addition to medication and exercise as ways of controlling your arthritis pain, you may want to consider herbal remedies, like glucosamine, among others. Some studies suggest that those using certain herbal formulas that are based on glucosamine and related substances may experience less joint pain and swelling. Ask your doctor if this is a good idea for you. There are other herbs that might reduce inflammation and ease joint pain, but check with a medical expert or an herbalist before taking any of these.

People who suffer from chronic conditions like arthritis often benefit from environmental therapies as well. Listening to soothing music or relaxing scents like potpourri can help to relieve stress and reduce discomfort associated with joint pain. Keeping a journal and writing about negative aspects of having arthritis for 15 to 20 minutes at least three days a week has been shown to improve immune function and decrease stress levels. Joining a support group or visiting with friends and family several times a month likewise provides comfort to ease difficult physical symptoms.

Don’t let arthritis keep you down. Take control of your life and your symptoms by trying strategies like these to build a better future.

Want to know more about managing arthritis discomfort? For helpful information, visit The Arthritis Directory at http://www.arthritisdir.com

Do You Have Degenerative Arthritis?

2005-11-02T16:27:00.000-08:00

With 10 million or more people with arthritis, the majority of them will have degenerative arthritis. This arthritis is called Osteoarthritis. Degenerative arthritis occurs when joints are overworked, rub against each other, experience excess friction, and slowly degenerate.

Most joints rub against each other, but bone joints have a protective layer called cartilage. This cartilage has no blood vessels or nerves so it cannot receive nutrients directly. This cartilage serves as a cushion or pad between bones so that bones don’t wear out and so you don’t feel pain.

Cartilage should not wear out if its surfaces remain lubricated with oils that you eat. But if you are not eating the right oils or the proper amount, then your cartilage can become dry. Under these conditions you will slowly deteriorate the cartilage, which will lead to degenerative arthritis.

Once your cartilage becomes damage or grinded down, it is hard to regenerate it. Cartilage is not a living tissue and does not receive its nourishment directly from blood vessels. It is made up of mucin, albumin and sulfuric acid. It absorbs oils and nutrients by osmosis.

Osmosis is the movement of oil from an area of high oil concentration, passing through a membrane, into an area of low oil concentration. So, if the cartilage is deficient in oil and you don’t eat the oil it needs to minimize cartilage-to-cartilage friction, then degenerative arthritis will occur over time.

Eating oil that is high in vitamin D and iodine is what is necessary for good cartilage strength and function. Oil such as cod liver oil is ideal as lubrication for cartilage function. Fish oil is another good oil to eat. When you eat cod liver oil, this oil passes through the joint lining into the joint cavity. Once in the cavity, this oil is absorbed into the cartilage through osmosis.

Once the cartilage is properly lubricated, it has an elasticity and lubrication so that when it rubs against other cartilage little friction and cartilage degeneration occurs.

There is another process that can affect the integrity of the cartilage. Calcium can deposit on the bone near the cartilage and break into the cartilage and wear it down.

To prevent this condition, calcium must be kept in solution in the lymph liquid. This is done by maintain a balance diet.

Degenerative arthritis is a process where the cartilage at the end of bones in joint structures slowly degrades. This degradation occurs from the lack of the right oil in the diet and through calcium build up in the bone joint. Joint degeneration starts to occur after the age of 20 and can continue if the right diet if not followed.

Eating the right food to prevent degenerative arthritis is difficult to do if you have been brought up eating the wrong kind of food. But as an adult, you can now make a choice as to whether you will have Osteoarthritis when you get older by continuing to eat the wrong kinds food.

Rudy Silva has a degree in Physics and is a Natural Nutritionist. He is the author of Constipation, Acne, Hemorrhoid, and Fatty Acid ebooks. He writes a newsletter called "Natural Remedies Thatwork.com". For more information on arthritis go to: http://www.arthritis-remedies.for--you.info

Deaths from Pain Relief Meds?

2005-11-02T05:52:00.000-08:00

Arthritis and Pain Relief Medications Cause 16,500 Deaths Per Year
By Brad Krueger DC

Almost everyone is familar with the pain relief formulas. Over 30 billion over the counter tablets, and 70 million prescriptions are sold annually just in the USA.

Known as "Nonsteroidal anti-inflammatory drugs" (NSAIDs), a few commonly known names include Aspirin, Ibuprofin, Advil, Motrin as well as prescription products like Celebrex, Vioxx, Daypro, and more.

Here's something you might "not" know about common pain relief...

"Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated." -American Journal of Medicine, July 1998

And from the prestigious New England Journal of Medicine...

"It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin’s disease.

If deaths from gastrointestinal toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain mainly a 'silent epidemic,' with many physicians and most patients unaware of the magnitude of the problem.

Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS." -New England Journal of Medicine

The Food and Drug Administration suggests even higher figures, estimating NSAID use accounts for 10,000 to 20,000 deaths per year in the United States alone. In spite of this knowledge, little has been done to notify the public. There has been no large scale public alert and pharmaceutical companies still market and promote worldwide sales of these products.

