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Steroid treatment might reduce risk of rheumatoid arthritis related lymphoma

The findings of a study, presented at the Annual European Congress of Rheumatology (EULAR) 2007, suggest that the risk of rheumatoid arthritis related lymphomas are significantly reduced in patients treated with oral steroid treatment for more than two years. The most pronounced steroidal effect was observed in the diffuse large B-cell lymphoma subtype. "The pros and cons of corticosteroid treatment in rheumatoid arthritis have been a subject of much debate, and long-term steroid treatment is often limited as a result of concerns about various side effects," said Eva Baecklund of the Uppsala University Hospital in Sweden. "Patients with severe rheumatoid arthritis are at increased risk for malignant lymphomas (cancer in the immune system), but long-term steroid treatment may decrease this risk." In this study, the steroid treatment outcome was not associated with the presence of the Epstein-Barr virus in lymphomas.

A study conducted at the Karolinska Institutet in Sweden showed that consuming three alcoholic drinks per week decreases the risk of developing rheumatoid arthritis. The researchers conducted a study of incident rheumatoid arthritis cases among 18 to 70-year-olds in a defined area of Sweden. DNA from 1,204 cases and 871 controls was examined to detect the presence of HLA-DRB1 SE alleles, a marker indicating a genetic risk factor for rheumatoid arthritis. "These are very interesting findings and are the first observation, from epidemiological data, which now should be confirmed by further clinical studies before a firm conclusion can be achieved,” said Tore Kvien, president of EULAR. These findings could prove useful in understanding the effects of lifestyle on the risk of developing rheumatoid arthritis, and prove useful in a potential treatment based on the beneficial effects of alcohol.

A recent study that used data from a study conducted in the early '90s in Spain found that breast feeding for 13 or more months reduced women's risk of developing rheumatoid arthritis compared to those who had never breast fed. "This study specifically highlights the potential of naturally-induced hormones in protecting individuals from developing RA (rheumatoid arthritis) in the future," said Mitra Keshavarz of the Malmö Hospital University in Sweden.

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Startling revelations about arthritis

Researchers made a surprising discovery when they found that it was more difficult for women to achieve remission from rheumatoid arthritis than it was for men. They declared their findings on the basis of a study conducted on around 700 adults, two thirds of whom were women. All had been suffering from the disease for an average of six months. At the end of two years, only 32 per cent of the women had gone into remission while 48 per cent of the men had. At the end of five years, the difference was even more glaring. While 52 per cent of the men were in remission only 31 per cent of women were. Also, though the severity of the disease was lesser in women at the beginning of the trial, its progression was much faster.

Meanwhile, another study has found that smoking tends to increase the pain from osteoarthritis of the knee. In the study, the researchers followed 159 men with symptomatic osteoarthritis of the knee for two and a half years. Around 12 per cent of the volunteers smoked. Magnetic Resonance Imaging (MRI) scans found that the risk of cartilage loss increased by double in smokers. Also, smokers felt the pain more acutely than non–smokers.

There is hope yet. Generally used for cosmetic purposes, Botox injections can relieve arthritic pain in the knee too. Researchers came to this conclusion after a trial on 37 participants who were given either Botox injections or inactive ones. At the end of one month, the participants who had received Botox experienced lesser pain and their ability to perform physical functions also improved. The researchers now aim to decide on an optimal dose and test how long the efficacy of the injection lasts.

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Gene research breakthroughs in RA, OA and OCD

Recent discoveries made in genetic research in the US will help in a better understanding of the nature of three different diseases—rheumatoid arthritis (RA), osteoarthritis (OA) and obsessive-compulsive disorder (OCD).

In order to understand the role of genes in the development of rheumatoid arthritis, scientists from the University of Michigan Medical School conducted a study on identical twins. Scientists compared gene expression patterns of 11 pairs of twins who were genetically identical but only one of them had RA. They found three new genes that were significantly over-expressed in the twin with RA compared to the one without the disease. The genes were laeverin, an enzyme that works to degrade proteins, 11b-HSD2, a protein that deactivates cortisol, and Cyr61, which plays a role in the formation of new blood vessels.

Researchers from Rhode Island Hospital have found that the loss of the gene matrilin-3 leads to osteoarthritis. When the researchers took out matrilin-3 in mice, they noticed that during embryonic development, the mice developed premature and extended hypertrophy. Compared with mice whose genes had not been altered, the mice lacking matrilin-3 showed significantly higher bone mineral density (BMD) both in the knee joint and throughout the body at 18 weeks of age. Clinical studies in humans have shown that the prevalence of osteoarthritis increases with increasing BMD.

Meanwhile, researchers have shed light on the one of the genetic factors that causes Obsessive Compulsive Disorder to run in families. In two separate papers, researchers have found an association between OCD and a glutamate transporter gene called SLC1A1. The gene encodes a protein called EAAC1 that regulates the flow of glutamate in and out of brain cells. Variations in the gene might lead to alterations in that flow, and increase the risk of a person developing OCD.

