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Arthritis pain can lead to a number of debilitating symptoms that patients will want to try and avoid.

The condition can make life more difficult when carrying out simply, everyday tasks.

But, just some simple lifestyle changes could go a long way in helping to prevent arthritis symptoms from flaring up.

One of the best ways to avoid triggering arthritis symptoms is to eat more nuts, it's been revealed.

READ MORE: Arthritis warning - the common vegetable you should avoid

"Certain foods can actually help to ease arthritis symptoms and improve your overall joint health," said Penn Medicine.

"Along with the use of medications, a proper diet can curb the inflammatory responses from the body that cause pain.

"Almonds, hazelnuts, peanuts, pecans, pistachios and walnuts contain high amounts of fibre, calcium, magnesium, zinc, Vitamin E and Omega-3 fats which all have anti-inflammatory effects.

"Nuts are also heart-healthy, which is particularly important for people with rheumatoid arthritis, since they have twice the risk of heart disease as healthy adults."

Common arthritis symptoms include joint pain, inflammation, and restricted movement.

There are two key types of arthritis in the UK; osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common type of arthritis to be diagnosed in the UK - around nine million people are believed to have osteoarthritis.

Rheumatoid arthritis, meanwhile, is an auto-immune disease that has been diagnosed in about 400,000 individuals.

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Arthritis pain - the cheap snack you should add to your shopping list to avoid symptoms - Express.co.uk

This article was originally published on CBD Seniors. To view the original article, click here.

In the United States, 23 percent of adults suffer from arthritis. Around the world, 350 million people have this condition. While most people who have arthritis are age 65 or older, there are still many young and middle-aged adults who also have this condition.

Unfortunately, there is no known cure for arthritis. The best thing that scientists can currently do for the condition is alleviate the symptoms and slow down the progression of the disease. By reducing the bodys inflammatory response, doctors can help you live in less pain for longer. While every drug carries some risks and side effects, cannabidiol (CBD) is showing promise as a way to treat the pain of arthritis and reduce the progression of the disease. How Does CBD Help?

Thanks to the passage of the 2018 Farm Bill, farmers can now grow and process hemp in the United States. Because of this, CBD is now widely available online for people across the country. In addition to helping with conditions like insomnia and anxiety, research also shows that CBD can help alleviate pain as well.

CBD is a chemical compound that is naturally found within cannabis plants. While this compound will not make you high, it does have other useful benefits. Since cannabis was completely illegal until very recently, scientists are still working to understand the effects of using cannabis. CBD is only one out of dozens of different cannabinoids in cannabis, so other cannabinoids may have additional effects as well.

In the United States, people can readily buy CBD balm, tinctures, vaporizers and gummies. One study by Harris Poll found that 85 percent of Americans have already heard about CBD. Out of these adults, more than 20 percent have actually tried it.

Once CBD is extracted from cannabis, it can be used to treat ailments ranging from anxiety to chronic stress. CBD works by targeting receptors in the endogenous cannabinoid system. The cannabinoid system consists of neurotransmitters that naturally bind to cannabinoid receptors. These cannabinoid receptor proteins are naturally made in the human body. CBD targets the same receptors in order to alleviate pain, anxiety and stress.

Currently, about 55 percent of users state that they take CBD in order to relax.An estimated half of people use CBD for anxiety and stress. The next most common reason why people used CBD was for pain. In addition, some people use CBD for menstrual symptoms, migraines, nausea and sexual enhancement.

What Does the Research Say?

Because CBD was illegal like the rest of the cannabis plant, researchers are still trying to gain a better understanding of how effective this drug is for various conditions. In addition, researchers still need to figure out effective dosages. In rats, moderate doses of CBD have been shown to produce an anti-anxiety effect.

Another rat study shows that oral and topical solutions of CBD can help to alleviate pain. This particular study involved scientists exposing the rats sciatic nerves using an incision. Then, they constricted the nerves. Another part of the study involved injecting bacteria into the rats paws to cause inflammation. Afterward, the scientists gave the rats CBD or a placebo for a week. They applied pressure or heat to the rats legs to see how their reaction changed in comparison to their pre-study reactions. The rats that received CBD had less pain than the control group.

In a 2010 study of human patients, 177 people experiencing cancer-related pain were given extracts of tetrahydrocannabinol (THC) and CBD. The patients who received extracts with THC and CBD were twice as likely to experience pain relief as the patients who received just THC. This seems to indicate that CBD alone or the combination of the two is the component that leads to pain relief.

Related: Looking for reliable CBD products backed by lab-test results? Check out RealTestedCBD.

CBD and Arthritis Pain

An estimated 54 million Americans suffer from arthritis. Out of this number, 24 million Americans have to limit their daily activities because of arthritis. While people may say they just have arthritis, arthritis is actually a term that covers more than 100 different conditions. All of these conditions involve some level of swelling, pain and stiffness. With certain kinds of arthritis, the organs can also be affected.

The most common type of arthritis is osteoarthritis. This is the form that causes cartilage to deteriorate. Since this cartilage helps to protect your bones from friction, it can lead to pain and joint damage. People who experience this condition can develop inflammation as well. Because it takes time for cartilage to deteriorate, this condition typically affects the elderly more than it affects young adults.

Inflammatory arthritis like psoriatic and rheumatoid arthritis are connected to autoimmune conditions. These kinds of conditions develop because the immune system thinks that it is under attack from invaders. Instead of attacking invading viruses, the body attacks organs or bones. This leads to severe pain and inflammation.

Once someone experiences joint deterioration, the symptoms tend to get worse over time. Other than treating joint and nerve pain, many patients also need help with inflammation. By using CBD, you might be able to limit your joint pain, inflammation and mobility issues. Arthritis symptoms like stiffness, decreased joint movement and pain tend to respond well to CBD.

How the Endocannabinoid System Works

The endocannabinoid system is a fairly recent discovery. It was discovered after researchers started learning about the way cannabis affects the body, which is how this system got its name. People have used cannabis for therapeutic purposes for centuries. In 1964, researchers finally managed to isolate THC. Amazingly, this was the first time scientists learned how cannabis made people high.

Out of all of the cannabinoids, THC is the most abundant in the plant. THC affects neuronal signaling in the body. During the 1990s, researchers found different cannabinoid receptors in the body. Researchers discovered that THC binds with CB1 receptors in the central nervous system. Outside of the central nervous system, THC binds with CB2 receptors. CBD is also thought to work closely with CB2 receptors, which are known to regulate the immune system. The human body does not have cannabinoid systems and receptors by accident.

These receptors were designed to work with natural cannabinoids that your body produces. There are actually two other types of endocannabinoid receptors, but scientists are still uncertain about what these receptors do.

Your cannabinoid system is responsible for processes involving learning, executive function, memory, emotions, sensory reception, motor function and decision making. Your cannabinoid receptors are located in the central nervous system and peripheral nerves. By making changes to the endocannabinoid system by taking CBD, you may be able to reduce your perceived pain and change any processes that are affected by the cannabinoid system.

The Benefits of CBD for Arthritis

Recent studies show that 42 percent of Baby Boomers already use CBD to help with their joint point. In animal research, CBD has been shown to have antioxidant, anti-inflammatory and pain-relieving properties. By taking CBD, you may be able to reduce the signs and symptoms of arthritis.

Pain Suppression

One of the major reasons why people use CBD for arthritis is to reduce pain. Recent studies show that 62.2 percent of marijuana users took marijuana for pain relief. Almost all seniors experience some kind of pain later in life, and CBD can help reduce this pain. Cannabis and CBD are especially useful for joint pain from conditions like arthritis.

