News February 2008 Issue

In The News: 02/08

Overweight? It Could Prevent RA Remission

If you suffer from rheumatoid arthritis (RA), those extra pounds could prevent you from going into remission. In a study presented

during a meeting of the American College of Rheumatology in November, 100 RA patients were given combination therapy consisting of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone combined with either infliximab or a placebo. After 12 months, 58 percent of the normal-weight participants taking combination therapy and placebo were in remission, compared to 35 percent of those who were considered overweight. Excess weight, however, had little to do with the patientsí ability to achieve remission when taking combination therapy and infliximab. "Obesity induces resistance to conventional antirheumatic drugs," the studyís authors said. "Infliximab overcomes this resistance, probably due to its direct effect on inflammatory mediators."

Wrinkle-Eraser Soothes Shoulder Pain

Botulinum toxin type A (BoNT/A), the active ingredient in Botox, may reduce pain in arthritic joints as well as smooth an aging face. According to a trial involving 38 patients with shoulder osteoarthritis (OA) presented at a November meeting of the

American College of Rheumatology, a single injection of BoNT/A into the shoulder was found to reduce pain by at least 30 percent for at least 28 days. The studyís authors also claimed that relief lasting up to six months had been observed in a study of similar injections for knee and ankle OA pain. Further study of these and other arthritis applications, said the authors, is still needed.

Bad News and Good News for Sufferers of Fibromyalgia

People who suffer from fibromyalgia, a condition characterized by widespread chronic pain, often report that they donít respond to medications that relieve other peopleís pain. According to a report

in the September issue of The Journal of Neuroscience, fibromyalgia patients were found to have reduced binding ability of a type of brain receptor that is the target of opioid painkillers such as morphine. Put simply, when painkillers canít bind to the brainís receptors, they canít alleviate pain. The good news: the U.S. Food and Drug Administration (FDA) recently approved pregabalin (Lyrica) as a first-line treatment for fibromyalgia. Approved in 2004 for the treatment of anxiety disorders, pregabalin has also been shown to be effective in treating the symptoms of fibromyalgia. Until now, physicians had been reluctant to prescribe the drug "off label" and some insurance companies did not cover its costs. That has now changed.

Teriparatide Bests Alendronate as Osteoporosis Bone-Builder

The osteoporosis drug teriparatide (Forteo) is more effective than alendronate (Fosamax) in strengthening bones in patients with glucocorticoid-induced osteoporosis. In a head-to-head comparison of the two drugs reported in the Nov. 15 issue of The New England Journal of Medicine, teriparatide more than doubled bone density

and significantly reduced the risk of new spinal fractures in patients when compared to those taking alendronate. Glucocorticoids such as prednisone are commonly used by arthritis patients to help reduce inflammation, but these drugs increase the risk of bone loss. For the study, 428 patients received a once-daily teriparatide injection or a once-daily alendronate pill; results were monitored over 18 months. Teriparatide increased lumbar spine density by 7.2 percent vs. 3.4 percent for alendronate, and it increased hip density by 3.8 percent compared to 2.4 percent for alendronate.

Low Vitamin D May Cause Knee OA Pain and Walking Difficulty

Patients with knee osteoarthritis who have low levels of vitamin D are more likely to have greater pain and are three times more likely to experience walking difficulty than are patients with higher levels of vitamin D, according to the results of a two-year study

that involved 65 women and 35 men with OA in their 60s. Recognizing that vitamin D deficiency is common among older adults, the studyís authors recommended that older patients get their vitamin D levels checked and take supplements if levels are low. The study was presented at the November 2007 meeting of the American College of Rheumatology.