Whitney Palmer

Healthcare. Politics. Family.

RA Survival Rates Outpacing that of General Population

Published on the July 13, 2016, Rheumatology Network website

By Whitney L.J. Howell

Advances in drug development and management strategies for rheumatoid arthritis over the past 15 years have improved survival rates for patients, researchers say.

The study appears in the June 23, 2016,Annuals of the Rheumatic Diseases.

To date, there have been no investigations into whether these improvements have positively impacted the lifespan of patients with rheumatoid arthritis. A few studies exist, researchers said, looking into how treatments impacted mortality up to 2004. However, there are none that look at later dates.

In a population-based cohort study, researchers reviewed how standard rheumatoid arthritis treatments impacted patients with this condition and compared the results to similar patients who did not have rheumatoid arthritis. They were also interested in whether other co-morbidities impacted survival.

Led by Yuqing Zhang, M.D., professor of medicine and epidemiology at Boston University School of Medicine, investigators determined rheumatoid arthritis patients treated after the advent of new drugs and management strategies had a longer survival rate than those treated earlier. The study, which looked at patients treated from 1999 to 2014, also revealed co-morbidities did not significantly impact life span.

Throughout the study, researchers surveyed electronic medical records from The Health Improvement Network in the United Kingdom for 10.2 million patients from 580 general practice clinics. They identified all patients, ages 18 to 89, with rheumatoid arthritis and up to five similar individuals who didn’t have the condition. They, then, divided patients into two cohorts: those treated between 1999 and 2006 (10, 126 rheumatoid arthritis patients and 50,546 non-rheumatoid arthritis patients) and those treated between 2007 and 2014 (10, 769 rheumatoid arthritis patients and 53, 749 non-rheumatoid patients).

According to study results, more patients from the early cohort died – and died younger – than patients from the later cohort. Based on the data, 936 rheumatoid arthritis patients from the early cohort, and 2,968 non-rheumatoid arthritis, died. The average ages were 77 and 78.4, respectively. In the later cohort, 605 rheumatoid arthritis patients, and 2,293 non-arthritis patients, died. The average ages were 77.9 and 78.4 respectively.

In terms of relative risk, rheumatoid arthritis patients in the early cohort had a 56 percent higher risk of all-cause mortality, and the later cohort had a 29 percent higher risk, researchers reported.

Investigators also found disease-modifying anti-rheumatic drug use was greater in the later cohort than the earlier one – 81 percent to 65 percent, respectively. And, of those using these medicines, 85 percent of late cohort and 68 percent of early cohort received methotrexate. Dosing and administration modes for these medications also improved between early to later cohorts.

“While patients with rheumatoid arthritis had higher mortality rates than individuals without rheumatoid arthritis in either the early or the late cohorts, the magnitude of difference in mortality was smaller in the late cohorts compared with that in earlier cohorts,” researchers said.

Investigators found age, sex, body mass index, alcohol consumption, and medication use didn’t impact results. However, rheumatoid arthritis patients were more likely to smoke and did have more co-morbidities.

Recent U.K. studies show a tripling (156 percent) of methotrexate use between 2001 and 2012. There was also an increase in the use of tumor necrosis factor inhibitor. Seen together, these measures are seen to reduce rheumatoid arthritis disease activity and to have led to improved longevity for patients.

Not only does this data indicate that early and effective interventions for rheumatoid arthritis help prevent permanent damage, but it also demonstrates that treat-to-target strategies have been utilized more frequently. When taken together, all the findings point to a reduction in rheumatoid arthritis disease activity and improved life longevity.

Further study is needed, however, because not enough data existed to determine actual cause of death in a large number of cases. Researchers also said future studies would be valuable to assess the extent to which improved survival among rheumatoid arthritis patients is directly attributable to the improvement of rheumatoid arthritis management and disease activity.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/ra-survival-rates-outpacing-general-population

July 19, 2016 Posted by | Healthcare | , | Leave a comment

Methotrexate Associated with “Profound” Improvements in RA

Published on the June 27, 2016, Rheumatology Network website

By Whitney L.J. Howell

Methotrexate therapy in patients with rheumatoid arthritis can cause significant changes in clinical disease activity, researchers say.

The study appears in the June 16 issue of RMD Open.

To date, researchers said, there have been no studies into the mechanism of action of methotrexate which look at serial prospective measures of serum cytokines and simultaneous measures of pharmacokinetics and clinical variables.