Nerve Protectant

Interestingly, CBD can also protect your nerves. It helps to reduce joint neuropathy. This is one of the reasons why it is useful for conditions like arthritis, multiple sclerosis and cancer.

Joint Support

Another one of the ways CBD can help is by supporting the joints. Taking CBD can reduce the inflammation around your joints. Reduced inflammation can also improve the symptoms of other diseases as well.

Insomnia Reduction

When you are in a lot of pain, it can feel impossible to sleep at night. In one study of Sativex and rheumatoid arthritis, many participants were able to sleep better when they used the drug. Cannabinoid products can help reduce physical discomfort and inflammation, which can naturally improve the quality of your sleep.

How Can You Use CBD?

You no longer have to roll a joint to use cannabis. Instead, there is a wide variety of different methods available for taking CBD. From edibles to topicals, you can choose the option that works best for you.

Until recently, the legality of CBD was in question. Some states legalized medical marijuana and recreational marijuana, but marijuana was still illegal on a federal level. Since CBD is made from the cannabis plant, this essentially meant that CBD was illegal.

More recently, the 2018 Farm Bill finally became law. This bill essentially legalized hemp under federal law with a few important caveats. While growers could produce hemp and CBD, they were not allowed to produce THC. Farmers can legally grow hemp, but the hemp is not allowed to have any THC in it. Is CBD Safe?

One of the biggest problems with CBD is knowing how much to take and which drugs to avoid. Because CBD has not gone through major clinical trials yet, there are still many unknowns about things like the dosage and other factors. If a medication is strong enough to cause a cure, it is safe to assume that it is also strong enough to cause side effects and drug interactions. Current research and anecdotal reports generally indicate very few side effects associated with CBD, but there are some potential risks to keep in mind.

Because of the potential side effects, it is important to talk to your doctor before taking CBD. This is especially important if you have other medical conditions or take any medications. CBD can change how prescription medications are processed in the liver. This means it can potentially cause drug interactions with medications like Zofran, Clozaril, Endometrin, Luminal, Valium, Prilosec, Motrin, Celebrex, Paxil and Allegra.

In general, most experts agree that CBD is safe to take. It carries very low risks. Currently, there has never been a reported case of a CBD overdose. CBD can potentially cause drowsiness for some users, so you should remember this if you plan on operating heavy machinery or driving. How Can You Use CBD for Arthritis?

When you first start using CBD, it is a good idea to start with a low dosage. By doing this, you can give your body time to adjust to the medication. If you do not see results, you can always increase your dose later on. Most people take CBD twice a day. In the beginning, people often start with a dose between 5 and 10 milligrams. If this does not alleviate your symptoms, you can gradually increase your dosage incrementally until you reach up to 100 milligrams a day. While scientists still do not know how all of the cannabinoids work, it seems like some cannabinoids work better when they are taken together. For example, taking THC and CBD at the same time may increase the effectiveness of your dose. With a full-spectrum oil or isolate, you can get a range of cannabinoids instead of just CBD.

For arthritis pain, some people start by just using the product at night so that they can sleep better. You can also start by using a topical product or vaping so that you get immediate effects. Then, you can use edibles. Candies and edible products take longer to take effect, but the effects last longer. Vaping the extract allows CBD to get into your bloodstream quickly, which is useful for acute pain relief.

If you use CBD orally, remember that your body may be unable to absorb the CBD for around an hour. Once the oral CBD is absorbed, it can last for a long time. If you have localized pain, you may want to use a topical remedy like a salve, lotion or balm instead. When you apply a CBD gel on the affected area, you can instantly get relief for acute pain, swelling and inflammation.

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The Ultimate Guide to CBD and Seniors With Arthritis - Cleveland Scene

EXTON, Pa., June 23, 2020 /PRNewswire/ --Spherix recently published the inaugural report of the semiannual report series included in their RealTime Dynamix: Psoriatic Arthritis (EU)service, which captured the responses of 246 EU5 rheumatologists surveyed last month. The market intelligence firm has been closely tracking the US psoriatic arthritis (PsA) market on a quarterly basis since 2016 and has observed a relatively stagnant treatment landscape over the past few years. However, the possible introduction of Janssen's IL-23 inhibitor, Tremfya, to both the EU and US PsA markets before the year is over will carry with it the debut of a novel class to the indication, likely causing a stir in rheumatologists' treatment algorithm.

According to the new Spherix report, TNF inhibitor use for the treatment of PsA across the EU5 remains widespread, accounting for two-thirds of all biologic/small molecule-treated patients. For adalimumab, etanercept and infliximab, use is relatively split between biosimilars and the branded reference agent (AbbVie's Humira, Amgen's Enbrel, and Janssen's Remicade, respectively), though use of Enbrel has been most eroded by generic competition.

When looking at use of alternate mechanism of action (AMOA) agents, Novartis' Cosentyx is the most penetrated brand across the EU5, showcasing the highest user base and self-reported brand share among all AMOA agents, followed by Janssen's Stelara. Eli Lilly's second-in-class IL-17 inhibitor, Taltz, has yet to reach the same heights as Cosentyx, and EU5 rheumatologists most often cite their level of experience as the key differentiator between the two agents. This, coupled with the fact that only one-quarter of respondents believe the two IL-17 inhibitors to be completely interchangeable, suggests that Taltz has ample room to grow (given more experience with the brand).

In fact, when assessing rheumatologists' six-month projected biologic/small molecule brand share in PsA, Taltz and Pfizer's Xeljanz are poised for the greatest growth. While Xeljanz is currently even-keeled with Taltz, Lilly's agent is expected to outgrow Pfizer's in the coming months, with anticipated share of Taltz expected to nearly double.

Despite the advantage of oral administration and a unique MOA in the EU PsA market, Xeljanz is struggling to surpass rheumatologists' expectations, and the majority of use is seen in second or later lines of therapy. Just shy of two years post EMA approval, respondents report long-term safety concerns as the most common primary barrier to use for the JAK inhibitor.

Interestingly, Spherix data included in a complementary service reveals EU5 rheumatologists' noticeable preference for Lilly's Olumiant over Xeljanz for the treatment of rheumatoid arthritis, and respondents perceive Olumiant's JAK 1/2 pathway to be the safest option regarding cardiovascular side effects. This is likely a contributing factor in addition to a longer tenure and multiple EMA-approved dosing options in RA to the slower anticipated uptake of Xeljanz in the EU5 PsA market, as prescribers may see the TNF or IL-17 inhibitors as more viable options concerning both safety and efficacy.

Nonetheless, Tremfya (guselkumab), which is in Phase 3 clinical trials for treatment in PsA, is currently under EMA review for EU approval. The introduction of the IL-23 inhibitor will be the first of its class and is expected to throw a curve in rheumatologists' current trajectories. Surveyed rheumatologists also provided six-month projected use patterns considering the commercialization of Tremfya in PsA, and respondents estimate the new entrant will capture a sizeable portion of the market.

As a result, in a post-Tremfya world, EU5 rheumatologists predict continued erosion of the TNF inhibitors and a significant reduction in the projected growth for Taltz and Xeljanz. Cosentyx share is also slated to decrease while Stelara and BMS' Orencia remain relatively stable. One-quarter of surveyed respondents consider Tremfya to be an advance over other treatments, and the majority cite "efficacy in skin/use in psoriasis" as the greatest advantage of the IL-23 class. On the other hand, perceived efficacy of the IL-23 inhibitors could also contribute to lackluster penetration of the class, as overall efficacy was also the number one disadvantage reported by rheumatologists, likely referring to unknown performance in joints for the treatment of PsA.

