Ankylosing Spondylitis (Bechterew's Disease) is a painful chronic inflammatory rheumatic disease, associated with stiffening of the vertrebral column. Between 100,000 and 150,000 cases have already been diagnosed in Germany, but milder forms of the disease may remain undiagnosed.
The research team, led by Dr. Roland R. Wick, with Dr. Elke A. Nekolla, Prof. Dr. Albrecht M. Kellerer and the late Prof. Dr. Wolfgang G?¶ssner have conducted a long-term follow-up study of 1,471 ankylosing spondylitis patients, whose disease symptoms were treated with repeated intravenous injections of 224Radium. A control cohort of 1,324 ankylosing spondylitis patients treated without the use of radioactive compounds and/or X-rays were also studied.
In the current publication an elevated rate of leukaemias was seen, a malignant disease of the haematopoietic system: In all, 19 observed cases of leukaemia were documented compared with 6.8 cases that would be expected in an age- and gender-matched cohort of a normal population. In particular, the incidence of acute myeloid leukaemia was significantly increased with 7.0 cases compared with 1.8 cases expected in a "normal" population.
Furthermore, four additional cases of preleukaemic diseases of the bone marrow were present in the exposed group and no cases in the control group. The frequency of leukaemia was not increased significantly in the control group compared with the expected value for a normal population.
"It is rather unlikely that impurities present in the radium preparations used before 1950 are responsible for the elevated appearance of myeloproliferative diseases in the exposed group observed here," commented Dr. Roland R. Wick. "In addition, the increased incidence of leukaemia is in line with experimental observations involving the treatment of animals with similar alpha emitting radioisotopes."
The results of these studies by the Helmholtz Zentrum M??nchen have contributed decisively to 224Radium preparations being declared obsolete and have resulted in the revocation of the licensing of SpondylAT ® by the Federal Institute for Drugs and Medical Devices (BfArM) and the decision by the licence holders to discontinue development of the treatment. In earlier legal proceedings the Cologne Administrative Court, in its decision of October 26th, 2006, came to the conclusion that the "increase of myeloid leukaemia [??¦] could be explained causally with the deposition of radium as a calcium-like element into the bone", because, due to its short half-life of only 3.66 days, the radiation released from 224Radium has its effect mainly at the bone surface in the proximity of the blood-forming bone marrow cells.
Although previous studies have shown that radium treatment has an analgesic effect the risks of 224Radium treatment exceed its benefit, particularly, since there are many other therapeutic options available. Accordingly, the Committee for Quality Assurance of the German Society for Rheumatology no longer include this therapy in its recommendations.
Source: Dr. Roland R. Wick
Helmholtz Zentrum M??nchen - German Research Center for Environmental Health
воскресенье, 30 октября 2011 г.
четверг, 27 октября 2011 г.
Rheumatoid Arthritis Patients At Higher Risk For Unrecognized Heart Disease And Cardiac Sudden Death
People with rheumatoid arthritis not only have a higher risk of coronary heart disease than those in the general
population, but they have more silent, unrecognized heart attacks and sudden cardiac deaths, according to a Mayo Clinic study
published in the February issue of Arthritis & Rheumatism (rheumatology/publications/ar). They are also much less likely to complain of chest pain.
The increased heart disease risk may be present even before the diagnosis of rheumatoid arthritis, according to the
researchers. During the two years before diagnosis of rheumatoid arthritis, patients with this disease were three times more
likely to have been hospitalized for an acute heart attack and five times more likely to have an unrecognized heart attack.
They were also less likely to have had a history of chest pain, compared to those without rheumatoid arthritis. After their
diagnosis, the rheumatoid arthritis patients were twice as likely to experience unrecognized heart attacks and sudden cardiac
deaths.
Hilal Maradit Kremers, M.D., lead study investigator and research associate in the Mayo Clinic Department of Health Sciences
Research, says the study suggests three major messages for rheumatoid arthritis patients:
-- The risk of heart attack is already there at the time a rheumatoid arthritis diagnosis is first made.
-- Heart disease can remain silent in those with rheumatoid arthritis. Regular cardiac checkups are important, as is lowering
traditional cardiac risk factors, such as taking care of blood pressure and cholesterol and quitting smoking.
-- Heart disease in rheumatoid arthritis patients can manifest for the first time as a cardiac sudden death.
The researchers were surprised to find that the increased cardiac events in rheumatoid arthritis patients could not be
explained by an increase in traditional heart disease risk factors such as elevated cholesterol, blood pressure and body mass
index, diabetes, and alcohol abuse, indicates Dr. Maradit Kremers.
"What we are finding is that though traditional cardiovascular risk factors are important, they are less important for those
with rheumatoid arthritis," says Dr. Maradit Kremers. "Something else is going on. It could be that rheumatoid arthritis and
heart disease have a common origin. What we do know is that the cause cannot be explained by just one factor. It is
multifactorial."
To date, there also is no definitive information for rheumatoid arthritis patients about steps they can take to avoid heart
disease, according to the Mayo Clinic researchers. Meanwhile, they indicate that it is critical that rheumatoid arthritis
patients recognize their risks for heart disease and that they seek medical care for any cardiac symptoms or complaints.
Dr. Maradit Kremers explains that the silent heart attacks found in the study usually were detected when the rheumatoid
arthritis patient saw a physician for some other reason and an electrocardiogram was ordered, revealing a past heart attack.
"It's possible that people suffering from rheumatoid arthritis have so much pain in their joints and are receiving so many
painkillers that they either don't feel the chest pain in the same way as those without rheumatoid arthritis or don't
appreciate its importance," she says.
Previous research has shown rheumatoid arthritis patients have a higher risk of early death than others and that these deaths
are mostly due to cardiovascular disease. The Mayo Clinic research team conducted this study to discover exactly why.
"We suspect that the systemic inflammation that characterizes rheumatoid arthritis also promotes cardiovascular disease and
cardiovascular death," says Sherine Gabriel, M.D., the study's senior author and Mayo Clinic rheumatologist, epidemiologist
and chair of the Department of Health Sciences Research. "And the goal of our research is to disentangle the complex
relationships between these two diseases."
For this study, Mayo Clinic researchers studied a group of 603 Rochester residents diagnosed with rheumatoid arthritis
between Jan. 1, 1955 and Jan. 1, 1995 and compared them with 603 Rochester residents of the same ages and gender without
rheumatoid arthritis. Both the patients and the comparison subjects were followed up for a median of 26 years before
rheumatoid arthritis diagnosis and 15 years after diagnosis. The researchers collected detailed information about all study
subjects' cardiac events and their traditional cardiovascular risk factors: diabetes, blood pressure, cholesterol, body mass
index and smoking.
The paper detailing these findings is entitled "Increased Unrecognized Coronary Heart Disease and Sudden Deaths in Rheumatoid
Arthritis: A Population-Based Cohort Study."
Note for reporters: As the subjects in which the present analysis was conducted 1) have no direct patient relationship with
the investigators and 2) participated in this study under strict confidentiality agreements, the participants are not
available for news media interviews. The lead investigator, Dr. Gabriel, is available to speak to news media.
To obtain the latest news releases from Mayo Clinic, go to mayoclinic/news. MayoClinic (mayoclinic) is
available as a resource for your health stories.
Lisa Lucier
newsbureaumayo
Mayo Clinic
population, but they have more silent, unrecognized heart attacks and sudden cardiac deaths, according to a Mayo Clinic study
published in the February issue of Arthritis & Rheumatism (rheumatology/publications/ar). They are also much less likely to complain of chest pain.
The increased heart disease risk may be present even before the diagnosis of rheumatoid arthritis, according to the
researchers. During the two years before diagnosis of rheumatoid arthritis, patients with this disease were three times more
likely to have been hospitalized for an acute heart attack and five times more likely to have an unrecognized heart attack.
They were also less likely to have had a history of chest pain, compared to those without rheumatoid arthritis. After their
diagnosis, the rheumatoid arthritis patients were twice as likely to experience unrecognized heart attacks and sudden cardiac
deaths.
Hilal Maradit Kremers, M.D., lead study investigator and research associate in the Mayo Clinic Department of Health Sciences
Research, says the study suggests three major messages for rheumatoid arthritis patients:
-- The risk of heart attack is already there at the time a rheumatoid arthritis diagnosis is first made.
-- Heart disease can remain silent in those with rheumatoid arthritis. Regular cardiac checkups are important, as is lowering
traditional cardiac risk factors, such as taking care of blood pressure and cholesterol and quitting smoking.
-- Heart disease in rheumatoid arthritis patients can manifest for the first time as a cardiac sudden death.
The researchers were surprised to find that the increased cardiac events in rheumatoid arthritis patients could not be
explained by an increase in traditional heart disease risk factors such as elevated cholesterol, blood pressure and body mass
index, diabetes, and alcohol abuse, indicates Dr. Maradit Kremers.
"What we are finding is that though traditional cardiovascular risk factors are important, they are less important for those
with rheumatoid arthritis," says Dr. Maradit Kremers. "Something else is going on. It could be that rheumatoid arthritis and
heart disease have a common origin. What we do know is that the cause cannot be explained by just one factor. It is
multifactorial."
To date, there also is no definitive information for rheumatoid arthritis patients about steps they can take to avoid heart
disease, according to the Mayo Clinic researchers. Meanwhile, they indicate that it is critical that rheumatoid arthritis
patients recognize their risks for heart disease and that they seek medical care for any cardiac symptoms or complaints.
Dr. Maradit Kremers explains that the silent heart attacks found in the study usually were detected when the rheumatoid
arthritis patient saw a physician for some other reason and an electrocardiogram was ordered, revealing a past heart attack.
"It's possible that people suffering from rheumatoid arthritis have so much pain in their joints and are receiving so many
painkillers that they either don't feel the chest pain in the same way as those without rheumatoid arthritis or don't
appreciate its importance," she says.
Previous research has shown rheumatoid arthritis patients have a higher risk of early death than others and that these deaths
are mostly due to cardiovascular disease. The Mayo Clinic research team conducted this study to discover exactly why.
"We suspect that the systemic inflammation that characterizes rheumatoid arthritis also promotes cardiovascular disease and
cardiovascular death," says Sherine Gabriel, M.D., the study's senior author and Mayo Clinic rheumatologist, epidemiologist
and chair of the Department of Health Sciences Research. "And the goal of our research is to disentangle the complex
relationships between these two diseases."
For this study, Mayo Clinic researchers studied a group of 603 Rochester residents diagnosed with rheumatoid arthritis
between Jan. 1, 1955 and Jan. 1, 1995 and compared them with 603 Rochester residents of the same ages and gender without
rheumatoid arthritis. Both the patients and the comparison subjects were followed up for a median of 26 years before
rheumatoid arthritis diagnosis and 15 years after diagnosis. The researchers collected detailed information about all study
subjects' cardiac events and their traditional cardiovascular risk factors: diabetes, blood pressure, cholesterol, body mass
index and smoking.
The paper detailing these findings is entitled "Increased Unrecognized Coronary Heart Disease and Sudden Deaths in Rheumatoid
Arthritis: A Population-Based Cohort Study."
Note for reporters: As the subjects in which the present analysis was conducted 1) have no direct patient relationship with
the investigators and 2) participated in this study under strict confidentiality agreements, the participants are not
available for news media interviews. The lead investigator, Dr. Gabriel, is available to speak to news media.
To obtain the latest news releases from Mayo Clinic, go to mayoclinic/news. MayoClinic (mayoclinic) is
available as a resource for your health stories.
Lisa Lucier
newsbureaumayo
Mayo Clinic
понедельник, 24 октября 2011 г.
Understanding What People With Arthritis Believe About Exercise
Study of Perceived Exercise Barriers, Enablers, and Benefits Suggests Ways to Increase the Rates of Regular Exercise Among Arthritis Patients.
Arthritis is the leading cause of disability in the United States. In total, the treatment and toll of this progressive disease costs our country about $86 billion per year, a figure expected to rise as Baby Boomers age. Among the many approaches to disease management, exercise has been shown to reduce pain, delay disability, and improve physical function, muscle strength, and quality of life. Yet, despite such compelling, well-documented benefits, rates of participation in regular exercise are lower among individuals with arthritis than those without it.
Understanding what motivates and enables some people with arthritis to exercise, and what prevents others, is the focus of a study featured in the August 2006 issue of Arthritis Care & Research (interscience.wiley/journal/arthritiscare). Conducted at the University of South Carolina, and supported by a grant from the Centers for Disease Control and Prevention and the Association of Schools of Public Health, its findings have direct implications for how to market exercise to arthritis patients, how to tailor exercise programs to their challenges, and how to encourage and sustain their participation.
To identify the perceived barriers to and benefits of exercise among people with arthritis, 68 people with arthritis were divided into 12 focus groups. To help participants feel more comfortable and willing to talk openly, the groups were segmented by exercise status, socioeconomic status, and race. Each focus group came together and discussed their perceptions of exercise, as well as their experiences. Each discussion was transcribed and coded by two people. Following the sessions, NVivo software was used to extract themes for exercisers with arthritis, defined by participation in moderate activities on at least 3 days per week for 30 minutes per day or vigorous activities on at least 3 days per week for 20 minutes per day or strength training on at least 3 days per week for 20 minutes per day, and for non-exercisers with arthritis. Among them:
-- Pain. Although all focus groups stressed pain as a barrier, exercisers were more likely to make adaptations and work through the pain to attain the benefits of exercise, while non-exercisers were more likely to give up exercise altogether.
-- Attitudes and beliefs. Non-exercisers were much more likely than exercisers to express the belief that they were physically unable to exercise.
-- Lack of support. Non-exercisers were more likely to cite their physician's failure to refer them to helpful exercise programs and to voice their desire for exercise partners with similar limitations.
-- Lack of programs. For both exercisers and non-exercisers, the lack of exercise programs or facilities for individuals with arthritis emerged as a barrier.
-- Symptom management. Exercisers tended to be more positive about how exercise could reduce pain, improve mobility, and more, because they had experienced these benefits. Non-exercisers often used such phrases as "this is what I hear" or "this is what I understand" to describe desired outcomes.
"Our findings provide useful information for understanding the experiences with and beliefs about exercise among persons with arthritis," notes study author, Sara Wilcox, Ph.D., "and informing recruitment and intervention strategies." To increase the rates of regular exercise among arthritis patients, Dr. Wilcox and her colleagues offer concrete recommendations for health care professionals and communities, including:
-- Make a practice of prescribing exercise, with referrals and instruction.
-- Work to expand the availability of arthritis-specific exercise programs.
-- Emphasize ways in which individuals with arthritis can modify exercise to accommodate their physical limitations and effectively manage the pain.
-- Move beyond knowledge-based approaches to change the mindsets and behavior of non-exercisers.
Article:
"Perceived Exercise Barriers, Enablers, and Benefits Among Exercising and Nonexercising Adults With Arthritis: Results From a Qualitative Study,"
Sara Wilcox, Cheryl Der Ananian, Jill Abbott, JoEllen Vrazel, Cornelia Ramsey, Patricia A. Sharpe, and Teresa Brady
Arthritis Care & Research, August 2006
(DOI: 10.1002/art.22098).
© 2005 American College of Rheumatology
rheumatology
Arthritis is the leading cause of disability in the United States. In total, the treatment and toll of this progressive disease costs our country about $86 billion per year, a figure expected to rise as Baby Boomers age. Among the many approaches to disease management, exercise has been shown to reduce pain, delay disability, and improve physical function, muscle strength, and quality of life. Yet, despite such compelling, well-documented benefits, rates of participation in regular exercise are lower among individuals with arthritis than those without it.
Understanding what motivates and enables some people with arthritis to exercise, and what prevents others, is the focus of a study featured in the August 2006 issue of Arthritis Care & Research (interscience.wiley/journal/arthritiscare). Conducted at the University of South Carolina, and supported by a grant from the Centers for Disease Control and Prevention and the Association of Schools of Public Health, its findings have direct implications for how to market exercise to arthritis patients, how to tailor exercise programs to their challenges, and how to encourage and sustain their participation.
To identify the perceived barriers to and benefits of exercise among people with arthritis, 68 people with arthritis were divided into 12 focus groups. To help participants feel more comfortable and willing to talk openly, the groups were segmented by exercise status, socioeconomic status, and race. Each focus group came together and discussed their perceptions of exercise, as well as their experiences. Each discussion was transcribed and coded by two people. Following the sessions, NVivo software was used to extract themes for exercisers with arthritis, defined by participation in moderate activities on at least 3 days per week for 30 minutes per day or vigorous activities on at least 3 days per week for 20 minutes per day or strength training on at least 3 days per week for 20 minutes per day, and for non-exercisers with arthritis. Among them:
-- Pain. Although all focus groups stressed pain as a barrier, exercisers were more likely to make adaptations and work through the pain to attain the benefits of exercise, while non-exercisers were more likely to give up exercise altogether.
-- Attitudes and beliefs. Non-exercisers were much more likely than exercisers to express the belief that they were physically unable to exercise.
-- Lack of support. Non-exercisers were more likely to cite their physician's failure to refer them to helpful exercise programs and to voice their desire for exercise partners with similar limitations.
-- Lack of programs. For both exercisers and non-exercisers, the lack of exercise programs or facilities for individuals with arthritis emerged as a barrier.
-- Symptom management. Exercisers tended to be more positive about how exercise could reduce pain, improve mobility, and more, because they had experienced these benefits. Non-exercisers often used such phrases as "this is what I hear" or "this is what I understand" to describe desired outcomes.
"Our findings provide useful information for understanding the experiences with and beliefs about exercise among persons with arthritis," notes study author, Sara Wilcox, Ph.D., "and informing recruitment and intervention strategies." To increase the rates of regular exercise among arthritis patients, Dr. Wilcox and her colleagues offer concrete recommendations for health care professionals and communities, including:
-- Make a practice of prescribing exercise, with referrals and instruction.
-- Work to expand the availability of arthritis-specific exercise programs.
-- Emphasize ways in which individuals with arthritis can modify exercise to accommodate their physical limitations and effectively manage the pain.
-- Move beyond knowledge-based approaches to change the mindsets and behavior of non-exercisers.
