Now, new findings by Yale researchers showed that in systemic autoimmune diseases (such as lupus and rheumatoid arthritis), B cells can be activated even in the absence of T cells — thereby leading to suggested news ways of intervention in tackling the process leading to autoimmune diseases.

Recently this same Yale group along with collaborators at Boston University discovered an unexpected role in autoimmunity of Toll-like receptors, previously thought to be stimulated by molecules expressed on microbial pathogens. Shlomchik and his colleagues showed that they can also recognize and react to “self” molecules, in particular mammalian DNA and RNA. When this occurs, these receptors help activate B cells that make the classical autoantibodies of lupus.

The new Yale study now shows that these signals substitute for T cells in starting the autoimmune process in B cells. The researchers propose that once B cells are activated via Toll-like receptors, they can subsequently recruit T cells and that this can lead to a “vicious cycle” of chronic autoimmune disease in which the two types of cell activate each other.

According to Mark Shlomchik, MD, professor of laboratory medicine and immunobiology at the Yale School of Medicine and senior author of the study:

“The findings were surprising because many scientists believed that B cells remain quiet in autoimmune diseases unless they are stimulated first by T cells.

It became a chicken or egg problem. If cooperation between T and B cells is needed to create an autoimmune disease, who falls off the fence first, and why?”

The findings of the said study may explain why treatments that target T cells fared very poorly while the newer treatments targeted at the B cells are working a lot better.

Here’s a brief explanation how B cells work in the immune system:

B cells react against invading bacteria or viruses by making proteins called antibodies. The antibody made is different for each different bug. The antibody locks onto the surface of the invading bacteria or virus. The invader is then marked with the antibody so that the body knows it is dangerous and it can be killed off.

The B cells are part of the memory of the immune system. The next time the same bug tries to invade, the B cells that make the right antibody are ready for it. They are able to make their antibody more quickly than the first time the bug invaded.

What happens here is that, the treatments to work should be able to intervene in the immune system’s attack to the body’s own tissue.

Read more details from Medical News Today.

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It is based on an understanding of the biological mechanisms that lead to of osteoarthritis and pain. In osteoarthritis, the body produces interleukin-1 (IL-1), a protein that contributes to the breakdown of cartilage.

To slow down or stop this process, the biological adversary of IL-1, the interleukin-1 receptor antagonist (IL-1Ra), is used. IL-1Ra neutralizes the effect of IL 1, and has anti-inflammatory, analgesic and cartilage-protective effects.

In the Orthokine method, various anti-flammatory proteins and growth factors such as IL-1Ra are obtained from the patient’s own blood and injected back into the affected joint.

Now, results of a two-year study which compared treatments of hyaluronic acid, orthokine and placebo in osteoarthritis of the knee, revealed that orthokine treatment is the safest and most effective treatment. This has been the GOAT study (German Osteoarthritis Trial) conducted by researchers at Heinrich Heine University in Düsseldorf.

They compared the effects of injections of Orthokine, hyaluronic acid and placebo in 310 arthritis patients over a two-year period. Hyaluronic acid, a joint lubricant, is widely used to treat arthritis. Saline was used as the placebo.

Two years after the series of injections, patients treated with Orthokine scored substantially better than those treated with hyaluronic acid or placebo on measures of pain and joint function.

Two years after the initial treatment, 188 of the 310 patients were still reporting improvements with respect to pain and joint function, while 122 had sought other treatments in the meantime such as surgery, injections, medication or acupuncture. The number of patients requiring further treatment was smallest in the Orthokine group.

According to Prof. Peter Wehling, chairman of the board of Orthogen AG and the co-developer of the orthokine therapy:

“The two-year results confirm our previous studies: Orthokine therapy provides long-term relief from pain and joint dysfunction in many patients and does so more effectively than comparable treatments”.

Findings appear in the journal Osteoarthritis and Cartilage. Read more details of this study from
The Medical News Today.

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Now it’s Friday. But before I close my week and take it easy the rest of the weekend, let me share with you all a few things that show how life with arthritis can be lived with some better quality, if we make some adjustments.