That is where other late-stage pipeline assets come in and set the stage for an even more dynamic future treatment landscape. Earlier this month, AbbVie announced the EMA regulatory application submission for their JAK inhibitor, Rinvoq (upadacitinib), for the treatment of PsA. While the JAK will likely come second to the Tremfya launch and will not bring with it the introduction of a novel class, early uptake and encouraging efficacy perceptions of Rinvoq for the treatment RA will likely translate to greater use in PsA (granted looming safety concerns surrounding the class do not prevail).

About RealTime DynamixRealTime Dynamix: Psoriatic Arthritis (EU)is an independent service providing strategic guidance through rapid and comprehensive semiannual reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave.

About Spherix Global InsightsSpherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact:Kristen Henn, Business Development ManagerEmail:info@spherixglobalinsights.comwww.spherixglobalinsights.com

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EU5 Rheumatologists Expect the Introduction of Janssen's Tremfya in Psoriatic Arthritis to Blunt Anticipated Growth of Eli Lilly's Taltz, Novartis'...

The latest report pertaining to Rheumatoid Arthritis Diagnosis Tests Market provides a detailed analysis regarding market size, revenue estimations and growth rate of the industry. In addition, the report illustrates the major obstacles and newest growth strategies adopted by leading manufacturers who are a part of the competitive landscape of this market.

Rheumatoid arthritis is a long-term, progressive and disabling autoimmune disease (as in this condition a persons immune system mistakes the bodys healthy tissues for foreign invaders). It is also a systemic disease, which means it affects the whole body. It causes inflammation, swelling, and pain in and around the joints and other body organs.

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It most commonly affects the hands and feet first, but it can occur in any joint. Its major symptoms includes; pain, swelling, and stiffness in more than one joint, symmetrical joint involvement, joint deformity, unsteadiness when walking, a general feeling of being unwell, fever, loss of function and mobility, weight loss, weakness and others. There are several different types of rheumatoid arthritis, some of them are seropositive RA, seronegative RA and JIA (juvenile idiopathic arthritis). It affects adults of any age, although most people are diagnosed between the ages of 40 and 60 and it is two to three times more common among women than men. A diagnosis of rheumatoid arthritis is based on the patients symptoms, a physical examination and the results of x-rays, scans and blood tests.

Global rheumatoid arthritis diagnosis tests market report is segmented on the basis of type, end-user and region & country level. Based upon type, global rheumatoid arthritis diagnosis tests market is classified into serology tests and monitoring rheumatoid arthritis treatment efficiency tests. The serology tests segment is further categorized into erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, antinuclear antibody, uric acid and others. The monitoring rheumatoid arthritis treatment efficiency tests segment is further categorized into muscle enzyme tests, salicylate level count and creatinine test. Based upon end-user, global rheumatoid arthritis diagnosis tests market is divided into hospitals, diagnostics laboratories and ambulatory surgical centers.

The regions covered in this Rheumatoid Arthritis Diagnosis Tests Market report are North America, Europe, Asia-Pacific and Rest of the World. On the basis of country level, the market of rheumatoid arthritis diagnosis tests is sub divided into U.S., Mexico, Canada, U.K., France, Germany, Italy, China, Japan, India, South East Asia, Middle East Asia (UAE, Saudi Arabia, Egypt) GCC, Africa, etc.

Key Players

Some major key players for Global Rheumatoid Arthritis Diagnosis Tests Market are Antibodies Inc., Euro Diagnostica AB, Qiagen NV, Siemens Healthcare GmbH, Bio Rad Laboratories Inc., Genway Biotech, Inc., Abbott Diagnostics, Beckman Coulter, Inc., F. Hoffmann-La Roche Ltd., Thermo Fisher Scientific Inc. and others.

Increasing Aging Population Coupled with the Increasing Prevalence of Rheumatoid Arthritis is Expected to Drive the Market Growth.

The major factor driving the growth of global rheumatoid arthritis diagnosis tests market is increasing aging population coupled with the increasing prevalence of rheumatoid arthritis globally. For example; As per National Center for Biotechnology Information, U.S.; The number of people with rheumatoid arthritis is projected to increase from 422,309 in 2015 to 579,915 in 2030. Health care costs for rheumatoid arthritis were estimated to be over $550 million in 2015, including $273 million spent on biologic disease-modifying antirheumatic drugs. Health care costs for rheumatoid arthritis are projected to rise to over $755 million by the year 2030.

In addition, increasing cases of obesity and growing cigarette smoking population are also anticipated to drive the growth of global rheumatoid arthritis diagnosis tests market. As Cigarette smoking significantly increases the risk of developing rheumatoid arthritis and obese people significantly have greater chance of developing rheumatoid arthritis than the healthy weight person. For example; the model created by Dr. Finkelstein and his colleagues at Duke and the Centers for Disease Control and Prevention estimated that the U.S. obesity rate will be at 42% by 2030. Furthermore, increasing awareness about the rheumatoid arthritis diagnosis tests and improving healthcare infrastructure are also supplementing the growth of the market. However, higher costs of these RA diagnostic test kits may hamper the market growth.

North America is Expected to Dominate the Global Rheumatoid Arthritis Diagnosis Tests Market

The global rheumatoid arthritis diagnosis tests market is segmented into North America, Europe, Asia-Pacific Latin America and Middle East & Africa. North America is expected to dominate the global rheumatoid arthritis diagnosis tests market within the forecast period attributed to the highly developed healthcare infrastructure and increased awareness in this region. Europe is projected to capture the significant share of global rheumatoid arthritis diagnosis tests market owing to the increasing obese population in this region. For example; The percentage of obese people in the countries of the European Union continues to increase every year. The dynamics of obesity growth in Europe is greater for men than for women (3.09% per year vs. 1.92% per year). With the growth rate remaining at the estimated level, in 2030 there will probably be more obese men (38.1%) than women (32.7%) in Poland, and in Europe likewise 36.6% and 32.0%, respectively. Asia Pacific is anticipated to witness a lucrative growth in global rheumatoid arthritis diagnosis tests market owing to the increasing research and development for new and more effective treatments and increasing cases of autoimmune diseases in this region.

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Rheumatoid Arthritis Diagnosis Tests Market Types, Trends, Size, Share, Industry Insights, Trends and Forecast upto 2025 - Cole of Duty

Significant increases were observed over time in age at arthroplasty and disease duration before the first arthroplasty in patients with juvenile idiopathic arthritis (JIA), according to study results published in Arthritis Care & Research. Researchers noted that JIA category, calendar year of arthroplasty, and the presence of complications were significantly associated with implant survival.

Investigators conducted a retrospective cohort study of patients with JIA who underwent total joint replacement surgery at a hospital in Milan, Italy between January 1992 and June 2019. Demographic and clinical data were extracted from patients medical records. Patients were followed up from their arthroplasty for implant survival, complications, and/or revision surgeries. The primary aim of the study was to describe trends in arthroplasty. Implant survival was calculated using the Kaplan-Meier method; predictors of survival were identified using Cox regression models.

Between 1992 and 2019, a total of 198 arthroplasties were observed in 85 patients (65% women). Median age at first prosthesis was 22.7 years and median disease duration before the first implant was 17.4 years. The most represented JIA categories were polyarticular and systemic JIA. No significant differences in age at arthroplasty, disease duration before surgery, number of implants, and rate of complications were observed between JIA categories. The most frequently replaced joint was the hip, followed by the knee and ankle.