It is important to note that most people have no warning signs that these drugs are causing internal damage before they end up in the hospital in serious condition. As the death toll rises annually, consumers are slowly learning the toxic effects of these medications and turning to Mother Earth to seek natural and less toxic alternatives to find relief from pain.

References;

Singh Gurkirpal, MD, "Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy", The American Journal of Medicine, July 27, 1998, p. 31S

Wolfe M. MD, Lichtenstein D. MD, and Singh Gurkirpal, MD, "Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs", The New England Journal of Medicine, June 17, 1999, Vol. 340, No. 24, pp. 1888-1889.

Fries James F., "NSAID Gastropathy: The Second Most Deadly Rheumatic Disease? Epidemiology and Risk Appraisal", Journal of Rheumatology, 1991, (Supplement 28), Vol. 18, pp. 6-10

healthsentinel.com & content.nejm.org/cgi/content/full/340/24/1888

Dr. Brad Krueger created FlexEasy™, the only liquid supplement that provides ingredients in useable dosages that maintain and repair cartilage, fight joint and muscle inflammation, and fight the release of your body's pain triggers, the COX-2 and 5-LO pain enzymes without the harmful side effects. Find out how FlexEasy™ can help you or others suffering from arthritis/joint pain at http://www.flexeasy.net

Arthritis And Your Diet

2005-11-01T17:23:00.000-08:00

By J Hall

In 2002, 43 million American adults (about 1 in 5) reported doctor-diagnosed arthritis. Another 23 million people reported chronic joint symptoms but had not been told by a doctor that they had arthritis. These data indicate that arthritis is one of the nation’s most common health problems. As the U.S. population ages, these numbers are likely to increase dramatically. Arthritis comprises over 100 different diseases and conditions but the two most common are:

OSTEOARTHRITIS – generally attributed to wear and tear and involves deterioration of the cartilage that covers the ends of the bones. Usually occurs in people over the age of 40 and appears first in the larger joints (hip, shoulders, etc).

RHEUMATOID ARTHRITIS – thought to be an autoimmune disease – literally where self attacks self. The white blood cells which usually attack foreign invaders begin attacking the delicate joint tissue causing inflammation, degradation and pain. This condition can also occur in children and will usually be seen in the smaller joints such as fingers and toes first.

Conventional medicine addresses these problems usually using steroid treatments or Non-Steroidal Anti-inflammatories (NSAIDs) such as Ibuprofen. While these may relieve the pain of arthritis they do nothing to halt the progression of the disease and can cause many unpleasant side-effects especially in the gut. Nutritional therapy on the other hand aims to halt or reverse the devastating effects of joint pain and swelling.

DIET - The role of diet in arthritis is a widely researched subject and many sufferers have responded incredibly well to identifying foods that may be triggering symptoms. These can be different for different people but there are 10 in particular that seem to be the most common. These are:

1. All dairy products including sheep’s or goat’s cheese, butter and milk
2. Corn and all corn products ie. corn flour or corn oil
3. Meat – many people find that adopting a vegetarian diet can help as meat is very acidic and can cause inflammation
4. Wheat, oats and rye
5. Eggs
6. Citrus fruits
7. Potatoes
8. Tomatoes
9. Nuts
10. Coffee

In order to identify which, if any, of these foods may be causing or contributing to problems it is necessary to cut them all out for 4 weeks and then reintroduce each one, one at a time, noting whether they have any negative effects.

Foods which can be beneficial to sufferers include:
• Oily fish such as mackerel, tuna, salmon, trout, herring, anchovies and sardines – these contain omega 3 fatty acids which are anti-inflammatory. Don’t eat more than a couple of times a week because of toxins in the fish.
• Ginger – either cooked or brewed with hot water and drunk as tea. Has an antiinflammatory effect.
• Vegetables in the diet – helps the system to stay alkaline.

John Hall , conquered arthritis http://www.beatyourarthritis.com to learn how to overcome your arthritis

Combo Treatment Best for Early Rheumatoid Arthritis

2005-10-31T13:02:00.000-08:00

(Newswire) -- A new study out of the Netherlands suggests early rheumatoid arthritis (RA) is best treated more aggressively with a combination of proven drugs.

Researchers note treatment for rheumatoid arthritis in recent years has migrated from a simple attempt to alleviate symptoms to strategies aimed at preventing long-term damage to the joints and organs. With so many new treatments available, doctors have been unsure which are best for people newly diagnosed with the condition.

In this study, investigators compared four different strategies: standard treatment with disease-modifying antirheumatic drugs (DMARDs), sequential therapy beginning with a DMARD and adding additional DMARDs and prednisone, a combination therapy consisting of DMARDs and prednisone, and a combination therapy consisting of a DMARD and the drug infliximab.

Results show all the strategies help people with the disease, with 32 percent reaching clinical remission. Those receiving the two combination therapies fared significantly better, with less progression of the disease and greater functional improvements.

Study authors say, "During the first year of follow up, patients with newly diagnosed RA who received initial combination therapy with either prednisone or infliximab had earlier function improvement, with less progression of radiographic joint damage and no more side effects than patients who receive sequential monotherapy or step-up combination therapy."