Article:
"Perceived Exercise Barriers, Enablers, and Benefits Among Exercising and Nonexercising Adults With Arthritis: Results From a Qualitative Study,"
Sara Wilcox, Cheryl Der Ananian, Jill Abbott, JoEllen Vrazel, Cornelia Ramsey, Patricia A. Sharpe, and Teresa Brady
Arthritis Care & Research, August 2006
(DOI: 10.1002/art.22098).
© 2005 American College of Rheumatology
rheumatology
пятница, 21 октября 2011 г.
The Critical Role Of The Meniscus In Osteoarthritis Of The Knee
Cartilage loss is a major component of osteoarthritis (OA), a joint disease that affects over 20 million Americans. In knee OA, cartilage loss is influenced by knee injury, as well as obesity and age. Every healthy knee is supported and protected by a pair of meniscus. This C-shaped tissue has many functions in the knee, including load bearing, shock absorption, and stability enhancement. The onset of knee OA after meniscectomy, the surgical removal of all or part of a torn meniscus, is fairly common and traditionally considered a result of the joint injury that leads to the operation in the first place.
While meniscectomy appears to be a significant risk factor for OA, researchers know little about the effect of meniscal damage and abnormalities on cartilage loss in knees with a predisposition for the disease. The March 2006 issue of Arthritis & Rheumatism (interscience.wiley/journal/arthritis) shares the results of a study that sheds new light on the importance of an intact and functioning meniscus for patients with symptomatic knee OA.
The study, led by David Hunter of Boston University School of Medicine, focused on 257 subjects enrolled in the Boston Osteoarthritis of the Knee Study. The majority, 58 percent, were men and the mean age was 66.6 years. All subjects met the American College of Rheumatology criteria for symptomatic knee OA, confirmed by X-rays and self-reports of frequent knee pain and stiffness. At the study's onset and follow-up examinations at 15 and 30 months, participants underwent magnetic resonance imaging (MRI) of the more symptomatic knee. Using the MR images, researchers measured the position of the meniscus, as well as evaluated and scored the severity of meniscal damage. Among the MRI-assessed knees, 29% had a previous injury, 27% had a previous surgery, and 5% had a previous meniscectomy.
The researchers, as expected, found a high correlation between meniscal malposition and meniscal damage. The impact of meniscal abnormality on cartilage lost was most pronounced in the medial tibiofemoral joint--the inner joint connecting the knee to the lower leg. Each measure of meniscal misalignment was associated with an increased risk of cartilage loss. There was also a strong association of meniscal tears with cartilage loss. Reductions in the coverage and height of the meniscus, provoked by partial dislocation of the meniscus, also increased the risk of cartilage loss.
This study does not distinguish the type of meniscal tear that may propel cartilage loss or implicate meniscus damage as a cause of OA. However, it does call attention to the potential of a strong, whole meniscus to protect the knee from rapid devastation in the early stages of OA, and perhaps even mitigate the need for need replacement surgery. "At present, efforts are being made to preserve a damaged meniscus rather than remove it, and an industry of meniscal replacement is developing," Dr. Hunter notes. "Our study points to the need for critical, prospective evaluation of these new therapeutic options."
Article: "The Association of Meniscal Pathologic Changes With Cartilage Loss in Symptomatic Knee Osteoarthritis," D.J. Hunter, Y.Q. Zhang, J.B. Niu, X. Tu, S. Amin, M. Clancy, A. Guermazi, M. Grigorian, D. Gale, and D. T. Felson, Arthritis & Rheumatism, March 2006, 54:3, pp. 795-801.
Contact: Amy Molnar
amolnarwiley
John Wiley & Sons, Inc.
While meniscectomy appears to be a significant risk factor for OA, researchers know little about the effect of meniscal damage and abnormalities on cartilage loss in knees with a predisposition for the disease. The March 2006 issue of Arthritis & Rheumatism (interscience.wiley/journal/arthritis) shares the results of a study that sheds new light on the importance of an intact and functioning meniscus for patients with symptomatic knee OA.
The study, led by David Hunter of Boston University School of Medicine, focused on 257 subjects enrolled in the Boston Osteoarthritis of the Knee Study. The majority, 58 percent, were men and the mean age was 66.6 years. All subjects met the American College of Rheumatology criteria for symptomatic knee OA, confirmed by X-rays and self-reports of frequent knee pain and stiffness. At the study's onset and follow-up examinations at 15 and 30 months, participants underwent magnetic resonance imaging (MRI) of the more symptomatic knee. Using the MR images, researchers measured the position of the meniscus, as well as evaluated and scored the severity of meniscal damage. Among the MRI-assessed knees, 29% had a previous injury, 27% had a previous surgery, and 5% had a previous meniscectomy.
The researchers, as expected, found a high correlation between meniscal malposition and meniscal damage. The impact of meniscal abnormality on cartilage lost was most pronounced in the medial tibiofemoral joint--the inner joint connecting the knee to the lower leg. Each measure of meniscal misalignment was associated with an increased risk of cartilage loss. There was also a strong association of meniscal tears with cartilage loss. Reductions in the coverage and height of the meniscus, provoked by partial dislocation of the meniscus, also increased the risk of cartilage loss.
This study does not distinguish the type of meniscal tear that may propel cartilage loss or implicate meniscus damage as a cause of OA. However, it does call attention to the potential of a strong, whole meniscus to protect the knee from rapid devastation in the early stages of OA, and perhaps even mitigate the need for need replacement surgery. "At present, efforts are being made to preserve a damaged meniscus rather than remove it, and an industry of meniscal replacement is developing," Dr. Hunter notes. "Our study points to the need for critical, prospective evaluation of these new therapeutic options."
Article: "The Association of Meniscal Pathologic Changes With Cartilage Loss in Symptomatic Knee Osteoarthritis," D.J. Hunter, Y.Q. Zhang, J.B. Niu, X. Tu, S. Amin, M. Clancy, A. Guermazi, M. Grigorian, D. Gale, and D. T. Felson, Arthritis & Rheumatism, March 2006, 54:3, pp. 795-801.
Contact: Amy Molnar
amolnarwiley
John Wiley & Sons, Inc.
вторник, 18 октября 2011 г.
Millions Of People With Musculoskeletal Conditions At Risk Of Being Let Down By NHS
One-in-five (21%) primary care trusts (PCTs) do not offer 'clinical assessment
and treatment services' (CATS) for people with musculoskeletal conditions, denying them services
deemed a 'keystone' of the government's 2006 musculoskeletal services strategy1. A report based on
Freedom of Information requests and published by the Arthritis and Musculoskeletal Alliance
(ARMA) also reveals that just under half (45%) of PCTs do not define life-long conditions such as
arthritis as 'long-term', meaning people with musculoskeletal conditions are being ignored in large areas
of the country1.
"The millions of people with musculoskeletal conditions in the UK have long been forced to endure low
standards of care from the NHS," said report lead Professor David Marsh, Consultant Orthopaedic
Surgeon, Royal National Orthopaedics Hospital. "The government has long recognised that the situation
must improve and its 2006 strategy should have been the starting point of the process, but people in
many areas are still receiving patchy and poor care."
The report - supported by an initial grant from the British Society of Rheumatology as well as Roche
Products Ltd and DePuy UK - also confirms the huge variation in spending on people with
musculoskeletal conditions, ranging from under ??100 per head in Lewisham PCT to almost ??1,400 per
head in Western Cheshire PCT1. To address these variations the report calls for the appointment of a
'tsar', to oversee improvements for people at a national level, and lead on revamping the Department of
Health's own musculoskeletal reform strategy.
"Long-standing musculoskeletal conditions are a major cause of long-term disability, ill-health and
ultimately the inability to work," said Ros Meek, Director of ARMA. "It is truly appalling to find so many
serious failings in the identification and management of these conditions across the country. We want to
see real leadership from the Department of Health in rectifying this, starting with a new plan for better
care. The people living with these conditions deserve not to be ignored."
'Musculoskeletal conditions' is a term which encompasses around 200 different problems affecting the
muscles, joints and skeleton2. Over 9.6 million adults, and around 12,000 children, have a musculoskeletal
condition in England today2. These conditions impose a huge burden on the country with NHS costs in
2006-7 totalling over ??3.5 billion3 and 11.2 million working days lost per annum on average over the
last three years4.
The development and distribution of this press release was sponsored by Roche Products Ltd.
Arthritis and Musculoskeletal Alliance (ARMA)
ARMA, a registered charity, is the umbrella organisation for the UK musculoskeletal community,
bringing together 36 patient / user and professional organisations campaigning for better services for
people living with musculoskeletal conditions. The member organisations of ARMA are:
- Arthritis Care
- Arthritis Research Campaign (ARC)
- BackCare
- Birmingham Arthritis Resource Centre
- British Chiropractic Association
- British Health Professionals in Rheumatology
- British Institute of Musculoskeletal Medicine (BIMM)
- British Orthopaedic Association
- British Osteopathic Association
- British Sjogren's Syndrome Association (BSSA)
- British Society for Paediatric and Adolescent
Rheumatology (BSPAR)
- British Society for Rheumatology (BSR)
- British Society of Rehabilitation Medicine
- Chartered Society of Physiotherapy
- Children's Chronic Arthritis Association
- COT Specialist Section - Rheumatology
- Early Rheumatoid Arthritis Network (ERAN)
- Fibromyalgia Association
- Lupus UK
- MACP
- Marfan Association (UK)
- McTimoney
- National Ankylosing Spondylitis Society (NASS)
- National Association for the Relief of Paget's Disease
- National Osteoporosis Society
- National Rheumatoid Arthritis Society (NRAS)
- Podiatry Rheumatic Care Association
- Primary Care Rheumatology Society
- Psoriasis Association
- Psoriasis & Psoriatic Arthritis Alliance (PAPAA)
- Raynaud's and Scleroderma Association
- Rheumatoid Arthritis Surgical Society
- Royal College of Nursing Rheumatology Forum
- RSI Action
- Scleroderma Society
- Society for Back Pain Research (SBPR)
The musculoskeletal services strategy
The musculoskeletal services strategy was launch in 2006 by current Secretary of State for Health Andy
Burnham MP.
The report
The report published - Joint working? An audit of the Department of Health's musculoskeletal services
Strategy- was kindly supported by an initial grant from the British Society of Rheumatology as well as
DePuy UK and Roche Products Ltd, who also sponsored the development and distribution of this press
release.
References
1. Arthritis and Musculoskeletal Alliance. Joint working? An audit of the Department of Health's musculoskeletal
services strategy July 2009
2. Department of Health. A joint responsibility: doing it differently - the musculoskeletal services framework. July
2006
3. Department of Health. Departmental Report 2008. May 2008
4. Hansard. 26 January 2009, Col. 84W
Source
NHS
and treatment services' (CATS) for people with musculoskeletal conditions, denying them services
deemed a 'keystone' of the government's 2006 musculoskeletal services strategy1. A report based on
Freedom of Information requests and published by the Arthritis and Musculoskeletal Alliance
(ARMA) also reveals that just under half (45%) of PCTs do not define life-long conditions such as
arthritis as 'long-term', meaning people with musculoskeletal conditions are being ignored in large areas
of the country1.
"The millions of people with musculoskeletal conditions in the UK have long been forced to endure low
standards of care from the NHS," said report lead Professor David Marsh, Consultant Orthopaedic
Surgeon, Royal National Orthopaedics Hospital. "The government has long recognised that the situation
must improve and its 2006 strategy should have been the starting point of the process, but people in
many areas are still receiving patchy and poor care."
The report - supported by an initial grant from the British Society of Rheumatology as well as Roche
Products Ltd and DePuy UK - also confirms the huge variation in spending on people with
musculoskeletal conditions, ranging from under ??100 per head in Lewisham PCT to almost ??1,400 per
head in Western Cheshire PCT1. To address these variations the report calls for the appointment of a
'tsar', to oversee improvements for people at a national level, and lead on revamping the Department of
Health's own musculoskeletal reform strategy.
"Long-standing musculoskeletal conditions are a major cause of long-term disability, ill-health and
ultimately the inability to work," said Ros Meek, Director of ARMA. "It is truly appalling to find so many
serious failings in the identification and management of these conditions across the country. We want to
see real leadership from the Department of Health in rectifying this, starting with a new plan for better
care. The people living with these conditions deserve not to be ignored."
'Musculoskeletal conditions' is a term which encompasses around 200 different problems affecting the
muscles, joints and skeleton2. Over 9.6 million adults, and around 12,000 children, have a musculoskeletal
condition in England today2. These conditions impose a huge burden on the country with NHS costs in
2006-7 totalling over ??3.5 billion3 and 11.2 million working days lost per annum on average over the
last three years4.
The development and distribution of this press release was sponsored by Roche Products Ltd.
Arthritis and Musculoskeletal Alliance (ARMA)
ARMA, a registered charity, is the umbrella organisation for the UK musculoskeletal community,
bringing together 36 patient / user and professional organisations campaigning for better services for
people living with musculoskeletal conditions. The member organisations of ARMA are:
- Arthritis Care
- Arthritis Research Campaign (ARC)
- BackCare
- Birmingham Arthritis Resource Centre
- British Chiropractic Association
- British Health Professionals in Rheumatology
- British Institute of Musculoskeletal Medicine (BIMM)
- British Orthopaedic Association
- British Osteopathic Association
- British Sjogren's Syndrome Association (BSSA)
- British Society for Paediatric and Adolescent
Rheumatology (BSPAR)
- British Society for Rheumatology (BSR)
- British Society of Rehabilitation Medicine
- Chartered Society of Physiotherapy
- Children's Chronic Arthritis Association
- COT Specialist Section - Rheumatology
- Early Rheumatoid Arthritis Network (ERAN)
- Fibromyalgia Association
- Lupus UK
- MACP
- Marfan Association (UK)
- McTimoney
- National Ankylosing Spondylitis Society (NASS)
- National Association for the Relief of Paget's Disease
- National Osteoporosis Society
- National Rheumatoid Arthritis Society (NRAS)
- Podiatry Rheumatic Care Association
- Primary Care Rheumatology Society
- Psoriasis Association
- Psoriasis & Psoriatic Arthritis Alliance (PAPAA)
- Raynaud's and Scleroderma Association
- Rheumatoid Arthritis Surgical Society
- Royal College of Nursing Rheumatology Forum
- RSI Action
- Scleroderma Society
- Society for Back Pain Research (SBPR)
The musculoskeletal services strategy
The musculoskeletal services strategy was launch in 2006 by current Secretary of State for Health Andy
Burnham MP.
The report
The report published - Joint working? An audit of the Department of Health's musculoskeletal services
Strategy- was kindly supported by an initial grant from the British Society of Rheumatology as well as
DePuy UK and Roche Products Ltd, who also sponsored the development and distribution of this press
release.
References
1. Arthritis and Musculoskeletal Alliance. Joint working? An audit of the Department of Health's musculoskeletal
services strategy July 2009
2. Department of Health. A joint responsibility: doing it differently - the musculoskeletal services framework. July
2006
3. Department of Health. Departmental Report 2008. May 2008
4. Hansard. 26 January 2009, Col. 84W
Source
NHS
суббота, 15 октября 2011 г.
Forest Laboratories, Inc. And Cypress Bioscience, Inc. Announce Positive Results Of Phase III Study Of Milnacipran For The Management Of Fibromyalgia
Forest Laboratories, Inc. (NYSE: FRX) and Cypress Bioscience, Inc. (Nasdaq: CYPB) announced positive top-line results from a 1,025 patient, multicenter, double-blind, placebo-controlled phase III study of milnacipran for the management of fibromyalgia. These results, which confirm the findings from the two previous phase III trials, showed that milnacipran demonstrated a highly statistically significant difference to placebo in responder analyses based on a concurrent and clinically meaningful improvement in pain, patient global impression of change, and physical functioning. Comprehensive analyses of the study data will be completed in the coming weeks, and it is anticipated that further results will be presented during 2009.
Study Background
In this study, designated MLN-MD-03, patients with an established history of fibromyalgia were enrolled at 75 centers in North America and randomized to receive a daily dose of 100 mg of milnacipran (n=516) or placebo (n=509). The design of the double-blind study included a 4 to 6-week dose escalation phase, a 12-week stable-dose treatment phase, and a 2-week discontinuation phase. The primary efficacy endpoints were the proportion of subjects meeting criteria as composite responders based on one of two definitions. In the first co-primary analysis, a patient had to demonstrate simultaneous improvements on both their daily pain ratings (visual analog scale) and on an overall measure of how their fibromyalgia condition had been since the start of the study (Patient Global Impression of Change or PGIC). In the second co-primary analysis, a patient had to demonstrate simultaneous improvements on three measures -- pain, PGIC, and physical functioning (as measured by the SF-36 Physical Component Summary).
Preliminary Results
A greater proportion of patients treated with milnacipran (100 mg/day) experienced at least a 30% reduction in pain from baseline and also rated themselves as "very much improved" or "much improved" based on the patient global assessment (PGIC) (p < 0.001). In addition, a greater proportion of patients treated with milnacipran met the criteria for a treatment response as measured by concurrent improvements in pain, patient global assessment (PGIC) and physical function (improvement of at least 6 points in SF-36 PCS), as compared to subjects on placebo (p < 0.001). Primary analysis results were conducted using the Baseline Observation Carried Forward (BOCF) imputation method.
Milnacipran was generally well tolerated. Similar to the safety data from the two previous U.S. phase III trials of milnacipran in fibromyalgia, the most common treatment emergent adverse events observed through the stable-dose treatment period of the placebo-controlled trial included nausea (37% vs. 21% placebo), constipation (15% vs. 4% placebo), hot flush (11% vs. 4% placebo), dizziness (11% vs. 5% placebo), hyperhidrosis (8% vs. 1% placebo), palpitations (7% vs. 3% placebo), tachycardia (5% vs. 1% placebo), and hypertension (5% vs. 1%).
Overall premature discontinuation rates (all causes including adverse event related) through the stable-dose treatment period of the trial were 31% for patients receiving 100 mg per day of milnacipran, and 30% for patients receiving placebo. Similar to the safety data from the two previous U.S. phase III trials of milnacipran in fibromyalgia, the most common adverse events that led to early withdrawal among the milnacipran treated patients were nausea (3.5%) and headache and palpitations, each of which occurred at a rate of less than 2%.