Compared with patients who underwent surgery before 2000, patients treated after 2010 were significantly older (mean ages, 21.93 vs 27.81 years, respectively). Similarly, mean disease duration before arthroplasty increased from 16.98 to 22.93 years. Rates of implant survival at 5, 10, and 15 years ranged from 84% to 89%, with 52% of implants lasting for 20 years. Compared with patients with polyarticular JIA, those with systemic JIA had lower survival rates at 10, 15, and 20 years (P <.001). According to multivariate analysis, the year of surgery was significantly associated with implant survival (hazard ratio [HR], 1.0004; 95% CI, 1.0002-1.0006; P <.001). The absence of complications predicted greater survival (HR, 3.69; 95% CI, 1.82-7.48; P <.001).

Between 1992 and 2019, significant upward trends were observed in age at arthroplasty and disease duration before arthroplasty in a cohort of patients with JIA. Procedure year, complications, and JIA subtype were each significantly associated with implant survival.

As study limitations, investigators noted the lack of data on implant functionality and health-related quality of life, as implant survival alone may have be an insufficient measure of arthroplasty experience. The upward trend in age at arthroplasty could have reflected the increased efficacy of other medical treatments, such as disease-modifying antirheumatic drugs.

The progressive improvement of medical treatment will lower the need for total joint replacement. Future researches should assess functional outcome and survival of implants in relation to medical therapy and different surgical approaches, the investigators wrote.

Reference

Marino A, Pontikaki I, Truzzi M, et al. Early joint replacement in juvenile idiopathic arthritis (JIA): trend over time and factors influencing implant survival [published online May 31, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24337

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Age at Arthroplasty, Disease Duration Increased With Time in Patients With Juvenile Idiopathic Arthritis - Rheumatology Advisor

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic inflammatory disease characterized by pain and inflammation in joints, typically of the hands and feet. It is an autoimmune disease in which the immune system of the body attacks its own healthy cells, resulting in inflammation of the membrane lining the joints (synovial membrane) and damage to joint tissue.

Rheumatoid arthritis also affects other organs such as the skin, heart, lungs, and eyes. The annual incidence of rheumatoid arthritis is approximately three cases per 10,000 people worldwide.

What is the main cause of rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown. However, some of the contributing factors to rheumatoid arthritis are:

What are the symptoms and signs of rheumatoid arthritis?

While rheumatoid arthritis is a chronic disease, there are times when symptoms worsen (flares) and times when the patient recuperates from the symptoms (remission). Some of the most common signs and symptoms of rheumatoid arthritis observed are:

What are the four stages of rheumatoid arthritis?

The American College of Rheumatology classifies rheumatoid arthritis into four stages, based on the disease progression and radiologic findings:

Based on the function of the patient, rheumatoid arthritis can be classified as:

How can be rheumatoid arthritis diagnosed?

Rheumatoid arthritis can be diagnosed based on its clinical presentation in the joints as well as using the following blood tests:

Radiographic findings are used by the doctor to assess the arthritis progression. The physician may suggest a magnetic resonance imaging (MRI) or joint aspiration for further evaluation.

What is the treatment for rheumatoid arthritis?

The goals of the treatment of rheumatoid arthritis include:

The treatment approach involves treating the disease with medication, education, and lifestyle modifications.

Drugs used to treat rheumatoid arthritis are:

Surgical treatment can be required for severe joint damage.

What are the complications of rheumatoid arthritis?

Rheumatoid arthritis can lead to the following complications:

Rheumatoid arthritis is not curable but with appropriate treatment, the disease can be controlled. Treatments are most effective when initiated early in the disease.

Medically Reviewed on 6/19/2020

References

https://emedicine.medscape.com/article/331715-overview

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What Is the Main Cause of Rheumatoid Arthritis? 4 Stages - MedicineNet

When you have an inflammatory disease like rheumatoid arthritis (RA), what you do every day can majorly impact your joints and your level of pain.

While treatment and medications will vary from patient to patient, doctors typically tell people living with RA to get regular activity since its been shown to reduce arthritis-related joint pain and delay disability. The Centers for Disease Control and Prevention (CDC) specifically recommends that RA patients strength train twice a week and do at least 150 minutes of moderate-intensity cardio (think: fast walking, swimming, and running) weekly.

But lets be real: Its one thing to hear that exercise can help, and another to actually do it when youre not feeling your best. To help you stick to a routine, we asked three women living with RA how they stay active on the regular.

Rheumatoid arthritis advocate Eileen Davidson, who blogs at ChronicEileen.com, says she makes working out at home a priority to help combat her RA symptoms. She tends to use an elliptical, but also likes going for brisk, long walks and doing pilates and yoga videos on YouTube. I just do the moves I can do. Davidson says.

Davidson loves doing yoga videos at home and going on long walks.

Davidson said she started small with working out and saw benefits from exercising and her medication, like less pain in her joints. The important thing was that I started and stayed consistent, she says. Now, when I am feeling crummy, I know that moving my body a little will help me feel better.

Linda Luckmann, who identifies herself on Instagram as a rheumatoid arthritis warrior, discovered after her diagnosis that she loves Zumba and taking long walks. It hurts sometimesmy joints don't feel greatbut being active definitely helps keep me feeling good, she says.

Luckman says being active helps her symptoms under control. But at the same time, she listens to her body when she needs to take a day off.

Still, Luckmann says there are some days when she needs to rest. I have to know how much energy I can spend doing things each day because you dont want to completely drain yourself, she says, pointing out that shes still not pain-free. Every day there is discomfort, but you kind of get used to it and learn to appreciate the days you feel less crappy, she says.

Davidson says she does all her strength training at home because she feels more comfortable and motivated when she has privacy. My balance is off, and I need to break things up, she says.

Chronic illness advocate Mariah Zebrowski Leach, who runs a blog about her life with RA called From This Point. Forward., was playing college water polo when she was initially diagnosed with RA. She eventually had to quit the team after her symptomswhich included pain, severely swollen joints, and low energygot to be too much. Now, shes found different ways to stay active.

Living with RA has actually encouraged me to try things I might not have done otherwise, she says. Leachs husband did a fundraising 525-mile bike ride, which inspired her to take up cycling. I had never been on a road bike before, but I bought one and started riding it, she said. She eventually ended up doing the same 525-mile bike ride as her husband. Its funny to me that one of the greatest athletic achievements of my life happened because of my RA diagnosis, she says.

Leach now has three kids, and says she largely stays active by doing walks and bike rides with them. I wore my third baby [in a baby carrier] a lot while trying to keep up with her very active brothers, she says, noting that it helped take the strain off of her hands and wrists, and made her core stronger.

Leach takes a moment to enjoy the scenery while on a family hike.

Leach was a snowboarder before she had RA, and says she stopped doing the sport for five years after she was diagnosed. Even when we found a treatment plan that was effective, for a long while I was still afraid to get back on my snowboard because I was worried about injuring myself, she says. It took a few more years for me to understand my new body well enough to try snowboarding again.

Now, Leach says she snowboards at a very different pace than I used to, adding, its more about getting out on the beautiful mountain and enjoying a few runs and fresh air than shredding all day long or doing double black diamonds.

Regular activity can help combat symptoms of rheumatoid arthritis, but everyone is different. If youre struggling with symptoms of RA, check in with your doctor. They should be able to provide personalized guidance to help.

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How 3 Women Stay Active with Rheumatoid Arthritis - Women's Health

For the first time, nationally endorsed performance measures in British Columbia, Canada, were operationalized using administrative data, allowing for population-level quality of care reports on patients with rheumatoid arthritis (RA). The reports showed improvements in access to rheumatologist care and early treatment over time, although suboptimal rates of specialist follow-up and accompanying low levels of disease modifying antirheumatic drug (DMARD) use persisted, according to study findings published in Arthritis Care & Research.

