Easing Arthritis

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2016-02-20T20:36:00.001-08:00

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2016-02-20T20:33:00.001-08:00

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Arthritis Treatments May Increase Skin Cancer Risk

2009-11-27T13:09:00.000-08:00

By Brenda Goodman

Researchers are urging people with arthritis who take biologic medications that block an inflammatory protein called tumor necrosis factor alpha, or TNF-alpha, to check their skin regularly for signs of cancer.

That advice comes after two new studies found higher rates of both non-melanoma and melanoma skin lesions in those who take these kinds of biologic medications compared to those who take traditional disease-modifying, anti-rheumatic drugs, or DMARDs.

The current studies, which were released Saturday at the annual meeting of the American College of Rheumatology meeting in Philadelphia, are the some of the first to look specifically at the risk of skin cancer in people who take TNF-alpha blockers, and though the findings are provocative, experts say they are not a reason to stop taking biologic medications.

"It’s my opinion that the benefits of these drugs so far outweigh the observed risks," says Kimme Hyrich, MD, PhD, of Manchester University in the U. K. and lead author of one of the papers. "Overall,the risk of skin cancers in the bigger picture remains low."

For the first study, a team of researchers from Washington University in St. Louis and the St. Louis Veterans Affairs Medical Center, analyzed the medical records of nearly 17,000 people with rheumatoid arthritis treated at VA hospitals around the country.

About 3,000 of those patients were on TNF-alpha blockers, and for every 1,000 people treated with TNF-alpha blockers for one year, researchers found about 26 non-melanoma skin cancers and nearly 20 melanomas.

Based on their analysis, the researchers concluded that taking a TNF-alpha blocking drug, including adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), infliximab (Remicade) and golimumab (Simponi), was associated with a nearly 35 percent greater risk of developing non-melanoma skin cancer and about a 50 percent greater risk of developing malignant melanoma compared to treatment with a non-biologic DMARD, such as methotrexate, leflunomide or sulfasalazine.

“The longer people were on these drugs, the higher the risk they had,” says lead author Prabha Ranganathan, MD, a rheumatologist at the Washington University School of Medicine.

Additionally, men seemed to be at greater risk for developing skin cancers, as were those who were older, had a history of cancer or were taking prednisone or other corticosteroids.

For the second study, British researchers analyzed non-melanoma skin cancer cases among those enrolled in the BSRBR, a British registry that tracks the progress of people with rheumatoid arthritis.

For patients with no previous history of skin cancer, taking a TNF-alpha blocking drug appeared to increase the risk of developing a skin lesion by about 70 percent compared to treatment with a traditional DMARD.
When they looked more closely at the numbers, however, the British team found that the biologic drugs did not appear to share the same risk.

In particular, infliximab was associated with a 3-fold increase in skin cancer risk over DMARD treatment.
Dr. Hyrich says she was surprised that the risk jumped so much for infliximab, but she thinks that may be because of something called surveillance bias.

“There are reasons why physicians choose certain drugs for certain patients,” Hyrich says. “It could be that those patients had a higher risk because their disease was more active, or it could be that since people have to go to the hospital to get Remicade, they’re around health care providers more often and therefore it’s more likely that their cancer would be identified.”

Other predictors of skin cancer in the British study were a previous cancer history, male gender, older age and use of corticosteroid medications.

The bottom line, Dr. Hyrich says, is that people on TNF-alpha blockers, or even any kind of immunosuppressive therapy, should be getting regular skin exams and keeping a close eye out for any unusual skin changes - including new moles, firm red bumps or flat scaly crusts that appear on sun exposed areas.

"I think this is an easy and important thing that probably all patients on immunosuppressive therapies should be doing."

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Some Foods Block the Effects of Meds

2009-11-27T12:58:00.000-08:00

Be Aware: Some foods and beverages can block your meds.

By Camille Noe Pag�n

If you’re like most people, you down your pills with juice or food, thinking you’re doing your stomach a favor by not taking the medications alone. As it turns out, you may be doing more harm than good due to food-drug interactions.

Recent research shows that foods and beverages can have a dramatic effect on how the body absorbs certain medications.

“Twenty years ago, a team of researchers and I realized that grapefruit juice could cause many medications to be as much as 10 times more powerful than they’re meant to be,” says David G. Bailey, PhD, clinical professor of pharmacology at the University of Western Ontario in Canada.

Thanks to their research, more than 50 medications now carry cautions about grapefruit juice on their labels.