1. Kitchen adjustments and tools that can help those with arthritis

Diagnosed with rheumatoid arthritis in 1987, Tuovi Cochrane, 67, of Rockford, has joined thousands of women in inventing new ways to create in the kitchen.

Using a specially designed ergonomic kitchen knife with a broad blade and sawlike handle that is easier to grip, Cochrane is able to slice, dice and chop.

For opening jar lids, she uses the adjustable Black & Decker Lids Off, which can handle even small prescription-pill containers.

2. Lower arthritis risks with simple changes

• Keep your weight down: excess weight puts additional stress on the joints and is especially hard on the knees and hips.
• Don’t avoid exercise: Although high-impact activities can irritate arthritis, keeping muscles strong and joints moving is therapeutic; try swimming, yoga or even golf.
• Take stretch breaks at work: Don’t sit or stand in the same position for long periods of time. Stand up and move or stretch every 30 minutes.
• Get your vitamins: everyone can benefit from a healthy, balanced diet, but getting adequate calcium and vitamin C is of particular importance to bone and joint health,
• Wear comfortable shoes: Don’t sacrifice your health for fashion; high heels put added stress on feet and knees.

3. Wii Fit as indoor exercise for arthritis patients

Elaine Bartz would never lie to her doctor.

Since the 62-year-old grandmother bought a Nintendo Wii Fit system to help fight her arthritis, that hasn’t been a consideration.

“Every time I go to the doctor, she would ask me if I’d been exercising, because I do have high cholesterol, too,” Bartz said. “I would say, ‘Uh, no, I’m not.’ Now, when I go to her, I can say I am exercising daily.”

4. Yoga for arthritis

Thanks to fascinating advances in medication too, which has definitely saved an arthritic from the devastating side effects of steroids. But, have we hit the nail on its head? Have we been able to cure or prevent joint diseases? The answer is a clear ‘No’.

5. Cooking workshop that may help arthritis patients

This month, the Indiana Chapter of the Arthritis Foundation will team up with Whole Foods Market to offer a short series of FREE, fun and educational courses for the community called Healthy Cooking 101. These courses were created for Indiana residents who struggle with rheumatoid arthritis but still want to maintain some sort of independence in the kitchen.

Well, we all do need all the help we can get. Be it turning ergonomic, doing yoga or buying the Wii fit, i think I won’t hurt to try and see what’s going to work for you. Take your prescribed meds too! Most importantly, you gotta eat right.

That’s all for now and I wish you all a great weekend.

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The authors of the said study have reported that patients who took the enriched herb experienced reduction in pain and increase in mobility in as little as seven days.

The herb was enriched with 30 percent AKBA (3-O-acetyl-11-keto-beta-boswellic acid), which exhibits potential anti-inflammatory properties by inhibiting the 5-lipoxygenase enzyme. This enzyme transforms essential fatty acids into leukotrienes, which use signals to regulate the body’s response to inflammation.

AKBA is believed to be the most active ingredient of the B. serrata herb.

“AKBA has anti-inflammatory properties, and we have shown that B. serrata enriched with AKBA can be an effective treatment for osteoarthritis of the knee,” said study leader Siba Raychaudhuri, a faculty member of the University of California, Davis.

“The high incidence of adverse effects associated with currently available medications has created great interest in the search for an effective and safe alternative treatment,” Raychaudhuri said.

Frankincense is something we knew that is used in incense and in perfumes. From wikipedia:

Frankincense is tapped from the very scraggly but hardy Boswellia tree through slashing the bark and allowing the exuded resins to bleed out and harden. These hardened resins are called tears. There are numerous species and varieties of frankincense trees, each producing a slightly different type of resin. Differences in soil and climate create even more diversity in the resin, even within the same species.

In the abovementioned study, the frankincense specie used is Boswellia serrata enriched with 30% 3-O-acetyl-11-keto-beta-boswellic acid (AKBA) — a product called 5-Loxin®.