This longitudinal population-based RA cohort study used administrative health data to operationalize and report on 4 of 6 nationally endorsed RA performance measures developed by the Arthritis Alliance of Canada. The 4 tested performance measures were: percentage of incident patients with 1 rheumatologist visits within 365 days of diagnosis; proportion of prevalent RA patients with 1 rheumatologist visits per year; percentage of prevalent RA patients who received DMARD therapy; and time from RA diagnosis to DMARD prescription. All adult patients who received care for RA in British Columbia from January 1, 1997, to December 31, 2009, were identified and followed until December 2014.

A total of 38,673 incident cases and 57,922 prevalent cases of RA were included in the cohort. Although the percentage of patients seeing a rheumatologist in the first year of diagnosis was suboptimal, rates improved from 35% in 2000 to 65% in 2009. Improved performance was noticed in patients who ever saw a rheumatologist in follow-up, which increased from 74% in 2000 to 96% in 2009; however, the lower performance in earlier years could have been due to longer follow-up times. When the measure was reported as patients seeing a rheumatologist within the first 5 years, the performance became 88% in 2000 and 97% in 2009.

The percentage of patients with RA under the care of a rheumatologist declined from 79% in 2001 to 39% in 2014 using the fixed interval method, or from 82% in 2001 to 42% in 2014 using the gaps method. Among patients not under the care of a rheumatologist, DMARD use was suboptimal, with little improvement over time. Overall, regardless of physician type, only 37% of patents were prescribed a DMARD in 2014, with the highest rates of DMARD use (87% in 2014) seen among patients under active rheumatology care. The median time from RA diagnosis to DMARD therapy initiation in patients seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 21% and 34% receiving DMARD treatment within the 14-day benchmark in 2000 and 2009, respectively.

The investigators concluded that the results of this study will inform further reporting on the measures nationally and help serve in benchmarking when planning quality improvement and advocacy work.

Timely communication of performance at the practice level could be used to influence clinical care, they added.

Reference

Barber CEH, Marshall DA, Szefer E, et al. A population-based approach to reporting system-level performance measures for rheumatoid arthritis care [published online March 7, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24178

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PopulationBased Reports of National Rheumatoid Arthritis Care Performance Measures - Rheumatology Advisor

The following article is part of coverage from the American Academy of Dermatologys Annual Meeting (AAD 2020). Because of concerns regarding the coronavirus disease 2019 (COVID-19) pandemic, all AAD 2020 sessions and presentations were transitioned to a virtual format. While live events will not proceed as planned, readers can click here to view more news related to research presented during the AAD VMX 2020 virtual experience.

Patients with a newly recorded diagnosis of hidradenitis suppurativa (HS) have increased risks for developing inflammatory arthritis, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA), according to study results presented at the American Academy of Dermatologys Virtual Meeting Experience (AAD VMX) 2020, held online from June 12 to 14, 2020.

To evaluate and compare the risk for inflammatory arthritis in patients with vs without HS, researchers collected data from patients having commercial insurance in the United States, from January 1, 2003 to January 1, 2017. The study cohort included patients with newly diagnosed HS who were propensity score-matched 1:1 with control participants without HS with similar risk profiles. All participants were followed until 1 of the events, including primary outcome, death, disenrollment, or end of datastream, occurred. The main outcome of the study was a new diagnosis of inflammatory arthritis, including AS, PsA, other spondyloarthritis (SpA), or RA. Researchers conducted all statistical analyses using a validated version of the Aetion Evidence Platform.

Researchers identified 70,697 patients with HS (mean age, 36.5414.65 years; 78.0% women) and 141,411 without HS (mean age, 38.2921.12 years; 52.0% women) after 2:1 risk set sampling and before propensity score matching. Researchers also noted that patients did not have a range of chronic inflammatory and autoimmune conditions before cohort entry. Median follow-up for patients with and without HS was 527 and 539 days, respectively.

After propensity score matching, results showed that age, sex, healthcare utilization, and comorbidities were similar between both groups. Patients with vs without HS (n=60,872 for both) had a 65%, 44%, and 16% increased risk for AS, PsA, and RA, respectively (incidence rates, 0.6 vs 0.4, 0.8 vs 0.6, and 4.5 vs 3.9 per 1000 person-years; hazard ratios [HRs; 95% CI], 1.65 [1.15-2.35], 1.44 [1.08-1.93], and 1.16 [1.03-1.31], respectively). Researchers did not observe any association of HS with other SpA (HR, 1.02; 95% CI, 0.89-1.93), including reactive arthropathy, spinal enthesopathy, sacroiliitis, or unspecific inflammatory spondylopathies.

Researchers concluded, Given the high burden of disease associated with both HS and arthritis, physicians treating patients with HS should be aware of symptoms suggestive of inflammatory arthritis (ie, morning stiffness, joint pain or swelling).

Reference

Schneeweiss MC, Kim SC, Schneeweiss S, Rosmarin D, Merola JF. Hidradenitis suppurativa and the risk of inflammatory arthritis: a population-based follow-up study. Presented at: AAD VMX 2020; June 12-14, 2020. Poster 14344.

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Increased Risk for Inflammatory Arthritis in Patients With Newly Diagnosed Hidradenitis Suppurativa - Dermatology Advisor

Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue.

Osteoarthritis, on the other hand, is attributed to lifestyle factors such as injury and obesity, and genetic factors such as family history.

Both are also united in their lack of cure but there are a number of treatments to help relieve the symptoms.

Several research studies suggest the anti-inflammatory properties found in ginger can have an alleviating effect, for example.

READ MORE:Arthritis symptoms: The tell-tale signs you could have the condition in your knees

Taking ginger extract helped to reduce knee pain upon standing and after walking.

What's more, researchers in study published in The Journal of Pain found that ginger was an effective pain reliever for human muscle pain resulting from an exercise-induced injury.

Participants who ingested two grams of either raw ginger or heated ginger experienced reduced pain and inflammation.

Heat-treated ginger was thought to have a stronger effect, but both types of ginger were found to be equally helpful.

Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems, says the NHS.

In fact, exercise can bring both direct and indirect benefits for managing arthritis, notes the health body.

In addition to aiding weight loss, exercise can:

"Your GP can recommend the type and level of exercise that's right for you," adds the NHS.

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Arthritis treatment: The natural extract shown to be as effective as a pain relief drug - Express

If you or someone you love has rheumatoid arthritis, youve probably thought about remission from rheumatoid arthritis more than once. As you likely know, rheumatoid arthritis is a very serious illness, and it can often be debilitating. So the concept of achieving remission can feel like a beacon of hope.

Today more than 1.3 million Americans are living with rheumatoid arthritis, and about 75 percent of them are women, according to the American College of Rheumatology. Rheumatoid arthritis is the most common form of autoimmune arthritis and causes pain, stiffness, and swelling in the joints of the hands, feet, and wrists.

As a quick refresher: Autoimmune diseases like rheumatoid arthritis arise when the bodys immune systemwhich typically keeps you healthy and defends against diseasestops working properly and mistakenly attacks healthy cells in your body, according to the U.S. National Library of Medicine. But with new advances in treatment options, it is possible to stop or slow the progression of rheumatoid arthritis with the right treatment. In some cases, people are even able to achieve a state of remission where the joints arent seeing further damage and the disease doesnt interfere with day-to-day living. Heres what you need to know about achieving rheumatoid arthritis remission.

Rheumatoid arthritis remission is defined as very, very low disease activity, or no disease activity for a particular individual, Dana DiRenzo, M.D., rheumatologist and instructor of medicine at Johns Hopkins Medicine, tells SELF.

You dont need to be completely free of symptoms to be in a state of remission, Dr. DiRenzo explains, but you would rate how your joints are feeling somewhere around a 0 or 1 out of 10, where 10 indicates the most pain or discomfort and 0 is the least.

