News July 2012 Issue

In The News: July 2012

Obesity Epidemic Sparks Rise in RA Among Women

With obesity and rheumatoid arthritis (RA) becoming more common, the question is, could one have something to do with the other? For women, say researchers at Mayo Clinic, it appears there is a link. The medical records of 813 adults with RA and 813 adults in a control group were examined over the period 1980-2007. Roughly 30 percent of the subjects in each group were obese and 68 percent were women. RA cases rose by 9.2 percent from 1985 to 2007, the study found, and obesity accounted for 52 percent of the increase. Although the exact nature of the link between obseity and autoimmune diseases such as RA is not clear, the study’s authors concluded, “We know that fat tissues and cells produce substances that are active in inflammation and immunity. We know, too, that obesity is related to many other health problems. It adds another reason to reduce and prevent obesity in the general population.”

Sleep Better, Ease Pain by Dwelling Less on What Ails You

If you suffer from chronic pain, you may sleep better and experience less day-to-day pain if you obsess less about your ailment. Researchers at Johns Hopkins University School of Medicine studied 214 people with chronic pain and found a major neurological pathway linking negative thinking about pain to increased pain and disturbed sleep. Roughly 80 percent of people with chronic pain experience sleep disturbances, researchers found, and previous studies have shown that people whose sleep patterns are altered are more sensitive to pain. It is also known, said the study’s authors, that people who focus frequently on their pain report more debilitating pain. Such “pain catastrophizing,” they claim, has been found to be a more robust predictor of pain and pain-related disability than depression, anxiety, or neuroticism. Sleeping pills and painkillers can help, the study concluded, but patients in pain may benefit as much, if not more, from cognitive behavioral therapy.

Steroids More Effective Than Etanercept for Back Pain

Despite the promise that injecting the pain medication etanercept (Enbrel) into the spine could relieve the leg and lower back pain of sciatica, researchers at Johns Hopkins School of Medicine have found that steroid injections, the current standard of care, work better. Etanercept is used to treat disorders in which the immune system attacks healthy tissue. The drug blocks tumor necrosis factor (TNF), a substance that causes inflammation. In the Johns Hopkins study, epidural injections of 60 milligrams of a steroid, 4 milligrams of etanercept, or 2 milliliters of saline were given to 84 patients with sciatica. The study found that more patients treated with steroids (75 percent) reported 50 percent or greater leg pain relief and felt better overall after one month compared to those who received saline (50 percent) or etanercept (42 percent). Those in the steroid group also reported lower levels of disability (21 percent) than those in the saline group (29 percent) or etanercept group (38 percent).

FDA Warns Over Long-Term Use of Bone-Building Drugs

The Food and Drug Administration (FDA) has suggested caution in the long-term use of bisphosphonates (Fosamax, Boniva, Reclast), a class of drugs commonly prescribed for post-menopausal women to prevent the loss of bone mass. The warning was prompted by a growing debate over how long women should continue using the drugs. The concern is that after years of use, the drugs may in rare cases lead to weaker bones in certain women, contributing to rare but serious adverse events, including femur fractures, esophageal cancer, and osteonecrosis (crumbling) of the jaw. The agency’s analysis examined only long-term use and did not address whether a woman should be prescribed a bone-building drug in the first place to reduce fracture risk. Because serious complications are rare, most physicians believe that for women with ostoeporosis and who are at high risk of fractures, the benefits of the drugs far outweigh the risks. The agency also said that women diagnosed with osteopenia—moderate to low bone density that is not low enough to be called osteoporosis—are unlikely to benefit from the long-term use of bisphosphonates and should probably stop taking the drugs after three years.