About Milnacipran
Milnacipran is a dual-reuptake inhibitor that preferentially blocks the reuptake of norepinephrine with higher potency than serotonin, two neurotransmitters thought to play a central role in the symptoms of fibromyalgia. Milnacipran is being developed for fibromyalgia in the United States jointly by Forest Laboratories, Inc. and its licensor, Cypress Bioscience, Inc. Milnacipran was originally developed, and is sold outside of the U.S. by Pierre Fabre Medicament. The FDA accepted for review the New Drug Application (NDA) for milnacipran for the management of fibromyalgia in February 2008. The application includes efficacy data from two pivotal phase III trials involving 2,084 patients (1,460 milnacipran, 624 placebo-treated subjects), which showed that milnacipran demonstrated improvement compared to placebo in treating the symptoms of fibromyalgia based on responder analyses. As previously disclosed, the FDA has yet to provide an action based on the NDA application. The Prescription Drug User Fee Act (PDUFA) date was October 18, 2008.
About Fibromyalgia
Fibromyalgia is a chronic and debilitating condition characterized by widespread pain and decreased physical functioning. According to the American College of Rheumatology fibromyalgia is estimated to affect over 6 million Americans. It is most often diagnosed in the primary care setting and is the second most commonly diagnosed condition in rheumatology clinics in the United States after osteoarthritis. Despite the high prevalence and severity of this condition, there are limited treatment options specifically approved for fibromyalgia in the United States.
About Forest Laboratories
Forest Laboratories (NYSE: FRX) is a U.S.-based pharmaceutical company with a long track record of building partnerships and developing and marketing products that make a positive difference in people's lives. In addition to its well-established franchises in therapeutic areas of the central nervous and cardiovascular systems, Forest's current pipeline includes product candidates in all stages of development and across a wide range of therapeutic areas. The company is headquartered in New York, NY. To learn more about Forest Laboratories, visit FRX.
Except for the historical information contained herein, this release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements involve a number of risks and uncertainties, including the difficulty of predicting FDA approvals, the acceptance and demand for new pharmaceutical products, the impact of competitive products and pricing, the timely development and launch of new products, and the risk factors listed from time to time in Forest Laboratories' Annual Report on Form 10-K, Quarterly Reports on Form 10-Q, and any subsequent SEC filings.
About Cypress Bioscience
Cypress Bioscience, Inc. is developing therapeutics and personalized medicine services, to facilitate improved and individualized patient care. Cypress' goal is to address the evolving needs of specialist physicians and their patients by identifying unmet medical needs in the areas of pain, rheumatology, and physical medicine and rehabilitation, including challenging disorders such as fibromyalgia and rheumatoid arthritis. We intend to use this approach to improve patient care and create a unique partnership with physicians.
For more information about Cypress, please visit the Company's website at cypressbio.
This press release, as well as Cypress' SEC filings and website at cypressbio, contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements about the potential of milnacipran to treat fibromyalgia. Actual results could vary materially from those described as a result of a number of factors, including those set forth in Cypress' Annual Report on Form 10-K, the most recent Quarterly Report on Form 10-Q and any subsequent SEC filings and including, but not limited to, that more detailed analysis of the trial results may not be favorable or may lead to different conclusions and that milnacipran may not be approved by the FDA for the management of fibromyalgia and even if approved may not achieve market acceptance.
Cypress Bioscience, Inc.
cypressbio
Study Background
In this study, designated MLN-MD-03, patients with an established history of fibromyalgia were enrolled at 75 centers in North America and randomized to receive a daily dose of 100 mg of milnacipran (n=516) or placebo (n=509). The design of the double-blind study included a 4 to 6-week dose escalation phase, a 12-week stable-dose treatment phase, and a 2-week discontinuation phase. The primary efficacy endpoints were the proportion of subjects meeting criteria as composite responders based on one of two definitions. In the first co-primary analysis, a patient had to demonstrate simultaneous improvements on both their daily pain ratings (visual analog scale) and on an overall measure of how their fibromyalgia condition had been since the start of the study (Patient Global Impression of Change or PGIC). In the second co-primary analysis, a patient had to demonstrate simultaneous improvements on three measures -- pain, PGIC, and physical functioning (as measured by the SF-36 Physical Component Summary).
Preliminary Results
A greater proportion of patients treated with milnacipran (100 mg/day) experienced at least a 30% reduction in pain from baseline and also rated themselves as "very much improved" or "much improved" based on the patient global assessment (PGIC) (p < 0.001). In addition, a greater proportion of patients treated with milnacipran met the criteria for a treatment response as measured by concurrent improvements in pain, patient global assessment (PGIC) and physical function (improvement of at least 6 points in SF-36 PCS), as compared to subjects on placebo (p < 0.001). Primary analysis results were conducted using the Baseline Observation Carried Forward (BOCF) imputation method.
Milnacipran was generally well tolerated. Similar to the safety data from the two previous U.S. phase III trials of milnacipran in fibromyalgia, the most common treatment emergent adverse events observed through the stable-dose treatment period of the placebo-controlled trial included nausea (37% vs. 21% placebo), constipation (15% vs. 4% placebo), hot flush (11% vs. 4% placebo), dizziness (11% vs. 5% placebo), hyperhidrosis (8% vs. 1% placebo), palpitations (7% vs. 3% placebo), tachycardia (5% vs. 1% placebo), and hypertension (5% vs. 1%).
Overall premature discontinuation rates (all causes including adverse event related) through the stable-dose treatment period of the trial were 31% for patients receiving 100 mg per day of milnacipran, and 30% for patients receiving placebo. Similar to the safety data from the two previous U.S. phase III trials of milnacipran in fibromyalgia, the most common adverse events that led to early withdrawal among the milnacipran treated patients were nausea (3.5%) and headache and palpitations, each of which occurred at a rate of less than 2%.
About Milnacipran
Milnacipran is a dual-reuptake inhibitor that preferentially blocks the reuptake of norepinephrine with higher potency than serotonin, two neurotransmitters thought to play a central role in the symptoms of fibromyalgia. Milnacipran is being developed for fibromyalgia in the United States jointly by Forest Laboratories, Inc. and its licensor, Cypress Bioscience, Inc. Milnacipran was originally developed, and is sold outside of the U.S. by Pierre Fabre Medicament. The FDA accepted for review the New Drug Application (NDA) for milnacipran for the management of fibromyalgia in February 2008. The application includes efficacy data from two pivotal phase III trials involving 2,084 patients (1,460 milnacipran, 624 placebo-treated subjects), which showed that milnacipran demonstrated improvement compared to placebo in treating the symptoms of fibromyalgia based on responder analyses. As previously disclosed, the FDA has yet to provide an action based on the NDA application. The Prescription Drug User Fee Act (PDUFA) date was October 18, 2008.
About Fibromyalgia
Fibromyalgia is a chronic and debilitating condition characterized by widespread pain and decreased physical functioning. According to the American College of Rheumatology fibromyalgia is estimated to affect over 6 million Americans. It is most often diagnosed in the primary care setting and is the second most commonly diagnosed condition in rheumatology clinics in the United States after osteoarthritis. Despite the high prevalence and severity of this condition, there are limited treatment options specifically approved for fibromyalgia in the United States.
About Forest Laboratories
Forest Laboratories (NYSE: FRX) is a U.S.-based pharmaceutical company with a long track record of building partnerships and developing and marketing products that make a positive difference in people's lives. In addition to its well-established franchises in therapeutic areas of the central nervous and cardiovascular systems, Forest's current pipeline includes product candidates in all stages of development and across a wide range of therapeutic areas. The company is headquartered in New York, NY. To learn more about Forest Laboratories, visit FRX.
Except for the historical information contained herein, this release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements involve a number of risks and uncertainties, including the difficulty of predicting FDA approvals, the acceptance and demand for new pharmaceutical products, the impact of competitive products and pricing, the timely development and launch of new products, and the risk factors listed from time to time in Forest Laboratories' Annual Report on Form 10-K, Quarterly Reports on Form 10-Q, and any subsequent SEC filings.
About Cypress Bioscience
Cypress Bioscience, Inc. is developing therapeutics and personalized medicine services, to facilitate improved and individualized patient care. Cypress' goal is to address the evolving needs of specialist physicians and their patients by identifying unmet medical needs in the areas of pain, rheumatology, and physical medicine and rehabilitation, including challenging disorders such as fibromyalgia and rheumatoid arthritis. We intend to use this approach to improve patient care and create a unique partnership with physicians.
For more information about Cypress, please visit the Company's website at cypressbio.
This press release, as well as Cypress' SEC filings and website at cypressbio, contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements about the potential of milnacipran to treat fibromyalgia. Actual results could vary materially from those described as a result of a number of factors, including those set forth in Cypress' Annual Report on Form 10-K, the most recent Quarterly Report on Form 10-Q and any subsequent SEC filings and including, but not limited to, that more detailed analysis of the trial results may not be favorable or may lead to different conclusions and that milnacipran may not be approved by the FDA for the management of fibromyalgia and even if approved may not achieve market acceptance.
Cypress Bioscience, Inc.
cypressbio
среда, 12 октября 2011 г.
Tipsheet: Focus On Gait Training, Pain Relief, Pressure Ulcers And Hearing Aid Training
Location of plantar ulcerations in diabetic patients referred to a Department of Veterans Affairs podiatry clinic, pg. 421
We described the location of foot ulcers through a chart review of diabetic patients in a Department of Veterans Affairs podiatry clinic and looked for connections between ulcer location and specific medical features. We hypothesized that individuals with diabetes rarely have heel ulcers but that heel ulcers are directly related to peripheral neuropathy and diminished vascular function. We found that patients with reduced vascular function were five times more likely to have heel ulcers than patients with adequate vascular function. The importance of understanding the risk factors for heel ulcers stems from a lack of available treatments. Further research should study the effectiveness of interventions for patients with reduced vascular status.
Effects of footwear on medial compartment knee osteoarthritis, pg. 427
This pilot study investigated whether lateral-wedge insoles inserted into shock-absorbing walking shoes relieved pain and stiffness and improved walking in people with painful knee osteoarthritis. People with knee pain in the medial knee compartment were asked to wear lateral-wedge insoles in lightweight cushioned walking shoes for 4 weeks. They answered questions about the amount of pain, stiffness, and problems with activity they had before wearing the insoles and after wearing them for 4 weeks. The results of this study showed that the lateral-wedge insoles decreased pain and stiffness and improved functional status in people with knee osteoarthritis. Pain was especially decreased for stair-climbing activities.
Isometric performance following total hip arthroplasty and rehabilitation, pg. 435
We examined differences in strength between total hip arthroplasty (THA) patients and community-dwelling older adults to provide comparative data for therapists who treat THA patients. Studies based on self-report data indicate that THA surgery successfully alleviates pain and improves function relative to presurgical levels. However, studies based on objective performancebased measures indicate that despite postoperative improvements, THA patients continue to exhibit deficits in strength, postural stability, and gait. Average hip strength during flexion (pushing upward) was significantly less for hip patients (in both their replaced and nonreplaced hip) compared with community-dwelling older adults. These deficits indicate that rehabilitation is not restoring THA patients to a level similar to their peers. Clinicians and therapists can use these results to improve current rehabilitation protocols.
Influence of a 6-week arm exercise program on walking ability and health status after hip arthroplasty: A 1-year follow-up pilot study, pg. 445
This follow-up study of elderly patients after total hip arthroplasty (THA) examined the effect of our arm exercise program on health status and walking ability. Though THA had a major effect on our patients' physical fitness and functional status, the added effects of the training were significant on those outcomes at both 2 months and 1 year after surgery. In a 6-minute walk test, the training group (TG) walked significantly longer distance than the normal rehabilitation group with a faster speed, longer stride length, and higher step cadence. Therefore, besides an improvement in fitness, the TG also might have improved gait efficiency. These preliminary results suggest the importance of endurance-type upper-body aerobic training after THA.
Are patient ratings of chronic pain services related to treatment outcome? pg. 451
We examined the relationships between ratings of services and outcomes of patients who received pain treatment at a teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and the effectiveness of services as well as changes in their pain condition and quality of life. The results indicated improvement on ratings of pain severity, pain interference, and depression. The patients' service ratings were significantly related to their outcomes; however, we found no significant change in disability. The results support the importance of assessing not only patients' satisfaction with treatment but also their perceived changes in disability, pain, and quality of life after pain-management services.
Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury, pg. 461
Cranial electrotherapy stimulation (CES) sends microcurrents to the brain via electrodes clipped to the ears. CES can effectively treat spinal, head, dental, and muscle pain and control conditions associated with pain (anxiety, depression, insomnia, and stress). We studied how daily 1-hour active CES or sham CES treatment for 21 days affected pain in 38 males with spinal cord injury (SCI). The active CES group reported significantly greater decreases in daily pain intensity than the sham CES group. Our results suggest that CES can effectively treat chronic pain in people with SCI. We also found that people with SCI can and will use the CES device at home for a 3-week period.
Race/ethnicity: Who is counting what? pg. 475
We examined the racial/ethnic classifications of 1,084 veterans with stroke in Florida who received inpatient and outpatient services within the Department of Veterans Affairs (VA) healthcare system. We compared the reliability of racial/ethnic classifications from the VA inpatient data with the VA outpatient data and the VA data with Medicare data. Misclassification of race/ethnicity in research data may produce spurious conclusions if overlooked or ignored. Our results showed that the rate of unknown racial/ethnic classification in VA outpatient and inpatient data was high. We also found that black and white classifications in the VA data had stronger agreement with Medicare data and Medicare data may underrepresent Hispanic patients. Minimizing the unknowns by substituting known values from other data when available would greatly enhance the overall and individual classification reliability.
Treadmill training with harness support: Selection of parameters for individuals with poststroke hemiparesis, pg. 485
Locomotor training with a treadmill and harness support is a promising, task-oriented approach to restoring gait function in individuals with poststroke hemiparesis. Considerable latitude exists in the application of locomotor training, and training protocols vary widely between experimenters and clinical settings. Recent studies indicate that the prescription of certain parameters, including body-weight support and treadmill speed, can affect treatment outcome in hemiparetic individuals. We reviewed the literature for studies that quantified the immediate effects of adjusting body-weight support, treadmill speed, support stiffness, and handrail hold during treadmill walking in hemiparetic and nondisabled subjects. We then summarized results from personal investigations of these parameters. Based on the currently available evidence, we discuss the scientific rationale for selecting certain training parameters for individuals with poststroke hemiparesis and outline future directions for research.
Caregiver distress in parkinsonism, pg. 499
We examined the frequency and degree of caregiver burden in persons with parkinsonism (PWP). Supporting the functioning of caregivers is vital for the successful medical management of individuals with chronic illness and disability. Associations between perceived caregiver burden and physical, cognitive, and functional impairments were assessed with well-established tools for PWP. Caregiver burden was significantly negatively associated with activities of daily living and motoric difficulties, self-reported sleep, and caregiver coping ability. Results did not demonstrate an association among mentation, behavior, and mood or between patients' self-reported pain and caregiver burden. An improved understanding of the severity and correlates of caregiver burden in PWPs may allow clinicians to better prioritize treatment strategies for PWP and be more aware of the caregivers' needs.
A noncontact sensor for measurement of distal residual-limb position during walking, pg. 509
We developed a noncontact means of measuring position of the residual-limb surface relative to the distal prosthetic socket during walking in a transtibial amputee so the amount of slip, or pistoning, between a limb and socket with different suspension systems for different activities could be evaluated. Results showed an average of 41.7 mm of displacement during swing phase relative to stance phase. A rest period caused the limb to displace in the socket approximately 4.8 mm during subsequent walking trials, possibly reflecting limb enlargement and thus a more proximal position in the socket after the rest period. This sensor could be used to identify systems that decrease limb-socket movement since excessive pistoning might detrimentally affect socket fit.
Acclimatization in wide dynamic range multichannel compression and linear amplification hearing aids, pg. 517
We studied acclimatization in hearing-impaired patients with no previous hearing aid (HA) experience who were fit bilaterally with either wide dynamic range multichannel compression (WDRMCC) or linear amplification (LA) HAs. Throughout 32 weeks of normal HA use, we monitored changes in nonsense syllable perception in speechspectrum noise. Syllable recognition for WDRMCC users improved by 4.6% over the first 8 weeks, but the 2.2% improvement for LA users was complete in 2 to 4 weeks. Consonant confusion analyses indicated that WDRMCC experience facilitated consonant identification, while LA users primarily changed their response biases. These results provide evidence for acclimatization in new users of WDRMCC HAs but not in new users of LA HAs. Acclimatization depended on the type of amplification and on the previous amplification experience.
Perceptual training improves syllable identification in new and experienced hearing aid users, pg. 537
We investigated the effects of perceptual training on speech processing in new and experienced hearing aid (HA) users with sensorineural hearing loss. New HA users were randomly assigned to immediate training (IT) or delayed training (DT) groups. IT subjects underwent 8 weeks of syllable identification training and in-laboratory testing, whereas DT subjects underwent identical in-laboratory testing without training. Training produced large improvements in syllable identification in the IT group, whereas untrained DT group showed minimal improvement. DT group then underwent training and showed performance improvements comparable with IT subjects. We also tested experienced HA users using identical training and testing procedures as those used for new HA users. The experienced users also showed significant performance improvements. Perceptual training appears to be a promising tool for improving speech perception in all HA users.
Interface pressure and cutaneous hemoglobin and oxygenation changes under ischial tuberosities during sacral nerve root stimulation in spinal cord injury, pg. 553
We studied how neuromuscular stimulation through a magnetic coil and a sacral anterior root stimulator (SARS) implant (used for bladder emptying) affects pressure and skin blood circulation under the ischial tuberosities (ITs) of participants with spinal cord injury (SCI). The ITs are the most common site for pressure ulcers among wheelchair users with SCI. With optimal stimulation through a magnetic coil, average IT peak pressure and gradient at peak pressure decreased significantly in five seated participants with SCI. Similar results were achieved in six seated participants with SCI during sacral nerve stimulation through their SARS implants. Results indicated that stimulation caused enough gluteal muscle contraction to significantly change the participants' pressures while they sat. In addition, long-term stimulation through a SARS implant may build up the gluteal muscles and help prevent or reduce pressure ulcers in people with SCI.