Now Bailey has discovered that grapefruit, apple and orange juices can actually have the opposite effect on some other drugs. “They block the pills’ absorption, so you get less or even no benefit from taking them,” says Bailey. “This might cause someone to think that they need to switch to a ‘better’ medication – when in fact changing what they eat, or when, would make the drug effective.”
Here are five common pill blockers to watch out for:

FOOD: Milk and yogurt
BLOCKS: Iron supplements; many antibiotics, including fluoroquinolone, cipro floxacin and “cycline” antibiotics like tetracycline; thyroid hormone; and penicillamine (Cuprimine, Depen), a disease-modifying antirheumatic drug

FOOD: Apple, orange and grapefruit juice
BLOCKS: Disease modifying anti-rheumatic drugs, including methotrexate (Theumatrex, Trexall); cyclosporine (Gengraf, Neoral, Sandimmune), a drug used for severe psoriasis and rheumatoid arthritis; beta blockers like acebutol (Sectral); cancer drugs like etoposide (Etopophos, Vepesid); alendronate (Fosamax), an osteoporosis drug; the allergy medicine fexofenadine (Allegra); some antibiotics including ciprofloxine (Cipro) and levofloxacin (Levaquin)

FOOD: Coffee
BLOCKS: Alendronate; the antibiotic penicillin

FOOD: Foods rich in vitamin K, including leafy green vegetables and liver
BLOCKS: Blood thinners like warfarin (Coumadin)

FOOD: Alcohol
BLOCKS: Antidepressants, especially monoamine oxidase inhibitors (MAOIs) like tranylcypromine (Parnate) – although people taking SSRIs like fluoxetine (Prozac) should avoid drinking more than moderate amounts of alcohol as well, as it counteracts their benefits.

How long should you wait?
In most cases, you can consume a potentially pill-blocking food or beverage about three to four hours after you’ve taken your meds, but it’s best to ask your pharmacist, who can tell you for sure. Plus, she can check to see if other medications or supplements you take might further affect how your body absorbs your medicines.

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Source: arthritistoday.org

Aspirin Therapy Warning

2009-11-25T13:09:00.000-08:00

A new review finds that the risks of taking low-dose aspirin to prevent a first heart attack may outweigh the benefits.

By Jennifer Davis

Daily aspirin therapy won’t prevent a first heart attack or stroke and may increase the risk of fatal stomach bleeding. That’s the conclusion of a large new review of the risks and benefits of low dose aspirin therapy.

A small dose of aspirin daily has long been recommended to ward off a second episode of cardiovascular disease. This is called secondary prevention, and researchers stress that this is still helpful.

“The evidence that aspirin will help prevent another heart attack is overwhelming, convincing and isn’t seriously challenged. So for [these patients], if they are taking aspirin, we are not offering them any new news. We are saying yes, according to the evidence you are doing the right thing,” says Ike Iheanacho, MD, editor of the Drug and Therapeutics Bulletin, a publication produced by an independent group in Britain that examines existing research and expert opinion.

But increasingly, doctors have been recommending low-dose aspirin to their patients for primary prevention of cardiovascular disease, and experts say that in those cases, the benefits are less clear-cut.

After analyzing six controlled studies on the topic involving 95,000 patients, the Drug and Therapeutics Bulletin is now suggesting that the guidelines about aspirin be amended for patients who’ve never had heart trouble because they say aspirin doesn’t prevent cardiovascular deaths in this group and may cause serious internal bleeding.

Dr. Iheanacho says the latest evidence shows if you take 2,000 patients and treat them for a year with a daily aspirin, you’ll only prevent one heart attack. And he says that for every 3,300 people you treated for a year, you’d get one extra incident of gastrointestinal bleeding, which can be fatal.

“Yes, you can say it’s a very small risk. But you can also say a lot of people are taking aspirin and it won’t make a big difference to preventing a heart attack or stroke,” he explains.

There has not been a study on the effect of a daily low dose aspirin on people with inflammatory arthritis, which can bring with it a nearly doubled risk of heart disease. But there have been studies on people with diabetes, who are also considered a high-risk group, and they show no benefit to a daily aspirin.

“The evidence doesn’t show so far that the prediction of high risk – whether family history or another condition – in itself, that doesn’t seem to be a predictor of who will benefit from aspirin and who won't,” Dr. Iheanacho says.

Eric Bates, MD, a cardiologist at the University of Michigan Health System in Ann Arbor, says he believes this new recommendation is likely correct.

He says the previous encouragement to take an aspirin a day was in an era before statin therapy, blood pressure control, diabetes control and other methods existed to help decrease risk. “The risk benefit balance has probably changed between the old era where we didn’t do a good job with prevention and risk factor control versus the new era,” Dr. Bates says.

Jon Giles, MD, works in the Johns Hopkins Arthritis Center and is an assistant Professor of Medicine at the institution in Baltimore. He agrees with the message that a daily aspirin doesn’t help and could actually hurt patients – especially those with rheumatoid arthritis, or RA.

“The adverse consequences of aspirin, both gastrointestinal and intracranial bleeding, are increased in RA patients because the majority also use nonsteroid anti-inflammatory drugs, or NSAIDs, daily or frequently, and many also use prednisone, which together increase the GI bleeding risk. Thus, any beneficial effect in cardiovascular disease prevention could completely be wiped out or exceeded by bleeding risk,” Dr. Giles explains.

The Drug and Therapeutics Bulletin is now calling on doctors to review the cases of patients currently taking a daily aspirin to prevent heart disease.

“I wouldn’t say to any patient – stop taking it. Those are individual decisions,” Dr. Iheanacho says. “If someone has inflammatory arthritis and they’ve seen several of their family members die from it, it may well be an overriding priority to take any measures which they think might help them have not such an episode. And that seems like an entirely reasonable way of proceeding. The only qualm of mine is that should be an informed choice. People should be allowed to know what the latest evidence is and be helped to make a judgment about how that relates to their particular situation. In our view, we think there’s not enough evidence to recommend using it, but we recognize that will be an individual decision.”