5-Loxin(R) is a novel Boswellia serrata extract enriched with 30% 3-O-acetyl-11-keto-beta-boswellic acid (AKBA), which exhibits potential anti-inflammatory properties by inhibiting the 5-lipoxygenase enzyme. A 90-day, double-blind, randomized, placebo-controlled study was conducted to evaluate the efficacy and safety of 5-Loxin(R) in the treatment of osteoarthritis (OA) of the knee.

5-Loxin(R) reduces pain and improves physical functioning significantly in OA patients; and it is safe for human consumption. 5-Loxin(R) may exert its beneficial effects by controlling inflammatory responses through reducing proinflammatory modulators, and it may improve joint health by reducing the enzymatic degradation of cartilage in OA patients.

5-Loxin® is a new, patent-pending joint health ingredient from P.L. Thomas.

Story sources: FOX News, Arthritis Research & Therapy abstract

5-LOXIN is a new, patent-pending joint health ingredient that is steeped in the historic roots of boswellia serrata extracts. The boswellia plant has been used for thousands of years in traditional Ayurvedic medicine in India, and recent studies have shown its benefits in promoting joint comfort, knee mobility and walking distance.

The application of modern science by the researchers at the renowned Laila Impex Research Center in India has resulted in the identification of the most powerful boswellia compound, acetyl-11-keto-beta boswellic acid, or AKBA.

I’m guessing it won’t take too long before this product makes it to the market for public consumption. Soon enough this will be the new osteoarthritis anti-inflammatory/pain drug, don’t you think?

Story sources: FOX News and Arthritis Research & Therapy abstract

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The committee’s vote was made after Roche presented results from five Phase III clinical trials. The clinical development program evaluated the effects of Actemra on signs and symptoms of RA, physical function, progression of structural damage, and health-related quality of life.

Of these five studies, three trials were conducted in patients with inadequate response to disease modifying anti-rheumatic drugs (DMARDs), one trial was conducted in patients who failed anti tumor necrosis factor (TNF) therapy and one monotherapy study comparing Actemra to methotrexate, a current standard of care, was also conducted.

Results of these studies demonstrated that treatment with Actemra, alone or combined with methotrexate or other DMARDs, significantly reduced RA symptoms regardless of previous therapy or disease severity, compared with current DMARDs.

Actemra (already approved in Japan, but not yet in the US and Europe) is a novel interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody, for reducing the signs and symptoms in adults with moderate to severe rheumatoid arthritis (RA).

Actemra is the result of research collaboration by Chugai and is being co-developed globally with Chugai. Actemra is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody. An extensive clinical development program of five Phase III trials was designed to evaluate clinical findings of Actemra. T

he five studies have reported meeting their primary endpoints. Actemra is awaiting approval in the United States and Europe. In Japan, Actemra was launched by Chugai in June 2005 as a therapy for Castleman’s disease; in April 2008, additional indications for rheumatoid arthritis, polyarticular-course juvenile idiopathic arthritis and systemic-onset juvenile idiopathic arthritis were also approved in Japan.

With the FDA panel’s recommending approval, it is almost sure that the FDA will grant approval of Actemra in September.

According to William M. Burns, CEO of Roche’s Pharmaceuticals Division:

“We are pleased with the FDA advisory committee’s very positive recommendation for Actemra, which helps move this promising new therapy closer to becoming available for patients who suffer from the debilitating symptoms of RA.

Based on the compelling data presented, and this positive recommendation from the committee, we remain hopeful that the FDA will approve Actemra for the treatment of RA and provide a new option to patients who are not achieving adequate symptom relief with current therapies.”

Actemra is generally well tolerated, as reported by Roche. Now reports are saying that if the drug gets FDA approval, Actemra is a potential blockbuster. Well…from a patient’s perspective, let’s cross our fingers that the drug really works well against rheumatoid arthritis.

The overall safety profile of Actemra is consistent across all global clinical studies. Serious adverse events reported in Actemra clinical trials include serious infections, diverticular perforations and hypersensitivity reactions including anaphylaxis.