Antinociceptive effect of linear polarized 0.6 to 1.6 ?¬m irradiation of lumbar sympathetic ganglia in chronic constriction injury rats, pg. 565
Linear polarized near-infrared light has been used to treat various painful disorders. We examinedthe effects of irradiation applied to an area near the lumbar sympathetic ganglia on the ligated side in a chronic constriction injury model in rats, which is believed to be an animal model of complex regional pain syndrome (CRPS). We believe the results of this study are relevant to the effect of irradiation for patients with upper-limb CRPS: that irradiation near the lumbar sympathetic ganglia of the rat is effective for thermal, but not mechanical, pain.
Skin and bone integrated prosthetic pylon: A pilot animal study, pg. 573
Direct skeletal attachment of limb prostheses is an alternative to traditional techniques based on a socket-residuum attachment. We investigated cell adhesion and penetration into the pores of a porous titanium pylon in rats. We hypothesized that the risk of skin infection during direct attachment of limb prostheses might be reduced with this type of pylon. Electronic scanning and morphological analysis showed that the porous titanium pylon integrated with the surrounding skin. Therefore, developing a natural barrier against the infection associated with direct skeletal attachment of limb prostheses may be possible. We preliminarily conclude that the experimental porous pylon provided an inviting environment for the surrounding tissues.
Contact: Stacieanne C. Yuhasz, PhD
VA Research Communications Service
We described the location of foot ulcers through a chart review of diabetic patients in a Department of Veterans Affairs podiatry clinic and looked for connections between ulcer location and specific medical features. We hypothesized that individuals with diabetes rarely have heel ulcers but that heel ulcers are directly related to peripheral neuropathy and diminished vascular function. We found that patients with reduced vascular function were five times more likely to have heel ulcers than patients with adequate vascular function. The importance of understanding the risk factors for heel ulcers stems from a lack of available treatments. Further research should study the effectiveness of interventions for patients with reduced vascular status.
Effects of footwear on medial compartment knee osteoarthritis, pg. 427
This pilot study investigated whether lateral-wedge insoles inserted into shock-absorbing walking shoes relieved pain and stiffness and improved walking in people with painful knee osteoarthritis. People with knee pain in the medial knee compartment were asked to wear lateral-wedge insoles in lightweight cushioned walking shoes for 4 weeks. They answered questions about the amount of pain, stiffness, and problems with activity they had before wearing the insoles and after wearing them for 4 weeks. The results of this study showed that the lateral-wedge insoles decreased pain and stiffness and improved functional status in people with knee osteoarthritis. Pain was especially decreased for stair-climbing activities.
Isometric performance following total hip arthroplasty and rehabilitation, pg. 435
We examined differences in strength between total hip arthroplasty (THA) patients and community-dwelling older adults to provide comparative data for therapists who treat THA patients. Studies based on self-report data indicate that THA surgery successfully alleviates pain and improves function relative to presurgical levels. However, studies based on objective performancebased measures indicate that despite postoperative improvements, THA patients continue to exhibit deficits in strength, postural stability, and gait. Average hip strength during flexion (pushing upward) was significantly less for hip patients (in both their replaced and nonreplaced hip) compared with community-dwelling older adults. These deficits indicate that rehabilitation is not restoring THA patients to a level similar to their peers. Clinicians and therapists can use these results to improve current rehabilitation protocols.
Influence of a 6-week arm exercise program on walking ability and health status after hip arthroplasty: A 1-year follow-up pilot study, pg. 445
This follow-up study of elderly patients after total hip arthroplasty (THA) examined the effect of our arm exercise program on health status and walking ability. Though THA had a major effect on our patients' physical fitness and functional status, the added effects of the training were significant on those outcomes at both 2 months and 1 year after surgery. In a 6-minute walk test, the training group (TG) walked significantly longer distance than the normal rehabilitation group with a faster speed, longer stride length, and higher step cadence. Therefore, besides an improvement in fitness, the TG also might have improved gait efficiency. These preliminary results suggest the importance of endurance-type upper-body aerobic training after THA.
Are patient ratings of chronic pain services related to treatment outcome? pg. 451
We examined the relationships between ratings of services and outcomes of patients who received pain treatment at a teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and the effectiveness of services as well as changes in their pain condition and quality of life. The results indicated improvement on ratings of pain severity, pain interference, and depression. The patients' service ratings were significantly related to their outcomes; however, we found no significant change in disability. The results support the importance of assessing not only patients' satisfaction with treatment but also their perceived changes in disability, pain, and quality of life after pain-management services.
Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury, pg. 461
Cranial electrotherapy stimulation (CES) sends microcurrents to the brain via electrodes clipped to the ears. CES can effectively treat spinal, head, dental, and muscle pain and control conditions associated with pain (anxiety, depression, insomnia, and stress). We studied how daily 1-hour active CES or sham CES treatment for 21 days affected pain in 38 males with spinal cord injury (SCI). The active CES group reported significantly greater decreases in daily pain intensity than the sham CES group. Our results suggest that CES can effectively treat chronic pain in people with SCI. We also found that people with SCI can and will use the CES device at home for a 3-week period.
Race/ethnicity: Who is counting what? pg. 475
We examined the racial/ethnic classifications of 1,084 veterans with stroke in Florida who received inpatient and outpatient services within the Department of Veterans Affairs (VA) healthcare system. We compared the reliability of racial/ethnic classifications from the VA inpatient data with the VA outpatient data and the VA data with Medicare data. Misclassification of race/ethnicity in research data may produce spurious conclusions if overlooked or ignored. Our results showed that the rate of unknown racial/ethnic classification in VA outpatient and inpatient data was high. We also found that black and white classifications in the VA data had stronger agreement with Medicare data and Medicare data may underrepresent Hispanic patients. Minimizing the unknowns by substituting known values from other data when available would greatly enhance the overall and individual classification reliability.
Treadmill training with harness support: Selection of parameters for individuals with poststroke hemiparesis, pg. 485
Locomotor training with a treadmill and harness support is a promising, task-oriented approach to restoring gait function in individuals with poststroke hemiparesis. Considerable latitude exists in the application of locomotor training, and training protocols vary widely between experimenters and clinical settings. Recent studies indicate that the prescription of certain parameters, including body-weight support and treadmill speed, can affect treatment outcome in hemiparetic individuals. We reviewed the literature for studies that quantified the immediate effects of adjusting body-weight support, treadmill speed, support stiffness, and handrail hold during treadmill walking in hemiparetic and nondisabled subjects. We then summarized results from personal investigations of these parameters. Based on the currently available evidence, we discuss the scientific rationale for selecting certain training parameters for individuals with poststroke hemiparesis and outline future directions for research.
Caregiver distress in parkinsonism, pg. 499
We examined the frequency and degree of caregiver burden in persons with parkinsonism (PWP). Supporting the functioning of caregivers is vital for the successful medical management of individuals with chronic illness and disability. Associations between perceived caregiver burden and physical, cognitive, and functional impairments were assessed with well-established tools for PWP. Caregiver burden was significantly negatively associated with activities of daily living and motoric difficulties, self-reported sleep, and caregiver coping ability. Results did not demonstrate an association among mentation, behavior, and mood or between patients' self-reported pain and caregiver burden. An improved understanding of the severity and correlates of caregiver burden in PWPs may allow clinicians to better prioritize treatment strategies for PWP and be more aware of the caregivers' needs.
A noncontact sensor for measurement of distal residual-limb position during walking, pg. 509
We developed a noncontact means of measuring position of the residual-limb surface relative to the distal prosthetic socket during walking in a transtibial amputee so the amount of slip, or pistoning, between a limb and socket with different suspension systems for different activities could be evaluated. Results showed an average of 41.7 mm of displacement during swing phase relative to stance phase. A rest period caused the limb to displace in the socket approximately 4.8 mm during subsequent walking trials, possibly reflecting limb enlargement and thus a more proximal position in the socket after the rest period. This sensor could be used to identify systems that decrease limb-socket movement since excessive pistoning might detrimentally affect socket fit.
Acclimatization in wide dynamic range multichannel compression and linear amplification hearing aids, pg. 517
We studied acclimatization in hearing-impaired patients with no previous hearing aid (HA) experience who were fit bilaterally with either wide dynamic range multichannel compression (WDRMCC) or linear amplification (LA) HAs. Throughout 32 weeks of normal HA use, we monitored changes in nonsense syllable perception in speechspectrum noise. Syllable recognition for WDRMCC users improved by 4.6% over the first 8 weeks, but the 2.2% improvement for LA users was complete in 2 to 4 weeks. Consonant confusion analyses indicated that WDRMCC experience facilitated consonant identification, while LA users primarily changed their response biases. These results provide evidence for acclimatization in new users of WDRMCC HAs but not in new users of LA HAs. Acclimatization depended on the type of amplification and on the previous amplification experience.
Perceptual training improves syllable identification in new and experienced hearing aid users, pg. 537
We investigated the effects of perceptual training on speech processing in new and experienced hearing aid (HA) users with sensorineural hearing loss. New HA users were randomly assigned to immediate training (IT) or delayed training (DT) groups. IT subjects underwent 8 weeks of syllable identification training and in-laboratory testing, whereas DT subjects underwent identical in-laboratory testing without training. Training produced large improvements in syllable identification in the IT group, whereas untrained DT group showed minimal improvement. DT group then underwent training and showed performance improvements comparable with IT subjects. We also tested experienced HA users using identical training and testing procedures as those used for new HA users. The experienced users also showed significant performance improvements. Perceptual training appears to be a promising tool for improving speech perception in all HA users.
Interface pressure and cutaneous hemoglobin and oxygenation changes under ischial tuberosities during sacral nerve root stimulation in spinal cord injury, pg. 553
We studied how neuromuscular stimulation through a magnetic coil and a sacral anterior root stimulator (SARS) implant (used for bladder emptying) affects pressure and skin blood circulation under the ischial tuberosities (ITs) of participants with spinal cord injury (SCI). The ITs are the most common site for pressure ulcers among wheelchair users with SCI. With optimal stimulation through a magnetic coil, average IT peak pressure and gradient at peak pressure decreased significantly in five seated participants with SCI. Similar results were achieved in six seated participants with SCI during sacral nerve stimulation through their SARS implants. Results indicated that stimulation caused enough gluteal muscle contraction to significantly change the participants' pressures while they sat. In addition, long-term stimulation through a SARS implant may build up the gluteal muscles and help prevent or reduce pressure ulcers in people with SCI.
Antinociceptive effect of linear polarized 0.6 to 1.6 ?¬m irradiation of lumbar sympathetic ganglia in chronic constriction injury rats, pg. 565
Linear polarized near-infrared light has been used to treat various painful disorders. We examinedthe effects of irradiation applied to an area near the lumbar sympathetic ganglia on the ligated side in a chronic constriction injury model in rats, which is believed to be an animal model of complex regional pain syndrome (CRPS). We believe the results of this study are relevant to the effect of irradiation for patients with upper-limb CRPS: that irradiation near the lumbar sympathetic ganglia of the rat is effective for thermal, but not mechanical, pain.
Skin and bone integrated prosthetic pylon: A pilot animal study, pg. 573
Direct skeletal attachment of limb prostheses is an alternative to traditional techniques based on a socket-residuum attachment. We investigated cell adhesion and penetration into the pores of a porous titanium pylon in rats. We hypothesized that the risk of skin infection during direct attachment of limb prostheses might be reduced with this type of pylon. Electronic scanning and morphological analysis showed that the porous titanium pylon integrated with the surrounding skin. Therefore, developing a natural barrier against the infection associated with direct skeletal attachment of limb prostheses may be possible. We preliminarily conclude that the experimental porous pylon provided an inviting environment for the surrounding tissues.
Contact: Stacieanne C. Yuhasz, PhD
VA Research Communications Service
воскресенье, 9 октября 2011 г.
Patients Taking Cymbalta(R) Reported Reduced Pain Severity Of Osteoarthritis Of The Knee In New Study
New data suggest that
patients with osteoarthritis pain of the knee treated with 60 mg and 120 mg
Cymbalta (duloxetine HCl) once daily experienced significant pain
reduction. Patients taking duloxetine reported significant pain improvement
compared to placebo within the first week of treatment that lasted
throughout the 13-week trial.(1) Results from the study of 231 patients
were presented today at the annual congress of the European League Against
Rheumatism (EULAR) in Paris, France.
Duloxetine showed statistically significant improvement in pain
associated with osteoarthritis of the knee according to the primary
efficacy measure of mean 24-hour average pain scores. Fifty-nine percent of
duloxetine-treated patients experienced a 30 percent improvement in pain
compared with 45 percent of patients taking placebo. Forty-seven percent of
duloxetine-treated patients experienced a 50 percent improvement in pain
compared with 29 percent of placebo-treated patients.
Treatment with duloxetine also was associated with improved patient
outcomes compared with placebo as measured by the Patient Global
Impressions of Improvement (PGI-I) and physical functioning as measured by
the Western Ontario and McMaster Universities (WOMAC) physical functioning
subscale.
In this study, the most common adverse events (occurred at a rate of
greater than or equal to 3 percent and at least twice the rate of placebo)
were nausea, fatigue, somnolence, dizziness, hypertension, constipation and
decreased libido.
"These data are important because it's the first time duloxetine has
been studied in a large, placebo-controlled trial in what's classified as
an inflammatory disease state," said Amy Chappell, M.D., lead study author
and medical fellow II, Eli Lilly and Company. "Although the exact mechanism
of action is unknown, this study may provide important insights into the
treatment of pain in the central nervous system."
It is estimated that 27 million adults in the United States have
osteoarthritis and the prevalence increases with age.(2) Osteoarthritis of
the knee is a common type of this disorder, impacting the lives of
approximately 10 million Americans.(2) Other symptoms of osteoarthritis in
addition to pain include aching, stiffness and limited range of motion of
the joint.(3)
Additional Study Highlights:
- Compared with patients receiving placebo, patients receiving duloxetine
experienced significant improvement in symptom severity associated with
osteoarthritis pain of the knee, including:
Significantly greater reduction in Brief Pain Inventory (BPI)
average pain severity (p
patients with osteoarthritis pain of the knee treated with 60 mg and 120 mg
Cymbalta (duloxetine HCl) once daily experienced significant pain
reduction. Patients taking duloxetine reported significant pain improvement
compared to placebo within the first week of treatment that lasted
throughout the 13-week trial.(1) Results from the study of 231 patients
were presented today at the annual congress of the European League Against
Rheumatism (EULAR) in Paris, France.
Duloxetine showed statistically significant improvement in pain
associated with osteoarthritis of the knee according to the primary
efficacy measure of mean 24-hour average pain scores. Fifty-nine percent of
duloxetine-treated patients experienced a 30 percent improvement in pain
compared with 45 percent of patients taking placebo. Forty-seven percent of
duloxetine-treated patients experienced a 50 percent improvement in pain
compared with 29 percent of placebo-treated patients.
Treatment with duloxetine also was associated with improved patient
outcomes compared with placebo as measured by the Patient Global
Impressions of Improvement (PGI-I) and physical functioning as measured by
the Western Ontario and McMaster Universities (WOMAC) physical functioning
subscale.
In this study, the most common adverse events (occurred at a rate of
greater than or equal to 3 percent and at least twice the rate of placebo)
were nausea, fatigue, somnolence, dizziness, hypertension, constipation and
decreased libido.
"These data are important because it's the first time duloxetine has
been studied in a large, placebo-controlled trial in what's classified as
an inflammatory disease state," said Amy Chappell, M.D., lead study author
and medical fellow II, Eli Lilly and Company. "Although the exact mechanism
of action is unknown, this study may provide important insights into the
treatment of pain in the central nervous system."
It is estimated that 27 million adults in the United States have
osteoarthritis and the prevalence increases with age.(2) Osteoarthritis of
the knee is a common type of this disorder, impacting the lives of
approximately 10 million Americans.(2) Other symptoms of osteoarthritis in
addition to pain include aching, stiffness and limited range of motion of
the joint.(3)
Additional Study Highlights:
- Compared with patients receiving placebo, patients receiving duloxetine
experienced significant improvement in symptom severity associated with
osteoarthritis pain of the knee, including:
Significantly greater reduction in Brief Pain Inventory (BPI)
average pain severity (p
четверг, 6 октября 2011 г.
RA Individuals From Lower GDP Countries Keep Working Despite Worse Symptoms Than Richer Countries
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
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
понедельник, 3 октября 2011 г.
Risk Of Heart Attacks And Strokes Reduced By Arthritis Medications
Patients prescribed drugs to treat rheumatoid arthritis could be at a reduced risk of heart attacks and strokes, according to a study published in the open access journal Arthritis Research & Therapy.
An international team of researchers led by Antonio Naranjo of the University of Las Palmas de Gran Canaria, Spain, and colleagues in Argentina, Europe, and the USA have analyzed data from the QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis) study. From this study, including 4,363 patients from 48 sites in 15 countries, the team has examined the causes and effects of rheumatoid arthritis, as well as the potential benefits of medications.
Rheumatoid arthritis is a known risk factor for hardening of the arteries and so can lead to stroke and heart attacks occurring in sufferers ten years earlier than in people without the condition. However, earlier studies have shown that treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, may reduce this risk. The current research quantifies this risk reduction in thousands of patients in the QUEST-RA study.
Naranjo and colleagues found that risk, when adjusted for age, sex, disease activity, and traditional risk factors such as lack of exercise, smoking, diabetes, and high cholesterol levels, correlated strongly with the use of drugs to treat rheumatoid arthritis. Taking methotrexate - the most widely used DMARD - for just one year for example was found to be associated with an 18% reduction in risk of heart attack and an 11% decrease in risk of stroke, the researchers say.
"Our study provides further support of the influence of both traditional and RA specific risk factors in the development of cardiovascular events, especially heart attack" the researchers conclude, "As assessed by this study, the risk was lower with the prolonged use of methotrexate, sulfasalazine, glucocorticoids, leflunomide and TNF-?± blockers."
In an accompanying editorial, Dr Ronald van Vollenhoven of Karolinska Institute, Sweden, reviews the research article. "The possibility that antirheumatic therapy decreases the risk for cardiovascular complications is tantalizing," writes the author. "The current study, while not exactly proving this point, adds a further measure of support to the concept, and suggests that it must now be formally addressed.
