Rheumatic Diseases
New theory on genesis of osteoarthritis comes with successful therapy in mice
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Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, they now have evidence that the bone underneath the cartilage is also a key player and exacerbates the damage. In a proof-of-concept experiment, they found that blocking the action of a critical bone regulation protein in mice halts progression of the disease.
The prevailing theory on the development of OA focuses on joint cartilage, suggesting that unstable mechanical pressure on the joints leads to more and more harm to the cartilage - and pain to the patient - until the only treatment option left is total knee or hip replacement. The new theory, reported May 19 in Nature Medicine, suggests that initial harm to the cartilage causes the bone underneath it to behave improperly by building surplus bone. The extra bone stretches the cartilage above and speeds its decline.
“If there is something wrong with the leg of your chair and you try to fix it by replacing the cushion, you haven’t solved the problem,” says Xu Cao, Ph.D., director of the Center for Musculoskeletal Research in the Department of Orthopaedic Surgery at the Johns Hopkins University School of Medicine. “We think that the problem in OA is not just the cartilage ‘cushion,’ but the bone underneath,” he adds.
Joints are formed at the intersection of two bones. To prevent the grinding and wearing down of the ends of the bones, they are capped with a thin layer of cartilage, which not only provides a smooth surface for joint rotation but also absorbs some of the weight and mechanical strain placed on the joint. The degeneration of this protective layer causes extreme pain leading to limited mobility.
RA Patients Get Cancer Screens, May Need More
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Patients with rheumatoid arthritis (RA) are receiving the recommended cancer screening tests, but the recommendations may not be adequate for these patients, researchers reported.
Compared with controls, women with RA were more likely to have had a Pap smear (HR 1.21, 95% CI 1.17 to 1.24), a mammogram (HR 1.49, 95% CI 1.45 to 1.53), and a colonoscopy (HR 1.69, 95% CI 1.61 to 1.77), according to Seoyoung C. Kim, MD, and colleagues from Brigham and Women’s Hospital in Boston.
However, “given the increased risk of some cancers in RA and concerns in the association between various types of RA treatment and malignancy, it may be worth investigating the effectiveness of current cancer screening guidelines in patients with RA and in subgroups on specific treatments,” Kim and colleagues wrote online in Arthritis & Rheumatism.
Obesity negatively predicts minimal disease activity achievement in patients with PSA
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According to a study presented today at EULAR 2012, the Annual Congress of the European League Against Rheumatism, patients with psoriatic arthritis (PsA) who are starting anti-tumour necrosis factor (anti-TNF) treatment and adhere to a hypocaloric diet have a significantly greater chance of achieving minimal disease activity (MDA, an important measure of disease activity) at six months compared to those on a standard diet.
The results of an Italian study of 138 obese PsA patients demonstrated that those who achieved a ≥10% weight loss following a calorie restricted diet, were more likely to achieve MDA, compared to patients on a standard diet (p=0.001). These patients also had significantly higher changes in erythrocyte sedimentation rate (ESR, a test that indirectly measures the amount of inflammation in the body), and c-reactive protein (CRP, a marker of systemic inflammation, a recently identified predictor of structural damage progression) compared to patients on a standard diet.
“A study presented at the 2009 meeting of the Society for Investigative Dermatology, alerted us to the fact that patients with psoriatic arthritis have an increased prevalence of obesity, however our study has gone beyond that, assessing whether diet is able to improve the achievement of minimal disease activity in obese patients treated with anti-TNFs” said Dr. Dario Di Minno from the University of Naples Federico II, Italy and lead author of the study. “The results of our study suggest that obese patients with psoriatic arthritis who stick to a hypocaloric diet have a greater chance of achieving treatment goals.”
Screening programs detect cases of undiagnosed rheumatic heart disease in low-resource countries
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Widespread screening of children in poorer countries is now being studied and is resulting in the diagnosis of rheumatic heart disease (RHD) in patients that would likely have gone undetected under normal circumstances, according to two new studies carried out in Fiji and Uganda presented today at the World Congress of Cardiology.