The most common adverse events reported in clinical trials were upper respiratory tract infection, nasopharyngitis, headache and hypertension. Increases in liver function tests (ALT and AST) were seen in some patients; these increases were generally mild and reversible, without injuries or any observed impact on liver function.

Laboratory changes, including increases in lipids (total cholesterol, LDL, HDL, triglycerides) and decreases in neutrophils and platelets, were seen in some patients without association with clinical outcomes.

Read more from the Roche press release or the report from Reuters.

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When: 1:30 p.m. Wednesday, July 30, 2008

Where: Holiday Inn Express (North Platte, Nebraska)

Sponsored by Great Plains Regional Medical Center (GPRMC) and North Platte Orthopedic and Sports Medicine, this workshop is free and open to the public.

If anybody reading this is near the area, you may want to drop by and listen to Dr. E. Scott Carroll present the seminar:

Dr. E. Scott Carroll, who will present the seminar, began practicing at GPRMC in April 2008. Carroll specializes in hand injuries and pathology. Specifically, he offers wrist arthroscopy, thumb basal joint procedures for arthritis, care of fractures and all hand trauma, including tendon, nerve and arterial repair.

Soft tissue flap coverage of the mutilated hand, as well as replantation of digits is performed here in North Platte. Distal radius fractures, ganglion cysts, fractures of the carpal bones, as well as carpal tunnel release are within the scope of his practice. He will also treat trigger fingers, Dupuytren’ s disease excision and tumors of the hand.

Carroll received a bachelor’s degree in biology from the University of Nebraska at Omaha, then attended the University of Health Sciences College of Osteopathic Medicine. Following his schooling, he held a rotating internship and general surgery residency in Des Moines, Iowa.

Carroll then accepted a residency in cardiothoracic surgery in New Jersey for three years. Following the program in New Jersey, Carroll then worked as a heart surgeon in Florida, and practiced in Kearney since March 2001.

It is good to know that such an expert is holding a free seminar. Pretty use he will attract more and more patients.

Which brings me to this other news saying that baby boomers are more like to seek arthritis care for their foot and ankle arthritis.

Foot and ankle surgeons say Baby Boomers are more likely than previous generations to seek care when arthritis develops in their toes, feet and ankles.

“Unlike their parents, Baby Boomers do not accept foot pain as a natural part of aging,” says John Giurini, DPM, a Boston foot and ankle surgeon and president of the American College of Foot and Ankle Surgeons (ACFAS). “When conservative treatments fail, they want to know what other options exist.”

“This generation has witnessed an explosion of new medical technology during its lifetime,” says Stephen Frania, DPM, a Cleveland foot and ankle surgeon. “They have high expectations, sometimes too high.”

Surgeons say many Boomers who seek treatment for arthritis assume they’ll be able to resume activities such as running or playing sports. Seeking treatment early can improve the odds of preventing irreversible joint damage. While there is no fountain of youth for arthritis, surgeons say there are more medical options available to Baby Boomers than ever before.

There are more  advanced treatment options these days, that is undeniable. Also the younger generation are enjoying the readily available resources that will urge them to seek healthcare when they feel something is wrong in their body.

Well the other extreme of that really is:  each one of us it at risk of the ‘knowing too much’ and the ‘reading too much information’ syndromes in this day and age. Like i have always said, information like the ones in this blog are for educational purposes only…don’t forget to seek the expert practicing doctor.

Let us not forget finding the right balance in all these.

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From Radiology Info, MSUS helps diagnose the following:

• tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle
• abnormalities of the muscles, such as tears and soft-tissue masses
• bleeding or other fluid collections within the muscles, bursae and joints

One limitation however of this imagine procedure is that it has difficulty penetrating to the bones and so can only see the outer surface of bony structures. For imaging of the internals of the bones and joints, MRI comes in.

According to UK’s National Rheumatoid Arthritis Society:

Ultrasound is relatively inexpensive and safe, avoiding the exposure to radiation that is necessary for conventional x-rays, CT and MRI scans.

