Rheumatic Diseases
30,000 Children with Form Of Juvenile Rheumatoid Arthritis May Have New Treatment Option
Anakinra may be effective in the treatment of an estimated 30,000 children with a certain form of juvenile arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.
Systemic onset juvenile idiopathic arthritis (often referred to as systemic-onset juvenile rheumatoid arthritis or Still’s disease) affects about 10 percent of children with arthritis. It begins with a recurrent fever that can be 103° F or higher, often accompanied by a pink rash that comes and goes. Systemic onset JIA may cause inflammation of the internal organs as well as the joints. Swelling of the joints may not be present initially, and may appear months or even years after the onset of fevers. Anemia (a low red blood cell count) and elevated white blood cell counts are also typical. Arthritis may persist despite the fevers and other systemic symptoms going away.
In a recent multicenter, randomized, double-blind trial, researchers compared the effectiveness of a one-month treatment with anakinra (Kineret)—which was delivered at 2 milligrams per kilogram, subcutaneously, each day with a maximum of 100 milligrams—to a placebo in two groups of children, each containing 12 patients with JIA. Treatment was blinded so that neither the children nor the investigators knew which injection was being given. After 1 month, patients were allowed to continue un-blinded therapy for another 11 months.
Gene Expression May Influence Lack of Response to RA Treatment
Genes might explain why some patients with rheumatoid arthritis respond better to anti-TNF therapy than others, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
Drugs known as tumor necrosis factor, or TNF, inhibitors are often prescribed to individuals with rheumatoid arthritis. They work by targeting and blocking the inflammation, and can help reduce pain, morning stiffness, tender and swollen joints, limit damage to the joints and improve function.
Working environment is 1 cause of rheumatoid arthritis
It has long been known that environmental factors play a part in the development of rheumatoid arthritis; smoking and drinking alcohol, along with heredity, are particularly instrumental in increasing the risk of the disease. Scientists at Karolinska Institutet have now produced results that suggest that working environment factors can also increase the chances of developing rheumatoid arthritis.
This is especially true of psychosocial workload, in particular what is called “low decision latitude”, according to the results of a study in progress due to be published in Psychotherapy and Psychosomatics. The project is being led by Professor Lars Alfredsson of the Department of Environmental Medicine and Professor Lars Klareskog of the Department of Medicine.
“We’ve uncovered clear correlations between the disease and jobs in which one cannot control one’s own situation,” says Professor Alfredsson.
Clinicians Debate Use of Arthroscopy in Patients with Osteoarthritis
In a study published in the New England Journal of Medicine (NEJM) issue of Sept. 11, 2008, investigators concluded that arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. In an accompanying editorial, however, Robert G. Marx, M.D., an associate attending orthopedic surgeon at Hospital for Special Surgery (HSS) in New York, points out that the study has some weaknesses and argues strongly that arthroscopy does have a role in some patients with osteoarthritis.
“Arthroscopy is still valuable and you have to know when to use it,” said Dr. Marx, who is also director of the Foster Center for Clinical Outcome Research at HSS. “While I do not recommend arthroscopy as a treatment for an arthritic knee, it can be extremely helpful for people with arthritis who also have a co-existing knee problem such as a meniscal tear or a loose piece of cartilage that is causing the majority of their symptoms.”
In the study reported in the NEJM, investigators randomized 92 individuals to arthroscopic surgery and 86 to non-operative treatment for osteoarthritis of the knee. The non-operative treatments included one physical therapy session per week for twelve weeks with a home physical therapy program, patient education, and the step-wise use of acetaminophen, non-steroidal anti-inflammatory drugs, glucosamine and an injection of hyaluronic acid. The study did not identify any benefit in the group that received surgery.
Heavy birthweight babies twice as likely to develop rheumatoid arthritis
Heavy birthweight female babies are twice as likely to develop rheumatoid arthritis in adulthood as their average birthweight peers, suggests research published ahead of print in the Annals of the Rheumatic Diseases.
The results support the fetal origin of disease theory, which argues that certain conditions and diseases in adult life are programmed by factors during the pregnancy.
Diabetes, coronary heart disease, and high blood pressure, for example, have been linked to low birthweight, while an increased risk of breast cancer and leukaemia have been linked to high birthweight.
Rheumatoid arthritis doubles heart risk: experts
People with rheumatoid arthritis have double the risk of suffering heart attacks or strokes and should be considered for treatment with statins and blood pressure drugs, rheumatology experts said on Friday.
A report by a medical task force to the annual congress of the European League Against Rheumatism in Paris concluded the risk was comparable to that associated with type 2 diabetes, which is already an established cardiovascular risk factor.
Dr Michael Nurmohamed , leader of the task force, said the inflammatory processes underlying rheumatoid arthritis appeared to increase patients’ risk of serious heart problems.
Obesity tough on the knees, and men’s hips
Obesity raises the risk of severe knee arthritis and may do similar damage in the hips, but perhaps only in men, a new study suggests.
Researchers found that among nearly 2,600 older Icelandic adults, those who were overweight were more likely to have had a total knee replacement due to severe arthritis. Obese men and women were particularly at risk.
When it came to the odds of total hip replacement, obese men were again at greater risk. However, weight was not a factor for women, the researchers report in the Annals of Rheumatic Diseases.