Coordinated screening and control programmes can help to identify patients before they progress to severe RHD for a fraction of the cost associated with treating these patients. While more work needs to be done to determine if these programmes should be widely promoted, there has been limited evidence to suggest that they are feasible in countries that have few resources – until now.
In one study carried out in Uganda, 4,869 school children were screened simply using a stethoscope and a portable echocardiography machine. Of the children screened, 72 (1.5 per cent) were diagnosed with possible, probably or definite RHD that required follow-up.
“This is one of the largest single-country child echo-based RHD screening studies that has been carried out,” said Dr. Andrea Beaton Children’s National Medical Center, USA. “This study proves that even in low-resource settings it is possible to embark on a screening programme that will identify children with probable or definite RHD, that would otherwise not have been seen until they had progressed to severe disease.”
Researchers Find Epidural Steroid Injections Do Not Benefit Spine Patients
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Researchers at the Rothman Institute at Jefferson examined data on patients being treated for lumbar stenosis and the degenerative spine condition spondylolisthesis and found that patients who received epidural steroid injections (ESI) had a higher rate of crossover to surgery and fared worse in physical health and bodily pain versus those who did not receive ESI, dispelling their pre-study hypothesis.
Data for this study was gathered from the database of the prospective, multicenter NIH-funded SPORT (Spine Patient Outcomes Research Trial) of surgical treatment versus nonoperative treatment for lumbar stenosis and degenerative spondylolisthesis. In the first three months of the trial, some patients were given ESI and some were not.
“At the onset of our study, we hypothesized that patients who received ESI would have improved outcomes and lower rates of surgery compared to patients who did not receive ESI,” said Kristen E. Radcliff, MD, of the Rothman Institute at Jefferson and an author on the study. “This was not supported by the data.”
Rituximab combined with a TNF inhibitor and methotrexate shows no safety signal in RA treatment
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A recent trial of rituximab in combination with a tumor necrosis factor (TNF) inhibitor and methotrexate (MTX) in patients with active rheumatoid arthritis (RA) found the safety profile to be consistent with other RA trials with TNF inhibitors. While the trial reported no new safety risks, clear evidence of an efficacy advantage in RA patients receiving the combination therapy was not observed in this study sample. Results of the trial are published in the March issue of Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology.
The National Arthritis Data Workgroup estimates that 1.3 million U.S. adults have RA which is characterized by systemic joint inflammation that often leads to joint damage, functional impairment and significant disability. While MTX is successfully used to treat many RA patients, the severity of the disease in some patient populations requires the use of additional disease-modifying antirheumatic drugs (DMARDs). A specific group of biologic DMARDs, called tumor necrosis factor (TNF) inhibitors and includes such therapies as etanercept and adalimumab, block the immune system response, and have been shown to be safe and effective in clinical trials.
Prior studies, however, have found that up to 40% of RA patients exhibit an inadequate response, intolerance, or inadequate slowing of the rate of joint damage with biologic therapies, and require additional treatment options. “Our objective was to assess the safety of the biologic DMARD, rituximab, in combination with a TNF inhibitor and MTX in patients with active RA,” said lead study author Maria Greenwald, M.D., from Desert Medical Advances in California. This was a small exploratory study to evaluate safety with this combination due to the prolonged effect of rituximab, and the fact that RA patients may switch to an alternate biologic such as a TNF inhibitor before the effects of rituximab may have resolved.
EULAR welcomes Council action to tackle chronic diseases
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The European League Against Rheumatism (EULAR) welcomes the outcomes of yesterday’s Council of the European Union (EPSCO Council). In its meeting on 7 December, ministers for health adopted Council Conclusions on chronic diseases, in which the Council calls on Member States and the European Commission to adopt concrete, coordinated measures to tackle chronic diseases in Europe. EULAR is pleased to note that the Council Conclusions reflect many of the recommendations made at the 19 October Presidency conference on Rheumatic and Musculoskeletal diseases. The conference was organised jointly by the Presidency and EULAR.