Traditionally, rheumatologists have referred patients to radiologists for all ultrasound examinations but recent developments have enabled them to conduct some scans themselves. The advent of portable ultrasound machines (figure 2) means that scans can be carried out at the bedside or in the outpatient clinic without the need for a second appointment in the x-ray department.

This speeds up the process of investigation and allows the rheumatologist to plan treatment without delay. Radiologists are expert at conducting detailed scans that often assist with a structural diagnosis. Rheumatologists tend to use ultrasound in a slightly different way. They may use it to guide them in carrying out difficult joint injections.

They also use it to detect subtle inflammation around tendons and small knuckle joints. This is important because clinical examination may not always identify inflammation, particularly in early arthritis. The earlier the diagnosis of rheumatoid arthritis, the better the chance of dampening down inflammation and preventing joint damage.

Well I guess it is always better to see a rheumatologist for this procedure…though the combined ‘reading’ or interpretation of both rheumatologist and radiologist alike would be a lot of help. Has anybody reading this underwent MSUS, let us know about it. Was the procedure helpful in the diagnosis?

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Co-authored by by physicians at the University of Alabama at Birmingham (UAB), the updated guidelines highlighted the fact that proven combinations of medicines and the introduction of new anti-arthritis drugs have significantly improved the treatment of rheumatoid arthritis (RA).

The strategies are updated in such a way that the goal is more focused on the prevention of joint damage and disability.

According to lead author Kenneth Saag, M.D., M.Sc., a professor in the UAB Division of Clinical Immunology and Rheumatology:

The new recommendations do not strive to replace individualized medical decisions. Instead, they are meant to guide rheumatologists and other health care workers toward the most updated recommendations.

The recommendations developed are not intended to be used in a ‘cookbook’ or prescriptive manner, or to limit a physician’s clinical judgment. They provide guidance based on clinical evidence and expert panel input.”

The last guidance issued by ACR is in year 2002. Some of the key recommendations included in the new guidelines are:

• Methotrexate or leflunomide therapy is recommended for most RA patients.
• Anti-TNF agents etanercept, infliximab, or adalimumab along with methotrexate can be used in new or early RA cases with worsening and severe symptoms.
• Doctors should not initiate or resume treatment with methotrexate, leflunomide, or biologics if RA patients have active bacterial infection, shingles (herpes-zoster), hepatitis B, hepatitis C and active or latent tuberculosis.
• Doctors should not prescribe anti-TNF agents to patients with a history of heart failure, lymphoma or multiple sclerosis.

For the complete guideline, the American College of Rheumatology has a pdf file.

The anti-TNFs popularly available in the market are:

1) Enbrel (entanercept) - product of Amgen and Wyeth

ENBREL is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance your body’s immune system makes called TNF. People with an immune disease, such as rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, or psoriasis, have too much TNF in their bodies.

ENBREL can reduce the amount of active TNF in the body to normal levels, helping to treat your disease. But, in doing so, ENBREL can also lower the ability of your immune system to fight infections.

2) Remicade (infliximab) - product of Centocor, Inc.

REMICADE is an advanced treatment that has been shown to have substantial benefits in patients with a number of inflammatory disorders involving the immune system. REMICADE targets specific proteins in the body’s immune system to help control the development of inflammation, significantly reducing painful symptoms in diseases such as plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, adult Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, and ankylosing spondylitis.

3) Humira (adalimumab) - product of Abbott

HUMIRA is a TNF Blocker.

TNF (tumor necrosis factor) blockers are a class of medications that fight both the painful symptoms and progressive joint damage of moderate to severe rheumatoid arthritis. They just might make a real difference in your fight against RA.

TNF blockers can slow down the rate at which RA causes damage to joints and bones. HUMIRA is one such TNF blocker.

For many patients, HUMIRA can provide relief to painful joints. It can help fight the fatigue. And it can help slow the progressive joint damage of moderate to severe rheumatoid arthritis.

