Rheumatoid arthritis triggers: they’re all around you
What triggers that arthritis attack that leaves you pain and immobile? It may be the air you breathe, the food you ate or the lipstick you just applied.
Rheumatoid arthritis is an autoimmune disease and these conditions and their causes are poorly understood. The genetic factors involved are pretty strong but other triggers are difficult to pinpoint. Researchers have been trying to identify the environmental factors that trigger these diseases. Scientists at Tel Aviv University report that
- People living close to airports have a higher likelihood of developing rheumatoid arthritis and lupus.
- Certain food additives can also trigger autoimmune diseases.
- Even chemicals in our body care products such as hairspray and lipstick or ingredients in our medications may serve as triggers.
According to rheumatologist Prof. Michael Ehrenfeld of Tel Aviv University’s Sackler School of Medicine:
Other factors that can trigger rheumatoid arthritis are
- Extreme stress
- Environmental and industrial pollutants
- Second-hand smoke
- Food additives
- UV radiation exposure
The high level of jet fuel fumes in airports predisposes nearby residents to autoimmune diseases.
Rheumatoid arthritis is a chronic inflammatory autoimmune disease afflicting more than 2 million Americans. Women are 3 times more susceptible than men. The disease occurs when the body’s own immune system to attack the joints, leading to pain, deformities and disability. Unlike osteoarthritis which is age-related, rheumatoid arthritis affects people of all ages.
Prof. Ehrenfeld explains:
Most of the other kinds of arthritis we see in the clinic, the debilitating and inflammatory types, usually occur in young women between the ages of 20 and 40. We hope that our research will lessen the occurrence and onset of these painful disorders.”
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Smoking and rheumatoid arthritis
That arthritis pain is killing you? Well, it might be the pack you smoked today that caused it.
Recent research evidence indicates that smoking cigarettes can increase your chances of getting rheumatoid arthritis, an autoimmune form of the disease that has nothing to do with age. The study looked at 860 people and 605 of these had rheumatoid arthritis and 255 didn’t. Analysis of the data showed that heavy long-term smokers (e.g. those who smoke a apack a day for 10 years) are the most likely to develop the disease. According to study author Ted Mikuls of the University of Nebraska Medical Center:
Smoking cigarettes is linked to many chronic diseases, including cancer, heart disease and stroke. Now we can add rheumatoid arthritis to this list.
So next time you feel that pain on your joints, check your lifestyle and check your health habits. What have you done today?
About rheumatoid arthritis:
No one knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute. Treatments include medicine, lifestyle changes and surgery. These can slow or stop joint damage and reduce pain and swelling.
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Vitamin D and rheumatoid arthritis
Vitamin D deficiency has been linked to a wide range on health conditions, including rheumatic diseases. Three European studies looked into the relationship between rheumatism and vitamin D levels as well as the effect of vitamin D supplementation.
Study 1:
An Italian study followed up 1191 patients with rheumatoid arthritis. The results showed that vitamin D levels in the blood were lower in these patients compared to the normal levels of at least 50 nmol/L . Furthermore, supplementation does not always help. Only 40% of these patients who are take vitamin D daily supplementation of 800IU or more reach the normal values. The vitamin D levels in the blood in 60% of patients are still below normal. Measures of disease activity using questionnaires show that low vitamin D levels are correlated to increased disability, decreased mobility, and more swollen joints.
According to Dr. L. Idolazzi of the Rheumatology Unit, University of Verona, Italy:
Study 2:
In another Italian study, the effect of vitamin D supplementation on inflammatory autoimmune diseases was investigated. In this group of 43 patients, only 29% achieved normal vitamin D levels following supplementation.
Study 3:
A third study conducted in the UK involved 90 patients with rheumatoid arthritis, osteoporosis or unexplained muscle pain. These patients, too, had below than normal levels of vitamin D.
About vitamin D:
Vitamin D is also called the sunshine vitamin as it can only be synthesized by the body when exposed to sunlight. Unfortunately, vitamin D is not available in sufficient amounts in the food that we eat. Although vitamin D is available through sun exposure, the risk for skin cancer than the sun rays bring has led many health experts to discourage this practice.
In recent years, there has been a big debate about the necessity of vitamin D supplementation. In many countries, including the US, milk is supplemented with vitamin D. In addition, doctors often recommend vitamin D supplementation to their patients, especially little babies who are being breastfed. The American Academy of Pediatrics recommends routine vitamin D supplementation for children and updated its guidelines on Vitamin D intake last 2008. The new guidelines increased the recommended dose from 200 IU to 400 IU per day.
Rheumatoid arthritis need not stop you from typing
People with arthritis may have problems with performing simple daily tasks. But how does rheumatoid arthritis affect a person’s capability to use a keyboard and therefore their performance at work? This is the question that researchers from the University of Pitt decided to address.
The researchers followed up 45 patients listed in the University of Pittsburgh Medical Center (UPMC) Arthritis Network Registry. The participants were most women with an average age of 55, and had been suffering from rheumatoid arthritis for about 17 years. Half of participants are employed full or part-time, and everybody in the group of working participants used computers in their jobs.
The researchers evaluated the hand function of the participants using the Keitel Hand Function Index (KHFI) and the Arthritis Hand Function Test (AHFT) and the abilities to use a standard keyboard and mouse using the Assessment of Computer Task Performance (ACTP).
The results of the study are quite encouraging:
- 73% of participants have been trained in touch typing and used the computer an average of 18 hours per week
- Participants with rheumatoid arthritis have comparable skills to non-impaired individuals in terms of keyboarding speed.
- Participants who were trained in touch typing had faster typing speeds than those using a visually-guided (“hunt and peck”) method, with or without rheumatoid arthritis.
- The ability of using a mouse is slightly impaired in workers with RA and the impact of this impairment on job productivity still needs to be evaluated.
These results are indeed good news for those with rheumatoid arthritis. Previous studies have reported that rheumatoid arthritis can impair people’s abilities to perform their jobs so that those suffering from this condition have higher rates of work disability, premature work cessation, and reduced hours on the job.