1. Cardiovascular disease in patients with rheumatoid arthritis. Results from the QUEST-RA study Antonio Naranjo, Tuulikki Sokka, Miguel A Descalzo, Jaime Calvo-Alen, Kim Horslev-Petersen, Reijo K Luukkainen, Bernard Combe, Gerd R Burmester, Joe Devlin, Gianfranco Ferraccioli, Alessia Morelli, Monique Hoekstra, Maria Majdan, Stefan Sadkiewicz, Miguel Belmonte, Ann-Carin Holmqvist, Ernest Choy, Recep Tunc, Aleksander Dimic, Martin Bergman, Sergio Toloza and Theodore Pincus
Arthritis Research & Therapy (in press)
Article available at journal website: arthritis-research/
All articles are available free of charge, according to BioMed Central's open access policy.
2. Arthritis Research & Therapy is an international, peer-reviewed online and print journal, publishing original research, reviews, commentaries and reports. Studies relate to the rationale and treatment of arthritis, autoimmune disease and diseases of bone and cartilage. The journal is edited by Prof Peter E Lipsky (USA) and Prof Sir Ravinder N Maini (UK) and has an Impact Factor of 3.8.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
Source: Charlotte Webber
BioMed Central
An international team of researchers led by Antonio Naranjo of the University of Las Palmas de Gran Canaria, Spain, and colleagues in Argentina, Europe, and the USA have analyzed data from the QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis) study. From this study, including 4,363 patients from 48 sites in 15 countries, the team has examined the causes and effects of rheumatoid arthritis, as well as the potential benefits of medications.
Rheumatoid arthritis is a known risk factor for hardening of the arteries and so can lead to stroke and heart attacks occurring in sufferers ten years earlier than in people without the condition. However, earlier studies have shown that treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, may reduce this risk. The current research quantifies this risk reduction in thousands of patients in the QUEST-RA study.
Naranjo and colleagues found that risk, when adjusted for age, sex, disease activity, and traditional risk factors such as lack of exercise, smoking, diabetes, and high cholesterol levels, correlated strongly with the use of drugs to treat rheumatoid arthritis. Taking methotrexate - the most widely used DMARD - for just one year for example was found to be associated with an 18% reduction in risk of heart attack and an 11% decrease in risk of stroke, the researchers say.
"Our study provides further support of the influence of both traditional and RA specific risk factors in the development of cardiovascular events, especially heart attack" the researchers conclude, "As assessed by this study, the risk was lower with the prolonged use of methotrexate, sulfasalazine, glucocorticoids, leflunomide and TNF-?± blockers."
In an accompanying editorial, Dr Ronald van Vollenhoven of Karolinska Institute, Sweden, reviews the research article. "The possibility that antirheumatic therapy decreases the risk for cardiovascular complications is tantalizing," writes the author. "The current study, while not exactly proving this point, adds a further measure of support to the concept, and suggests that it must now be formally addressed.
1. Cardiovascular disease in patients with rheumatoid arthritis. Results from the QUEST-RA study Antonio Naranjo, Tuulikki Sokka, Miguel A Descalzo, Jaime Calvo-Alen, Kim Horslev-Petersen, Reijo K Luukkainen, Bernard Combe, Gerd R Burmester, Joe Devlin, Gianfranco Ferraccioli, Alessia Morelli, Monique Hoekstra, Maria Majdan, Stefan Sadkiewicz, Miguel Belmonte, Ann-Carin Holmqvist, Ernest Choy, Recep Tunc, Aleksander Dimic, Martin Bergman, Sergio Toloza and Theodore Pincus
Arthritis Research & Therapy (in press)
Article available at journal website: arthritis-research/
All articles are available free of charge, according to BioMed Central's open access policy.
2. Arthritis Research & Therapy is an international, peer-reviewed online and print journal, publishing original research, reviews, commentaries and reports. Studies relate to the rationale and treatment of arthritis, autoimmune disease and diseases of bone and cartilage. The journal is edited by Prof Peter E Lipsky (USA) and Prof Sir Ravinder N Maini (UK) and has an Impact Factor of 3.8.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
Source: Charlotte Webber
BioMed Central
пятница, 30 сентября 2011 г.
What Is Water On The Knee (Knee Effusion)? What Causes Water On The Knee?
Knee effusion, colloquially known as water on the knee, occurs when excess fluid accumulates in or around the knee joint. There are many common causes for the swelling, including arthritis, injury to the ligaments or meniscus, or when fluid collects in the bursa. This condition is known as prepatellar bursitis.
According to Medilexicon's medical dictionary:
Knee effusion is a large bursa between the inferior part of the femur and the tendon of the quadriceps femoris muscle. It usually communicates with the cavity of the knee joint and is pathologically distended with blood or synovial fluid in suprapatellar bursitis ("water on the knee").
A small amount of fluid exists in normal joints. When a joint is affected by arthritis, particularly an inflammatory arthritis such as rheumatoid arthritis (RA), increased abnormal amounts of fluid buildup, the knee appears swollen. The fluid is produced by the tissues that are affected by the arthritis and that line the joint.
What are the symptoms of Knee Effusion?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Signs and symptoms of water on the knee depend on the cause of excess fluid build-up in the knee joint. With osteoarthritis, pain occurs when bearing weight. The pain typically subsides with rest and relaxation.
One knee may appear larger than the other. Puffiness around the bony parts of the knee appears prominent when compared with the other knee.
When the knee joint contains excess fluid, it may become difficult to bend or straighten the knee in certain cases.
If an individual has injured his or her knee, he or she may note bruising on the front, sides or rear of the knee. Bearing weight on the knee joint may be impossible and the pain unbearable.
What are the causes of Knee Effusion?
Causes of the swelling can include arthritis, injury to the ligaments of the knee or an accident after which the body's natural reaction is to surround the knee with a protective fluid.
There could also be an underlying disease or condition. The type of fluid that accumulates around the knee depends on the underlying disease, condition or type of traumatic injury that caused the excess fluid. The swelling can, in most cases, be easily cured.
Having osteoarthritis or engaging in high-risk sports that involve rapid cut-and-run movements of the knee, football or tennis for example, means an individual is more likely to develop water on the knee.
In overweight or obese individuals the body places more weight on the knee joint. This causes more wear in the joint. Over time, the body will produce excess joint fluid.
Diagnosing Knee Effusion
An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation.
The most common traumatic causes of knee effusion are ligamentous, osseous and meniscal injuries, and overuse syndromes. Atraumatic etiologies include arthritis, infection, crystal deposition and tumor. It is essential to compare the affected knee with the unaffected knee.
Systematic physical examination of the knee, using specific maneuvers, and the appropriate use of diagnostic imaging studies and arthrocentesis establish the correct diagnosis and treatment.
Joint aspiration, also known as arthrocentesis, is a procedure that includes withdrawal of fluid from inside the knee for analysis such as cell count, culture for bacteria, and examination for crystals, such as uric acid or calcium pyrophosphate dihydrate crystals found in gout or pseudogout.
An X-ray is useful to verify that there is no break or dislocation when there is a history of trauma and may show signs of osteoarthritis.
An MRI (Magnetic Resonance Imaging) detects abnormalities of the bone or knee joint, such as a tear in the ligaments, tendons or cartilage.
If the knee is swollen, red and warm to the touch when compared to the other knee, a doctor may be concerned about inflammation due to rheumatoid arthritis or a crystalline arthritis, such as gout or pseudogout, or joint infection. Besides sending the joint fluid to a laboratory for analysis, he or she may request blood tests to determine a white blood cell count, erythrocyte sedimentation rate, and perhaps the level of C-reactive protein or uric acid. If blood tests reveal Lyme's disease antibodies forming, the condition may be attributed to it.
Psoriatic arthritis often undiagnosed cause of joint conditions. Patients with the skin condition psoriasis can also have the related arthritis subtype called psoriatic arthritis. This arthritic condition tends to be overlooked, even in patients with diagnosed psoriasis.
What are the treatment options for Knee Effusion?
Along with any sort of medical care, knee joint effusion responds well to simple self-care measures, such as rest and elevation as well as icing and exercise. As with any sort of injury, ice should be applied to the affected area only for 15 to 20 minutes at a time. With exercise, a series of fitness activities are established by a physical therapist to strengthen the area to support the weakened knee.
Most treatments for knee joint effusion are based on the cause of the condition, making a "standard" approach to care nonexistent. However, many people with water on the knee need to have the excess fluid removed, so one may undergo a procedure known as aspiration.
Finally, one may need a series of corticosteroid injections, non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics to reduce inflammation or treat an infection. For others, knee surgery or even joint replacement may be necessary.
Preventing Knee Effusion
Avoiding sudden jolting movements and rough running surfaces can help prevent knee injuries. Obesity adds pressure to the vulnerable knee joint, so weight reduction may help.
Exercises considered better for the knees include small (not deep) knee bends and straightening motions done while in supination with most weight on the outside of the foot.
Sports that are easier on the knees include walking, swimming (flutter kicks, knees straight), skating, baseball, cross-country skiing, and, depending on the state of the knee, cycling (seat high, low gear, avoiding hills).
Choose activities to suit your own knee strength and capacity, and remember that sports especially hard on the knees include football, sprinting, soccer, rugby, hockey, squash, volleyball, basketball, downhill skiing, tennis and jogging or anything that pounds, jolts, or twists the knees.
Written by Sy Kraft (B.A.)
According to Medilexicon's medical dictionary:
Knee effusion is a large bursa between the inferior part of the femur and the tendon of the quadriceps femoris muscle. It usually communicates with the cavity of the knee joint and is pathologically distended with blood or synovial fluid in suprapatellar bursitis ("water on the knee").
A small amount of fluid exists in normal joints. When a joint is affected by arthritis, particularly an inflammatory arthritis such as rheumatoid arthritis (RA), increased abnormal amounts of fluid buildup, the knee appears swollen. The fluid is produced by the tissues that are affected by the arthritis and that line the joint.
What are the symptoms of Knee Effusion?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Signs and symptoms of water on the knee depend on the cause of excess fluid build-up in the knee joint. With osteoarthritis, pain occurs when bearing weight. The pain typically subsides with rest and relaxation.
One knee may appear larger than the other. Puffiness around the bony parts of the knee appears prominent when compared with the other knee.
When the knee joint contains excess fluid, it may become difficult to bend or straighten the knee in certain cases.
If an individual has injured his or her knee, he or she may note bruising on the front, sides or rear of the knee. Bearing weight on the knee joint may be impossible and the pain unbearable.
What are the causes of Knee Effusion?
Causes of the swelling can include arthritis, injury to the ligaments of the knee or an accident after which the body's natural reaction is to surround the knee with a protective fluid.
There could also be an underlying disease or condition. The type of fluid that accumulates around the knee depends on the underlying disease, condition or type of traumatic injury that caused the excess fluid. The swelling can, in most cases, be easily cured.
Having osteoarthritis or engaging in high-risk sports that involve rapid cut-and-run movements of the knee, football or tennis for example, means an individual is more likely to develop water on the knee.
In overweight or obese individuals the body places more weight on the knee joint. This causes more wear in the joint. Over time, the body will produce excess joint fluid.
Diagnosing Knee Effusion
An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation.
The most common traumatic causes of knee effusion are ligamentous, osseous and meniscal injuries, and overuse syndromes. Atraumatic etiologies include arthritis, infection, crystal deposition and tumor. It is essential to compare the affected knee with the unaffected knee.
Systematic physical examination of the knee, using specific maneuvers, and the appropriate use of diagnostic imaging studies and arthrocentesis establish the correct diagnosis and treatment.
Joint aspiration, also known as arthrocentesis, is a procedure that includes withdrawal of fluid from inside the knee for analysis such as cell count, culture for bacteria, and examination for crystals, such as uric acid or calcium pyrophosphate dihydrate crystals found in gout or pseudogout.
An X-ray is useful to verify that there is no break or dislocation when there is a history of trauma and may show signs of osteoarthritis.
An MRI (Magnetic Resonance Imaging) detects abnormalities of the bone or knee joint, such as a tear in the ligaments, tendons or cartilage.
If the knee is swollen, red and warm to the touch when compared to the other knee, a doctor may be concerned about inflammation due to rheumatoid arthritis or a crystalline arthritis, such as gout or pseudogout, or joint infection. Besides sending the joint fluid to a laboratory for analysis, he or she may request blood tests to determine a white blood cell count, erythrocyte sedimentation rate, and perhaps the level of C-reactive protein or uric acid. If blood tests reveal Lyme's disease antibodies forming, the condition may be attributed to it.
Psoriatic arthritis often undiagnosed cause of joint conditions. Patients with the skin condition psoriasis can also have the related arthritis subtype called psoriatic arthritis. This arthritic condition tends to be overlooked, even in patients with diagnosed psoriasis.
What are the treatment options for Knee Effusion?
Along with any sort of medical care, knee joint effusion responds well to simple self-care measures, such as rest and elevation as well as icing and exercise. As with any sort of injury, ice should be applied to the affected area only for 15 to 20 minutes at a time. With exercise, a series of fitness activities are established by a physical therapist to strengthen the area to support the weakened knee.
Most treatments for knee joint effusion are based on the cause of the condition, making a "standard" approach to care nonexistent. However, many people with water on the knee need to have the excess fluid removed, so one may undergo a procedure known as aspiration.
Finally, one may need a series of corticosteroid injections, non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics to reduce inflammation or treat an infection. For others, knee surgery or even joint replacement may be necessary.
Preventing Knee Effusion
Avoiding sudden jolting movements and rough running surfaces can help prevent knee injuries. Obesity adds pressure to the vulnerable knee joint, so weight reduction may help.
Exercises considered better for the knees include small (not deep) knee bends and straightening motions done while in supination with most weight on the outside of the foot.
Sports that are easier on the knees include walking, swimming (flutter kicks, knees straight), skating, baseball, cross-country skiing, and, depending on the state of the knee, cycling (seat high, low gear, avoiding hills).
Choose activities to suit your own knee strength and capacity, and remember that sports especially hard on the knees include football, sprinting, soccer, rugby, hockey, squash, volleyball, basketball, downhill skiing, tennis and jogging or anything that pounds, jolts, or twists the knees.
Written by Sy Kraft (B.A.)
вторник, 27 сентября 2011 г.
Flexcin Arthritis Remedy Proves Worthy Substitution For Acetaminophen
An advisory panel for the Food and Drug Administration (FDA) recently recommended limiting sales of acetaminophen products like Tylenol and also recommended banning prescription pain medications Vicodin and Percocet. This recommendation will prompt more people to change their habits and focus on joint pain remedy and pain relievers found in the natural vitamin supplements industry for arthritis treatment.
Acetaminophen, along with prescription pain medications like Vicodin and Percocet, have all recently made headlines attracting consumers' attention because the FDA panel believes the drugs pose a risk of liver failure. The headlines underscore why 32 percent more people are now choosing arthritis remedy supplements like Flexcin, which offers the only joint pain treatment with the CM8TM ingredient.
"Like millions of others, I have little interest in taking prescription pain medications because of the uncomfortable and dangerous side effects that can possibly do even more harm to my body," said Lisa Sharron, who takes Flexcin arthritis remedy regularly. "Additionally, I don't want to just put a mask over my pain, I want to repair my arthritis so I can get back to living a normal life, which Flexcin joint pain remedy allows me to do."
Unlike prescription pain medications that work to mask pain, Flexcin with CM8 (cetyl myristoleate) is a natural vitamin supplement that instead works to repair joint damage. Flexcin with CM8 works as an arthritis remedy, joint pain treatment and arthritis treatment for hip pain, shoulder, knee, elbow, hand or foot pain, and muscle pain. Cetyl myristoleate is clinically proven to promote optimal joint health by helping to stimulate the lubricating fluid in the joints, support stronger cartilage and increase total mobility.
Source
Flexcin International, Inc.
Acetaminophen, along with prescription pain medications like Vicodin and Percocet, have all recently made headlines attracting consumers' attention because the FDA panel believes the drugs pose a risk of liver failure. The headlines underscore why 32 percent more people are now choosing arthritis remedy supplements like Flexcin, which offers the only joint pain treatment with the CM8TM ingredient.
"Like millions of others, I have little interest in taking prescription pain medications because of the uncomfortable and dangerous side effects that can possibly do even more harm to my body," said Lisa Sharron, who takes Flexcin arthritis remedy regularly. "Additionally, I don't want to just put a mask over my pain, I want to repair my arthritis so I can get back to living a normal life, which Flexcin joint pain remedy allows me to do."
Unlike prescription pain medications that work to mask pain, Flexcin with CM8 (cetyl myristoleate) is a natural vitamin supplement that instead works to repair joint damage. Flexcin with CM8 works as an arthritis remedy, joint pain treatment and arthritis treatment for hip pain, shoulder, knee, elbow, hand or foot pain, and muscle pain. Cetyl myristoleate is clinically proven to promote optimal joint health by helping to stimulate the lubricating fluid in the joints, support stronger cartilage and increase total mobility.
Source
Flexcin International, Inc.
суббота, 24 сентября 2011 г.
NIH GAIT Study Supports Use Of Glucosamine And Chondroitin For Osteoarthritis Treatment
Arthritis experts and orthopaedic surgeons are discussing the
results of the NIH study that shows a supplement to be as effective as the
most expensive NSAIDs for moderate and severe pain from arthritis.
Dr. Kevin R. Stone, Chairman of the Stone Foundation for Sports Medicine
and Arthritis Research in San Francisco pioneered the use of glucosamine in a
beverage form for athletes and arthritis sufferers and is vocal about the
results of this new study.
"The supplements glucosamine and chondroitin together, which are
inexpensive and have zero negative side effects, performed as well as the very
expensive and somewhat risky Celebrex," said Stone. "I believe the standard
of care in medicine will now be to prescribe the supplements first and if they
are not enough then to add additional medications," Stone said.
The GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) study
funded by the National Institutes for Health (NIH)) evaluates the use of
glucosamine and chondroitin in treating and preventing osteoarthritis.
(nccam.nih/news/19972000/121100/qa.htm#12)
Published study results indicate that the combination of glucosamine and
chondroitin sulfate might be most effective in osteoarthritis patients who had
moderate to severe knee pain.