As we already know, rheumatoid arthritis is an autoimmune disease causing the chronic inflammation of the joints. We already know too that with the proper treatment, therapy, diet, lifestyle, etc…rheumatoid arthritis need not be a death sentence. Discuss the options with your doctor in order to still have the best quality of life despite your condition.

Read more from Medical News Today or UAB News.

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If you dig into my archives, the top 2 exercise for arthritis that will come out are:

1. Tai Chi

Tai Chi is most known to relieve stress and improve one’s agility. Recently however, it has been noticed as a beneficial exercise form for people with arthritis. From the Mayo Clinic’s list of uses of tai chi, one cannot deny the fact that it can indeed help against arthritis:

• Reduce stress
• Increase flexibility
• Improve muscle strength and definition
• Increase energy, stamina and agility
• Increase feelings of well-being

In the case of oseoarthritis, stress is a risk factor. Therefore tai chi in one way to relieve stress and improve one’s quality of life.

2. Water Aerobics or other water exercises

Exercising in water doesn’t strain the joints and so it offers a different way of exercising with too much stress to people suffering from arthritis. Besides, studies have attested to its benefits. It is better though to have a trainor for this or join a class. With the approval of course of your doctor.

From wikipedia:

In addition to the standard benefits of any exercise, the use of water in water aerobics supports the body and reduces the risk of muscle or joint injury. The mitigation of gravity by flotation places less stress on the joints when stretching, and can allow a greater range of motion. The mitigation of gravity makes water aerobics safe for any individual able to keep their head out of water, including the elderly.[2] Exercise in water can also prevent overheating through continuous cooling of the body. Most classes last for 45-55 minutes.

I couldn’t agree more. People with arthritis should exercise but with minimal to none injury to the muscle or joints.

Swimming and walking, am not to sure to add to this list. While it may be beneficial, it should with done with caution as we do not want to be strained, stress nor injured. Simple stretching exercises could be helpful as well. Nothing too fancy, I guess. It would be best to discuss with your doctor, it might be good to consider as well if you work with a professional therapist or trainor experienced in arthritis patients. At least from my reading about managing life with arthritis, that piece of info I has always bumped into.

Would you mind sharing to us here, what kinds of exercises have you found beneficial in living life with arthritis? We’d like to know.

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There is always the option of taking the supplemental Calcium with Vitamin D. I was on this too when I got pregnant and even afterwards. However, I have always believed that taking the dietary sources are a lot better than taking the supplements. That’s why I have always resorted to other dairy products ( and other food sources rich in calcium) such as cheese and fruit yoghurt (yikes, i never thought the day would come I’d be brave enough to try yoghurt!). Just think non-fat dairy folks, that’s arthritis-friendly.

Speaking of grapefruit. Who likes it? It isn’t one of the nicest citrus fruits to eat but it has become popular in lose-weight fad diets. One time I bought grapefruit juice and was repulsed by the taste. Really. That time I thought maybe that’s why people lose weight with grapefruit because after eating (or drinking the juice) you feel horrible in the stomach and the mouth and then you can’t eat anything else anymore.

Now results of  Texas AMU research showed that red grapefruit pulp may compete with Calcium and Vitamin D for bone health, at least in their study using male rats:

The pulp of grapefruit may improve bone health and reduce the risk of developing osteoporosis, according to a new study with male rats.

Consumption of the red grapefruit pulp led to a slow down in bone resorption, and an increase in bone mineral build-up and calcium absorption, according to researchers from Texas A&M University.

If the results can be repeated in humans, grapefruit pulp may offer a new ingredient to the growing bone health market dominated by calcium and vitamin D.

Well…if grapefruit pulp later becomes a supplement, I guess I can take it better than eating fresh grapefruits! But then that’s just me. Other people may disagree and find grapefruit appealing to their taste buds.

So there, I’m just saying there goes maybe another option in the future for people who can’t drink milk. There are always substitute, even for people with cow’s milk allergy and even for the lactose-intolerant. Really I should be thankful because I only cannot take the smell and taste of fresh milk that’s why I have turned creative and put them in my fruit shake. Yum!

What about you, I want to here how you take care of your bones. And joints too!

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