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Archive for the ‘Arthritis’ Category

Adherence to ophthalmological screening recommendations and course of uveitis in children with juvenile idiopathic arthritis: data from the Inception…

Saturday, February 29th, 2020

As JIA-associated uveitis (JIAU) is asymptomatic in the majority of patients, ophthalmologic screening examinations are recommended, depending on the risk constellation for uveitis development. This study analyses disease characteristics in JIAU depending on adherence with the screening intervals.953 patients were included in the ICON registry. In patients without uveitis, ophthalmologic screening was recommended in accordance with the standards currently applied in Germany. Dates and results of the screening examinations were noted for each patient.Until the 3-year-follow up, uveitis developed in 133 of 953 JIA patients. In 56 of them, uveitis was present before study inclusion, and those were excluded from the prospective analysis. For the remaining 897 JIA patients, screening results were available in 557, 46 of whom developed uveitis. In those patients, adherence with the suggested screening intervals until uveitis onset was assessed, and patients were classified accordingly: screenings as recommended (Sc+ group, n=356) vs. infrequent screening (Sc- group, n=201). Non-adherence with the screening schedule significantly correlated with younger age at study inclusion and JIA diagnosis, shorter JIA disease duration, JIA oligoarthritis subtype and positive antinuclear antibody status. The Sc+ group had a better visual acuity (VA) at initial uveitis diagnosis, however, at the 3-year-follow up, VA and uveitis complication rates did not differ significantly.Especially high-risk patients often do not adhere to the initial frequently recommended screening intervals, resulting in a reduced visual acuity at initial uveitis diagnosis. A recommendation for changing the current screening intervals cannot be deduced from our data.

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Local Hand Surgeon Helps Patients with Painful Wrist Injury – Patch.com

Saturday, February 29th, 2020

Over the past three decades, hand surgeon Scott Wolfe, who sees patients at Hospital for Special Surgery (HSS) in New York City and at HSS Stamford, has been conducting research to find a better way to repair a common wrist injury that results in pain and disability.

Now a new surgical procedure to repair a torn scapholunate ligament shows promise in relieving wrist pain and restoring function, according to Dr. Wolfe, Chief Emeritus of the Hand and Upper Extremity Service at HSS. He believes it may also prevent the arthritis that many people with the injury develop over time.

Forty-year-old Asad Spahic, a mechanical engineer from Southington, Connecticut, is among the patients who say the procedure has relieved their pain and enabled them to return to activities they enjoy.

The scapholunate is a critical ligament that connects and stabilizes the scaphoid and lunate, two small bones near the center of the wrist. When an injury, often a fall on an outstretched hand, causes the ligament to rupture, patients can experience pain, lose grip strength and develop arthritis that gets worse as time goes on.

"When the ligament tears, the scaphoid and lunate bones will separate, start to rotate and degenerate. Some patients can feel the scaphoid popping in and out of its normal position," Dr. Wolfe explains. Without treatment to repair the torn ligament, people ultimately develop a condition known as SLAC wrist. SLAC, which stands for "scapholunate advanced collapse," is the most common form of post-traumatic arthritis in the wrist, affecting about four million people. As the bones rub abnormally against each other, their protective cartilage wears away.

"The injury most often affects healthy active people. When the ligament ruptures, any activity that combines wrist motion and wrist strength becomes difficult, if not impossible," Dr. Wolfe says. "Affected patients report problems performing jobs that require manual work. They can no longer play sports such as golf or tennis, do yoga or Pilates, or work out with weights at the gym."

Until now, surgery to reconstruct a torn scapholunate ligament has not been ideal, Dr. Wolfe says. The most common repair, which entails the use of metal wires and pins, fails in about 30 percent of patients.

Dr. Wolfe is one of just a few hand surgeons in the U.S. performing the new procedure, known as ANAFAB (anatomic front and back repair). "The goal is to reconnect the bones and restore their normal motion to provide pain relief, make the wrist stable again and stop the arthritic process," he explains.