In this prospective, open-label, long-term mechanism of action study, investigators looked to describe changes in immune parameters that are observed during long-term methotrexate therapy in patients with active rheumatoid arthritis. They also wanted to explore correlations with simultaneously measured methotrexate pharmacokinetic parameters.

Led by Joel M. Kremer, M.D., from the Division of Rheumatology at Albany Medical College, researchers demonstrated that methotrexate treatment is associated with serum interleukin-6 (IL-6) and interleukin-8 (IL-8) decreases. This three-year study, conducted in the 1990s, also shows these drops correlate well with long-term, sequential measures of methotrexate pharmacokinetics and with clinical outcomes.

Throughout the study, 17 patients received single, weekly 7.5 mg doses of methotrexate. The doses were adjusted for efficacy and toxicity throughout the study, and researchers gathered baseline measures for disease activity and took follow-up measurements every six months for three years. Each clinical evaluation assessed serum cytokine measurements in blood together with lymphocyte surface immunophenotypes and stimulated peripheral blood mononuclear cell cytokine production.

According to study results, cytokine concentrations revealed several significant correlations over time with disease activity measures. The two strongest were: interleukin-6 (r=0.45, p<0.0001 for swollen joints and r=0.32, p=0.002 for tender joints) and interleukin-8 (r=0.25, p=0.01 for swollen joints).

Results also found significant decreases for serum interleukin-1B, interleukin-6, and interleukin-8 from baseline measurements with interleukin-6 being the most substantial change (p<0.001). Data also revealed noteworthy increases from baseline for interleukin-2 release from peripheral blood mononuclear cells ex vivo (p<0.01). However, the change in swollen joint count correlated inversely with the changes for methotrexate (r=-0.63, p=0.007).

“These data strongly support the notion that MTX (methotrexate) mediates profound and functionally relevant effects on the immunological hierarchy in the RA lesion,” the researchers wrote.

Ultimately, investigators said, knowing methotrexate can significantly affect serum interleukin-6 will increase understanding around methotrexate’s mechanism of action. It also offers insight into further changes in transaminase levels and possible additive effects on interleukin-6 when used with biological response modifiers and Janus kinase inhibitors.

“The compelling relationship between the immune changes reported and simultaneous pharmacokinetic measures strongly suggest that the findings are related to methotrexate intervention and are not simply a surrogate for general disease improvement,” investigators said.

In addition, they said, the significant decrease in serum interleukin-6 observed with methotrexate may further explain increases in transaminase enzymes when the drug is combined with either interleukin-6 or Janus kinase inhibitors.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/methotrexate-associated-%E2%80%9Cprofound%E2%80%9D-improvements-ra?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=28062016

June 28, 2016 Posted by | Healthcare | , , , , , , | Leave a comment

High BMI Not a Factor in Axial Spondyloarthritis

Published on the June 22, 2016, Rheumatology Network website

By Whitney L.J. Howell

Researchers say it is not necessary to take body mass index into account when assessing disease activity in axial spondyloarthritis patients.

The study appears in the June 16 issue of RMD Open.

Physicians primarily rely on two measures to assess axial spondyloarthritis (axSpA) and ankylosing spondylitis disease status:  the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS). While BASDAI relies on patient-reported outcomes to measure ankylosing spondylitis in patients, ASDAS combines patient-reported outcomes with C reactive protein (CRP) to assess axial spondyloarthritis status.

Because adipose tissue is frequently associated with increased production of pro-inflammatory cytokines, such as C reactive protein, investigators hypothesized whether an elevated body mass index could be an accurate disease-activity indicator. Obesity, measured by body mass index (BMI), is associated with increased levels of C reactive protein (CRP). High levels occur in response to inflammation, including that associated with ankylosing spondylitis.

Led by Roxana Rubio Vargas of the Leiden University Medical Center in The Netherlands, researchers found body mass index only influences CRP blood serum levels in women. But, the impact is not clinically relevant.

Knowing whether body mass index and excess adipose tissue contributed to CRP levels and self-reported outcomes could influence how providers guide patients on how best to control their axial spondyloarthritis.

Using patients and data from the existing SPondyloArthritis Caught Early (SPACE) cohort, launched in January 2009, researchers evaluated 428 patients over age 16 who had chronic back pain for more than three months, but less than two years. Investigators divided patients into normal weight (body mass index ≤24.9) and overweight (≥25). Collected C reactive protein levels of ≥5 mg/L were considered elevated.

