November 29, 2006, 4:34 AM CT

The impact of immunosuppressive medications

Patients with rheumatoid arthritis (RA) have an increased risk of heart attack and stroke. As per extensive evidence, the key driver for this increased risk of cardiovascular disease is the increased systemic inflammation characteristic of RA. Studies are less clear on whether medications that work to reduce RA's inflammatory symptoms provide protective benefits against cardiovascular events. Some data have suggested that the most potential biologic therapies, such as the TNF blockers, might reduce the risk of ischemic cardiovascular events.

To investigate, scientists at Harvard Medical School's Brigham and Women's Hospital compared the effects of a variety of immunosuppressive agents on cardiovascular events in a large sample of RA patients. Based on their findings, featured in the December 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), TNF blockers were not linked to either a reduction or an increase in the risk of heart attack or stroke compared with the most usually used RA therapy, methotrexate. While certain anti-inflammatory drugs appeared to exacerbate the risk of heart attack and stroke for RA patients, especially among older women.

Drawing on a database of Medicare patients receiving a drug benefit from the state of Pennsylvania, the scientists identified 946 individuals who had been diagnosed with RA, prescribed an immunosuppressive agent, and hospitalized for either heart attack or stroke within a six-year period. These patients were defined as case subjects for studying the role of anti-inflammatory RA therapies in the risk of cardiovascular disease. Each case subject was matched by age and gender to ten controls. The controls, a total of 9,460 RA patients, did not experience cardiovascular events during the delineated period. All the subjects were over age 65 and most were female and white.........

Posted by: Mark      Permalink         Source

November 7, 2006, 11:06 PM CT

Bones At The Nanoscale

A bone is made up of two different elements: half of it is a stretchable fibrous protein called collagen and the other half a brittle mineral phase called apatite. These components make this biomineralized tissue highly strong and tough. at the same time, In order to understand how this construction is achieved and functions, researchers from the Max Planck Institute of Colloids and Interfaces in Potsdam (Gera number of) came to the ESRF. Using X-rays they were able to see for the first time the simultaneous re-arrangement of organic and inorganic components at a micro and nanoscale level under tensile stress.

The researchers realised that when strain/pressure is applied to a bone, this is absorbed by soft layers at successively lower length scales, and less than a fifth of the strain is actually noticed in the mineral phase. The soft structures form a single rigid unit at the next level and so on, enabling the tissue to sustain large strains. This is why the brittle apatite remains shielded from excessive loads and does not break.

The results also showed that the mineral crystallites are nonetheless very strong, capable of carrying more than 2 - 3 times the fracture load of bulk apatite. Their small size preserves them from large cracks. This is the first experimental evidence for this effect in biomaterials - small particles resist failure better.........

Posted by: Mark      Permalink         Source

November 7, 2006, 4:43 AM CT

Smoking, Fractures And Ligament Injuries

Cigarette smoking, which causes over 8.6 million illnesses annually in the U.S., has been shown to have harmful effects on a variety of orthopedic conditions. Studies have shown that the numerous toxins contained in cigarette smoke can undermine fracture and ligament repair following injury. In addition, smokers have higher rates of hip fracture, fracture healing problems and bone infections and smoking has been shown to impair soft tissue wound healing. Two new studies, funded by the National Institutes of Health and the National Football League Charities, examined the effects of smoking on fractures and ligament healing in mice and observed that healing of both types of injury was delayed. The studies are published in the December 2006 issue of the Journal of Orthopaedic Research (http://www.interscience.wiley.com/journal/jor), the official journal of the Orthopaedic Research Society.

Led by Hossam B. El-Zawawy of the Washington University School of Medicine in St. Louis, MO the first study involved 35 mice divided into a smoking group, which was exposed to cigarette smoke 6 days per week for a month, and a control group. Surgery waccording toformed on all the mice to achieve a simple fracture. Scientists used type II collagen expression as a marker of cartilage formation (chondrogenesis) during healing. They observed that smoking delayed fracture healing and that it began at the early stages of the healing process, eventhough over time it did not inhibit normal healing. Specifically, they were able to show that there was a delay in the development of mature cartilage cells in the mice exposed to cigarette smoke. This was the first study to analyze the molecular and cellular mechanisms of fracture healing in mice exposed to smoke.........

Posted by: Mark      Permalink         Source

November 1, 2006, 4:40 AM CT

Rock Climbing Does Not Increase Risk Of Osteoarthritis

A study in the US has found there is no greater risk of osteoarthritis in rock climbers in comparison to non climbers, contrary to prior theory.