Dr. Wolfe describes the surgery as a complex and highly technical procedure. "The critical ligaments in the front and the back of the wrist are reconstructed by using a portion of one of the tendons in the patient's wrist, combined with a synthetic tape that's 10 times stronger than steel, weight for weight. The tape is very strong, but also very lightweight and very thin," he says. "The patient's own tendon and this synthetic material are woven through the bones in such a way that the scapholunate ligament, as well as two other nearby ligaments, are repaired all at once. This brings the bones back into the proper position and stabilizes them, so abnormal movement is stopped."

The new procedure is performed without the use of wires and pins, a major advantage, he says, as metal hardware in the wrist can loosen, become infected, fail and necessitate another surgery.

Dr. Wolfe has performed the ANAFAB procedure on 14 patients to date and is monitoring their progress. So far, so good. Asad Spahic, Dr. Wolfe's patient from Southington, found Dr. Wolfe online. His ligament injury, sustained nine years earlier, had led to worsening wrist instability and weakness. He enjoyed participating in sports, but his wrist felt like it was giving way during certain activities, and he began to experience a dull ache. X-rays showed that arthritis was developing.

"A local doctor said the arthritis would get worse, the longer I waited to have surgery. I searched online for the best doctor I could find, reading medical journals," Mr. Spahic said. He knew that once arthritis became severe, a wrist fusion was the standard procedure for pain relief, but a fusion would limit wrist motion and curtail his athletic activities.

He opted for the new surgery with Dr. Wolfe in May 2019. "My experience has been nothing short of phenomenal," Mr. Spahic says. "I don't even think about my wrist. I go skiing, I play soccer, although I use a wrist brace in case I fall because it's been less than a year since my surgery. I have zero pain, zero problems, and the same strength as in my other wrist."

Dr. Wolfe says he will continue to conduct follow-up to gauge the outcomes of ANAFAB surgery to see how patients fare over the long term. "The results are preliminary, but in my 30-year career I have not been this excited about this kind of ligament repair. We're seeing patients who are now pain-free and back to activities they enjoy."

# # #

About HSS

HSS is the world's leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the tenth consecutive year), No. 3 in rheumatology by U.S. News & World Report (2019-2020), and named a leader in pediatric orthopedics by U.S. News & World Report "Best Children's Hospitals" list (2019-2020). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In addition, HSS will be opening a new facility in Florida in early 2020. In 2018, HSS provided care to 139,000 patients and performed more than 32,000 surgical procedures, and people from all 50 U.S. states and 80 countries travelled to receive care at HSS. There were more than 37,000 pediatric visits to the HSS Lerner Children's Pavilion for treatment by a team of interdisciplinary experts. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is the world's leading provider of education on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. http://www.hss.edu.

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Rheumatoid Arthritis Treatment Market Analysis and Forecast to 2026 by Recent Trends, Developments in Manufacturing Technology and Regional Growth…

Saturday, February 29th, 2020

In this new business intelligence Rheumatoid Arthritis Treatment market report, PMR serves a platter of market forecast, structure, potential, and socioeconomic impacts associated with the global Rheumatoid Arthritis Treatment market. With Porters Five Forces and DROT analyses, the research study incorporates a comprehensive evaluation of the positive and negative factors, as well as the opportunities regarding the Rheumatoid Arthritis Treatment market.

With having published myriads of Rheumatoid Arthritis Treatment market reports, PMR imparts its stalwartness to clients existing all over the globe. Our dedicated team of experts deliver reports with accurate data extracted from trusted sources. We ride the wave of digitalization facilitate clients with the changing trends in various industries, regions and consumers. As customer satisfaction is our top priority, our analysts are available 24/7 to provide tailored business solutions to the clients.

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The Rheumatoid Arthritis Treatment market report has been fragmented into important regions that showcase worthwhile growth to the vendors Region 1 (Country 1, Country 2), region 2 (Country 1, Country 2) and region 3 (Country 1, Country 2). Each geographic segment has been assessed based on supply-demand status, distribution, and pricing. Further, the study provides information about the local distributors with which the Rheumatoid Arthritis Treatment market players could create collaborations in a bid to sustain production footprint.