Of the 428 patients, 168 (39.3%) fulfilled the Assessment in SpondyloArthritis International Society axial spondyloarthritis classification. This group had statistically lower rates of overweight and obesity— 18.4% and 11.9%, respectively — than those without the condition — 31.5% and 14.2%, respectively. Among patients with axial spondyloarthritis and those without, overweight patients had statistically significant higher C reactive protein rates (p=0.02 and 0.01, respectively). Researchers also discovered body mass index increases C reactive protein blood serum levels by 0.35 mg/L for each body mass index point – but only for women.

Overall, the researchers found, the impact of body mass index on C reactive protein in women isn’t enough to warrant using it as a measure of disease activity. It also doesn’t significantly impact any patient-reported outcomes.

“In general, it is not necessary to take BMI into account when assessing disease activity by ASDAS in axSpA patients with high BMI, but there may be a slight increase in ASDAS in female patients with very high BMI,” researchers wrote.

Further research into the influence of body mass index on CRP is needed, though. Researchers recommend conducting MRI and spectroscopy studies on a larger sample size of overweight women with axial spondyloarthritis to achieve more accurate results.

To read the story at its original location: http://www.rheumatologynetwork.com/spondyloarthritis/high-bmi-not-factor-axial-spondyloarthritis

June 23, 2016 Posted by | Healthcare | , , , | Leave a comment

Omega-3 Fatty Acids May Have a Protective Effect in RA

Published on the June 6, 2016, Rheumatology Network website

By Whitney L.J. Howell

The Omega-3 fatty acids found in certain fish can provide a possible protective benefit to individuals with rheumatoid arthritis and other related autoimmunity conditions. In fact, the benefit is strongest among those who have a genetic susceptibility to rheumatoid arthritis.

An Annals of Rheumatic Diseases studypublished in May, “Omega-3 fatty acids are associated with a lower prevalence of autoantibodies in shared epitope-positive subjects are at risk for rheumatoid arthritis,” found that people with the human leucocyte antigen class II genetic susceptibility are most likely to experience the positive result.

It’s the association between the n-3 fatty acids and anti-CCP2, the antibody that can pinpoint early rheumatoid arthritis development, as well as rheumatoid factor positivity, that supports the fatty acid’s ability to be protective, the study revealed. And, this work supports and furthers existing research, investigators said.

“Previous studies suggest n-3 [fatty acids] could possibly protect against the development of rheumatoid arthritis where our results suggest that the mechanism behind this might be through the prevention of autoantibody development,” they wrote. “More importantly, our results suggest the effect of longer-chain n-3 [fatty acids] on rheumatoid arthritis-related autoimmunity could depend on shared epitope status.”

Researchers recruited 2,166 participants from the Studies of the Etiology of Rheumatoid Arthritis (SERA) multi-center study, including those who didn’t have rheumatoid arthritis but were at-risk. They included two groups: first-degree relatives of persons with rheumatoid arthritis and parents of children with the allele for type 1 diabetes.

Each participant completed a 68-count joint exam and a questionnaire about environmental risk factors to evaluate the association between n-3 fatty acid supplement use and the prevalence of rheumatoid factor and anti-CCP2, the antibody that can pinpoint early rheumatoid arthritis development.

SERA participants were screened for shared epitope, the strongest predictor of seropositive rheumatoid arthritis. They were considered shared epitope positive if they a subtype of human leucocyte antigen-antigen D related 4 or –antigen D related 1 was present in their blood.

Investigators also conducted a 136-participant nested case-control study to understand the association between rheumatoid factor and anti-CCP2 positivity and n-3 fatty acid percentage in red blood cells.

According to results, in the shared epitope-positive group, rheumatoid factor cases are more likely to have lower levels of total red blood cell n-3 fatty acid percentage compared to the control group (OR 0.26, 95% CI 0.09 to 0.77, p=0.02). There was no association observed among the shared epitope-negative group.

In addition, data revealed an inverse association between anti-CCP2 positivity and the increasing total of red blood cell n-3 fatty acid percentage. (0.59, 95% CI 0.36 to 0.96) and the longer-chain n-3 fatty acids, eicosapentaenoic and docosahexaenoic acid (OR 0.56, 95% CI 0.34 to 0.92). The increasing total red blood cell n-3 fatty acid percentage was also inversely associated with anti-CCP2 positivity in shared epitope-positive participants (OR 0.44, 95% CI 0.21 to 0.93, p=0.03).

Based on questionnaire data, n-3 fatty acid supplement use was connected to a lower prevalence of anti-CCP2 in the shared epitope-positive group.