However, this study indicates that computer work is not greatly affected by rheumatoid arthritis According to figures from the U.S. Census Bureau, the number of workers using computers increased from 46% in 1993 to 56% in 2003 with figures expected to continue climbing higher.
Thus people with rheumatoid arthritis skilled in computer work especially touch typing need actually not fear for significant impairment that may cost their jobs.
According to lead author Dr. Nancy Baker:
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Fish oil to treat rheumatoid arthritis
It is well-known that fish oil is beneficial to cardiovascular health. Fish oils are rich in long-chain omega-3 fatty acids docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA), the so-called “good fats.”
New research evidence suggests that fish oil may also help treat other chronic diseases, especially inflammatory conditions such as rheumatoid arthritis.
According to Medline Plus Encyclopedia,
Rheumatoid arthritis is a form of arthritis that causes pain, inflammation, stiffness and loss of function of the joints. It can affect any joint but is common in the wrist and fingers. More women than men get rheumatoid arthritis. Unlike osteoarthritis, which the common arthritis that comes with old age, rheumatoid arthritis can occur in young adults starting between ages 25 and 55 years. There are different grades of rheumatoid arthritis. It can last only for a short period of time; it can come and go. The severe form can last a lifetime and can lead to disability. Aside from the joints, rheumatoid arthritis can also attack the eyes, mouth, and lungs.
Rheumatoid arthritis is an autoimmune disease, e.g. the body’s immune system attacks its own tissues. I Researchers from the University of London and Harvard Medical School report that consumption of fish oil can reduce inflammation associated with rheumatoid arthritis. Inflammation occurs when the body’s immune system targets healthy tissue by mistake leading to white blood cells sticking to the endothelium (blood vessel lining). The human body converts DHA in the fish oil into Resolvin D2, which has some anti-inflammatory properties. Resolvin D2 causes the endothelial cells to produce small amount of nitric oxide, a chemical signal that discourages the white blood cells from sticking to the endothelium, thus preventing inflammation.
According to study leader Mauro Perretti, Professor of Immunopharmacology at Queen Mary, University of London
The study suggests that fish oil, DHA and Resolvin D2 could form the basis of new treatments, not only for rheumatoid arthritis, but also for other inflammatory diseases. An additional advantage of fish oil is that it is natural, does not come with side effects associated with anti-inflammatory pharmacologic agents such as suppression of the immune system and increased cardiovascular risks.
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Information On Rheumatoid Arthritis Focuses On Treatment
January 21, 2009 by HART 1-800-HART
Filed under ARTHRITIS
One of the causes of arthritis is an autoimmune disease that causes the body to go into a self-preservation mode and attack healthy tissues, believing they are a threat to its well-being. While there is no known exact cause of autoimmune deficiencies, information on rheumatoid arthritis points out that some environmental factors may be involved. It is also thought that viruses, bacteria or fungus has some role in its development, information on rheumatoid arthritis targets the treatment more than the cause.
Unlike osteoarthritis, which generally affects older people as a degenerative disease, information on rheumatoid arthritis points out this disease can attack not only the cartilage in the joints, but also the bone structure. When pain usually associated with arthritis is experienced, it is sometimes difficult to pinpoint the exact cause of the pain, but thorough diagnosis by the doctor can determine if is a natural progression of cartilage loss or an internal strike by the body’s immune system that is causing the problem.
The repeated inflammation of bone tissue cause the pain to come and go, making diagnosis difficult. Exploratory x-rays and CAT-scans can help determine the cause. Additionally, information on rheumatoid arthritis suggests that the degeneration it causes is symmetrical, meaning if one hand is affected, the same effect will be experienced in the other hand as well.
No Known Cure For Rheumatoid Arthritis
There is no known treatment to totally stop the progression of this type of infection, but many drug therapies used in the initial stages have been shown to help reduce the frequency of inflammation as well as damage to the joints and other organs. Most of the information on rheumatoid arthritis is aimed at treating the pain and stopping the spread of the inflammation and two different classes of drugs are most often used.
Anti-inflammatory drugs are often used to help reduce the pain in affected joints and to help reduce swelling. Non-steroidal Anti-inflammatory drugs are often used in place of regular aspirin due to the lower dosage requirement to achieve the same effects. Additional information on rheumatoid arthritis accepts the idea that long-term use of long-acting drugs to prevent bone deformity may also be needed.
While the first line drugs work against the inflammation and pain, these second line drugs, which can take months to show signs of working, are the prevent the crippling effects of bone deformity. Newer drug therapies work biologically to halt the progression of inflammation, and are many of the same drugs used to fight the effects of cancer.
B Cells Can Act Independent of T Cells In Autoimmune Diseases
August 11, 2008 by Gloria Gamat
Filed under ARTHRITIS
In autoimmune diseases, it has long been believed by scientists that B cells (the source of damaging autoantibodies) are activated only by when stimulated by T cells.
Now, new findings by Yale researchers showed that in systemic autoimmune diseases (such as lupus and rheumatoid arthritis), B cells can be activated even in the absence of T cells — thereby leading to suggested news ways of intervention in tackling the process leading to autoimmune diseases.
Recently this same Yale group along with collaborators at Boston University discovered an unexpected role in autoimmunity of Toll-like receptors, previously thought to be stimulated by molecules expressed on microbial pathogens. Shlomchik and his colleagues showed that they can also recognize and react to “self” molecules, in particular mammalian DNA and RNA. When this occurs, these receptors help activate B cells that make the classical autoantibodies of lupus.
The new Yale study now shows that these signals substitute for T cells in starting the autoimmune process in B cells. The researchers propose that once B cells are activated via Toll-like receptors, they can subsequently recruit T cells and that this can lead to a “vicious cycle” of chronic autoimmune disease in which the two types of cell activate each other.
According to Mark Shlomchik, MD, professor of laboratory medicine and immunobiology at the Yale School of Medicine and senior author of the study:
“The findings were surprising because many scientists believed that B cells remain quiet in autoimmune diseases unless they are stimulated first by T cells.
It became a chicken or egg problem. If cooperation between T and B cells is needed to create an autoimmune disease, who falls off the fence first, and why?”
The findings of the said study may explain why treatments that target T cells fared very poorly while the newer treatments targeted at the B cells are working a lot better.