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Readers can get the answers of the following questions while going through the Rheumatoid Arthritis Treatment market report:

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PMR is a third-platform research firm. Our research model is a unique collaboration of data analytics and market research methodology to help businesses achieve optimal performance.

To support companies in overcoming complex business challenges, we follow a multi-disciplinary approach. At PMR, we unite various data streams from multi-dimensional sources. By deploying real-time data collection, big data, and customer experience analytics, we deliver business intelligence for organizations of all sizes.

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Rheumatoid Arthritis Stem Cell Therapy Market Key Development by 2025 – News Times

Saturday, February 29th, 2020

As per a report Market-research, the Rheumatoid Arthritis Stem Cell Therapy economy is likely to see a CAGR increase of XX% within the forecast period (2019-2029) and reach at a value of US$ at the ending of 2029. The macro economic and micro elements which are predicted to influence the trajectory of this market are examined from the market analysis that was presented.

Light onto the material throws Providers, vendors, manufacturers, and market participants at the value string of their industry that is Rheumatoid Arthritis Stem Cell Therapy . Whats more, its particular influence on the market and the political and economic scenarios of regions are discussed within the analysis.

Critical Details included from this record:

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Competitive Outlook

Light onto the throws Business prospects of players operating from the industry that is Rheumatoid Arthritis Stem Cell Therapy . The item pricing plans, marketing stations that were preferred and product portfolio of most players, and promote presence of every and every provider is contained in the title. The players comprise Business 4, Business two, Business 3, and Business.

Regional Assessment

The marketplace research that is introduced sheds light onto the Marketplace Scenario in numerous markets. Additionally, the effects of the governmental and regulatory policies to this market in every regions prospects is examined from the report.

Competitive landscape

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The report Suits the questions pertaining Into the Rheumatoid Arthritis Stem Cell Therapy economy:

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Rheumatoid Arthritis Stem Cell Therapy Market Key Development by 2025 - News Times

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Antibe Therapeutics Announces Enrollment of Last Patient in Phase 2B Dose-ranging, Efficacy Study of Lead Drug, ATB-346 – Business Wire

Saturday, February 29th, 2020

TORONTO--(BUSINESS WIRE)--Antibe Therapeutics Inc. ("Antibe" or the Company) (TSXV: ATE, OTCQB: ATBPF), a leader in developing safer, non-addictive therapeutics for pain and inflammation, is pleased to announce that the last patient has been enrolled and is on treatment in the Phase 2B dose-ranging, efficacy study of Antibes lead drug, ATB-346. The study is evaluating the effectiveness of ATB-346 in reducing osteoarthritis (OA) pain compared to placebo in 360 patients.

The final patients will be on treatment for two weeks, followed by a two-week monitoring period and analysis of the primary endpoint data. The primary endpoint in the study is the change in OA knee pain of ATB-346 versus placebo as measured by the WOMAC subscale pain score, considered the gold standard in pain assessment for arthritis trials. Patients have been randomized to placebo or one of three doses of ATB-346 administered once daily: 150 mg, 200 mg or 250 mg.

The Company anticipates the release of top-line results within six weeks.

About ATB-346

ATB-346 is a hydrogen sulfide-releasing derivative of naproxen. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used therapy for osteoarthritis, but their use is associated with a high incidence of gastrointestinal ulceration and bleeding. NSAIDs are also widely used in conditions such as rheumatoid arthritis, ankylosing spondylitis, gout, and general pain reduction, with a similarly high rate of gastrointestinal ulceration and bleeding. It is well-accepted that patients with these conditions would benefit greatly from an effective, non-addictive, GI-sparing anti-inflammatory/analgesic agent such as ATB-346.

About Antibe Therapeutics Inc.