The study, reported in the recent issue of Journal of Anatomy, examined osteological changes in the hands and fingers of rock climbers that result from intense, long-term mechanical stress placed on these bones. Specifically, whether rock climbing leads to increased cortical bone thickness and joint changes linked to osteoarthritis. Scientists also wanted to identify whether climbing intensity and frequency of different styles of climbing influence changes.

Adam Sylvester of the University of Tennessee explains: "Radiographs of both hands were taken for each participant and were scored for radiographic signs of osteoarthritis using an atlas method. We compared 27 recreational rock climbers and 35 non-climbers for four measures of bone strength and dimensions and osteoarthritis. The results suggest that climbers are not at an increased risk of developing osteoarthritis compared with non-climbers.

Climber's finger and hand bones are, however, greater in cross-sectional area and total width, indicating that additional bone is being deposited on the external surface, not commonly seen in adults. The strength of the finger and hand bones are correlated with styles of climbing that emphasize athletic difficulty. Significant predictors include the highest levels achieved in bouldering and sport climbing".........

Posted by: Mark      Permalink         Source

October 22, 2006, 11:15 PM CT

Genes And Perception Of Pain

A new NIH-funded study shows that a specific gene variant in humans affects both sensitivity to short-term (acute) pain in healthy volunteers and the risk of developing chronic pain after one kind of back surgery. Blocking increased activity of this gene after nerve injury or inflammation in animals prevented development of chronic pain.

The gene in this study, GCH1, codes for an enzyme called GTP cyclohydrolase. The study suggests that inhibiting GTP cyclohydrolase activity might help to prevent or treat chronic pain, which affects as a number of as 50 million people in the United States. Doctors also may be able to screen people for the gene variant to predict their risk of chronic post-surgical pain before they undergo surgery. The results appear in the October 22, 2006, advance online publication of Nature Medicine.*.

"This is a completely new pathway that contributes to the development of pain," says Clifford J. Woolf, M.D., of Massachusetts General Hospital and Harvard Medical School in Boston, who led the research. "The study shows that we inherit the extent to which we feel pain, both under normal conditions and after damage to the nervous system." .

Dr. Woolf carried out the study in collaboration with Mitchell B. Max, M.D., of the National Institute of Dental and Craniofacial Research (NIDCR) in Bethesda, Maryland, and his colleagues at the National Institute on Alcoholism Abuse and Alcoholism (NIAAA) and elsewhere. Dr. Woolf's work was funded by the National Institute of Neurological Disorders and Stroke (NINDS). The research team also received funding from NIDCR, NIAAA, and other organizations.........

Posted by: Daniel      Permalink         Source

October 19, 2006, 9:40 PM CT

Reducing Knee Pain And Reliance On Painkillers

Older people with knee pain who receive their main care from physiotherapists and pharmacists are more likely to experience improvements in pain levels and knee function, and are less likely to need NSAIDs (non-steroidal anti-inflammatory drugs, eg asprin and ibuprofen), as per a BMJ study.

Scientists from Keele University undertook a study involving over 300 people with knee pain. The participants (aged over 55), were split into three groups.

The first group took part in an 'enhanced pharmacy review' with up to 6 appointments with an experienced community pharmacist to monitor the appropriateness and effectiveness of medication. A second group received up to 6 sessions with a physiotherapist, which included general aerobic exercise and specific muscle strengthening and stretching exercises. A final 'control' group received an information and advice leaflet which was also issued to the other two groups plus a telephone call to reinforce the information in the leaflet and address any specific concerns about putting the advice into practice.

When compared with the control group, those in the physiotherapy group reported a significant improvement in pain levels and in knee function after three months of therapy. Participants in the pharmacy group also reported improvements in pain levels.........

Posted by: Mark      Permalink         Source

October 15, 2006, 7:20 PM CT

Drug Might Give Prolonged Arthritis Relief

Scientists at Duke University have devised a new way to significantly prolong the effects of an anti-inflammatory drug, potentially making it useful for providing longer-lasting therapy for osteoarthritis, the most common form of arthritis.

The modified drug, which would be injected directly into arthritic joints, could last for several weeks rather than just the few hours the unmodified drug would last, the scientists said.

In their study, the scientists modified a drug called interleukin-1 receptor antagonist (IL1RA). They observed that the drug, which is a protein, could be improved by attaching a second protein that clumps together at normal body temperatures. The combined drug likewise would assemble into clumps in the body to serve as "drug depots" that gradually release active drug particles, the scientists said.