Here’s a brief explanation how B cells work in the immune system:
B cells react against invading bacteria or viruses by making proteins called antibodies. The antibody made is different for each different bug. The antibody locks onto the surface of the invading bacteria or virus. The invader is then marked with the antibody so that the body knows it is dangerous and it can be killed off.
The B cells are part of the memory of the immune system. The next time the same bug tries to invade, the B cells that make the right antibody are ready for it. They are able to make their antibody more quickly than the first time the bug invaded.
What happens here is that, the treatments to work should be able to intervene in the immune system’s attack to the body’s own tissue.
Read more details from Medical News Today.
Springing Back From The Flu, Some Tidbits On Living Life With Arthritis
August 1, 2008 by Gloria Gamat
Filed under ARTHRITIS
I’ve been bugged down by flu recently and so I had to rest for awhile and just sleep the night off than usual. But I am back and now it’s the first of August. Wow, time flies really!
Now it’s Friday. But before I close my week and take it easy the rest of the weekend, let me share with you all a few things that show how life with arthritis can be lived with some better quality, if we make some adjustments.
1. Kitchen adjustments and tools that can help those with arthritis
Diagnosed with rheumatoid arthritis in 1987, Tuovi Cochrane, 67, of Rockford, has joined thousands of women in inventing new ways to create in the kitchen.
Using a specially designed ergonomic kitchen knife with a broad blade and sawlike handle that is easier to grip, Cochrane is able to slice, dice and chop.
For opening jar lids, she uses the adjustable Black & Decker Lids Off, which can handle even small prescription-pill containers.
2. Lower arthritis risks with simple changes
- Keep your weight down: excess weight puts additional stress on the joints and is especially hard on the knees and hips.
- Don’t avoid exercise: Although high-impact activities can irritate arthritis, keeping muscles strong and joints moving is therapeutic; try swimming, yoga or even golf.
- Take stretch breaks at work: Don’t sit or stand in the same position for long periods of time. Stand up and move or stretch every 30 minutes.
- Get your vitamins: everyone can benefit from a healthy, balanced diet, but getting adequate calcium and vitamin C is of particular importance to bone and joint health,
- Wear comfortable shoes: Don’t sacrifice your health for fashion; high heels put added stress on feet and knees.
3. Wii Fit as indoor exercise for arthritis patients
Elaine Bartz would never lie to her doctor.
Since the 62-year-old grandmother bought a Nintendo Wii Fit system to help fight her arthritis, that hasn’t been a consideration.
“Every time I go to the doctor, she would ask me if I’d been exercising, because I do have high cholesterol, too,” Bartz said. “I would say, ‘Uh, no, I’m not.’ Now, when I go to her, I can say I am exercising daily.”
Thanks to fascinating advances in medication too, which has definitely saved an arthritic from the devastating side effects of steroids. But, have we hit the nail on its head? Have we been able to cure or prevent joint diseases? The answer is a clear ‘No’.
5. Cooking workshop that may help arthritis patients
This month, the Indiana Chapter of the Arthritis Foundation will team up with Whole Foods Market to offer a short series of FREE, fun and educational courses for the community called Healthy Cooking 101. These courses were created for Indiana residents who struggle with rheumatoid arthritis but still want to maintain some sort of independence in the kitchen.
Well, we all do need all the help we can get. Be it turning ergonomic, doing yoga or buying the Wii fit, i think I won’t hurt to try and see what’s going to work for you. Take your prescribed meds too! Most importantly, you gotta eat right.
That’s all for now and I wish you all a great weekend.
Roche RA Drug Actemra Wins Support of US FDA Panel
July 31, 2008 by Gloria Gamat
Filed under ARTHRITIS
Roche is happy to announce that its rheumatoid arthritis drug Actemra (tocilizumab) has won the recommending approval of the US FDA‘s Arthritis Advisory Committee.
The committee’s vote was made after Roche presented results from five Phase III clinical trials. The clinical development program evaluated the effects of Actemra on signs and symptoms of RA, physical function, progression of structural damage, and health-related quality of life.
Of these five studies, three trials were conducted in patients with inadequate response to disease modifying anti-rheumatic drugs (DMARDs), one trial was conducted in patients who failed anti tumor necrosis factor (TNF) therapy and one monotherapy study comparing Actemra to methotrexate, a current standard of care, was also conducted.
Results of these studies demonstrated that treatment with Actemra, alone or combined with methotrexate or other DMARDs, significantly reduced RA symptoms regardless of previous therapy or disease severity, compared with current DMARDs.
Actemra (already approved in Japan, but not yet in the US and Europe) is a novel interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody, for reducing the signs and symptoms in adults with moderate to severe rheumatoid arthritis (RA).
Actemra is the result of research collaboration by Chugai and is being co-developed globally with Chugai. Actemra is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody. An extensive clinical development program of five Phase III trials was designed to evaluate clinical findings of Actemra. T
he five studies have reported meeting their primary endpoints. Actemra is awaiting approval in the United States and Europe. In Japan, Actemra was launched by Chugai in June 2005 as a therapy for Castleman’s disease; in April 2008, additional indications for rheumatoid arthritis, polyarticular-course juvenile idiopathic arthritis and systemic-onset juvenile idiopathic arthritis were also approved in Japan.
With the FDA panel’s recommending approval, it is almost sure that the FDA will grant approval of Actemra in September.
According to William M. Burns, CEO of Roche’s Pharmaceuticals Division:
“We are pleased with the FDA advisory committee’s very positive recommendation for Actemra, which helps move this promising new therapy closer to becoming available for patients who suffer from the debilitating symptoms of RA.
Based on the compelling data presented, and this positive recommendation from the committee, we remain hopeful that the FDA will approve Actemra for the treatment of RA and provide a new option to patients who are not achieving adequate symptom relief with current therapies.”
Actemra is generally well tolerated, as reported by Roche. Now reports are saying that if the drug gets FDA approval, Actemra is a potential blockbuster. Well…from a patient’s perspective, let’s cross our fingers that the drug really works well against rheumatoid arthritis.
The overall safety profile of Actemra is consistent across all global clinical studies. Serious adverse events reported in Actemra clinical trials include serious infections, diverticular perforations and hypersensitivity reactions including anaphylaxis.