Antibe develops safer, non-addictive medicines for pain and inflammation. Antibes technology involves linking a hydrogen sulfide-releasing molecule to an existing drug to produce an improved medicine. Antibes lead drug, ATB-346, targets the global need for a safer, non-addictive drug for chronic pain and inflammation. ATB-352, the second drug in Antibes pipeline, targets the urgent global need for a non-addictive analgesic for treating post-surgical pain, while ATB-340 is a GI-safe derivative of aspirin. Citagenix Inc., an Antibe subsidiary, is a market leader and worldwide distributor of regenerative medicine products for the dental marketplace. http://www.antibethera.com.

Forward Looking Information

This news release includes certain forward-looking statements, which may include, but are not limited to, the proposed licensing and development of drugs and medical devices. Any statements contained herein that are not statements of historical facts may be deemed to be forward-looking, including those identified by the expressions "will", "anticipate", "believe", "plan", "estimate", "expect", "intend", "propose" and similar wording. Forward-looking statements involve known and unknown risks and uncertainties that could cause actual results, performance, or achievements to differ materially from those expressed or implied in this news release. Factors that could cause actual results to differ materially from those anticipated in this news release include, but are not limited to, the Companys inability to secure additional financing and licensing arrangements on reasonable terms, or at all, its inability to execute its business strategy and successfully compete in the market, and risks associated with drug and medical device development generally. Antibe Therapeutics assumes no obligation to update the forward-looking statements or to update the reasons why actual results could differ from those reflected in the forward-looking statements except as required by applicable law.

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Antibe Therapeutics Announces Enrollment of Last Patient in Phase 2B Dose-ranging, Efficacy Study of Lead Drug, ATB-346 - Business Wire

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Anti-IL-1 Agents May Be Effective in the Treatment of Familial Mediterranean Fever in Patients With Colchicine Resistance/Intolerance – Rheumatology…

Saturday, February 29th, 2020

Anti-interleukin-1 (anti-IL-1) agents anakinra and canakinumab may be safe and effective in the treatment of familial Mediterranean fever (FMF), according to study results published in Advances in Rheumatology. Researchers showed that these anti IL-1 agents were effective in reducing proteinuria but less effective in cases with FMF associated with arthritis and sacroiliitis.

Colchicine is typically the primary treatment for FMF attacks and amyloidosis; however, 5% to 15% of patients become resistant/unresponsive to colchicine for whom biologic agents including anti-IL-1 are indicated. In this study, the researchers investigated the safety and efficacy of anakinra and canakinumab in patients with colchicine-resistant FMF.

Investigators enrolled 65 patients (median age, 32 years [range, 17-60 years]; 50.8% men) from the Sivas Cumhuriyet University between January 2014 and March 2019 who were diagnosed with FMF, according to Tel-Hashomer criteria, and had colchicine resistance/intolerance. Researchers collected data from laboratory values, clinical features, and disease activities, and analyzed the information every 3 months. More than half (63.1%) of the patients received anakinra (100 mg/d subcutaneous) and 36.9% of the patients received canakinumab (150 mg/8 week subcutaneous). Median duration of the anti-IL-1 agents was 6 and 8 months for anakinra and canakinumab, respectively.

Researchers found a statistically significant improvement in the visual analog scale, erythrocyte sedimentation rate, C-reactive protein, and attack duration with anti-IL-1 treatment. A total of 96.9% patients (n=63) achieved FMF-50 score response for the anti-IL-1 treatments. Anti-IL-1 agents significantly decreased proteinuria in patients with glomerular filtration rate 60 mL/min/m2; the median proteinuria decreased from 2390 mg/d (range, 1400-7200 mg/d) to 890 mg/d (range, 120-2750 mg/d; P =.008). For the group with glomerular filtration rate <60 mL/min/m2, the median proteinuria decreased from 4472 mg/d (range, 1950-11,200 mg/d) to 3960 mg/d (range, 2050-12,200 mg/d), although the difference was not statistically significant (P =.345). In terms of safety issues, there were serious infections or tuberculosis or malignancy, except in 1 patient.

Study limitations included the small sample size, lack of a randomized controlled trial, and the fact that there was no adjustment for confounding factors such as blood pressure, use of angiotensin receptor blocker drugs, and diet.