As a physician treating patients with glucosamine and chondroitin for more
than a decade, Dr. Stone says, "We recommend it for all our patients, both
athletes and those with arthritis. Many of our patients with arthritis have
given up using nonsteroidal anti-inflammatories because glucosamine has been
effective for them." Stone prescribes 1,500 milligrams a day, taken all at
once in beverage form.
WHO: Harvard- and UNC at Chapel Hill-educated Dr. Kevin R. Stone, founder
of the Stone Clinic and chairman of the Stone Foundation for Sports Medicine
and Arthritis Research (stoneclinic), and inventor and founder of
Joint Juice, the first glucosamine beverage. Dr. Stone has provided
commentary for media ranging from The Wall Street Journal and Newsweek to
USAToday and CBSNews, is the author of numerous scientific articles, and is a
frequent lecturer at leading forums and symposia. He is passionate and
objective about the role of supplements in medical practice.
WHEN: Dr. Stone is available for phone and in-person interviews now.
WHERE: Dr. Stone is based in San Francisco.
Background
Initiated in 1998, GAIT is the first multicenter clinical trial in the
United States to test the effects of the dietary supplements glucosamine and
chondroitin for treatment of knee osteoarthritis.
The study tests whether glucosamine and chondroitin used separately or in
combination are effective in reducing pain in patients with knee
osteoarthritis. GAIT includes an additional study (or sub-study) that will
assess whether glucosamine and chondroitin can reduce or halt the progression
of knee osteoarthritis.
GAIT was designed to rigorously assess the effectiveness and safety of
these supplements when taken separately or in combination. Almost 1,600
patients with painful knee osteoarthritis were recruited from 16 U.S. academic
rheumatology centers for the study.
Results of previous studies in the medical literature have yielded
conflicting results on the effectiveness of glucosamine and chondroitin as
treatments for osteoarthritis. This study tested the short-term (6 months)
effectiveness of glucosamine and chondroitin in reducing pain in a large
number of patients with knee osteoarthritis.
The sub-study will also evaluate the impact of glucosamine and chondroitin
on progression of knee osteoarthritis following an additional 18-month
treatment regimen.
Stone Research Foundation
stoneclinic
results of the NIH study that shows a supplement to be as effective as the
most expensive NSAIDs for moderate and severe pain from arthritis.
Dr. Kevin R. Stone, Chairman of the Stone Foundation for Sports Medicine
and Arthritis Research in San Francisco pioneered the use of glucosamine in a
beverage form for athletes and arthritis sufferers and is vocal about the
results of this new study.
"The supplements glucosamine and chondroitin together, which are
inexpensive and have zero negative side effects, performed as well as the very
expensive and somewhat risky Celebrex," said Stone. "I believe the standard
of care in medicine will now be to prescribe the supplements first and if they
are not enough then to add additional medications," Stone said.
The GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) study
funded by the National Institutes for Health (NIH)) evaluates the use of
glucosamine and chondroitin in treating and preventing osteoarthritis.
(nccam.nih/news/19972000/121100/qa.htm#12)
Published study results indicate that the combination of glucosamine and
chondroitin sulfate might be most effective in osteoarthritis patients who had
moderate to severe knee pain.
As a physician treating patients with glucosamine and chondroitin for more
than a decade, Dr. Stone says, "We recommend it for all our patients, both
athletes and those with arthritis. Many of our patients with arthritis have
given up using nonsteroidal anti-inflammatories because glucosamine has been
effective for them." Stone prescribes 1,500 milligrams a day, taken all at
once in beverage form.
WHO: Harvard- and UNC at Chapel Hill-educated Dr. Kevin R. Stone, founder
of the Stone Clinic and chairman of the Stone Foundation for Sports Medicine
and Arthritis Research (stoneclinic), and inventor and founder of
Joint Juice, the first glucosamine beverage. Dr. Stone has provided
commentary for media ranging from The Wall Street Journal and Newsweek to
USAToday and CBSNews, is the author of numerous scientific articles, and is a
frequent lecturer at leading forums and symposia. He is passionate and
objective about the role of supplements in medical practice.
WHEN: Dr. Stone is available for phone and in-person interviews now.
WHERE: Dr. Stone is based in San Francisco.
Background
Initiated in 1998, GAIT is the first multicenter clinical trial in the
United States to test the effects of the dietary supplements glucosamine and
chondroitin for treatment of knee osteoarthritis.
The study tests whether glucosamine and chondroitin used separately or in
combination are effective in reducing pain in patients with knee
osteoarthritis. GAIT includes an additional study (or sub-study) that will
assess whether glucosamine and chondroitin can reduce or halt the progression
of knee osteoarthritis.
GAIT was designed to rigorously assess the effectiveness and safety of
these supplements when taken separately or in combination. Almost 1,600
patients with painful knee osteoarthritis were recruited from 16 U.S. academic
rheumatology centers for the study.
Results of previous studies in the medical literature have yielded
conflicting results on the effectiveness of glucosamine and chondroitin as
treatments for osteoarthritis. This study tested the short-term (6 months)
effectiveness of glucosamine and chondroitin in reducing pain in a large
number of patients with knee osteoarthritis.
The sub-study will also evaluate the impact of glucosamine and chondroitin
on progression of knee osteoarthritis following an additional 18-month
treatment regimen.
Stone Research Foundation
stoneclinic
среда, 21 сентября 2011 г.
Pain Is Not A Symptom Of Arthritis, Pain Causes Arthritis: New Study
Pain is more than a symptom of osteoarthritis, it is an inherent and damaging part of the disease itself, according to a study published today in journal Arthritis and Rheumatism. More specifically, the study revealed that pain signals originating in arthritic joints, and the biochemical processing of those signals as they reach the spinal cord, worsen and expand arthritis. In addition, researchers found that nerve pathways carrying pain signals transfer inflammation from arthritic joints to the spine and back again, causing disease at both ends.
Technically, pain is a patient's conscious realization of discomfort. Before that can happen, however, information must be carried along nerve cell pathways from say an injured knee to the pain processing centers in dorsal horns of the spinal cord, a process called nociception. The current study provides strong evidence that two-way, nociceptive "crosstalk" may first enable joint arthritis to transmit inflammation into the spinal cord and brain, and then to spread through the central nervous system (CNS) from one joint to another.
Furthermore, if joint arthritis can cause neuro-inflammation, it could have a role in conditions like Alzheimer's disease, dementia and multiple sclerosis. Armed with the results, researchers have identified likely drug targets that could interfere with key inflammatory receptors on sensory nerve cells as a new way to treat osteoarthritis (OA), which destroys joint cartilage in 21 million Americans. The most common form of arthritis, OA eventually brings deformity and severe pain as patients loose the protective cushion between bones in weight-bearing joints like knees and hips.
"Until relatively recently, osteoarthritis was believed to be due solely to wear and tear, and inevitable part of aging," said Stephanos Kyrkanides, D.D.S., Ph.D., associate professor of Dentistry at the University of Rochester Medical Center. "Recent studies have revealed, however, that specific biochemical changes contribute to the disease, changes that might be reversed by precision-designed drugs. Our study provides the first solid proof that some of those changes are related to pain processing, and suggests the mechanisms behind the effect," said Kyrkanides, whose work on genetics in dentistry led to broader applications. The common ground between arthritis and dentistry: the jaw joint is a common site of arthritic pain.
Study Details
Past studies have shown that specific nerve pathways along which pain signals travel repeatedly become more sensitive to pain signals with each use. This may be a part of ancient survival skill (if that hurt once, don't do it again). Secondly, pain has long been associated with inflammation (swelling and fever).
In fact, past research has shown that the same chemicals that cause inflammation also cause the sensation of pain and hyper-sensitivity to pain if injected. Kyrkanides' work centers around one such pro-inflammatory, signaling chemical called Interleukin 1-beta (IL-1??), which helps to ramp up the bodies attack on an infection.
Specifically, Kyrkanides' team genetically engineered a mouse where they could turn up on command the production of IL-1?? in the jaw joint, a common site of arthritis. Experiments showed for the first time that turning up IL-1?? in a peripheral joint caused higher levels of IL-1?? to be produced in the dorsal horns of the spinal cord as well.
Using a second, even more elaborately engineered mouse model, the team also demonstrated for the first time that creating higher levels of IL-1?? in cells called astrocytes in the spinal cord caused more osteoarthritic symptoms in joints. Past studies had shown astrocytes, non-nerve cells (glia) in the central nervous system that provide support for the spinal cord and brain, also serve as the immune cells of CNS organs. Among other things, they release cytokines like IL-1?? to fight disease when triggered. The same cytokines released from CNS glia may also be released from neurons in joints, possibly explaining how crosstalk carries pain, inflammation and hyper-sensitivity back and forth.
In both mouse models, experimental techniques that shut down IL-1?? signaling reversed the crosstalk effects. Specifically, researchers used a molecule, IL-1RA, known to inhibit the ability of IL-1?? to link up with its receptors on nerve cells. Existing drugs (e.g. Kineret® (anakinra), made by Amgen and indicated for rheumatoid arthritis) act like IL-1RA to block the ability IL-1?? to send a pain signal through its specific nerve cell receptor, and Kyrkanides' group is exploring a new use for them as osteoarthritis treatment.
The implications of this process go further, however, because the cells surrounding sensory nerve cell pathways too can be affected by crosstalk. If 10 astrocytes secrete IL-1?? in response to a pain impulse, Kyrkanides said, perhaps 1,000 adjacent cells will be affected, greatly expanding the field of inflammation. Spinal cord astrocytes are surrounded by sensory nerve cells that connect to other areas of the periphery, further expanding the effect. According to Kyrkanides' model, increased inflammation by in the central nervous system can then send signals back down the nerve pathways to the joints, causing the release of inflammatory factors there.
Among the proposed, inflammatory factors is calcitonin gene related peptide (CGRP). The team observed higher levels calcitonin-gene related peptide (CGRP) production in primary sensory fibers in the same regions where IL-1?? levels rose, and the release of IL-1?? by sensory neurons may cause the release of CGRP in joints. Past studies in Kyrkanides reveal that CGRP can also cause cartilage-producing cells (chondrocytes) to mature too quickly and die, a hallmark of osteoarthritis.
Joining Kyrkanides in the publication from the University of Rochester School of Medicine and Dentistry were co-authors M. Kerry O'Banion, M.D., Ph.D., Ross Tallents, D.D.S., J. Edward Puzas, Ph.D. and Sabine M. Brouxhon, M.D. Paolo Fiorentino was a student contributor and Jennie Miller was involved as Kyrkanides' technical associate. Maria Piancino, led a collaborative effort at the University of Torino, Italy. This work was supported in part by grants from the National Institutes of Health.
"Our study results confirm that joints can export inflammation in the form of higher IL-1?? along sensory nerve pathways to the spinal cord, and that higher IL-1?? inflammation in the spinal cord is sufficient in itself to create osteoarthritis in peripheral joints," Kyrkanides said. "We believe this to be a vitally important process contributing to orthopaedic and neurological diseases in which inflammation is a factor."
Source: Greg Williams
University of Rochester Medical Center
View drug information on Kineret.
Technically, pain is a patient's conscious realization of discomfort. Before that can happen, however, information must be carried along nerve cell pathways from say an injured knee to the pain processing centers in dorsal horns of the spinal cord, a process called nociception. The current study provides strong evidence that two-way, nociceptive "crosstalk" may first enable joint arthritis to transmit inflammation into the spinal cord and brain, and then to spread through the central nervous system (CNS) from one joint to another.
Furthermore, if joint arthritis can cause neuro-inflammation, it could have a role in conditions like Alzheimer's disease, dementia and multiple sclerosis. Armed with the results, researchers have identified likely drug targets that could interfere with key inflammatory receptors on sensory nerve cells as a new way to treat osteoarthritis (OA), which destroys joint cartilage in 21 million Americans. The most common form of arthritis, OA eventually brings deformity and severe pain as patients loose the protective cushion between bones in weight-bearing joints like knees and hips.
"Until relatively recently, osteoarthritis was believed to be due solely to wear and tear, and inevitable part of aging," said Stephanos Kyrkanides, D.D.S., Ph.D., associate professor of Dentistry at the University of Rochester Medical Center. "Recent studies have revealed, however, that specific biochemical changes contribute to the disease, changes that might be reversed by precision-designed drugs. Our study provides the first solid proof that some of those changes are related to pain processing, and suggests the mechanisms behind the effect," said Kyrkanides, whose work on genetics in dentistry led to broader applications. The common ground between arthritis and dentistry: the jaw joint is a common site of arthritic pain.
Study Details
Past studies have shown that specific nerve pathways along which pain signals travel repeatedly become more sensitive to pain signals with each use. This may be a part of ancient survival skill (if that hurt once, don't do it again). Secondly, pain has long been associated with inflammation (swelling and fever).
In fact, past research has shown that the same chemicals that cause inflammation also cause the sensation of pain and hyper-sensitivity to pain if injected. Kyrkanides' work centers around one such pro-inflammatory, signaling chemical called Interleukin 1-beta (IL-1??), which helps to ramp up the bodies attack on an infection.
Specifically, Kyrkanides' team genetically engineered a mouse where they could turn up on command the production of IL-1?? in the jaw joint, a common site of arthritis. Experiments showed for the first time that turning up IL-1?? in a peripheral joint caused higher levels of IL-1?? to be produced in the dorsal horns of the spinal cord as well.
Using a second, even more elaborately engineered mouse model, the team also demonstrated for the first time that creating higher levels of IL-1?? in cells called astrocytes in the spinal cord caused more osteoarthritic symptoms in joints. Past studies had shown astrocytes, non-nerve cells (glia) in the central nervous system that provide support for the spinal cord and brain, also serve as the immune cells of CNS organs. Among other things, they release cytokines like IL-1?? to fight disease when triggered. The same cytokines released from CNS glia may also be released from neurons in joints, possibly explaining how crosstalk carries pain, inflammation and hyper-sensitivity back and forth.
In both mouse models, experimental techniques that shut down IL-1?? signaling reversed the crosstalk effects. Specifically, researchers used a molecule, IL-1RA, known to inhibit the ability of IL-1?? to link up with its receptors on nerve cells. Existing drugs (e.g. Kineret® (anakinra), made by Amgen and indicated for rheumatoid arthritis) act like IL-1RA to block the ability IL-1?? to send a pain signal through its specific nerve cell receptor, and Kyrkanides' group is exploring a new use for them as osteoarthritis treatment.
The implications of this process go further, however, because the cells surrounding sensory nerve cell pathways too can be affected by crosstalk. If 10 astrocytes secrete IL-1?? in response to a pain impulse, Kyrkanides said, perhaps 1,000 adjacent cells will be affected, greatly expanding the field of inflammation. Spinal cord astrocytes are surrounded by sensory nerve cells that connect to other areas of the periphery, further expanding the effect. According to Kyrkanides' model, increased inflammation by in the central nervous system can then send signals back down the nerve pathways to the joints, causing the release of inflammatory factors there.
Among the proposed, inflammatory factors is calcitonin gene related peptide (CGRP). The team observed higher levels calcitonin-gene related peptide (CGRP) production in primary sensory fibers in the same regions where IL-1?? levels rose, and the release of IL-1?? by sensory neurons may cause the release of CGRP in joints. Past studies in Kyrkanides reveal that CGRP can also cause cartilage-producing cells (chondrocytes) to mature too quickly and die, a hallmark of osteoarthritis.
Joining Kyrkanides in the publication from the University of Rochester School of Medicine and Dentistry were co-authors M. Kerry O'Banion, M.D., Ph.D., Ross Tallents, D.D.S., J. Edward Puzas, Ph.D. and Sabine M. Brouxhon, M.D. Paolo Fiorentino was a student contributor and Jennie Miller was involved as Kyrkanides' technical associate. Maria Piancino, led a collaborative effort at the University of Torino, Italy. This work was supported in part by grants from the National Institutes of Health.
"Our study results confirm that joints can export inflammation in the form of higher IL-1?? along sensory nerve pathways to the spinal cord, and that higher IL-1?? inflammation in the spinal cord is sufficient in itself to create osteoarthritis in peripheral joints," Kyrkanides said. "We believe this to be a vitally important process contributing to orthopaedic and neurological diseases in which inflammation is a factor."
Source: Greg Williams
University of Rochester Medical Center
View drug information on Kineret.
воскресенье, 18 сентября 2011 г.
Geisinger Rheumatology Experts To Present At National Conference
The Geisinger Department of Rheumatology has been selected to present six abstracts at the 2009 American College of Rheumatology (ACR)/Association of Rheumatology Health Professionals (ARHP) Annual Scientific Meeting in Philadelphia Oct. 16-21.
In addition, Rheumatology Director Eric Newman, M.D., will present a workshop on Practical Approaches to Redesigning Your Rheumatology Practice, and chair and moderate a podium session, Quality Measures and Innovations in Practice Management and Delivery of Care. Rheumatologist Thomas P. Olenginski, M.D., FACP, will participate in a Meet the Professor session on Osteoporosis-Applying FRAX Methodology and moderate a clinical symposium regarding Osteoporosis Care in 2010.
"All six of the abstracts submitted by our department were selected for the scientific meeting," said Dr. Newman. "This level of acceptance speaks to the high caliber of work being done at Geisinger. It is an honor for the rheumatology department to be recognized by such esteemed professional organizations."
Podium presentations and presenters at the scientific meeting include: Rheumatology Touch Screen Questionnaire to Improve Efficiency and Patient-centric Care with Successful Development and Implementation Using Process Redesign (Dr. Newman); Closing Osteoporosis Care Gaps through Process Redesign-The Primary Care/Rheumatology DXA Partnership (Dr. Newman); and Glucocorticoid-Induced Osteoporosis Program (GIOP)-A Highly Successful Care Program with Improved Clinical Outcomes After Two Years (Cynthia Matzko, RN, MSN, clinical nurse specialist.
Poster presentations and presenters include: High-Risk Osteoporosis Clinic (HiROC)-Closing the Loop in Clinical Osteoporosis Care (Dr. Olenginski); DXA Testing in Women Older than 65-Closing the Osteoporosis Quality Care Gap at the Point of Service Using an Electronic Health Record Best Practice Alert (Dr. Newman); and Hydroxychloroquine Use-Significant Improvement of Lipid Profile in Rheumatoid Arthritis Patients (Stephanie Morris, D.O., fellow).
