Rheumatic Diseases
Genes may be important in back, neck pain
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A person’s genetic makeup may play an important role in the odds of suffering neck or back pain, new research suggests.
In a study of more than 15,000 twins ages 20 to 71, Danish researchers found that genetic susceptibility seemed to explain a large share of the risk of suffering back and neck aches.
Chronic and recurrent pain along the spine is one of the most common health complaints among adults, yet the precise cause remains unknown in most cases. And in general, researchers know little about the mechanisms underlying these aches and pains.
Getting a new knee may boost quality of life
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People with severe osteoarthritis of the knee who have knee replacement surgery are apt to see significant improvements in their “health-related” quality of life, new research shows.
Knee osteoarthritis—the wear-and-tear form of arthritis in which the cartilage cushioning the joints gradually breaks down and, in severe cases, can completely wear away—is a major cause of pain and disability, particularly in aging individuals.
“The demand for total knee replacement is increasing as patients gain considerable pain relief and increased mobility and health-related quality of life,” Dr. Montserrat Nunez, from the Hospital Clinic in Barcelona, Spain, and colleagues note in a report in the journal Arthritis and Rheumatism.
63 percent of RA patients suffer psychiatric disorders, with depressive spectrum conditions most lik
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Copenhagen, Denmark, Friday 12 June 2009: Over half (63%) of patients with rheumatoid arthritis (RA) also suffer from psychiatric disorders, with the majority of these (87%) occurring in the depressive spectrum, according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. Interestingly, over half (52%) of the patients studied indicated that they had experienced stress events before the onset of their RA.
The study also revealed a number of other interesting findings about the emotional burden of RA:
* Cognitive dysfunction was diagnosed in 23% of patients, with 16% of this attributed to depression
* A third (33%) suffered from sleep disorders
* Those with depression also exhibited more severe RA (measured by X-ray), greater functional insufficiency and pain, as well as having received less aggressive treatment than patients without depression. (No significant differences in age, duration of illness, gender or DAS28* scores were noted between the two groups)
* Significantly, cognitive impairments were found more often (p=0.02) in patients older than 50 years (39% vs. 9%)
* The age of the first prednisone intake was significantly higher (p<0.05) in patients with depression compared to those without (48 vs. 30 years)
RA individuals from lower GDP countries keep working despite worse symptoms than richer countries
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Copenhagen, Denmark, Friday 12 June 2009: Individuals diagnosed with rheumatoid arthritis (RA) in lower gross domestic product (GDP) countries (GDP below $11,000) are more likely to continue working despite higher disease activity and functional disability scores compared to their counterparts in higher GDP countries (GDP >$24,000) according to a new multinational study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.
Among 1,650 individuals from 30 countries whose symptoms had begun during the 2000’s and who remained working after RA diagnosis, disability levels according to the Health Assessment Questionnaire (HAQ*) were 0.25 vs. 0.82 in men and 0.50 vs. 0.94 in women (p<0.001) in higher-GDP and lower-GDP countries, respectively, and the Disease Activity Scores (DAS28**) were 3.1 vs. 4.7 in men, and 3.5 vs. 4.8 in women (p<0.001). A Kaplan-Meier analysis (95% CI) showed that the probability of individuals continuing work for 2 years was 80% and the probability of continuing to work for 5 years was 68%.
Dr Tuulikki Sokka, Jyväskylä Central Hospital, Finland, who leads the project said: “Work disability is the most costly consequence of RA, and the rheumatology community would welcome better treatment strategies to effectively address this. However, real-life data from 30 countries indicate that work disability is still a major issue in early RA during this decade, and especially in low-GDP countries where people continue to work with considerable disease activity and functional limitations.”
Breastfeeding cuts baby girls’ pneumonia risk
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Breastfeeding appears to reduce the risk for severe lung infection and associated hospitalization among infant girls, but not among infant boys.
The finding comes from a study of babies in Buenos Aires, Argentina, by Dr. Fernando Polack, from Vanderbilt University in Nashville, Tennessee, and colleagues.
Boys may derive some protection from breastfeeding, noted Polack, but this study may have been too small to sufficiently identify this benefit.
Still, the results mirror previous research conducted in Argentina and the United States, Polack told Reuters Health, and when taken together indicate that “mothers of girls should pay close attention to the importance of breastfeeding to protect their infant’s lungs.”
TNF-blocker therapy for RA may trigger psoriasis
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Evidence continues to mount that so-called TNF-blockers used to treat rheumatoid arthritis (RA) may lead to psoriasis. The latest study by UK researchers adds to individual case reports of psoriasis occurring in RA patients treated with TNF blockers.
“We observed 25 cases of new-onset psoriasis in our cohort of almost 10,000 patients with rheumatoid arthritis receiving anti-TNF therapy,” investigator Dr. Kimme L. Hyrich told Reuters Health. This compared to “no cases reported in our non-biologic treated control cohort.”
As reported in the Annals of the Rheumatic Diseases, Hyrich of the University of Manchester and colleagues studied data on 9826 anti-TNF-treated patients and 2880 treated with so-called DMARDS (short for disease modifying anti-rheumatic drugs).
30,000 Children with Form Of Juvenile Rheumatoid Arthritis May Have New Treatment Option
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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
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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
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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
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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
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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
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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
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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.