[Randomized controlled trials] should be conducted to demonstrate the efficiency of the treatment in these clinical situations. Further studies are needed to determine the safety and long-term side effects of anti-IL-1 therapies, the researchers concluded.

Reference

Sahin A, Derin ME, Albayrak F, Karakas B, Karagoz Y. Assessment of effectiveness of anakinra and canakinumab in patients with colchicine-resistant/unresponsive familial Mediterranean fever. Adv Rheumatol. 2020;60(1):12.

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Rheumatoid Arthritis Associated With Increased Risk for Depression – Rheumatology Advisor

Wednesday, February 26th, 2020

Resultsfrom 2 longitudinal cohort studies conducted in South Korea indicate asignificantly increased risk for depression among patients with rheumatoidarthritis (RA), with women and those >30 years of age displaying the highestrates. This is according to an article published in Rheumatology.

Investigatorsabstracted data from the Korean Health Insurance Review and Assessment Service National Sample Cohort (HIRA-NSC) from the years 2002-2013. The HIRA-NSC is apopulation-based cohort established by the National Health Insurance Service ofSouth Korea. HIRA-NSC queries demographics, health, and diagnostic data from >1million individuals randomly selected from South Koreas National HealthInsurance Database.

The present analyses included data from 114,369,638 medical claims filed by 1,125,691 patients. Patients with depression and/or RA were identified through their respective International Statistical Classification of Diseases version 10 (ICD-10) codes. Two studies were designed. Study I matched patients with depression 1:4 with cohort members without depression. Study matched patients with RA 1:4 with cohort members without RA. Matching in both studies was performed for age group, sex, income bracket, and region of residence. Cox proportional hazards models were used to calculate hazard ratios (HRs) for depression and RA in each study. HR calculations were adjusted for number of comorbidities.

StudyI enrolled a total of 38,087 patients with depression and 152,348 individualsin a control group. A greater proportion of the patients with depression(n=1260; 0.7%) had a diagnosis of RA compared with the control group (n=883;0.6%) (P =.02). However, the HR for RA was not significantly elevated inthe depression group compared with the control group.

StudyII enrolled a total of 7385 patients with RA and 29,540 individuals in acontrol group, of whom 408 (5.5%) and 1246 (4.3%) had a diagnosis of depression,respectively (P <.001). Patients with RA had significantly increasedrisk for depression compared to those in the control group without RA (HR,1.20; 95% CI, 1.07-1.34; P =.002). In subgroup analyses, patients withRA over 30 years of age had the greatest HRs for depression compared with theircontrol subgroups.

Specifically,patients with RA aged 30-59 years (HR, 1.17; 95% CI, 1.01-1.36; P =.036)and patients 60 years (HR, 1.29; 95% CI, 1.08-1.55; P =.006) hadsignificantly elevated risk for depression compared to controls in the same agebrackets. Women with RA, unlike men, also displayed significantly higherdepression risk compared with controls of the same gender (HR, 1.19; 95%,1.05-1.35; P =.006).

Theseresults suggest that while RA increases the risk for depression, this associationis not bidirectional. Women with RA and patients >30 years were particularlysusceptible to depression. Of note, data on RA and depression severity were notavailable, nor were data on smoking, alcohol consumption, or physical activity.As such, analyses may not have accounted for all possible factors contributing todepression. Even so, the elevated HRs for depression observed among RAsubgroups emphasize the need for mental health care access for patients withRA.

Reference

Kim SY, Chanyang M, Oh DJ, Choi HG. Association between depression and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort [published online November 19, 2019]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez559

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Voltaren Arthritis Pain Receives FDA Approval for Over-the-counter Sale: How Does It Compare to Other Topical Treatments? – DocWire News

Wednesday, February 26th, 2020

The Food and Drug Administration (FDA) approved Voltaren Arthritis Pain (diclofenac sodium topical gel, 1%) for nonprescription, over-the-counter (OTC) use to treat osteoarthritis (OA)-associated pain. The medication was initially available through prescription; the change is possible through the FDAs prescription (Rx)-to-OTC switch process.