There is no definitive answer to how many people achieve remission from rheumatoid arthritis, but it may fall somewhere between 5% and 45%, according to a 2017 analysis of studies. Diagnosis and aggressive treatment early on in the course of the illness seems to be an important factor in achieving remission, according to the Arthritis Foundation.

Remission can be achieved at any point, Dr. DiRenzo says, but its more likely with earlier treatment, especially within the first six to 12 months or so after diagnosis.

While there isnt one specific test that can show when someone is in remission, a rheumatologist can determine if youre in remission by evaluating your reported symptoms along with a number of clinical signs and symptoms. In the process, theyll often use a scoring guide such as the Clinical Disease Activity Index (CDAI) or the Disease Activity Score (DAS / DAS28). These scoring guides bring together different criteria and test results to measure disease activity for each patient in order to indicate how active the disease is at a specific point in time.

So this way we have an idea of whos doing really well and whos having a lot of disease activity, Fotios Koumpouras, M.D., rheumatologist, assistant professor of medicine at Yale School of Medicine, and director of the Yale Lupus Program, tells SELF.

Being in remission doesnt look exactly the same for everyone, but if youre in remission youll experience very minimal joint symptoms or none at all, and your joint symptoms wont interfere with your day-to-day life in any way.

Typically, a combination of medication and lifestyle changes are needed in order to achieve remission, but the exact requirements for achieving remission wont be the same from person to person.

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What Does It Mean to Be in Remission from Rheumatoid Arthritis? - Self

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Early, intensive treatment that combines methotrexate with prednisone can reduce the debilitating fatigue tied to rheumatoid arthritis even in patients at low risk of severe disease, finds a two-year study.

Rheumatoid arthritis causes chronic inflammation that can lead to weakness, exhaustion, and abnormal tiredness in up to 90% of patients, explained researchers from Belgium. Their study examined whether intensive treatment directly after diagnosis could change the disease course and reduce fatigue.

The investigators followed 80 patients with a low risk profile who were randomized into two groups. Immediately following diagnosis, participants received either 15 mg of methotrexate weekly or a combination therapy of 15 mg of methotrexate weekly plus cortisone (prednisone), starting at 30 mg and tapered weekly to 5mg. Both methotrexate and prednisone suppress inflammation, but prednisone is a quicker-acting anti-inflammatory and researchers used it as a bridge between initial treatment and the time the methotrexate took to be effective.

While disease activity in both groups was comparable over time, patients who received the intensive combination therapy for two years were less tired than patients in the monotherapy control group. Differing fatigue levels between the groups became more pronounced over time, the researchers reported.

In response, the European League Against Rheumatism has recommended that clinicians consider initiating early, intensive treatment, even in low-risk patients.

The study was published in Annals of Rheumatic Diseases.

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Early drug therapy eases exhaustion in rheumatoid arthritis patients: study - Clinical Daily News - McKnight's Long Term Care News

Objective:To investigate the association between allergic rhinitis (AR) and the risk of rheumatoid arthritis (RA).

Methods:Potentially eligible studies were identified from MEDLINE and EMBASE databases from inception to November 2019. Eligible cohort study must report relative risk with 95% confidence intervals (95% CIs) of incident RA between AR patients and comparators. Eligible case-control studies must include cases with RA and controls without RA, and must explore their history of AR. Odds ratio with 95% CIs of the association between AR and RA must be reported. Point estimates with standard errors from each study were combined using the generic inverse variance method.

Results:A total of 21,824 articles were identified. After two rounds of the independent review by three investigators, two cohort studies and 10 case-control studies met the eligibility criteria. The pooled analysis showed no association between AR and risk of RA (RR = 0.94; 95% CI, 0.73 to 1.20; I2= 84%). However, when we conducted a sensitivity analysis including only studies with acceptable quality, defined as Newcastle-Ottawa score of seven or higher, we found that patients with AR had a significantly higher risk of RA (RR = 1.36; 95% CI, 1.12 to 1.65; I2= 45%).

Conclusions:The current systematic review and meta-analysis could not reveal a significant association between AR and RA. However, when only studies with acceptable quality were included, a significantly higher risk of RA among patients with AR than individuals without AR was observed.

Keywords:allergic rhinitis; hay fever; meta-analysis; rheumatoid arthritis; systematic review.

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The Association Between Allergic Rhinitis and Risk of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis - DocWire News

A new paper provides timely evidence to explain the therapeutic benefits of vagal nerve stimulation(VNS), a nervous system-modifying treatment that proponents say could offer relief to patients with lupus, arthritis and even heart failure.

Its a prospect that sounds too good to be true. One 20-minute outpatient surgery could lead to relief from epilepsy, depression, arthritis, heart failure and lupus. Thats the ultimate promise of VNSn, a technique that has accrued interest from enthusiastic startups and major biopharma firms alike.

Importantly, it has also accrued some convincing evidence to back up at least some of its claims VNS has been approved by the FDA as a therapy for treatment-resistant depression and epilepsy. As of 2015, 100,000 people worldwide had received a VNS implant.

But large gaps remain in our understanding of how VNS works. One of those gaps has now been plugged with the publication of a paper investigating how a technique called anodal block works to allow targeted stimulation during VNS. The research team behind the paper, led by Dr Stavros Zanos, have published their work in Scientific Reports.

VNS involves implanting electrodes on the vagal nerve near the carotid artery in the neck. The vagal nerve is in charge of routing signals between the brain and the peripheral organs. As Zanos, an assistant professor in the Institute of Bioelectronic Medicine at the Feinstein Institutes for Medical Research, explains, this means it is a uniquely attractive target for neurotechnology. This is primarily the nerve that the brain uses to convey information to the organs and change the way they function. And also, it's the main nerve through which information about the function of the organs is conveyed back into the brain. Because it's such an important nerve for ongoing physiology, it's a very attractive target for neuromodulation, says Zanos.

During VNS implantation, a pair of electrodes is attached to the vagus nerve. Depending on the electrode polarity, signals to or from the brain are stimulated or blocked when the VNS device is activated.

But the nervous system is a little more complicated than a two-lane highway. Nerve fibers sending signals in different directions exist within these larger bundles. Getting the level of stimulation right to ensure therapeutic benefit is of central importance, but is currently done quite crudely, Zanos tells me: The way VNS is done clinically is by increasing intensity. The healthcare provider changes some parameters, most notably the intensity, until the patient starts getting some side effects. Typically, those side effects have to do with contraction of the laryngeal muscles, so it causes coughing, and voice hoarseness.

This is far from optimal, and Zanos says that fine-tuning the approach is a priority. If we wanted to deliver an individualized therapy, we would have to know exactly how we're affecting the physiology of a specific individual, he says.

Anodal block is a central tenet of the current surgical procedure. The precise placement of the VNS electrodes can limit nerve conduction in the fibers under the positively charged anode back in the simplified highway example, this is the equivalent of setting up a tollbooth for traffic going in one direction the flow is slowed, if not stopped. But evidence that anodal block works this way in practice was sorely lacking from the wider literature. Would it be possible to find a biomarker, Zanos wondered, that could show that anodal block works as intended?Zanos and his team investigated this possibility by carrying out experiments with rats. Firstly, they needed to see what would happen when electrical impulses up and down the vagus highway were stopped entirely. The rodents had VNS devices implanted, and then had their vagus nerve cut either above or below the implant completely ending any vagus electrical stimulation towards the brain or the peripheral organs, respectively.

Zanos team noticed a consistent marker. Rats with intact vagus nerves showed a heavy reduction in their breathing and heart rates. When the same rats had their vagus nerve severed near the brain, the rats breathing rates returned to normal whilst the heart rate remained low. Severing the nerve nearer to the body had the opposite effect.