The most common adverse events reported in clinical trials were upper respiratory tract infection, nasopharyngitis, headache and hypertension. Increases in liver function tests (ALT and AST) were seen in some patients; these increases were generally mild and reversible, without injuries or any observed impact on liver function.
Laboratory changes, including increases in lipids (total cholesterol, LDL, HDL, triglycerides) and decreases in neutrophils and platelets, were seen in some patients without association with clinical outcomes.
Read more from the Roche press release or the report from Reuters.
Free RA Worshop in North Platte
July 29, 2008 by Gloria Gamat
Filed under ARTHRITIS
What: Workshop On Rheumatoid Arthritis
When: 1:30 p.m. Wednesday, July 30, 2008
Where: Holiday Inn Express (North Platte, Nebraska)
Sponsored by Great Plains Regional Medical Center (GPRMC) and North Platte Orthopedic and Sports Medicine, this workshop is free and open to the public.
If anybody reading this is near the area, you may want to drop by and listen to Dr. E. Scott Carroll present the seminar:
Dr. E. Scott Carroll, who will present the seminar, began practicing at GPRMC in April 2008. Carroll specializes in hand injuries and pathology. Specifically, he offers wrist arthroscopy, thumb basal joint procedures for arthritis, care of fractures and all hand trauma, including tendon, nerve and arterial repair.
Soft tissue flap coverage of the mutilated hand, as well as replantation of digits is performed here in North Platte. Distal radius fractures, ganglion cysts, fractures of the carpal bones, as well as carpal tunnel release are within the scope of his practice. He will also treat trigger fingers, Dupuytren’ s disease excision and tumors of the hand.
Carroll received a bachelor’s degree in biology from the University of Nebraska at Omaha, then attended the University of Health Sciences College of Osteopathic Medicine. Following his schooling, he held a rotating internship and general surgery residency in Des Moines, Iowa.
Carroll then accepted a residency in cardiothoracic surgery in New Jersey for three years. Following the program in New Jersey, Carroll then worked as a heart surgeon in Florida, and practiced in Kearney since March 2001.
It is good to know that such an expert is holding a free seminar. Pretty use he will attract more and more patients.
Which brings me to this other news saying that baby boomers are more like to seek arthritis care for their foot and ankle arthritis.
Foot and ankle surgeons say Baby Boomers are more likely than previous generations to seek care when arthritis develops in their toes, feet and ankles.
“Unlike their parents, Baby Boomers do not accept foot pain as a natural part of aging,” says John Giurini, DPM, a Boston foot and ankle surgeon and president of the American College of Foot and Ankle Surgeons (ACFAS). “When conservative treatments fail, they want to know what other options exist.”
“This generation has witnessed an explosion of new medical technology during its lifetime,” says Stephen Frania, DPM, a Cleveland foot and ankle surgeon. “They have high expectations, sometimes too high.”
Surgeons say many Boomers who seek treatment for arthritis assume they’ll be able to resume activities such as running or playing sports. Seeking treatment early can improve the odds of preventing irreversible joint damage. While there is no fountain of youth for arthritis, surgeons say there are more medical options available to Baby Boomers than ever before.
There are more advanced treatment options these days, that is undeniable. Also the younger generation are enjoying the readily available resources that will urge them to seek healthcare when they feel something is wrong in their body.
Well the other extreme of that really is: each one of us it at risk of the ‘knowing too much’ and the ‘reading too much information’ syndromes in this day and age. Like i have always said, information like the ones in this blog are for educational purposes only…don’t forget to seek the expert practicing doctor.
Let us not forget finding the right balance in all these.
Muscuskeletal Ultrasound in Rheumatoid Arthritis
July 28, 2008 by Gloria Gamat
Filed under ARTHRITIS
Musculoskeletal ultrasound (MSUS) has been around for quite sometime and has turned into an established imaging technique for the diagnosis and follow up of patients with rheumatic diseases — such as rheumatoid arthritis. MSUS generates pictures/imaging of muscles, tendons, ligaments, joints and soft tissue throughout the body.
From Radiology Info, MSUS helps diagnose the following:
- tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle
- abnormalities of the muscles, such as tears and soft-tissue masses
- bleeding or other fluid collections within the muscles, bursae and joints
One limitation however of this imagine procedure is that it has difficulty penetrating to the bones and so can only see the outer surface of bony structures. For imaging of the internals of the bones and joints, MRI comes in.
According to UK’s National Rheumatoid Arthritis Society:
Ultrasound is relatively inexpensive and safe, avoiding the exposure to radiation that is necessary for conventional x-rays, CT and MRI scans.
Traditionally, rheumatologists have referred patients to radiologists for all ultrasound examinations but recent developments have enabled them to conduct some scans themselves. The advent of portable ultrasound machines (figure 2) means that scans can be carried out at the bedside or in the outpatient clinic without the need for a second appointment in the x-ray department.
This speeds up the process of investigation and allows the rheumatologist to plan treatment without delay. Radiologists are expert at conducting detailed scans that often assist with a structural diagnosis. Rheumatologists tend to use ultrasound in a slightly different way. They may use it to guide them in carrying out difficult joint injections.
They also use it to detect subtle inflammation around tendons and small knuckle joints. This is important because clinical examination may not always identify inflammation, particularly in early arthritis. The earlier the diagnosis of rheumatoid arthritis, the better the chance of dampening down inflammation and preventing joint damage.
Well I guess it is always better to see a rheumatologist for this procedure…though the combined ‘reading’ or interpretation of both rheumatologist and radiologist alike would be a lot of help. Has anybody reading this underwent MSUS, let us know about it. Was the procedure helpful in the diagnosis?
ACR New Guidelines For Rheumatoid Arthritis Treatment
July 27, 2008 by Gloria Gamat
Filed under ARTHRITIS
Updated guidelines for the treatment of rheumatoid arthritis has been issued by the American College of Rheumatology.
Co-authored by by physicians at the University of Alabama at Birmingham (UAB), the updated guidelines highlighted the fact that proven combinations of medicines and the introduction of new anti-arthritis drugs have significantly improved the treatment of rheumatoid arthritis (RA).