As a result of the Rx-to-OTC switch process, many products sold over-the-counter today use ingredients or dosage strengths that were available only by prescription 30 years ago, said Karen Mahoney, MD, acting deputy director of the Office of Nonprescription Drugs in the FDAs Center for Drug Evaluation and Research, in an FDA press release. Approval of a wider range of nonprescription drugs has the potential to improve public health by increasing the types of drugs consumers can access and use that would otherwise only be available by prescription. This includes providing the millions of people that suffer with joint pain from arthritis daily over-the-counter access to another non-opioid treatment option.

Voltaren Arthritis Pain, formerly known as Voltaren Gel 1%, received initial FDA approval in 2007. It is not intended for immediate relief; patients should allow up to seven days to feel its effects. If patients feel no change after seven days or are still using the product after 21 days, it is recommended that they terminate use and seek medical attention.

Voltaren Arthritis Pain is a non-steroidal anti-inflammatory drug (NSAIDs). A study published in The BMJ linked NSAIDs to increased heart failure risk, with seven posing the most significant risk; one of these NSAIDs was diclofenac.

The Voltaren website describes the drug, Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID) that is often used to treat arthritis pain. It falls in the same class (NSAID) as drugs such as ibuprofen (Advil) and naproxen (Aleve). Diclofenac works by temporarily blocking the production of pain signaling chemicals called prostaglandins.

Unlike Voltaren Arthritis Pain, Biofreeze pain relief gel and Salonpas deep relieving gel are not NSAIDs; they are both considered topical rubefacients. They are not prescribed specifically for OA-related pain. Salonpas is sold OTC, and Biofreeze is available OTC and by prescription.

According to drugs.com, there are no known drug interactions associated with Biofreeze. Eleven drugs are associated with minor interactions in Salonpas. An estimated 111 drugs are known to interact with Voltaren Arthritis Pain Gel: seven major, and 104 moderate.

There are no known disease interactions associated with Biofreeze or Salonpas. Voltaren Arthritis Pain is reportedly known to interact with asthma, renal dysfunction, heart failure, hypertension, and platelet aggregation inhibition.

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Voltaren Arthritis Pain Receives FDA Approval for Over-the-counter Sale: How Does It Compare to Other Topical Treatments? - DocWire News

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Arthritis, muscle and spinal service success in Barrow – NW Evening Mail

Wednesday, February 26th, 2020

A SERVICE for people with arthritis, hip and knee conditions, joint and muscle injuries and spinal pain is proving to be a success with around 5,000 patients using it last year.

The main aim of the Integrated Musculoskeletal Service is to ensure that patients are seen by the right person first time. The service is involving and supporting patients to make the right decision, for themselves, about their treatment - for example by highlighting alternative treatments to hip and knee surgery.

The aim of the service is to get it right first time for our patients and to support them to choose the right treatment for their condition, said James Geary, extended scope physiotherapist. Weve had some great feedback from our patients which is positive.

The service is provided by the University Hospitals of Morecambe Bay NHS Foundation Trust which runs Furness General.

Patient feedback has included:

Considerate and quick. Someone who listened well and sorted out the problem. I wanted a good explanation about what was happening with my body and I got it. Thank you.

The team has expanded its specialist clinics for those with musculoskeletal problems across the following sites: Westmorland General Hospital, Ulverston Community Health Centre, Grange Health Centre, Heysham Primary Care Centre, Alfred Barrow Health Centre, Furness General Hospital, Royal Lancaster Infirmary, Millom Health Centre and Queen Victoria Hospital in Morecambe.

This new way of working is another example of Bay Health and Care Partners working together more effectively to provide better care in the community, which will keep people across Morecambe Bay healthier and at home for longer without having to come into hospital.

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Nursing homes can’t administer medical cannabis. This bill would change that. – wtvr.com

Wednesday, February 26th, 2020

RICHMOND, Va. -- Virginia lawmakers continue to fine tune legislation that aligns with the states growing medical cannabis program by advancing two Senate bills facilitating the work of caregivers and lab employees.