This told Zanos team that:

With these easy-to-measure markers identified, the next step was to work out whether breathing and heart rate were consistently affected by anodal block.The theories behind anodal block suggested that if the anode polarity was towards the brain, then the VNS devices effects on breathing rate would be reduced. Anode polarity facing the body would impair the effects on heart rate.

Whilst the same drastic changes seen in the first experiment were not present the rats in this group had intact vagus nerves, so signals still traveled both ways Zanos noted that their results supported the theories around anode block in a large number of the rats studied.

Importantly, these results werent consistent across all the rats studied. Three rats actually showed reversed effects. This paradox, says Zanos, is likely to be explained by the stimulation of the nearby aortic depressor nerve by the VNS. This unintended stimulation hasnt proved an issue in human VNS studies, so is likely to be a quirk only seen in certain rodents.

Even if the inconsistent data has an explanation, the study still highlights that the mechanisms behind VNS would be much easier to understand if those individual types of nerve fiber could be better identified. Zanos says this will be the target of an upcoming paper that should advance understanding in the area further. In the upcoming paper, says Stavros, We look at even finer relationships between some of these biomarkers; heart rate, breathing rate, but also additional biomarkers with the activation of specific fiber types.

Zanos suggests his teams data supports the idea that anodal block can make VNS more directional and targeted. But there is obviously more research to be done to support our understanding of why VNS works. This, says Zanos, could lead to the technique meeting its potential sooner than we might think. He highlights two US-based companies, LivaNova and Set Point Medical, who are investigating VNS for heart failure and rheumatoid arthritis respectively. My guess is that in the next two or three years at least one of these [companies], based on what I what I see in preliminary reports, will be successful, and VNS will be part of the therapeutic options for physicians for these two diseases.

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Vagus Nerve Stimulation Breakthrough Suggests Route To Therapies for Arthritis, Heart Failure - Technology Networks

Plasma omega-3 levels, body mass index (BMI), and smoking history are predictors of treatment response in patients with early rheumatoid arthritis (RA), according to study data published in ACR Open Rheumatology. As such, modification of these lifestyle factors may be beneficial in improving treatment response in this population.

This study enrolled patients with recent-onset RA (disease duration <12 months) who were attending the Early Arthritis Clinic at the Royal Adelaide Hospital in Australia. The researchers aimed to examine lifestyle factors as predictors for treatment response in early RA. Patients with prior exposure to disease-modifying antirheumatic drugs (DMARDs) were excluded.

Enrollees received triple therapy with conventional synthetic DMARDs sulfasalazine, hydroxychloroquine, and methotrexate. Every 3 to 6 weeks, patients returned to the study clinic for evaluation of treatment response. If disease response was subpar at any visit, therapeutic doses were adjusted. A subset of patients received fish oil supplementation in addition to study treatment. Disease activity was evaluated using the 28-joint Disease Activity Score (DAS28) with erythrocyte sedimentation rate (ESR). The primary end points were achievement of remission (DAS28 2.6) or low disease activity (DAS28 3.2) at 1 year.

The study cohort comprised 300 patients, of whom 211 (70.3%) were women. Mean age at RA onset was 55.514.9 years, and median disease duration at enrollment was 16.0 weeks. Mean baseline DAS28 score was 5.41.3, suggesting high disease activity. Of 300 participants, 179 (57.6%) and 136 (43.7%) achieved DAS28 low disease activity and remission at 1 year, respectively.

In the total cohort, higher mean plasma EPA level was associated with a significantly increased likelihood of achieving DAS28 low disease activity (odds ratio [OR], 1.27; 95% CI, 1.12-1.45; P <.0001) and DAS28 remission (OR, 1.21; 95% CI, 1.08-1.36; P <.001) at 1 year. Separate logistic regression models were used to examine 2-way interactions involving BMI, sex, and plasma EPA, but no significant associations were found.

An interaction between smoking status and BMI was observed for the low disease activity outcome. Specifically, increased BMI was associated with lower odds of achieving DAS28 low disease activity among participants who reported current (OR, 0.803; 95% CI, 0.670-0.962; P =.017) and prior smoking (OR, 0.913; 95% CI, 0.842-0.991; P =.029). This association was not apparent among those who had never smoked. BMI alone was also modestly associated with RA remission (OR, 0.94; 95% CI, 0.89-0.99; P =.034).

According to these results, increased omega-3 uptake and smoking cessation may benefit patients with early RA, and weight-loss treatment may also be beneficial, particularly for patients with a history of smoking. As study limitations, the investigators noted the lack of data on potential confounders, including socioeconomic status, physical activity, and medication adherence.

Reference

Brown Z, Metcalf R, Bednarz J, et al. Modifiable lifestyle factors associated with response to treatment in early rheumatoid arthritis [published online May 26, 2020]. ACR Open Rheumatol. doi:10.1002/acr2.11132

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Omega-3 Levels, Smoking, and BMI Associated With Treatment Response in Early RA - Rheumatology Advisor

The modified Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) is a strong predictor of rapid radiographic progression in patients with early rheumatoid arthritis (RA), according to research results published in ACR Open Rheumatology.

Using data from PREMIER, a 2-year, multicenter, double-blind, active comparator-controlled, phase 3 clinical trial, researchers aimed to determine which measures of disease activity best predicted rapid radiographic progression in a population of patients with early RA. They examined the DAS28-CRP; modified DAS28-CRP, using weighted coefficients of CRP, physician global assessment, and swollen joint count in 28 joints; Clinical Disease Activity Index; and patient-reported outcomes, including the patient global assessment and the Health Assessment Questionnaire Disability Index.

Disease activity measures were taken at baseline and at 3-month follow-up. Investigators defined rapid radiographic progression as a change in the modified total Sharp score of >3.5 between baseline and 12 months. A decrease in DAS28-CRP >1.2 from baseline to 3 months was considered an improvement in disease.

In total, 149 patients were included in the analysis (mean age, 52.913.3 years; 75.8% women; mean RA duration, 0.80.9 years; 85.2% rheumatoid factor positive). Mean DAS28-CRP was 6.30.9, mean Clinical Disease Activity Index was 44.712.2, and mean modified DAS28-CRP was 5.11.3. With regard to therapies, 30.9% of patients were previously treated with conventional synthetic disease-modifying antirheumatic drugs, whereas 41.6% of patients were treated with steroids.

At baseline, modified DAS28-CRP was the strongest predictor of rapid radiographic progression at 12 months (adjusted odds ratio [aOR], 3.29; 95% CI, 1.70-6.36); other measures of RA showed no significant effect on progression at 12 months. The area under the curve (AUC) for modified DAS28-CRP at baseline was also higher compared with other measures (AUC, 0.66; 95% CI, 0.57-0.74), with a significant difference noted for AUC between the modified DAS28-CRP and DAS28-CRP (AUC difference, 0.10; P =.02).

At 3 months, investigators found that all disease activity measures and patient-reported outcomes were significant predictors for rapid radiographic progression. Despite this, only modified DAS28-CRP was a significant predictor at 12 months after applying the multivariate analysis and adjusting for potential confounders (aOR, 2.56; 95% CI, 1.43-4.56). Investigators also noted that the effect of modified DAS28-CRP at 3 months was less than its effect at baseline.

Results of a multivariable logistic regression analysis demonstrated that CRP at baseline and 3 months (aORs, 2.82 and 4.03, respectively) had the strongest effect on radiographic progression predictions at 12 months.