The strategies are updated in such a way that the goal is more focused on the prevention of joint damage and disability.
According to lead author Kenneth Saag, M.D., M.Sc., a professor in the UAB Division of Clinical Immunology and Rheumatology:
The new recommendations do not strive to replace individualized medical decisions. Instead, they are meant to guide rheumatologists and other health care workers toward the most updated recommendations.
The recommendations developed are not intended to be used in a ‘cookbook’ or prescriptive manner, or to limit a physician’s clinical judgment. They provide guidance based on clinical evidence and expert panel input.”
The last guidance issued by ACR is in year 2002. Some of the key recommendations included in the new guidelines are:
- Methotrexate or leflunomide therapy is recommended for most RA patients.
- Anti-TNF agents etanercept, infliximab, or adalimumab along with methotrexate can be used in new or early RA cases with worsening and severe symptoms.
- Doctors should not initiate or resume treatment with methotrexate, leflunomide, or biologics if RA patients have active bacterial infection, shingles (herpes-zoster), hepatitis B, hepatitis C and active or latent tuberculosis.
- Doctors should not prescribe anti-TNF agents to patients with a history of heart failure, lymphoma or multiple sclerosis.
For the complete guideline, the American College of Rheumatology has a pdf file.
The anti-TNFs popularly available in the market are:
1) Enbrel (entanercept) – product of Amgen and Wyeth
ENBREL is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance your body’s immune system makes called TNF. People with an immune disease, such as rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, or psoriasis, have too much TNF in their bodies.
ENBREL can reduce the amount of active TNF in the body to normal levels, helping to treat your disease. But, in doing so, ENBREL can also lower the ability of your immune system to fight infections.
2) Remicade (infliximab) – product of Centocor, Inc.
REMICADE is an advanced treatment that has been shown to have substantial benefits in patients with a number of inflammatory disorders involving the immune system. REMICADE targets specific proteins in the body’s immune system to help control the development of inflammation, significantly reducing painful symptoms in diseases such as plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, adult Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, and ankylosing spondylitis.
3) Humira (adalimumab) – product of Abbott
HUMIRA is a TNF Blocker.
TNF (tumor necrosis factor) blockers are a class of medications that fight both the painful symptoms and progressive joint damage of moderate to severe rheumatoid arthritis. They just might make a real difference in your fight against RA.
TNF blockers can slow down the rate at which RA causes damage to joints and bones. HUMIRA is one such TNF blocker.
For many patients, HUMIRA can provide relief to painful joints. It can help fight the fatigue. And it can help slow the progressive joint damage of moderate to severe rheumatoid arthritis.
As we already know, rheumatoid arthritis is an autoimmune disease causing the chronic inflammation of the joints. We already know too that with the proper treatment, therapy, diet, lifestyle, etc…rheumatoid arthritis need not be a death sentence. Discuss the options with your doctor in order to still have the best quality of life despite your condition.
Read more from Medical News Today or UAB News.
UK’s NICE Decision Regarding Arthritis Drugs Curtails Switching Treatments
July 21, 2008 by Gloria Gamat
Filed under ARTHRITIS
The UK’s National Institute for Health and Clinical Excellence (Nice) decision on arthritis drug will prevent tens of thousands of arthritis sufferers to switch to powerful drugs.
In a separate post I already mentioned UK Nice’s ruling that do not allow switching of arthritis drug to more powerful ones, once the patient do not respond in one in the premise that it isn’t cost effective. Now the final draft on that ruling (before definitive guidance is issued) has been issued by Nice already.
Charity groups and arthritis patients alike are going berserk of course, simply because this ruling will prevent access of arthritis patients to hopefully better drugs to manage their arthritis.
The Telegraph reports:
The National Institute for Health and Clinical Excellence (Nice), today issues a final appraisal document – the last draft before definitive guidance is issued – stating that patients who do not respond to one powerful drug cannot try another of the same type.
Currently doctors are able to try patients on three variants of a drug type which work by blocking the action of a chemical.
If one does not work or its effectiveness wears out over time, sufferers can switch to another, prolonging the period they can remain fit and active.
But the drugs are very expensive, with even the cheapest costing around £100 a week per patient.
Many rheumatoid arthritis patients live with the disease for decades. They argue that cutting down the options will leave them needlessly living in agony for years.
Cutting access to the drugs will speed their decline, meaning they are less able to work for a living and will have to rely more on benefits and care, campaigners say.
I don’t understand it either. I came from a country where regular citizens don’t have access to the best treatment just because they don’t have money nor the medical coverage. I always thought thought that in the first world, access to the best treatments and prescribed drugs isn’t a problem. But then I guess it all boils down to business. I don’t know how medical coverage in the UK works, but then I guess since the government seems to have a say in which drug to opt for in the case of anti-TNFs for rheumatoid arthritis, they are probably covering a huge bulk of the medical treatments.
The anti-TNF drugs currently available on the NHS are Enbrel (its generic name being etanercept), Humira (adalimumab) and Remicade (infliximab).
Scientists are not sure why one anti-TNF drug might stop working over time but doctors and patients agree being able to switch between them can be highly beneficial.
Once arthritis patients have exhausted the anti-TNF options, under NHS rules they can move on to another drug called rituximab, a ‘biologic’ which works by modifying the immune system.
Until recently they would have then been able to try a separate drug called abatacept, but in April Nice quashed that option, saying it was not cost effective.
However, it just doesn’t sound fair to declare some drug class to be not cost effective. Then why don’t they just charge the patient with the extra cost they don’t cover?! At least leave the doctors and patients to have more options for treatment, right? I don’t know…I’m just saying.
Enbrel (etanercept)-Methotrexate Drug Combo For Remission of Rheumatoid Arthritis
July 16, 2008 by Gloria Gamat
Filed under ARTHRITIS
As reported by Wyeth – maker of the rheumatoid arthritis drug Enbrel – the combination of the drug Enbrel and methotrexate help improve to remission of rheumatoid arthritis.