Painkillers affect heart adversely

A recent study has found that non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac increase the risk of heart disease. This comes as a major blow to sufferers of acute chronic pain as these drugs are extensively used as a source of relief.

Researchers from the University of Oxford and the University of Rome found that consuming these drugs in the highest recommended dose could double the risk of heart attack. The study was published in the British Medical Journal.

The researchers collected the outcomes of all trials in which vascular events had been recorded for both COX-2 inhibitors and NSAIDs. They found three more heart attacks per 1,000 people every year among subjects who did not already have heart disease, but who were taking COX-2 inhibitors or NSAIDs. Dr Colin Baigent, who headed the research, said that the study was carried out over several years and involved 140,000 patients. When all “vascular events”—heart attacks, stroke or vascular disease—were considered together, the drugs increased the risk by 40 per cent. On the other hand, naproxen was found to be safe while aspirin was not included in the analysis.

An earlier study had confirmed that COX-2 inhibitors were responsible for the increase of vascular events. This had led to Vioxx being withdrawn from the market. With the latest study establishing that NSAIDs also increased the chances of heart failure, sufferers from painful conditions like arthritis claim that the respite given by these drugs is worth the risk. The researchers have also reassured the people saying that the heart attack rate is small and there is no need to panic.

Australian clinical trial to test effectiveness of glucosamine in treating osteoarthritis

The Australian government has commissioned a national clinical trial to test the effectiveness of glucosamine in treating osteoarthritis.

The trial, costing AUD 450,000, will test the use of this popular dietary supplement on 340 people with osteoarthritis in their knees. The trial will last nine months and will be conducted by a research team from Sydney University's George Institute for International Health.

It will determine how useful glucosamine - a supplement created by extracting amino sugars from shellfish - is in various preparations, for different joints, and at varying stages of  disease severity. A long-term follow-up study is also planned.

Glucosamine has long been hailed as an effective means of alleviating the pain of osteoarthritis. There is no cure for the disease, but evidence points to the fact that glucosamine can be effective, especially in the short term.

In a randomized, placebo-controled clinical trial conducted in Belgium and published in The Lancet in 2001, 212 patients were given glucosamine or a placebo. The conclusion was that while glucosamine appears to be well tolerated and may have a role as a disease-modifying agent in the treatment of osteoarthritis of the knee, more studies are needed to determine the true benefit, its optimum dose, and the role of other agents such as chondroitin.

Glucosamine and chondroitin sulfate are substances found naturally in the body. Glucosamine is a form of amino sugar that is thought to play a role in forming and repairing cartilage. Chondroitin sulfate is a part of a large protein molecule that makes cartilage elastic.

 

Remicade (infliximab) effective against psoriasis

Remicade (infliximab) - a drug prescribed to treat autoimmune disorders such as Crohn's disease, rheumatoid arthritis, and psoriatic arthritis - has successfully treated moderate to severe cases of the skin disease psoriasis in a randomised trial. The results were published in the medical journal, The Lancet.

Researchers at the University of Manchester School of Medicine in the U.K. recruited 378 patients with psoriasis to intravenously receive either Remicade or a placebo at intervals for at least one year. By the tenth week, 80% of the patients treated with Remicade experienced at least a 75% improvement vs. less than 3% for placebo patients. The drug also had a positive effect on nail psoriasis, which is present in 20% to 50% of psoriasis patients.

Psoriasis is thought to be an autoimmune disorder, occuring when the body overproduces skin cells which accumulate on the surface of the skin before they mature, creating bright red patches that cause itching, burning, and stinging.

Tumour necrosis factor alpha (TNF alpha) - a protein in the body involved in inflammation which triggers rheumatoid arthritis and Crohn's - is thought to play a part in the development of psoriasis. Remicade can neutralise the activity of TNF alpha.

The scientists reported none of the patients given Remicade had any serious side effects, but noted that the treatment is not a cure.

EntreMed to file with FDA to begin human trials for experimental rheumatoid arthritis drug

Researchers at EntreMed Inc. have discovered that daily doses of the company's lead compound, 2-methoxyestradiol (known as 2ME2) significantly reduced the severity of joint inflammation and damage in rats that had been given arthritis. They also discovered that the drug significantly delayed the onset of arthritis in rats.

EntreMed presented the preclinical rheumatoid arthritis results for 2ME2 at the Paris Anti-Inflammatory Drugs 2005 Conference, October 7-8.

The company announced today that in 2006 it will file with the U.S. Food and Drug Administration to begin human trials of 2ME2 as an experimental rheumatoid arthritis drug.

Rheumatoid arthritis occurs when the immune system mistakenly attacks the membranes surrounding the joints, causing inflammation. The disease, characterized by pain, stiffness, and deformity, can be debilitating.

EntreMed's 2EM2 also made the news last April when the company announced the results of multiple preclinical studies confirming the mechanisms-of-action for the compound in treating various types of cancer.

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