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Source

Illness, surgery not linked to seniors' mental decline

2009-11-09T17:34:00.001-08:00

New research published in the journal Anesthesiology suggests that illness and surgery don't contribute to long-term cognitive decline in seniors, nor do they accelerate the development of dementia. Researchers say their finding suggests that post-surgery cognitive decline may not be a major public health issue.

Radiation from medical scans skyrocketing

2009-11-09T16:42:00.001-08:00

U.S. patients' radiation exposure from medical scans is six times higher today than it was in 1980, researchers say. In just one year (2006), 18 million nuclear medicine exams were performed in the United States, along with nearly 380 million diagnostic/interventional radiological procedures. Scientists say exposure to radiation from medical procedures has risen 600 to 700 percent in the past 20 years, and it is now the biggest source of radiation for Americans.

Childhood abuse linked to osteoarthritis

2009-11-09T16:41:00.001-08:00

University of Toronto researchers have found that adults who experienced childhood physical abuse are 56 percent more likely to have osteoarthritis (OA) than people who were not abused. After reviewing data on self-reported childhood physical abuse and the diagnosis of OA, investigators found a "significant" relationship between the two factors. Scientists say the finding suggests the need for further research into the link between child abuse and the development of chronic illness.

Easing Arthritis

2009-11-04T12:29:00.001-08:00

Be mobile and minimize arthritis pain. Get actionable tips and news that will help you manage arthritis. Plus, special savings from health brands you know and trust.

Drink More Water for Fewer Gout Attacks

2009-10-17T13:00:00.000-07:00

By Jennifer Davis

10/17/09 A new study suggests that drinking plenty of water can help reduce the chances of having a gout attack.

Gout is an agonizing condition caused by an excess of a metabolic by-product called uric acid. When uric acid builds, it can form needle-like crystals that deposit in the joints and other organs, causing severe pain, inflammation, and hard lumps called tophi.

People who have gout may also experience flares – intense episodes of pain and swelling in individual joints – most often in the feet.

While medication can help lower uric acid levels, recurrences are common, and managing the disease can be difficult because of related diet and lifestyle factors.

It has been thought that dehydration is a possible trigger for gout attacks, so researchers at the Boston University School of Medicine wanted to determine if drinking water could reduce their likelihood.

“Dehydration can increase the concentration of serum uric acid in the blood. It can also affect the kidney’s ability to clear uric acid and can make uric acid more likely to form crystals. In combination, these factors can lead to an increased risk for a gout attack. Water can reverse the effects of dehydration,” says lead author Tuhina Neogi, MD, PhD.

For this Internet-based study, researchers recruited 535 people with gout who had experienced a gout attack within one year of the study. Seventy-eight percent were men, their average age was 53 and their gout diagnosis was confirmed through medical records. Participants were asked to provide information about how much water they consumed in the 24 hours before each gout attack and during times when they did not have a gout attack. Participants could respond with zero to one glasses per 24 hour period, two to four, five to eight or more than eight.

The results showed that with each glass of water consumed in the 24 hours before an attack, the risk for recurrent gout attacks decreased, even when accounting for other fluid intake.

“For example, those drinking five to eight glasses of water had a 40 percent reduced risk of gout attack compared with those who drank only one glass of water or less in the prior 24 hours,” Dr. Neogi explains.

Dr. Neogi says he can’t make specific recommendations about the amount of water people should drink because it depends on their underlying medical conditions and physical activity levels. He says patients should talk to their doctor if they have any questions on that front.

The study was presented at the 2009 annual meeting of the American College of Rheumatology in Philadelphia.

John Sundy, MD, PhD, a rheumatologist and associate professor of medicine at Duke University Medical Center in Durham, N.C., questions the reliability of the information in this study because it is based solely on patient’s recall. “If you are asking people to recall dietary intake any more than 12 hours after the fact, it is notoriously inaccurate,” he explains.

But he says the results are still intriguing because they provide scientific proof to existing anecdotal evidence. “I think it’s probably one of the first efforts to try to actually gather data to test this hypothesis or this notion that dehydration is important. The dehydration issue had been driven a lot by doctor-patient experience but there are limited examples,” Dr. Sundy says. “I think what it is, is an effort to provide new confirmation to an old idea.”

Dr. Sundy says there are plenty of other benefits to staying hydrated, so he doesn’t think it would hurt most patients to drink water regularly. “It’s one more tool in the tool chest that might be helpful,” he says. “This might be a reasonable thing to try.”

But he cautions there are some people who have to be careful with their fluid intake. That includes people with poor heart function or poor fluid handling by kidneys not able to eliminate a water burden.

Dr. Neogi says he and his research team are continuing to study potential triggers for gout attacks, including other liquids. They don’t think all liquids will have a beneficial effect on reducing the risk for recurrent gout attacks because some, including caffeinated and alcoholic beverages, may have potentially detrimental effects on serum uric acid and volume status.

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Source: arthritistoday.org