Wyeth Pharmaceuticals (a division of Wyeth) and Amgen today announced the publication of data from the COMET (COmbination of Methotrexate and ETanercept in Active Early Rheumatoid Arthritis) trial demonstrating that half of patients treated with the combination of ENBREL and methotrexate achieved Disease Activity Score (DAS) clinical remission and nearly all had no progression of joint damage.
Enbrel is a tumor necrosis factor (TNF) blocker that blocks the action of a substance that the body’s immune system makes (called TNF) and is FDA-approved for the treatment of moderate-to-severe rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, ankylosing spondylitis and juvenile idiopathic arthritis. It looks like that Enbrel is prescribedx for most types of the inflammatory autoimmune kind of rheumatic arthritis.
Combination therapy with ENBREL plus methotrexate also helped patients remain more functionally active. Based on the Health Assessment Questionnaire (used to assess certain daily life activities), 61 percent (n = 256) of patients treated with combination therapy demonstrated improvement in their functionality versus 44 percent (n = 241) of those treated with only methotrexate. Further, the COMET trial showed that patients who were treated with combination therapy had a nearly three-fold reduction in work stoppage compared with those who received methotrexate alone.
The above findings were published online on July 15 by The Lancet.
In the United States, Enbrel has the following indications (more in details as I have already enumerated above:
- ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderate to severe rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.
- ENBREL is indicated for reducing the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients ages 2 and older.
- ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone.
- ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.
- ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
Read more from Wyeth’s press release and visit Enbrel’s website for more details about this drug. Remember, Enbrel is a prescription drug. Talk to your doctor about it if he hasn’t mentioned this already.
Some Arthritis Patient Story
July 9, 2008 by Gloria Gamat
Filed under ARTHRITIS
Strong we can relate to ( in this case arthritis patient story) is something that can inspire us, learn lesson from or just plainly give strength that you are not alone in your woes.
Here are a few recent arthritis stories I found on the web, in case you miss it:
In an Indianapolis Zoo, a polar bear is suffering from arthritis in the legs and shoulders
Arthritis has settled into the bones of the 600-pound polar bear, the nation’s second-oldest in captivity. She’d probably be dead if she were in the wild, where the old and weak are often eaten or simply crawl away to die.
Instead, Tahtsa is one of about a dozen animals that are living past their prime in the back alleys of the Indianapolis Zoo — mostly outside the view of the general public and with special attention from a team of caregivers specializing in geriatrics.
Canadian singer finally feeling relief from nagging arthritis
Chantal Chamberland extends her hands for closer inspection.
“Look, no inflammation,” the Canadian jazz songbird says smugly. Her supple hands have looked like this for the last 18 months, and, she hopes, superstitiously knocking on the table in front of her, they’ll stay that way the rest of her life.
A joint effort in a woman’s fight against rheumatoid arthritis
An active mother of two sons, Laura Janson keeps appointments with her physician and her physical therapist, shows up for X-rays and tests and takes all the medications prescribed for rheumatoid arthritis.
Janson also is active in terms of self-care, working out twice a week to build muscular strength, which in turn reduces stress on her joints. She was diagnosed with rheumatoid arthritis in 2000. “We were living in Naples, Fla., at the time, and I was used to jogging three miles a day,” Janson says. “Then I started having trouble with my feet.”
MÖTLEY CRÜE Guitarist Says He Lost 6 Inches Through Arthritis
MÖTLEY CRÜE guitarist Mick Mars is a prisoner of his own home when he’s not on the road with his band — because a debilitating form of arthritis has left him unable to drive anywhere.
Mars was diagnosed with Ankylosing Spondylitis (AS) when he was 19 and reveals the degenerative disease has left him unable to move his head.
He tells Blender magazine, “If I could go places I would, but I’m stuck. This stuff I have won’t allow me to move my head, so I can’t drive. It’s quite an inconvenience.”
Wonder woman Jane’s life of pain
WONDER woman Jane Evans has defied doctors by overcoming a life of pain.
Crippled by rheumatoid arthritis for more than 30 years, she has undergone numerous operations to her joints.Despite her condition, the 34-year-old has battled on to walk, drive and even have a child – all things experts warned she’d never do.
Just a few inspiring stories to let us know that arthritis need not be a life sentence. Have a nice read!
Possible Master Switch Gene in Juvenile Arthritis, Identified
July 2, 2008 by Gloria Gamat
Filed under ARTHRITIS
The ‘master switch’ gene that has been to play a role in some varities of rheumatoid arthritis in adults has now been identfied in all types of childhood arthritis.
Such were the findings of pediatric researchers at The Children’s Hopsital of Philadelphia. We all know arthritis isn’t an age-related condition anymore.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joint. Of course the old notion that the condition is age-related still prevails. Well, even my own mother cannot believe that arthritis can happen to younger people. But then it really can.
Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system. The immune system is a complex organization of cells and antibodies designed normally to “seek and destroy” invaders of the body, particularly infections.
Going back to the above findings. Researchers are claiming that the gene identifies may be the master switch’ that helps turn on rheumatoid arthritis.
Researchers at The Children’s Hospital of Philadelphia reported on the link between the gene region and juvenile idiopathic arthritis (JIA), formerly called juvenile rheumatoid arthritis. The genetic variant is on chromosome 9 in a region housing two genes, TRAF1 and C5.
The TRAF1 gene codes for a protein that regulates tumor necrosis factor, a chemical strongly associated with JIA. However, the researchers say further study is needed to determine whether the TRAF1 gene or the C5 gene is altered in the disease.
According to Terri H. Finkel, M.D., Ph.D — the chief of Rheumatology at Children’s Hospital and one of the study’s lead author:
“There are only a few genes that may act as master switches like this to regulate autoimmune diseases. This switch we discovered probably has to be an ‘ON’ gene and when it interacts with other genes and environmental triggers, a child may get juvenile arthritis.”
What are the implications of the above findings? For one, hopefully better targeted treatments that will benefit both children and adults suffering from rheumatoid arthritis. In children the condition is called juvenile idiopathic arthritis (formerly juvenile rheumatoid arthritis).
Edward M. Behrens, M.D. , a pediatric rheumatologist at The Children’s Hospital, said:
“We think this finding may be a clue to the specific disease pathway that leads to arthritis. We currently use medicines called tumor necrosis factor blockers to treat children with JIA.