However, additional research is needed to study the interaction between n-3 fatty acids and shared epitope, as well as the progression of clinically-apparent rheumatoid arthritis. Doing so, investigators said, could offer insight into the group most likely to benefit from prevention strategies and how they are timed.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/omega-3-fatty-acids-may-have-protective-effect-ra

June 7, 2016 Posted by | Healthcare | , , , , | Leave a comment

Common Genetic Pathways Implicated RA and SLE

Published on the May 31, 2016, Rheumatology Network website

By Whitney L.J. Howell

Rheumatoid arthritis and lupus are distinct conditions that present in unique ways, but they do share various genetic risk factors. A recent study revealed a new risk locus for both diseases.

Previously, the genetic overlap between the two hadn’t been thoroughly examined. But, a study published in the May Annals of Rheumatic Diseases identified additional risk loci that are shared between rheumatoid arthritis and lupus.

Using genome-wide association studies, the study, “A combined large-scaled meta-analysis identifies COG6 as a novel shared risk locus for rheumatoid arthritis and systemic lupus erythematosus,” revealed the genetic variant rs9603612 is located near the COG6 (component of oligomeric Golgi complex 6) gene.

COG6 is located on chromosome 13q14.11, and it’s crucial to proper protein sorting and glycosylation. However, its role in immune-mediated disorders remains unknown.

This study is the first comprehensive, large-scale analysis that looks into the genetic overlap between both disorders. Small sample sizes has been a limiting factor to-date.

“Our results highlight the existence of a relevant genetic correlation between both diseases, as well as the influence of common molecular mechanisms in their pathophysiology,” the authors wrote. “Since common genetic pathways are implicated in rheumatoid arthritis and lupus, a reclassification of patients from a genetic point of view will lead to more specific and effective therapeutic procedures.”

Overall, researchers included 17,552 patients with rheumatoid arthritis, 4,194 patients with lupus, and 46,907 control patients. Data came from Sweden, the United Kingdom, Germany, Italy, Spain, The Netherlands, and the United States.

Through silico expression quantitative trait locus analysis, researchers learned the associated polymorphism acts like a regulator variant that influences COG6 expression. In particular, rs9603612 impacts the transcription factor binding and is linked to gene target expression, most likely regulating COG6 expression in monocytes.

According to investigators, the protein-protein interaction and gene ontology enrichment analyses pointed to an overlap with specific biological processes. Results pointed specifically to the type I interferon signaling pathway. Additionally, the genetic correlation and polygenic risk score analyses showed cross-phenotype associations between rheumatoid arthritis and lupus.

Bivariate analysis revealed a significant genetic correlation between rheumatoid arthritis and lupus. Polygenic risk score analysis showed significant differences between the case groups and controls and that lupus cases had a significant enrichment of rheumatoid arthritis-risk alleles.

The findings, they said, point to rs9603612 being a good candidate for being the casual variant involved in the genetic predisposition of autoimmune disorders.

To read the story at its original location: http://www.rheumatologynetwork.com/lupus/common-genetic-pathways-implicated-ra-and-sle

June 2, 2016 Posted by | Healthcare, Science | , , , , | Leave a comment

Herpes Zoster Infection Most Often Associated with Tofacitinib

Published on the May 2, 2016, Rheumatology Network website

By Whitney L.J. Howell

Among individuals with rheumatoid arthritis (RA), those who take tofacitinib experience double the rate of associated herpes zoster (HZ) than individuals taking other biologics.

According to an April Annuals of Rheumatic Disease study, entitled, “Real-world comparative risks of herpes virus infections in tofacitinib and biologic-treated patients with rheumatoid arthritis,” researchers from the University of Alabama at Birmingham determined the rate of herpes zoster  infection is substantially higher among patients who take tofacitinib than those who take infliximab, tocilizumab and abatacept, or rituximab.

Tofacitinib, a small molecule used to treat rheumatoid arthritis has immunomodulatory effects, mainly inhibits janus kinase (JAK) 1/3 kinases. Almost all tofacitinib data is based on placebo-based trials, so its real-world safety and comparability with biologics, relating to herpes simplex virus and herpes simplex virus (HSV), is unknown. Existing research does show, however, that rheumatoid arthritis patients have an elevated herpes zoster risk compared to the general population.

“Our analysis is the first real-world evaluation of HZ risk involving tofacitinib and biologic therapies simultaneously, while controlling for other HZ risk factors,” researchers wrote. “Our observations are consistent with the conclusions from the tofacitinib clinical trial experience and provide real-world comparative evidence.”