"Eventhough the conventional drug is being used for autoimmune diseases, no one yet knows how much of it would be needed to achieve a therapeutic effect for osteoarthritis," said Lori Setton, associate professor of biomedical engineering and surgery. "Current estimates suggest it would require perhaps two injections per week of the unmodified drug.

"With this advance, we believe therapys could go from twice a week to perhaps twice a month, and that would be a huge clinical gain," she said.........

Posted by: Mark      Permalink         Source

October 11, 2006, 4:54 AM CT

Rheumatoid Arthritis Patients Face Unofficial Postcode Lottery

People suffering from the debilitating pain of rheumatoid arthritis (RA) face a postcode lottery over whether they can have access to a therapy that is known to improve their condition significantly.

New research reported in the medical journal Rheumatology [1] today (11 October 2006) reveals that, despite the National Institute for Health and Clinical Excellence (NICE) approving anti-tumour necrosis factor alpha (TNF) treatment for RA in 2002, a number of primary care trusts are refusing to fund it adequately or are putting a cap on the numbers of patients that can be treated.

The picture is even worse for the use of anti-TNF treatment in other arthritic conditions such as psoriatic arthritis (PsA) and ankylosing spondylitis (AS) where NICE approval has only just been given or is being awaited.

As a result of these findings, rheumatologists are calling on the Government and primary care trusts to end the unofficial postcode lottery and ensure that every patient who meets the NICE criteria can receive anti-TNF treatment if their consultants consider it appropriate.

Dr Lesley Kay, a member of the British Society for Rheumatology Biologics Register (BSRBR) management committee and co-author of the research, said: "The BSRBR urges the Government and primary care trusts to put an end to this patently unfair situation, which is in direct contravention of government policy. The postcode lottery continues to operate, even though NICE aims to stop this happening. It's unfair on patients with these devastating, painful and unglamorous conditions to be forced to take a low priority and to be deprived of this very successful therapy".........

Posted by: Mark      Permalink         Source

October 1, 2006, 7:00 PM CT

Osteoarthritis A Biological Ageing?

Osteoarthritis is a common disease of the old age. It can often be seen in younger individuals. No some researchers are saying that those who get osteoarthritis at younger age might be biologically in an older age. Thse findings are published ahead of print in the Annals of the Rheumatic Diseases.

The authors base their findings on a study of almost 1100 people, aged between 30 and 79. Most of them were female twins.

X-rays of both hands were taken of all participants to check for signs of osteoarthritis and a blood sample was taken to assess "biological ageing" in white cell DNA.

Biological ageing is likely to be reflected by the gradual shortening of telomeres, the length of DNA which caps the tips of chromosomes. A host of factors make them shorten over time, including insufficient repair of the damage caused by oxygen free radicals (oxidative stress).

Oxygen free radicals are the unstable molecules produced as a by-product of normal bodily processes, as well as external factors, such as tobacco, alcohol, and sunlight.

Osteoarthritis is the most common form of arthritis, with the hands being one of the sites most often affected. Its frequency rises dramatically with age, but it is still not known exactly what causes it.

Unsurprisingly, the findings showed that white cell telomere lengths were associated with chronological age. The older a person was, the shorter they were.........

Posted by: Mark      Permalink         Source

September 28, 2006, 10:07 PM CT

Cancer Drug For Rheumatoid Arthritis

The potent cancer drug Gleevec, used to combat leukemia and some gastrointestinal cancers, may be useful in treating rheumatoid arthritis, as per a team of scientists at the Stanford University School of Medicine. Their findings would be reported in the recent issue of the Journal of Clinical Investigation.

Eventhough the study shows that Gleevec worked well in mice, the scientists cautioned against doctors using Gleevec for treating rheumatoid arthritis until clinical trials are completed demonstrating its effectiveness and safety for people with the disease.

Rheumatoid arthritis is a painful, chronic autoimmune disorder, characterized by inflammation of the lining of the joints. It affects more than 2 million Americans; up to half of those with the disease are disabled after 15 years due to disfigured joints. Standard treatment for rheumatoid arthritis now includes agents that suppress the immune system, but a number of patients do not benefit from such therapys. They do not get adequate reduction in the symptoms and signs of disease; they may also continue to have damage to their joints or develop side effects that make continued use of such therapies impossible. Thus, new approaches are needed.

Bill Robinson, MD, PhD, assistant professor of medicine and the study's senior author, led a team that set out to find drugs that might provide additional benefit to rheumatoid arthritis patients. They screened a range of drugs in mice that have a condition similar to human rheumatoid arthritis.........

Posted by: Janet      Permalink         Source