More than 5,000 abstracts are submitted worldwide for the ACR/ARHP Annual Scientific Meeting; however, only about 5 percent are accepted for podium presentations and 30 percent for poster presentations. More than 13,000 health professionals from around the world are expected to attend this year.
ABOUT GEISINGER HEALTH SYSTEM
Founded in 1915, Geisinger Health System is one of the nation's largest integrated health services organizations. Serving more than two million residents throughout central and northeast Pennsylvania, the physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger is comprised of two medical centers, a children's hospital, 740-member group practice, a not-for-profit health insurance company and the Henry Hood Center for Health Research dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.
Source: Geisinger Health System
In addition, Rheumatology Director Eric Newman, M.D., will present a workshop on Practical Approaches to Redesigning Your Rheumatology Practice, and chair and moderate a podium session, Quality Measures and Innovations in Practice Management and Delivery of Care. Rheumatologist Thomas P. Olenginski, M.D., FACP, will participate in a Meet the Professor session on Osteoporosis-Applying FRAX Methodology and moderate a clinical symposium regarding Osteoporosis Care in 2010.
"All six of the abstracts submitted by our department were selected for the scientific meeting," said Dr. Newman. "This level of acceptance speaks to the high caliber of work being done at Geisinger. It is an honor for the rheumatology department to be recognized by such esteemed professional organizations."
Podium presentations and presenters at the scientific meeting include: Rheumatology Touch Screen Questionnaire to Improve Efficiency and Patient-centric Care with Successful Development and Implementation Using Process Redesign (Dr. Newman); Closing Osteoporosis Care Gaps through Process Redesign-The Primary Care/Rheumatology DXA Partnership (Dr. Newman); and Glucocorticoid-Induced Osteoporosis Program (GIOP)-A Highly Successful Care Program with Improved Clinical Outcomes After Two Years (Cynthia Matzko, RN, MSN, clinical nurse specialist.
Poster presentations and presenters include: High-Risk Osteoporosis Clinic (HiROC)-Closing the Loop in Clinical Osteoporosis Care (Dr. Olenginski); DXA Testing in Women Older than 65-Closing the Osteoporosis Quality Care Gap at the Point of Service Using an Electronic Health Record Best Practice Alert (Dr. Newman); and Hydroxychloroquine Use-Significant Improvement of Lipid Profile in Rheumatoid Arthritis Patients (Stephanie Morris, D.O., fellow).
More than 5,000 abstracts are submitted worldwide for the ACR/ARHP Annual Scientific Meeting; however, only about 5 percent are accepted for podium presentations and 30 percent for poster presentations. More than 13,000 health professionals from around the world are expected to attend this year.
ABOUT GEISINGER HEALTH SYSTEM
Founded in 1915, Geisinger Health System is one of the nation's largest integrated health services organizations. Serving more than two million residents throughout central and northeast Pennsylvania, the physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger is comprised of two medical centers, a children's hospital, 740-member group practice, a not-for-profit health insurance company and the Henry Hood Center for Health Research dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.
Source: Geisinger Health System
четверг, 15 сентября 2011 г.
Plexxikon Initiates Phase 1 Clinical Trial For Oral Rheumatoid Arthritis Agent PLX5622
Plexxikon Inc. announced that dosing began in the first of two Phase 1 clinical trials with PLX5622, a novel, oral and highly selective Fms inhibitor, targeted for the treatment of rheumatoid arthritis (RA). PLX5622 has been shown in preclinical arthritis models to reduce inflammation, reduce cartilage damage and prevent bone resorption. Fms-related inflammatory mediators and cells, including macrophages, osteoclasts and T-cells, have been validated as key players in RA, other autoimmune diseases and osteoarthritis.
The initial Phase 1 trial is a single-ascending dose study in 32 healthy volunteers. The second trial is a multiple-ascending dose study in 32 RA patients that will begin once the first cohort of healthy volunteers has been cleared for safety, with continued enrollment in a staggered fashion relative to the single-ascending dose study.
"PLX5622 is an important and differentiated candidate among Plexxikon's portfolio of Fms inhibitors that are being developed for multiple indications, and yet another first-in-class compound from Plexxikon," said K. Peter Hirth, CEO of Plexxikon. "By targeting key drivers of the inflammatory process, we are hopeful that PLX5622 may provide relief to patients with rheumatoid arthritis and other autoimmune disorders, with the convenience of a pill."
PLX5622 is expected to provide therapeutic benefit by modulating macrophage proliferation, inhibiting production of pro-inflammatory cytokines, and preventing the formation of osteoclasts. Osteoclasts' bone resorptive activity is responsible for excessive bone destruction in several diseases.
In preclinical models of arthritis, PLX5622 demonstrated substantial disease suppression, including in advanced models of collagen-induced arthritis. PLX5622 significantly improved grip strength and clinical scores, as well as improved knee joint range-of-motion scores.
Plexxikon is completing a Phase 1 trial with PLX3397, another Plexxikon Fms inhibitor that selectively targets Fms, Kit and the Flt-3-ITD mutation. This study has provided validation of Fms-specific biomarkers, which will be directly applicable to the development of PLX5622 in defining a dose response. The company plans to initiate several proof-of-concept clinical trials with PLX3397, including in Hodgkin lymphoma, glioblastoma, acute myelogenous leukemia (AML) and metastatic breast cancer in 2011.
About Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, and swelling primarily in the joints, and affects more than 1.3 million Americans.
RA occurs when the body's immune system malfunctions and attacks healthy tissue. This malfunction causes inflammation which leads to pain, swelling in the joints and may eventually cause permanent joint damage, bone erosion and deformation, and painful disability.
Source:
Plexxikon
The initial Phase 1 trial is a single-ascending dose study in 32 healthy volunteers. The second trial is a multiple-ascending dose study in 32 RA patients that will begin once the first cohort of healthy volunteers has been cleared for safety, with continued enrollment in a staggered fashion relative to the single-ascending dose study.
"PLX5622 is an important and differentiated candidate among Plexxikon's portfolio of Fms inhibitors that are being developed for multiple indications, and yet another first-in-class compound from Plexxikon," said K. Peter Hirth, CEO of Plexxikon. "By targeting key drivers of the inflammatory process, we are hopeful that PLX5622 may provide relief to patients with rheumatoid arthritis and other autoimmune disorders, with the convenience of a pill."
PLX5622 is expected to provide therapeutic benefit by modulating macrophage proliferation, inhibiting production of pro-inflammatory cytokines, and preventing the formation of osteoclasts. Osteoclasts' bone resorptive activity is responsible for excessive bone destruction in several diseases.
In preclinical models of arthritis, PLX5622 demonstrated substantial disease suppression, including in advanced models of collagen-induced arthritis. PLX5622 significantly improved grip strength and clinical scores, as well as improved knee joint range-of-motion scores.
Plexxikon is completing a Phase 1 trial with PLX3397, another Plexxikon Fms inhibitor that selectively targets Fms, Kit and the Flt-3-ITD mutation. This study has provided validation of Fms-specific biomarkers, which will be directly applicable to the development of PLX5622 in defining a dose response. The company plans to initiate several proof-of-concept clinical trials with PLX3397, including in Hodgkin lymphoma, glioblastoma, acute myelogenous leukemia (AML) and metastatic breast cancer in 2011.
About Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, and swelling primarily in the joints, and affects more than 1.3 million Americans.
RA occurs when the body's immune system malfunctions and attacks healthy tissue. This malfunction causes inflammation which leads to pain, swelling in the joints and may eventually cause permanent joint damage, bone erosion and deformation, and painful disability.
Source:
Plexxikon
понедельник, 12 сентября 2011 г.
Hit Back At Pain, Says Arthritis Care, England
A shocking 90% of calls to Arthritis Care's helpline in the last 12 months have been cries for help over pain - so this year, the charity is marking its awareness week by urging doctors, nurses and allied health professionals to support people with arthritis in making a special challenge to pain and the constraints it imposes on their lives.
Pain is the chief reason people give for visiting their GP - and arthritis and musculoskeletal disorders are the commonest cause of that pain. That's why the charity has chosen 'Take control of pain' as the theme for this year's Arthritis Care Awareness Week, and is also calling for more investment in vital pain management services across the country.
Arthritis Care's chief executive Neil Betteridge said: "Most people with chronic pain have some form of arthritis, and when you are stuck with debilitating pain year in, year out, you may be unaware of new developments in treatment - some available on prescription, but many that don't require a doctor's signature. We want to remind people that something can always be done, and that if you can take control of your pain, you really can reclaim great tracts of your life.
Our message during this year's Arthritis Care Awareness Week is simple: nobody with arthritis should be struggling alone with pain. We want people to take a fresh look at how they are managing it. There's plenty of support out there. For example, people with arthritis can ask their pharmacist about any new drugs or products on the market, request a medication review, keep a pain diary, and speak to their GP about referral to a pain specialist, to physiotherapy, hydrotherapy, or to an ergonomist, or occupational therapist."
Arthritis Care believes that if pain were regarded as the 'fifth vital sign', it would be managed more holistically and effectively. Chronic pain has a major impact on people's lives, causing sleeplessness and depression and interfering with everyday activities. It can destroy physical mobility and mental concentration, and undermine all aspects of social, family and work life. People with chronic pain are seven times more likely to quit their jobs due to ill health than the general population. Overall, 25% of people with chronic pain eventually lose their jobs4.
"Drugs and surgery have an obvious place in pain management but GPs and nurses can also think about 'information prescriptions' - perhaps pointing people with arthritis to services like Arthritis Care's website, with its free, downloadable resources on living with arthritis, and its free-to-enter peer-support forums. They can also direct patients to the free professionally-staffed Helplines, or prescribe one of the free-to-user Arthritis Care courses like 'Challenging Pain' where patients learn pain-cheating techniques and develop a step-by-step plan to take control of their condition,"said Neil Betteridge.
65-year-old Muriel Weisz from Nottingham, was diagnosed with rheumatoid arthritis two years ago - a month before retiring from her work as a social care manager. Muriel, who recently formed a self help group for people with arthritis, said: "I'm in some level of pain everyday and where it is in my body changes often. One of the worst things is waking up not knowing which part of you is going to hurt most that day - at the moment it's my feet and wrists. For example, there's sometimes a pain that's so paralyzing - I go to swing my legs out of bed in the morning and the pain is so intense that I have to stop and prepare myself for making any smaller movement to test out what going to be possible.
"Walking outside the house is just too painful. Sometimes I use a wheelchair to help me get around, but I'm just not very mobile - it's so strange to think that 6 months before I was diagnosed, I'd walked the Cumbrian Way!
"It's taking a lot to get used to not being able to do the things that I used to, but learning about my condition and how to deal with the pain means that I have some kind of control and that's crucial. I keep a pain diary so that when I see my doctor I can tell him exactly how many days of the month I've been in severe pain or too tired to get out of bed. I've also just started on a trial for a new medication and it's working wonders for me - the pain and inflammation has reduced considerably and my friends keep telling me how much better and less tired I look.
"When I was first diagnosed, reading Arthritis Care's magazine, which had information about rheumatoid arthritis, appropriate treatments and also the experiences of other people with arthritis, was incredibly helpful.
"My advice to anyone out there struggling with arthritis is : don't try to pretend to the outside world that the pain isn't there - make sure you're honest with your family and friends about the support you need. Have the confidence to say how you're experiencing the pain to your GP, so they know exactly what's going on. There might be a solution out there that could really help you, but you won't know if you stay silent."
Neil Betteridge added: "As well as encouraging people with arthritis to take control of their own pain we also call on all national governments in the UK to improve the services available to people with arthritis. In his recent report, Sir Liam Donaldson the Chief Medical Officer for England, concludedthat a major initiative to widen access to high-quality pain services was needed to improve the lives of millions of people in the UK3. We know that there are people with arthritis who struggle for years in pain before they get any kind of specialist support. Arthritis Care believes that pain services in the UK are under-funded and urgently in need of investment. We want to see GPs more committed to assessing and monitoring people's pain, a better network of specialist pain clinics, and more accessible services like physiotherapy and hydrotherapy to help people to reduce their pain levels."
Arthritis Care will mark the week by extending its Helplines service, offering a free 'Pain Pack', and running its free-to-user 'Challenging Pain' courses in venues around the UK. To order a free 'Pain Pack' or for information about arthritis go to arthritiscare.uk or call Arthritis Care's Helpline on 0808 800 4050.
Take control of arthritis pain - Ten Arthritis Care Tips
1. Lighten Up: Shed excess pounds to reduce stress on weight-bearing joints, like back, hips, and knees.
2. Be a Poser: Use good posture to protect your back and the joints of your legs and feet. Alter position often, take a break from the desk, and sit down to do some tasks instead of bending awkwardly.
3. Don't suffer in silence: Your GP needs to know that you are in pain, and what kind in order to find you an effective treatment or refer you to a pain management specialist.
4. Mix it up: Different pain can be eased by different drugs and treatments. Discuss with your doctor and pharmacist the best combination for your condition.
5. The Ex Factor: Exercise releases the body's own natural 'morphine' in the form of endorphins so appropriate exercise really can make you feel better.
6. Chuck out the chintz! Have a look at your furniture and decide if your bed and chairs are helping your pain or making it worse.
7. Listen to pain: Don't force already damaged, painful, or stiff joints into an activity that puts strain on them. But remember joints are supposed to move, so do not be afraid of persevering with gentle exercise recommended by your clinician.
8. Have an Exit Strategy: Plan how to leave before you arrive if you can't stand or walk for long. Plot your ways of lifting, carrying, pulling, pushing, or carrying objects before starting the action.
9. Big it up: Make your strongest joints and muscles work harder to cut stress on smaller joints - e.g. use a backpack instead of a briefcase or handbag, sparing fingers and wrist. Lift heavy objects in your arms instead of with your hands
10. Doctor Gadget: Look in Arthritis News and catalogues for self-help products - designed to make everyday tasks easier. Occupational therapists, physiotherapists, ergonomists and doctors can suggest helpful work or home devices.
Notes
1. Arthritis Care exists to support people with arthritis. We are the UK's largest organisation working with and for all people who have arthritis. We are a user led organisation which means people with arthritis are at the heart of our work - they form our membership, are involved in all of our activities and direct what we do.
2. Arthritis is the biggest single cause of physical disability in the United Kingdom, affecting people of all ages, including 12,000 children .Arthritis means inflammation of the joints. Most people with arthritis will experience pain and difficulty moving around. Over nine million people in the UK have arthritis. There are over 200 kinds of rheumatic diseases - the word rheumatic means aches and pains in joints, bones and muscles. Two of the most common forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA).
Arthritis is not just a disease of older people - it can affect people of all ages, including babies and children. It is not clear what causes arthritis and there is no cure at present. However, there is plenty you can do to manage your condition and lead a full and active life.
3. The Chief Medical Officer's Annual Report 2008
4. The Chief Medical Officer's Annual Report 2008
- 7.8 million people live with chronic pain
- ??3.8 billion cost of adolescent pain
- ??584 million spent on prescriptions for pain
- 49% of people with chronic pain experience depression
- 25% of people with chronic pain lose their jobs
- 16% of people feel their chronic pain is so bad that they sometimes want to die
Source
Arthritis Care
Pain is the chief reason people give for visiting their GP - and arthritis and musculoskeletal disorders are the commonest cause of that pain. That's why the charity has chosen 'Take control of pain' as the theme for this year's Arthritis Care Awareness Week, and is also calling for more investment in vital pain management services across the country.
Arthritis Care's chief executive Neil Betteridge said: "Most people with chronic pain have some form of arthritis, and when you are stuck with debilitating pain year in, year out, you may be unaware of new developments in treatment - some available on prescription, but many that don't require a doctor's signature. We want to remind people that something can always be done, and that if you can take control of your pain, you really can reclaim great tracts of your life.
Our message during this year's Arthritis Care Awareness Week is simple: nobody with arthritis should be struggling alone with pain. We want people to take a fresh look at how they are managing it. There's plenty of support out there. For example, people with arthritis can ask their pharmacist about any new drugs or products on the market, request a medication review, keep a pain diary, and speak to their GP about referral to a pain specialist, to physiotherapy, hydrotherapy, or to an ergonomist, or occupational therapist."
Arthritis Care believes that if pain were regarded as the 'fifth vital sign', it would be managed more holistically and effectively. Chronic pain has a major impact on people's lives, causing sleeplessness and depression and interfering with everyday activities. It can destroy physical mobility and mental concentration, and undermine all aspects of social, family and work life. People with chronic pain are seven times more likely to quit their jobs due to ill health than the general population. Overall, 25% of people with chronic pain eventually lose their jobs4.
"Drugs and surgery have an obvious place in pain management but GPs and nurses can also think about 'information prescriptions' - perhaps pointing people with arthritis to services like Arthritis Care's website, with its free, downloadable resources on living with arthritis, and its free-to-enter peer-support forums. They can also direct patients to the free professionally-staffed Helplines, or prescribe one of the free-to-user Arthritis Care courses like 'Challenging Pain' where patients learn pain-cheating techniques and develop a step-by-step plan to take control of their condition,"said Neil Betteridge.
65-year-old Muriel Weisz from Nottingham, was diagnosed with rheumatoid arthritis two years ago - a month before retiring from her work as a social care manager. Muriel, who recently formed a self help group for people with arthritis, said: "I'm in some level of pain everyday and where it is in my body changes often. One of the worst things is waking up not knowing which part of you is going to hurt most that day - at the moment it's my feet and wrists. For example, there's sometimes a pain that's so paralyzing - I go to swing my legs out of bed in the morning and the pain is so intense that I have to stop and prepare myself for making any smaller movement to test out what going to be possible.
"Walking outside the house is just too painful. Sometimes I use a wheelchair to help me get around, but I'm just not very mobile - it's so strange to think that 6 months before I was diagnosed, I'd walked the Cumbrian Way!