It’s unclear how tofacitnib causes HZ, but cell-mediated immunity is important in controlling the varicella virus. Patients with waning VZV-specific CD4 T-cell function also have a high HZ risk. Researchers also said one potential explanation is that tofacitnib diminishes CD4 T-cell proliferation and subsequent interferon-Ɣ production.

Based on this study’s results, tofacitinib patients were slightly younger at 55 years old than biologics patients. They were also somewhat less likely than biologics patients to use concomitant methotrexate – 39 percent versus 43 to 56 percent.

Investigators used Cox proportional hazard models to evaluate the adjusted association between tofacitinib and herpes zoster. They also analyzed incident cases HSV.

Based on results, crude herpes zoster incidence associated with tofacitinib was 3.57/100 patient years. When tofacitinib use was compared to abatacept, through multivariable adjustments, researchers discovered herpes zoster risk was significantly elevated – HR 2.01 (95 percent CI 1.40 to 2.58).

RA biologics and abatacept rates, as well as adjusted HRs, were comparable. Older age, female sex, >7.5 mg/day of prednisone, prior outpatient infections, and a greater number of hospitalizations were also associated with herpes zoster risk.

The incidence rates for combined outcomes is greatest for tofacitinib (7.61/100 patient years). They are also significantly elevated after adjustment – HR=1.40, 95 percent CI 1.09 to 1.81).

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/herpes-zoster-infection-most-often-associated-tofacitinib

May 2, 2016 Posted by | Healthcare | , , , | Leave a comment

Where Biologics Fail in RA, Baricitinib Could Succeed

Published on the April 13, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with active rheumatoid arthritis (RA) resistant to standard-of-care treatments with synthetic or conventional DMARDs can benefit from selective Janus kinase (JAK) 1 and 2 inhibitors when paired with once-daily baricitinib, a study shows.

In a study, designed to test baricitinib safety and efficacy, from Stanford University Medical Center published in the March 31 New England Journal of Medicine issue, researchers found patients experience the largest reduction in rheumatoid arthritis symptoms with a 4mg daily baricitinib dose. Symptoms also decreased with a 2 mg daily dose.

“These results provide evidence that selective inhibition of JAK1 and JAK2 with once-daily baricitinib has clinical efficacy in patients with active rheumatoid arthritis that is refractory to aggressive standard-of-care treatment with both conventional synthetic DMARDs and biologic DMARDs,” the authors wrote.

In this phase III, 24-week trial with 527 patients, investigators divided participants into three groups:  a 4 mg baricitinib group, a 2 mg barcitinib group, and a placebo group. At 12 weeks, patients were tested for the American College of Rheumatology 20 percent (ACR20) response, the Health Assessment Questionnaire-Disability Index (HAQ-DI) Score, 28-Joint Disease Activity Score based on C-reactive protein level (DAS28-CRP), and Simplified Disease Activity Index (SDAI) Score of 3.3 or less.

At 12 weeks, more participants receiving 4 mg than the placebo had an ACR20 response — 55 percent and 27 percent, respectively. The same patient group also saw significant improvement in DAS28-CRP and HAQ-DI scores. There was no significant difference in SDAI scores for 2 mg and placebo groups.

Higher levels of adverse effects, such as withdrawal, cancer or cardiovascular events, appeared throughout the 24 weeks for both the 2 mg and 4 mg groups rather than the placebo. Among the 2 mg, 4 mg, and placebo groups, the rates were 71 percent, 77 percent, and 64 percent, respectively. Infections occurred in 44 percent, 40 percent, and 31 percent of cases. Serious events occurred in 4 percent, 10 percent, and 7 percent of patients, respectively.

According to study authors, results revealed rheumatoid arthritis patients with active disease and inadequate DMARD responses see the most clinical improvement from 4 mg baricitinib daily doses after 12 weeks. Additional studies are necessary, however, to determine long-term safety and response durability.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/where-biologics-fail-ra-baricitinib-could-succeed

 

