News December 2003 Issue

In the News: 12/03

RA Patients At Higher Risk For Periodontal Disease
New evidence suggests that individuals with moderate to severe periodontal (gum) disease are at higher risk of rheumatoid arthritis, and vice-versa. Although it’s not known just how closely the two conditions are allied, researchers at the University of Queensland (Australia) School of Dentistry have discovered similarities in factors contributing to both diseases.

Their report, which appeared in the September 2003 Journal of Clinical Periodontology, analyzed the medical histories and dental records of 1,412 patients referred for periodontal treatment. The prevalence of rheumatoid arthritis was found to be 3.95 percent—significantly higher than in the general population (1 percent). Among patients with rheumatoid arthritis, 62.5 percent had an advanced form of periodontal disease.

A follow-up article noted many commonalities between rheumatoid arthritis and periodontic disease, which develop in similar ways, though their causes differ. People with either condition suffer from chronic inflammation. Patients with rheumatoid arthritis not only have a higher prevalence of periodontic disease, explains Dr. Ken Parish, head of the Periodontics Section at The Cleveland Clinic, they also tend to have more bone loss and deeper gum pockets. “The evidence is not yet huge,” he says, “but it’s clearly adequate to suggest an association exists.”

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New Finding, Treatment For Psoriatic Arthritis
A team of scientists at the University of Rochester claims it has found the cause of bone damage in psoriatic arthritis. One of the researchers, Dr. David Hicks, a diagnostic surgical pathologist now with The Cleveland Clinic, calls the human skeleton a “dynamic tissue,” with bone continually being formed and resorbed.

Dr. Hicks and his associates determined that bone loss is due to an increased number of osteoclasts, large cells involved in bone resorption. When osteoclasts reach an inflamed area, they become active and begin destroying bone. Says Dr. Hicks, “We believe psoriatic arthritis patients have a higher level of TNF [Tumor Necrosis Factor, a protein with anti-tumor characteristics]. This leads to a higher number of circulating osteoclasts and acts as a trigger that can cause painful damage to joints and connective tissue.”

Dr. Hicks and his team further found that by treating psoriatic arthritis with the anti-TNF medication Enbrel (etanercept), used as an inflammation-fighter by people with rheumatoid arthritis, the number of potential osteoclasts were reduced, and bone resorption was decreased. Enbrel, which had never before been used for the treatment of psoriatic arthritis, was approved for the condition by the FDA in January 2003.

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Good Vibrations For Better Balance
The use of vibrating shoe insoles could improve balance for elderly people, dramatically reducing falls and consequent bone fractures. Researchers in the biomedical engineering department at Boston University recently set out to determine whether stimulating the sensory nervous system with vibrating insoles could improve posture control. The study, as reported in a recent issue of The Lancet, consisted of 15 young people (average age 23 years) and 12 older people (average age 73).

All participants received low-frequency subsensory (undetectable) mechanical stimulation via their insoles, or no stimulation (the control measure), during a series of 30-second trials in which participants had to stand quietly with their eyes closed. After measuring the degree of sway of each participant, the vibrating insoles were found to improve balance for both groups, but they substantially improved balance among the older participants. Said lead researcher James J. Collins, “Elderly people gain more in motor control performance than do young people with the application of noise to the feet. Devices such as randomly vibrating shoe insoles might be effective in enhancing the performance of dynamic balance activities—such as walking—and could enable older adults to overcome postural instability caused by age-related sensory loss.”