However, not all children respond to these drugs, and other children may develop severe allergic reactions and other side effects. If we can fully identify all the genes that interact with environmental risk factors, we might develop more targeted treatments with fewer side effects.”
The abovementioned study appears in the July 2008 issue of Arthritis & Rheumatism.
Indeed this is an exciting development worth watching out for, don’t you think? We’ll see how this goes.
Rheumatoid Arthritis and Your Birthweight
July 1, 2008 by Gloria Gamat
Filed under ARTHRITIS
I was born at home. Natural birth method. No epidural, no anything. The local midwife helped my mother bring me out to this world. I am my mother eldest. I still can’t imagine how she did it. Well I had a c-section when I delivered my son. So the real pains of childbirth will always remain a “concept” to me.
So what about childbirth? This is an arthritis blog, right?
There is a new report of a study from UK linking rheumatoid arthritis to birth weight of women. it said women are more likely to develop rheumatoid arthritis later in life if they were heavy at birth.
The findings, based on patient records of more than 87,000 women aged between 30 and 55 when the US Nurses’ Health Study began in 1976, revealed that those weighing more than 10lb (4.54kg) at birth were twice as likely to develop rheumatoid arthritis as women of average birthweight. During the period of the research, 619 women were diagnosed with rheumatoid arthritis. Doctors at the Hospital for Special Surgery in New York describe how they found a striking link between women who developed the joint condition and their birthweight.
I have always mentioned in this blog how losing some weight can alleviate your arthritis, especially off the knees — if that is the kind you have.
But this is the first I encountered linking your weight at birth and the risk of developing rheumatoid arthritis later in life.
Well I don’t know how much I weight at birth, because I was born at home. But you see, a 10 lb baby at birth is HUGE. My son was just (if I remember it right) 7.2 lbs at birth and everyone was surprised that he is big already. How can something so big come out of a barely 5-ft tall woman like me. No wonder he cannot be delivered the natural way.
But a more than 10 lb baby?! It’s kinda scary you know. No wonder the baby can be at a higher risk of developing any serious condition later in life. Now I understand why pregnant women are told to watch what they eat and how much they eat. First and foremost, it becomes difficult to deliver a bigger than normal baby. Second, the health risks to both mother and the baby.
The results held true even after taking account of factors likely to influence the baby’s birthweight.
These included socioeconomic status, parental smoking, maternal diabetes, age at first period, use of oral contraceptives or HRT, breastfeeding and weight.
There is no obvious biological explanation for the findings, say the authors. But adults with rheumatoid arthritis have abnormal hormone regulation, and it is thought that this process may be triggered while in the womb.
Although completely speculative, they go on to suggest that if the risk of rheumatoid arthritis could be lessened during pregnancy, altering the mother’s diet could open up an exciting avenue for prevention.
The above research findings are published ahead of print in the Annals of the Rheumatic Diseases.
Fish Oil and Risk of Rheumatoid Arthritis
June 20, 2008 by Gloria Gamat
Filed under ARTHRITIS
Fish oil. We’ve been hearing and reading tonnes of health benefits from increase intake of fish oil (omega-3 fatty acids), either from food sources or dietary supplements.
Now, as presented at EULAR 2008 (the Annual Congress of the European League Against Rheumatism held in Paris, France)…fish oil has been associated with reduced risk of rheumatoid arthritis.
Take note of the following summary of findings:
Intake of oily fish is associated with a reduced risk of developing rheumatoid arthritis (RA), whereas psychosocial work stress and smoking can increase the risk of developing the condition.
The findings were taken from a Swedish large population-based case-control study called EIRA (Epidemiological Investigation of Rheumatoid Arthritis).
The above research claims to be the first to demonstrate the protective effect of fish oil to rheumatoid arthritis. The reduction of risk was estimated at 20-30%.
Studying 1,899 subjects with a confirmed diagnosis of RA (fulfilling ACR criteria) and 2,145 controls (randomly selected and matched for age, sex and residential area), investigators concluded that the odds ratio (OR) for developing RA was 0.8 (0.7-1.0) for those who consumed oily fish 1-7 times per week or 1-3 times per month, compared with those who never, or seldom consumed oily fish. Interestingly, no significant association with RA risk was observed for consumption of fish oil supplements.
There goes the bit again on supplements. When dietary sources are found effective, the supplements aren’t. At least not significantly. Though sometimes it is the other way around. But then keep in mind that it is always always a lot better to intake the dietary sources instead of popping the supplemental form. In this case, fish oil. There are are just too much fish oil supplements in the market.
But take this: you may be popping fish oil supplements but your diet contains all food bad for arthritis. Do you think you’ll benefit from the fish oil you’ve been taking? I think not. So as I have always said, dietary changes are crucial. We just gotta do it, at one point or another. It isn’t easy, but it can be done, right?
Tobacco smoking is an established risk factor for RA, but the investigators found that there is a dose dependency for the level of smoking (i.e. the number of cigarettes smoked across a given period) on the odds ratio of developing anti-citrulline (anti-CCP) positive RA.
Psychosocial stress at work, defined as low decision latitude (or low level of control) was found to be associated with a higher risk for RA.
So need I say more? I say put fish oil in your diet as early in your life as possible. You’ll benefit more from it and not just in terms of rheumatoid arthritis.
Read more from Science Daily.
Recent News on Everything Arthritis Drug
June 18, 2008 by Gloria Gamat
Filed under ARTHRITIS
In lieu of the recent EULAR 2008 (the Annual European Congress of Rheumatology in Paris, France), updates are abound regarding the developments of arthritis drugs, either of those already existing in the market but most especially of those that are still under clinical trials.
1. CEL-SCI Announces Discovery of Novel Compound for the Treatment of Rheumatoid Arthritis
CEL-SCI Corporation today announced the discovery of a novel peptide for the treatment of rheumatoid arthritis. This peptide, called CEL-2000, was tested in a well established animal model of rheumatoid arthritis and was compared to Enbrel(R), a leading treatment for people with rheumatoid arthritis.