Prof. Paul Emery (EULAR President) highlighted the “political relevance of the Council Conclusions”, as the Council’s position “represents a clear message in favour of concrete initiatives at both EU and national levels, to address chronic diseases. This is particularly important for those disorders which represent a huge burden on our economies and health systems, such as musculoskeletal diseases.” According to Prof. Emery, it is now time to look into innovative approaches at Member States’ level. National action plans targeting musculoskeletal conditions could be an excellent way of making progress.
The Council invites Member States to “further develop patient-centred policies for health promotion, primary prevention and secondary prevention, treatment and care of chronic diseases”. Neil Betteridge, EULAR Vice President PARE (People with Arthritis and Rheumatism in Europe), welcomed this recommendation: “EULAR long ago adopted the call of its patient group members of ‘Nothing about us without us’, meaning that the sort of collaboration between clinicians and patient representatives recommended in the Council Conclusions is already recognised as a key component of managing rheumatic and musculoskeletal diseases optimally. EULAR can be proud that its own best practice in this respect, as well as in the scientific and research fields, has been identified by ministers across Europe as an essential part of the new framework for managing chronic conditions generally”.
Statins Not Routinely Indicated for Children and Adolescents with Lupus
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While statins are known to help prevent the progression of atherosclerosis, research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta indicates they should not be routinely prescribed in children and adolescents with lupus despite their increased risk of premature atherosclerosis.
Lupus, or SLE, is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and other organs of the body. Usually, patients have skin rashes and arthritis, as well as fatigue and fever. It is often more severe when it begins in childhood. Lupus has been identified as a strong independent risk factor for heart attack and stroke, and children with lupus are at a particularly high risk because of their lifelong exposure to the disease. Atherosclerosis—a buildup of fatty deposits in the artery walls—which normally leads to heart attack and strokes in older adults, starts at an at an unusually early age and progresses more quickly in people with lupus.
Statins have been shown to reduce cardiovascular complications and death among the general adult population, but they have not been studied in the prevention of atherosclerosis among young people with lupus. In the largest trial of its kind—and the first major trial completed by the Childhood Arthritis and Rheumatology Research Alliance (called CARRA)—researchers recently completed a study looking at whether the use of statins would be helpful enough in the prevention of atherosclerosis in children and adolescents with lupus to make it worthwhile for them to start taking at such a young age.
Combination of Methotrexate and Prednisone Produces Remission In People with Newly-Developed Rheumatoid Arthritis and Undifferentiated Arthritis
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People with newly-developed rheumatoid arthritis or undifferentiated arthritis may be able to achieve remission, with continued drug therapy, after four months of treatment with methotrexate and prednisone, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.
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. The new ACR/EULAR 2010 Rheumatoid Arthritis Classification Criteria are based on the recognition that undifferentiated arthritis may be the earliest clinical manifestation of RA.
Researchers recently assessed whether people with RA (which had developed less than two years before the start of the study) or undifferentiated arthritis (defined, for this study, as having arthritis in more than one joint and being considered at risk for developing RA) could achieve remission after four months of taking a combination of methotrexate and prednisone.
Tai Chi Relieves Arthritis Pain, Improves Reach, Balance, Well-Being
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In the largest study to date of the Arthritis Foundation’s Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.
Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study’s lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC’s Thurston Arthritis Research Center.
“Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis,” Callahan said. “We found this in both rural and urban settings across a southeastern state and a northeastern state.”
Fybromyalgia Symptoms Can Vary Widely By admin
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Sometimes you’ll hear someone grumble that it’s “just aches and pains” or something that one should just suffer through, but in reality 2% of the population suffers from this painful disorder. The American College of Rheumatology and the Food and Drug Administration have recognized this debilitating disorder and drug companies are actively seeking ways of treating Fibromyalgia.