Per the Youden index, investigators found that the optimal cutoff point for the modified DAS28-CRP at baseline was 4.5 (positive and negative predictive values 50% and 76%, respectively) in predicting rapid radiographic progression at 1 year. The 3-month corresponding optimal cutoff point for the modified DAS28-CRP was 2.6 (positive and negative predictive values 59% and 81%, respectively).

The study was limited by its relatively small sample size in the original study and an inability to access data from all treatment groups in the PREMIER study.

[A] modified version of disease activity scores, such as the [modified DAS28], might be beneficial as an alternative measure of disease activity for rheumatologists in the routine care setting for their treat-to-target approach, the researchers concluded.

Disclosure: This clinical trial was supported by Horizon Therapeutics. Please see the original reference for a full list of authors disclosures.

Reference

Movahedi M, Weber D, Akhavan P, Keystone EC. Modified disease activity score at 3 months is a significant predictor for rapid radiographic profession at 12 months compared with other measures in patients with rheumatoid arthritis. ACR Open Rheumatol. 2020;2(3):188-194.

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Modified DAS28-CRP an Effective Predictor of Rapid Radiographic Progression in Early RA - Rheumatology Advisor

The incidence and severity of coronavirus disease 2019 (COVID-19) in patients with rheumatic disease receiving disease-modifying antirheumatic drugs (DMARDs) vs the general population is not significantly different, according to study results published in Arthritis and Rheumatology.

Patients at 2 rheumatology centers in Lombardy, Italy were invited to participate in a survey for the study between February 25t and April 10, 2020. All patients with rheumatic disease were being treated with targeted synthetic or biologic DMARDs (ts/bDMARDs). The survey included data on contact with individuals infected with COVID-19, viral symptoms, and changes in behavior, or disease management; COVID-19 was confirmed by a nasopharyngeal swab.

A total of 955 patients (67.4% women; mean age, 53.714 years) with rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, and other autoinflammatory diseases, were included in the study, with a survey responder rate of 98.05%. A majority of patients were receiving anti-tumor necrosis factor (TNF) therapy (55.8%), with nearly half the patient cohort (47.3%) receiving a bDMARD as monotherapy. A total of 47.3% of patients had 1 comorbidity, mostly high blood pressure.

The survey indicated that 90.6% of patients took precautionary measures to prevent infection with COVID-19; 93.2% of patients maintained their ts/bDMARD treatment regimen, and rheumatic disease activity remained stable in 89.5%. In total, 6 patients with rheumatic diseases tested positive for COVID-19, 5 of whom were treated with anti-TNF agents; 2 patients were receiving bDMARDs as monotherapy.

Researchers observed that the COVID-19 infection rate of patients with rheumatic disease did not differ from the general population (0.62% vs 0.66%; P =.92). While half the number of infected patients (n=3) were admitted to the hospital for oxygen supplementation, none were admitted to the intensive care unit. All patients who tested positive for COVID-19 temporarily discontinued receiving ts/bDMARD therapy during viral infection. An additional 144 patients developed respiratory symptoms; however, they had no access to nasopharyngeal swabs. Of these patients who suspected to have COVID-19, 33 temporarily suspended receiving biologic therapy for an average of 16.9 days, with 9 patients reporting a disease relapse.

A limitation of this study was the cross-sectional survey design. Patients were interviewed by telephone, and it was possible that some symptoms were missed or that nonresponsive patients (n=24) were infected. Furthermore, tests for COVID-19 were unavailable for many patients who were experiencing respiratory symptoms.

Researchers concluded [The] results highlight the attitude [of patients with] rheumatic [disease] to prevent the contagion while maintaining their chronic treatments. The incidence and severity of COVID-19 in patients treated with ts/bDMARDs was not significantly different from that of the general population in the same region.

Reference

Favalli EG, Monti S, Ingegnoli F, Balduzzi S, Caporali R, Montecucco C. Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data? [published online June 7, 2020] Arthritis Rheum. doi:10.1002/ART.41388

Excerpt from:
Similar Rates of COVID-19 Incidence, Severity in Patients With and Without Rheumatic Disease - Rheumatology Advisor

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Global Rheumatoid Arthritis Treatment Market Latest Trends, Development, Growth Analysis And Forecast by 2027 - Cole of Duty

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Know Future Opportunities of the Rheumatoid Arthritis and Lupus Treatments Market latest Technology, New Innovation, Growing factors with Top Key...

Osteoarthritis pain can be debilitating. Strategies can help get you moving again.

Pain from osteoarthritis is more than just a nuisance. Knee pain, in particular, can not only keep people from exercising, but also have a chilling effect on their ability to participate in social activities, especially those that involve walking or traveling, says Elena Losina, the Robert W. Lovett Professor of Orthopedic Surgery at Harvard Medical School and co-director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital.

"In fact, the quality of life of a person with persistent pain due to knee osteoarthritis is similar to quality of life in women with metastatic breast cancer controlled by therapy," she says.

Arthritis can produce a range of symptoms from pain to stiffness. "The patterns of pain differ from person to person, but it often comes in waves or flares," says Losina. "Also, evolving data show that while pain may fluctuate between flares, a relative minority 10% to 15% of knee osteoarthritis patients experience a steady worsening."

Osteoarthritis is the most common type of arthritis, affecting nearly half of all Americans over 65. It results from the deterioration of the cartilage that acts as a cushion between the bones in a joint. A number of factors can cause cartilage to break down, including general wear and tear from friction and pressure on the joint over time, injuries, and even your genes, as osteoarthritis tends to run in families. Obesity is also a risk factor for osteoarthritis.

As the cartilage padding wears thin, the bones begin to rub together, causing pain and in some cases spurring, an overgrowth of bone as it attempts to heal. All this can lead to inflammation and tissue damage in the surrounding area.

Symptoms of arthritis typically develop over time and may include

Living with arthritis pain can be a challenge, but there are numerous strategies you can use to manage it. There is not yet a treatment that can reverse the underlying joint damage caused by osteoarthritis, Losina says, although several pharmaceutical companies are pursuing disease-modifying agents.

Current treatments for osteoarthritis instead focus on relieving symptoms. They fall into three categories:

Nondrug therapies. These include exercise (one of the most effective treatments currently available) and physical therapy, says Losina. Regular exercise can reduce stiffness, pain, and fatigue. But it can be a challenge to get moving if you aren't exercising regularly already. Try starting off slow, with simple activities such as regular walks.

Drug therapies. Doctors often treat osteoarthritis with nonsteroidal anti-inflammatory drugs, which relieve swelling and pain. Examples include ibuprofen (Advil) and naproxen (Aleve). "There is also evolving research on the role of the antidepressant duloxetine [Cymbalta] and muscle relaxants," says Dr. Losina.

A strategy that has come under scrutiny in recent years is the use of corticosteroid injections to treat pain. This treatment, in which a doctor injects a strong anti-inflammatory medication into the joint, is often used to temporarily relieve pain in people who aren't responding well to other medications or nondrug strategies.

"Recent data suggest that pain control from corticosteroid injections is limited to the short term," says Losina.

These injections may actually lead to more damage to the joint. This means that while you may alleviate pain in the short term, you're making the joint worse in the long term, which could make it harder to control symptoms over time.

Surgery. Joint replacement is sometimes an option for people who aren't seeing success with other strategies. A total knee replacement, for example, can be used to alleviate pain for people with severe knee osteoarthritis.

"It is shown to be effective, leading to substantial pain relief in about four out of five recipients," says Losina. Having this procedure can help many people with severe osteoarthritis regain function in their joint. The replacement can last for 15 to 20 years.

To find the best treatment for your condition, you should discuss your options with a primary care physician or a specialist, such as a rheumatologist, physiatrist, or orthopedic surgeon.

Image: Victor_69/Getty Images

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Easing the ache - Harvard Health