Top-line data from the first-in-man study with Biotie’s fully humanVAP-1 monoclonal antibody BTT-1023 have become available. The studywas conducted in a clinical pharmacology unit in the United Kingdomand investigated the safety, tolerability and pharmacokineticcharacteristics of single intravenous doses of BTT-1023 in healthyvolunteer subjects.A total of 35 subjects, of whom 29 received BTT-1023, were enrolledinto the placebo-controlled study. BTT-1023 was generally welltolerated and no serious adverse events were reported in the study.
3. J&J, Schering arthritis drug effective in trials
An experimental treatment for rheumatoid arthritis being developed by Johnson & Johnson and Schering-Plough Corp appeared to be effective and very safe in three late-stage trials, the companies said on Tuesday.
The once-monthly injectable drug, called golimumab, is a newcomer in a family of arthritis medicines that work by blocking an inflammation-causing protein called tumor necrosis factor (TNF).
UCB has announced new data showing that Cimzia® (certolizumab pegol), the only PEGylated, Fc-Free anti-TNF (Tumor Necrosis Factor), combined with methotrexate (MTX), significantly inhibits progression of joint damage in patients with active rheumatoid arthritis (RA) as early as 16 weeks after the start of treatment.
Presented at the European League Against Rheumatism (EULAR) meeting in Paris, these data are the first to show such rapid inhibition of progression of structural damage in patients receiving an anti-TNF.
Abbott Japan Co., Ltd. (Pharmaceutical Products Group in Tokyo, President: Glenn S. Warner) and Eisai Co., Ltd. (Headquarters in Tokyo, President and CEO: Haruo Naito) announced that HUMIRA(R) subcutaneous injection 40mg Syringe 0.8mL (referred to as HUMIRA hereinafter) will be available for the treatment of rheumatoid arthritis from June 18, 2008.
HUMIRA received approval for manufacturing and distribution in Japan on April 16, 2008, and was listed in the National Health Insurance drug price list on June 13, 2008. After its launch, Abbott and Eisai will take a one-brand, one-channel and two-promotion scheme to ensure provision of information on proper use of HUMIRA. Both Abbott and Eisai will provide specialist medical representatives (MRs), and Abbott will cooperate with Eisai’s hospital MRs.
6. Abbott says arthritis drug works up to 7 years
Abbott Laboratories said Friday that long-term data showed its drug Humira, in combination with a common treatment used to treat a type of arthritis pain, led to remission of the disease for up to seven years.
The studies involved enrolled 1,469 patients with long-standing rheumatoid arthritis who took Humira with methotrexate every other week continuously, for at least 30 days and up to seven years. Abbott said that after six months of therapy, patients’ symptoms improved, with additional improvements seen after two or more years.
7. New drug for rheumatoid arthritis
A new “smart” drug could save thousands of rheumatoid arthritis patients from years of worsening pain and disability, research has shown.
Tocilizumab is being hailed as a major breakthrough in combating the crippling auto-immune disease which attacks the joints.
Tocilizumab monotherapy is superior to methotrexate monotherapy in patients with active rheumatoid arthritis (RA) who have not failed earlier treatment with methotrexate or biologics, according to phase 3 results released on June 13 at EULAR 2008, the Annual Congress of the European League Against Rheumatism.
Tocilizumab is an anti-interleukin (IL)-6 receptor antibody that inhibits IL-6 signalling. IL-6 has been implicated in the pathogenesis of RA and is thought to play a role in synovial inflammation and in the damage to periarticular bone and cartilage.
9. Roche’s Actemra helps in hard-to-treat arthritis
Thirty percent of rheumatoid arthritis patients who failed to respond adequately to anti-TNF therapy achieved remission from their disease when given Roche’s new drug Actemra, research showed on Friday.
After 24 weeks of treatment, 30.1 percent of patients receiving Actemra plus the older drug methotrexate achieved DAS28 — a standard measure of disease remission — compared with only 1.6 percent in the placebo group, the Swiss group said.
Okay, this all for now. Notice that all the above drugs in the pipeline are all specific for rheumatoid arthritis (RA) — an autoimmune, inflammatory, degenerative joint disease.
Drinking Your Way Out of Rheumatoid Arthritis Risk
June 18, 2008 by Gloria Gamat
Filed under ARTHRITIS
Okay, before you all get too excited with the title, let us all remember the word moderation when pertaining to alcohol intake. 😉
Now…studies are claiming that it may be possible that drinking five glasses of wine per week can reduce the risk of the onset of rheumatoid arthritis by 50 percent.
I got the following from HealthNews:
According to a recent Annals of the Rheumatic Diseases report, people who drank the equivalent of five glasses of an alcoholic beverage per week were approximately 50 percent less likely to develop rheumatoid arthritis than those who drank little or no alcohol.
The Sweden-based Karolinska Institute conducted two studies with 2,750 people and analyzed environmental and genetic risk factors that come into play with rheumatoid arthritis. All of the participants in the studies were asked about their lifestyles, including smoking and drinking habits, and blood samples were done to balance the research with genetic risk factors. Over half of the participants were found to have rheumatoid arthritis.
Those who drank alcohol were found to have significantly lower risks of developing the disease, and the more alcohol consumed, the lower the risk. In fact, the quarter of the participants who drank the most was found to be up to 50 percent less likely to develop rheumatoid arthritis than those who drank the least. As with other inflammatory diseases having to do with the heart, alcohol consistently seems to reduce the risk of inflammation, which now rings true with arthritis, though the cause of this correlation remains undetermined.
But then the news on the health benefits of moderately drinking wine (especially red wine!) isn’t exactly new. In recent years, wine has been found to be good for our heart and in some types of cancer.
With regards to rheumatoid arthritis, I think, like in any other condition, the effects will most likely be seen to those who has been drinking wine for the long term. I mean you cannot just start drinking wine say this month and expect to lower the onset of your rheumatoid arthritis. Besides, there are just too many factors to consider.
Still, if taken moderately, I see nothing wrong with me. Wine is wine and it made from the fruit of the vine (grapes). Even our wine-drinking ancestors knew it is good for the body. Maybe one reason why people in the old days lived longer? Maybe.
So let us drink to that. Just watch how much you wine you drink, okay? It says here wine, not beer. Not brandy and those distilled alcohol stuff. 😉