The defining symptoms of this disorder include chronic, widespread pain and tenderness to the touch. Generally, Fibromyalgia and chronic fatigue go hand-in-hand. Allodynia, or skin sensitivity that feels like pins and needles, may accompany the pain. As a result of the Fibromyalgia pain, sufferers often encounter sleep deprivation or abnormal sleeping patterns and wake up feeling unrefreshed. Some people have irritable bowel syndrome, leg spasms in the night, headaches or Temporomandibular joint (TMJ) dysfunction that causes rigidity in the face.
For severe cases, depression, mood disorders, impaired memory, anxiety, dry skin and mouth, or chest pain may accompany the other symptoms, making it nearly impossible to get through the day. In fact, it’s estimated that 30% of people with Fibromyalgia Syndrome are incapable of working and require government assistance.
Obesity, Alcohol Among Factors Linked to Women’s Gout Risk
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Obesity, high blood pressure and alcohol consumption are among the major risk factors for gout in women, a new study finds.
Gout, a common and painful inflammatory arthritis, is caused by elevated uric acids levels in the blood.
U.S. researchers analyzed data from 2,476 women and 1,951 men who took part in the Framingham Heart Study. The participants were in their mid-40s and free of gout at the start of the study.
Moderate drinking may slow arthritis progression
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Some studies have suggested that moderate drinkers have a lower risk of developing rheumatoid arthritis, and now new findings link the habit to a slower progression of the joint disease.
In a study that followed 2,900 adults with rheumatoid arthritis (RA), Swiss researchers found that light-to-moderate drinkers showed slower progression in their joint damage compared with non-drinkers. Heavy drinkers, on the other hand, showed the greatest progression.
The findings, reported in the journal Arthritis & Rheumatism, are based on X-ray evidence of patients’ joint damage and its progression over an average of four years.
Award Supports Excellence in Musculoskeletal and Rheumatic Disease Education
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At the core of the American College of Rheumatology Research and Education Foundation’s mission is to attract the best and brightest trainees into a career in rheumatology. To do this, the REF has an extensive portfolio of awards and grants that provide support during critical career stages. One special award, the ACR REF Clinician Scholar Education Award, supports unique individuals who serve as excellent role models for future rheumatologists and rheumatology health professionals.
The REF is pleased to announce the newest class of Clinician Scholar Educator Award Recipients. The 2010 recipients are:
Eugene Kissin, MD
Boston University
A Competency Based Musculoskeletal Ultrasound Curriculum
Osteoarthritis increases aggregate health care expenditures by $186 billion annually
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Osteoarthritis (OA), a highly prevalent disease, raised aggregate annual medical care expenditures in the U.S. by $185.5 billion according to researchers from Stony Brook University. Insurers footed $149.4 billion of the total medical spend and out-of-pocket (OOP) expenditures were $36.1 billion (2007 dollars). Results of the cost analysis study are published in the December issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.
The Centers for Disease Control and Prevention (CDC) estimate 27 million Americans suffer from OA with more women than men affected by the disease. Forecasts indicate that by the year 2030, 25% of the adult U.S. population, or nearly 67 million people, will have physician-diagnosed arthritis. OA is a major debilitating disease causing gradual loss of cartilage, primarily affecting the knees, hips, hands, feet, and spine.
John Rizzo, Ph.D., and colleagues used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to determine the overall annual expected medical care expenditures for OA in the U.S. The sample included 84,647 women and 70,590 men aged 18 years and older who had health insurance. Expenditures for physician, hospital, and outpatient services, as well expenditures for drugs, diagnostic testing, and related medical services were included. Healthcare expenses were expressed in 2007 dollars using the Medical Care Component of the Consumer Price Index.