April 14, 2016 Posted by | Healthcare | , , | Leave a comment

It’s Not Enough to “Tell” RA Patients to Exercise: They Need a Challenge

Published on the Nov. 11, 2015, Rheumatology Network website

By Whitney L.J. Howell

Improving physical activity could be an effective tool in decreasing fatigue associated with rheumatoid arthritis, according to a small study.
Fatigue is universally associated with rheumatoid arthritis, as well as depression, poor sleep and obesity. Physical activity can mitigate these problems, meaning increased movement could positively impact rheumatoid arthritis-associated fatigue.
In a presentation given on Nov. 11 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Patricia Katz, MD, professor of medicine at the University of California at San Francisco, discussed how increased walking is enough to be beneficial. At study’s end, participants experienced no increase in rheumatoid-arthritis activity, but they did see a marked decreased in tiredness.
“For years, people with rheumatoid arthritis experiencing fatigue have been told they should rest more,” Katz said. “This research flies in the face of that advice. Resting more is probably the opposite of what they need to do.”
Ninety-six participants were divided into three groups: (1) education-only (2) pedometer and (3) pedometer with step targets. Group 1 received only a Centers for Disease Control and Prevention booklet about incorporating exercise into daily routines. Group 2 monitored their steps, and Group 3 was challenged to increase their steps by 10 percent each week for 21 weeks. Both groups received phone call follow-ups at 10 weeks and 21 weeks.
Overall, the median baseline step count was 3,710, fewer than 5,000 daily steps is considered sedentary. At the study’s end, Group 1 saw virtually no change in their number of steps, but experienced a 38 percent drop in fatigue. Group 2 increased their steps by 87 percent and decreased their fatigue 54 percent. Group 3 augmented their steps by 159 percent and saw their fatigue dip by 48 percent. The PROMIS Fatigue short-form was used to assess fatigue levels.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/it%E2%80%99s-not-enough-%E2%80%9Ctell%E2%80%9D-ra-patients-exercise-they-need-challenge

November 11, 2015 Posted by | Healthcare | , , , , | Leave a comment

Treatment Can Reduce Pericarditis in RA

Published on the Nov. 10, 2015, Rheumatology Network website

By Whitney L.J. Howell

Taking anakinra, a drug that treats rheumatoid arthritis, can significantly reduce pericarditis in patients with highly inflammatory disease and elevated CRP protein, according to a small study.

Among acute pericarditis instances, recurrence occurs in 30 percent of cases. Most patients with recurrent cases don’t respond to or can’t tolerate NSAID, corticosteroid or colchicine treatments. But, for those with a history of high fever, elevated CRP level and pleural effusions, anakinra can be highly effective.

In a presentation given on Nov. 10 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Antonio Brucato, MD, an internal medicine specialist with Hospital Papa Giovanni XXIII in Bergamo Italy, discussed the role anakinra plays in controlling the interleukin-1 family cytokines responsible for regulating immune responses and inflammation, particularly in patients with high-disease activity.

“We were impressed to see how quick and immediate the effect of anakinra was on patients with severe, acute and inflammatory disease,” he said. “It allowed for the prompt discontinuation of other drugs.”

Anakinra showed itself to be effective and safe, he said, with the most common side effect being a mild injection-site skin reaction.

In the double-blind study conducted in three medical centers, 21 patients were divided into two groups – a placebo group and an anakinra-treatment group. Between June 2014 and June 2015, pericarditis recurrence occurred in nine out of 10 participants in the placebo group and in two of 11 anakinra-treatment participants. The median time to a flare-up among the placebo group was just over 48 days.

After a patient achieves remission, Brucato said, they should complete a gradual anakinra taper, reducing the dose by 100 mg/week until they drop to 300 mg/week. They should, then, reduce by another 100 mg/week every two-to-three months.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/treatment-can-reduce-pericarditis-ra

November 10, 2015 Posted by | Healthcare | , , , , , , , | Leave a comment

Vitamin D’s Effect on Rheumatoid Arthritis

Published on the Oct. 27, 2015 Rheumatology Network website

By Whitney L.J. Howell

Severe Vitamin D deficiency could be responsible for persistent rheumatoid arthritis (RA) disease activity, according to a new study.

The study, conducted with 149 patients with active RA, observed the impact of Vitamin D supplementation on illness duration, pain severity, tender joint counts (TJC), swollen joint counts (SJC), serum Vitamin D levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

The mean participant age at recruitment was 49, with 94% being female and 6% being male. The average duration of illness was 78 months, and average length of disease-modifying anti-rheumatic drugs (DMARDs) treatment was 44 months. Participants also had other co-morbid conditions, including diabetes, hypothyroidism, asthma, and benign prostatic hyperplasia.

Patients were divided into four groups:

(1) high disease activity with low Vitamin D

(2) high disease activity with normal Vitamin D

(3) low disease activity with low Vitamin D

(4) low disease activity with normal Vitamin D

To see the remainder of the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/vitamin-d-effect-rheumatoid-arthritis

October 27, 2015 Posted by | Healthcare, Science | , , , | Leave a comment

   

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