"It's taking a lot to get used to not being able to do the things that I used to, but learning about my condition and how to deal with the pain means that I have some kind of control and that's crucial. I keep a pain diary so that when I see my doctor I can tell him exactly how many days of the month I've been in severe pain or too tired to get out of bed. I've also just started on a trial for a new medication and it's working wonders for me - the pain and inflammation has reduced considerably and my friends keep telling me how much better and less tired I look.
"When I was first diagnosed, reading Arthritis Care's magazine, which had information about rheumatoid arthritis, appropriate treatments and also the experiences of other people with arthritis, was incredibly helpful.
"My advice to anyone out there struggling with arthritis is : don't try to pretend to the outside world that the pain isn't there - make sure you're honest with your family and friends about the support you need. Have the confidence to say how you're experiencing the pain to your GP, so they know exactly what's going on. There might be a solution out there that could really help you, but you won't know if you stay silent."
Neil Betteridge added: "As well as encouraging people with arthritis to take control of their own pain we also call on all national governments in the UK to improve the services available to people with arthritis. In his recent report, Sir Liam Donaldson the Chief Medical Officer for England, concludedthat a major initiative to widen access to high-quality pain services was needed to improve the lives of millions of people in the UK3. We know that there are people with arthritis who struggle for years in pain before they get any kind of specialist support. Arthritis Care believes that pain services in the UK are under-funded and urgently in need of investment. We want to see GPs more committed to assessing and monitoring people's pain, a better network of specialist pain clinics, and more accessible services like physiotherapy and hydrotherapy to help people to reduce their pain levels."
Arthritis Care will mark the week by extending its Helplines service, offering a free 'Pain Pack', and running its free-to-user 'Challenging Pain' courses in venues around the UK. To order a free 'Pain Pack' or for information about arthritis go to arthritiscare.uk or call Arthritis Care's Helpline on 0808 800 4050.
Take control of arthritis pain - Ten Arthritis Care Tips
1. Lighten Up: Shed excess pounds to reduce stress on weight-bearing joints, like back, hips, and knees.
2. Be a Poser: Use good posture to protect your back and the joints of your legs and feet. Alter position often, take a break from the desk, and sit down to do some tasks instead of bending awkwardly.
3. Don't suffer in silence: Your GP needs to know that you are in pain, and what kind in order to find you an effective treatment or refer you to a pain management specialist.
4. Mix it up: Different pain can be eased by different drugs and treatments. Discuss with your doctor and pharmacist the best combination for your condition.
5. The Ex Factor: Exercise releases the body's own natural 'morphine' in the form of endorphins so appropriate exercise really can make you feel better.
6. Chuck out the chintz! Have a look at your furniture and decide if your bed and chairs are helping your pain or making it worse.
7. Listen to pain: Don't force already damaged, painful, or stiff joints into an activity that puts strain on them. But remember joints are supposed to move, so do not be afraid of persevering with gentle exercise recommended by your clinician.
8. Have an Exit Strategy: Plan how to leave before you arrive if you can't stand or walk for long. Plot your ways of lifting, carrying, pulling, pushing, or carrying objects before starting the action.
9. Big it up: Make your strongest joints and muscles work harder to cut stress on smaller joints - e.g. use a backpack instead of a briefcase or handbag, sparing fingers and wrist. Lift heavy objects in your arms instead of with your hands
10. Doctor Gadget: Look in Arthritis News and catalogues for self-help products - designed to make everyday tasks easier. Occupational therapists, physiotherapists, ergonomists and doctors can suggest helpful work or home devices.
Notes
1. Arthritis Care exists to support people with arthritis. We are the UK's largest organisation working with and for all people who have arthritis. We are a user led organisation which means people with arthritis are at the heart of our work - they form our membership, are involved in all of our activities and direct what we do.
2. Arthritis is the biggest single cause of physical disability in the United Kingdom, affecting people of all ages, including 12,000 children .Arthritis means inflammation of the joints. Most people with arthritis will experience pain and difficulty moving around. Over nine million people in the UK have arthritis. There are over 200 kinds of rheumatic diseases - the word rheumatic means aches and pains in joints, bones and muscles. Two of the most common forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA).
Arthritis is not just a disease of older people - it can affect people of all ages, including babies and children. It is not clear what causes arthritis and there is no cure at present. However, there is plenty you can do to manage your condition and lead a full and active life.
3. The Chief Medical Officer's Annual Report 2008
4. The Chief Medical Officer's Annual Report 2008
- 7.8 million people live with chronic pain
- ??3.8 billion cost of adolescent pain
- ??584 million spent on prescriptions for pain
- 49% of people with chronic pain experience depression
- 25% of people with chronic pain lose their jobs
- 16% of people feel their chronic pain is so bad that they sometimes want to die
Source
Arthritis Care
пятница, 9 сентября 2011 г.
Osteoarthritis Initiative Releases First Data
The Osteoarthritis Initiative (OAI), a public-private partnership between the National Institutes of Health (NIH) and private industry that seeks to improve diagnosis and monitoring of osteoarthritis (OA) and foster development of new treatments, has released its first set of data.
Making this information available to researchers worldwide will expedite the pace of scientific studies and identification of biological and structural markers (biomarkers) for OA. Researchers can analyze the data to form new hypotheses for further study of OA, which is the major cause of activity limitation and disability in older people. Images, including x rays and magnetic resonance imaging scans, will also be available to researchers upon request. All data are stored with an anonymous identification number to protect the confidentiality of the participants' information.
"Since its inception, the OAI has been a premier example of how industry, government, and academic sectors might work together to add value to biomedical research," says NIH Director Elias A. Zerhouni, M.D. "This first data release is proof positive that with cooperation, we can achieve results that neither the government nor its private partners is able to reach alone."
Over the next five years, the OAI will provide an unparalleled, state-of-the-art longitudinal database of images and clinical outcome information to facilitate the discovery of biomarkers for development and progression of OA. In this case, a biomarker would be a physical sign or biological substance that indicates changes in bone or cartilage.
Nearly 5,000 people at risk of developing knee OA, in the early stage of the disease or with more advanced knee OA are participating in the OAI at four centers around the United States. Participants in the research study provide biological specimens (blood, urine, and DNA); images (X rays and magnetic resonance scans); and clinical data such as dietary intake, medication use and pain, function, and general health assessments.
Data gathered from participants are available to researchers at oai.ucsf/. The data include symptoms; pain severity; a measure of pain, stiffness, and function known as the WOMAC OA index; walking ability; endurance; balance and strength; nutrition; and prescription medicines and alternative therapies used by the participants.
A second set of data will be released later in 2006, and a third release will take place early in 2007. Subsequent data will be released at approximately six -- month intervals.
The four centers taking part in the study and their principal investigators include:
* The University of Maryland School of Medicine, Baltimore; Marc Hochberg, M.D., M.P.H., in conjunction with Johns Hopkins Bayview Medical Center; Joan Bathon, M.D.
* The Ohio State University, Columbus; Rebecca Jackson, M.D.
* The University of Pittsburgh; C. Kent Kwoh, M.D.
* Memorial Hospital of Rhode Island , Pawtucket; Charles Eaton, M.D.
The study is coordinated and the data from the study and the Web site are managed by the University of California, San Francisco. The principal investigator for the Data Coordinating Center is Michael Nevitt, Ph.D.
Today, 35 million people -- 13 percent of the U.S. population -- are 65 and older, and more than half of them have radiological evidence of osteoarthritis in at least one joint. By 2030, an estimated 20 percent of Americans -- about 70 million people -- will have passed their 65th birthday and will be at increased risk for OA.
The OAI is a public-private partnership comprised of five contracts funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA), Office of Research on Women's Health (ORWH), National Institute of Dental and Craniofacial Research (NIDCR), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Center on Minority Health and Health Disparities (NCMHD) and National Center for Complementary and Alternative Medicine (NCCAM), all part of the Department of Health and Human Services' National Institutes of Health.Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. Private-sector funding for the OAI is managed by the Foundation for the National Institutes of Health.
The mission of the NIAMS is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at niams.nih/. Information on bone and its disorders can be obtained from the NIH Osteoporosis and Related Bone Diseases - National Resource Center; Phone (toll free) 800-624-BONE (2663) or visit osteo/.
The NIA leads the Federal Government effort conducting and supporting research on the biomedical and social and behavioral aspects of aging and the problems of older people. For more information on aging and aging-related research, please visit the NIA Web site at nia.nih/. The public may also call for publications at 1-800-222-2225, the toll-free number for the National Institute on Aging Information Center.
The Foundation for the National Institutes of Health was established by the United States Congress to support the mission of the National Institutes of Health -- improving health through scientific discovery. The foundation identifies and develops opportunities for innovative public-private partnerships involving industry, academia and the philanthropic community. A nonprofit, 501(c)(3) corporation, the Foundation raises private-sector funds for a broad portfolio of unique programs that complement and enhance NIH priorities and activities. The foundation's Web site address is fnih/.
The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih/.
Contact: Ray Fleming
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
Making this information available to researchers worldwide will expedite the pace of scientific studies and identification of biological and structural markers (biomarkers) for OA. Researchers can analyze the data to form new hypotheses for further study of OA, which is the major cause of activity limitation and disability in older people. Images, including x rays and magnetic resonance imaging scans, will also be available to researchers upon request. All data are stored with an anonymous identification number to protect the confidentiality of the participants' information.
"Since its inception, the OAI has been a premier example of how industry, government, and academic sectors might work together to add value to biomedical research," says NIH Director Elias A. Zerhouni, M.D. "This first data release is proof positive that with cooperation, we can achieve results that neither the government nor its private partners is able to reach alone."
Over the next five years, the OAI will provide an unparalleled, state-of-the-art longitudinal database of images and clinical outcome information to facilitate the discovery of biomarkers for development and progression of OA. In this case, a biomarker would be a physical sign or biological substance that indicates changes in bone or cartilage.
Nearly 5,000 people at risk of developing knee OA, in the early stage of the disease or with more advanced knee OA are participating in the OAI at four centers around the United States. Participants in the research study provide biological specimens (blood, urine, and DNA); images (X rays and magnetic resonance scans); and clinical data such as dietary intake, medication use and pain, function, and general health assessments.
Data gathered from participants are available to researchers at oai.ucsf/. The data include symptoms; pain severity; a measure of pain, stiffness, and function known as the WOMAC OA index; walking ability; endurance; balance and strength; nutrition; and prescription medicines and alternative therapies used by the participants.
A second set of data will be released later in 2006, and a third release will take place early in 2007. Subsequent data will be released at approximately six -- month intervals.
The four centers taking part in the study and their principal investigators include:
* The University of Maryland School of Medicine, Baltimore; Marc Hochberg, M.D., M.P.H., in conjunction with Johns Hopkins Bayview Medical Center; Joan Bathon, M.D.
* The Ohio State University, Columbus; Rebecca Jackson, M.D.
* The University of Pittsburgh; C. Kent Kwoh, M.D.
* Memorial Hospital of Rhode Island , Pawtucket; Charles Eaton, M.D.
The study is coordinated and the data from the study and the Web site are managed by the University of California, San Francisco. The principal investigator for the Data Coordinating Center is Michael Nevitt, Ph.D.
Today, 35 million people -- 13 percent of the U.S. population -- are 65 and older, and more than half of them have radiological evidence of osteoarthritis in at least one joint. By 2030, an estimated 20 percent of Americans -- about 70 million people -- will have passed their 65th birthday and will be at increased risk for OA.
The OAI is a public-private partnership comprised of five contracts funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA), Office of Research on Women's Health (ORWH), National Institute of Dental and Craniofacial Research (NIDCR), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Center on Minority Health and Health Disparities (NCMHD) and National Center for Complementary and Alternative Medicine (NCCAM), all part of the Department of Health and Human Services' National Institutes of Health.Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. Private-sector funding for the OAI is managed by the Foundation for the National Institutes of Health.
The mission of the NIAMS is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at niams.nih/. Information on bone and its disorders can be obtained from the NIH Osteoporosis and Related Bone Diseases - National Resource Center; Phone (toll free) 800-624-BONE (2663) or visit osteo/.
The NIA leads the Federal Government effort conducting and supporting research on the biomedical and social and behavioral aspects of aging and the problems of older people. For more information on aging and aging-related research, please visit the NIA Web site at nia.nih/. The public may also call for publications at 1-800-222-2225, the toll-free number for the National Institute on Aging Information Center.
The Foundation for the National Institutes of Health was established by the United States Congress to support the mission of the National Institutes of Health -- improving health through scientific discovery. The foundation identifies and develops opportunities for innovative public-private partnerships involving industry, academia and the philanthropic community. A nonprofit, 501(c)(3) corporation, the Foundation raises private-sector funds for a broad portfolio of unique programs that complement and enhance NIH priorities and activities. The foundation's Web site address is fnih/.
The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih/.
Contact: Ray Fleming
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
вторник, 6 сентября 2011 г.
A shallow hip socket predicts osteoarthritis of the hip
Long-term study suggests moderate acetabular dysplasia, a developmental condition of hip instability, as an independent
risk factor for the disease -
Osteoarthritis (OA) of the hip is one of the leading causes of disability among elderly men and women. This progressive joint
disease involves multiple factors, including genes, age, gender, hormones, as well as body mass index, mechanical stress. In
addition, a developmental condition known as acetabular dysplasia can contribute to disease risk. Often present at birth,
acetabular dysplasia is marked by a shallow hip socket, making the hip unstable and, in extreme cases, prone to dislocation.
Severe acetabular dysplasia has been linked to premature hip OA. The influence of moderate acetabular dysplasia on the
development of hip OA is less clear.
To assess the role of moderate acetabular dysplasia in the onset of hip OA, a research team in the Netherlands conducted a
long-term study on 835 women and men ages 55 years and older. Their results, published in the March 2005 issue of Arthritis &
Rheumatism (interscience.wiley/journal/arthritis), indicate acetabular dysplasia, even when assessed at a mild
degree, as a strong independent risk factor for OA of the hip, even in an elderly population.
Led by Dr. M Reijman and supported by the Dutch Arthritis Association, the research team drew its subjects from The Rotterdam
Study, a comprehensive investigation of the incidence of, and risk factors for, chronic disabling diseases. At baseline, the
participants had no signs of radiographic OA of the hip. Women comprised 57 percent of the sample, whose mean age was 65
years. At baseline, all participants underwent radiographs in order to detect the presence and assess the depth and degree,
using the center-edge angle, of acetabular dysplasia. Participants were also evaluated for current BMI and history of heavy,
physically demanding work.
Over a follow-up period averaging six years, participants were examined, through radiographs, for definite signs -
osteophytes and joint space narrowing - of hip OA. Calculating odds ratios, subjects with acetabular dysplasia, from moderate
to mild, had a 4.3 times increased risk for radiographic OA of the hip. Among subjects with acetabular dysplasia, the
incidence and severity of hip OA was greater among women, as well as associated with a high-stress mechanical workload and a
low BMI.
Based on this study's findings, Dr. Reijman concludes that acetabular dysplasia, at any measurable depth or degree, is a
strong, independent indicator for the development of OA of the hip. "Furthermore," he notes, "the associations between
acetabular dysplasia and incident radiographic OA of the hip may even be underestimated because of the relatively high mean
age of the study population. In other words, we assume that in a younger population the association between acetabular
dysplasia and OA may be even higher."
Article: "Acetabular Dysplasia Predicts Incident Osteoarthritis of the Hip: The Rotterdam Study," M. Reijman, J.M.W. Hazes,
H.A.P. Pols, B.W. Koes, and S.M.A. Bierma-Zeinstra, Arthritis & Rheumatism, March 2005; 52:3; pp. 787-793.
John Wiley & Sons, Inc.
interscience.wiley
risk factor for the disease -
Osteoarthritis (OA) of the hip is one of the leading causes of disability among elderly men and women. This progressive joint
disease involves multiple factors, including genes, age, gender, hormones, as well as body mass index, mechanical stress. In
addition, a developmental condition known as acetabular dysplasia can contribute to disease risk. Often present at birth,
acetabular dysplasia is marked by a shallow hip socket, making the hip unstable and, in extreme cases, prone to dislocation.
Severe acetabular dysplasia has been linked to premature hip OA. The influence of moderate acetabular dysplasia on the
development of hip OA is less clear.
To assess the role of moderate acetabular dysplasia in the onset of hip OA, a research team in the Netherlands conducted a
long-term study on 835 women and men ages 55 years and older. Their results, published in the March 2005 issue of Arthritis &
Rheumatism (interscience.wiley/journal/arthritis), indicate acetabular dysplasia, even when assessed at a mild
degree, as a strong independent risk factor for OA of the hip, even in an elderly population.
Led by Dr. M Reijman and supported by the Dutch Arthritis Association, the research team drew its subjects from The Rotterdam
Study, a comprehensive investigation of the incidence of, and risk factors for, chronic disabling diseases. At baseline, the
participants had no signs of radiographic OA of the hip. Women comprised 57 percent of the sample, whose mean age was 65
years. At baseline, all participants underwent radiographs in order to detect the presence and assess the depth and degree,
using the center-edge angle, of acetabular dysplasia. Participants were also evaluated for current BMI and history of heavy,
physically demanding work.
Over a follow-up period averaging six years, participants were examined, through radiographs, for definite signs -
osteophytes and joint space narrowing - of hip OA. Calculating odds ratios, subjects with acetabular dysplasia, from moderate
to mild, had a 4.3 times increased risk for radiographic OA of the hip. Among subjects with acetabular dysplasia, the
incidence and severity of hip OA was greater among women, as well as associated with a high-stress mechanical workload and a
low BMI.
Based on this study's findings, Dr. Reijman concludes that acetabular dysplasia, at any measurable depth or degree, is a
strong, independent indicator for the development of OA of the hip. "Furthermore," he notes, "the associations between
acetabular dysplasia and incident radiographic OA of the hip may even be underestimated because of the relatively high mean
age of the study population. In other words, we assume that in a younger population the association between acetabular
dysplasia and OA may be even higher."
Article: "Acetabular Dysplasia Predicts Incident Osteoarthritis of the Hip: The Rotterdam Study," M. Reijman, J.M.W. Hazes,
H.A.P. Pols, B.W. Koes, and S.M.A. Bierma-Zeinstra, Arthritis & Rheumatism, March 2005; 52:3; pp. 787-793.
John Wiley & Sons, Inc.
interscience.wiley
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