SB 185 sponsored by Sen. Siobhan Dunnavant, R-Henrico, would allow employees at nursing homes, assisted living facilities and hospices to administer CBD and THC-A oil to residents who have a valid written certification to use the medication. SB 885 from Sen. David W. Marsden, D-Fairfax, would remove criminal liabilities for analytical lab workers who transport and possess both substances during the course of their work.

Marsden also introduced legislation to protect individuals from possession charges for having marijuana in the form of cannabidiol oil or THC-A oil, if they have valid written certification from a practitioner.

In 2019, Dunnavant and Marsden helped pass legislation signed by the governor to reduce restrictions for patient access to the substances (SB 1557 , SB 1719]).

CBD products are used to treat epilepsy and to help with pain management for a variety of ailments. The product can be extracted from hemp, a plant in the cannabis family that is typically low in THC. The non psychoactive version of THC is THC-A; it does not produce a high. THC-A has been used to treat seizures, arthritis and chronic pain. Fibers of the hemp plant are also used in making rope, clothing, paper and other products. Hemp recently became legal [vox.com] at the federal level, and its cultivation is still regulated].

There is a distinction between hemp-derived CBD oil and marijuana-derived CBD oil, namely the level of THC present.

Dunnavant told a Senate panel that the bill is needed so that staff at assisted living facilities can be included as those authorized to store and administer both CBD and THC-A to residents and patients. Registered nurses and licensed practice nurses can legally administer the oils. Last year lawmakers passed legislation protecting school nurses from prosecution for possessing or distributing such oils, in accordance with school board policy.

Several nursing homes and assisted living facilities when contacted said that currently the use of CBD or THC-A are not allowed at their locations and that there are no immediate plans to incorporate such use into the care of their residents or patients.

Marsden sees his bill as an opportunity for further research and development of medical marijuana in Virginia. The state pharmaceutical processors permitted to manufacture and dispense marijuana-derived medications can distribute products with doses that do not exceed 10 milligrams of THC.

If a laboratory is going to handle a drug that is marijuana, they need immunity from prosecution. Marsden said. Even if we go into decriminalization, that still has some civil penalties for it.

Richmonder Brion Scott Turner is glad that steps are being made towards CBD becoming more available. Turner uses CBD to help with his own medical condition.

I use a CBD infused lotion for my psoriasis, Turner said. It gives me relief from the itching and the psoriatic arthritis that comes with it.

Turner has said that most of his friends and family use CBD to help with a variety of ailments from minor headaches to anxiety attacks.

My mother uses CBD for anything from lower back pain, helping with an upset stomach or even migraines, Turner said.

Other cannabis related bills moving through the General Assembly include HB 972 , which would decriminalize simple possession of marijuana down to a civil penalty of no more than $25. The Senate version [lis.virginia.gov] of the bill carries a civil penalty of no more than $50.

HJ 130, currently in the Senate Committee of Rules, would direct the Joint Legislative Audit and Review Commission to study options for the regulation of recreational adult use and medical use of cannabis. SJ 67 , which has passed the House and Senate, directs JLARC to study options and make recommendations for how Virginia should go about the growth, sale and possession of marijuana. JLARCs recommendations are due by July 1, 2022.

Both Dunnavant and Marsdens bills reported out of committee and are headed to the House floor.

By Chip Lauterbach/Capital News Service

Capital News Service is a flagship program of VCUs Robertson School of Media and Culture. Students participating in the program provide state government coverage for Virginias community newspapers and other media outlets, under the supervision of Associate Professor Jeff South.

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Nursing homes can't administer medical cannabis. This bill would change that. - wtvr.com

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TLR4 Blockade May Not Treat RA With Inadequate Response to MTX – Rheumatology Advisor

Wednesday, February 26th, 2020

The toll-like receptor 4 (TLR4) pathway is not likely arelevant target in treating patients with rheumatoid arthritis (RA) whodemonstrate an inadequate response to methotrexate therapy, according toresearch published in the Annals of the Rheumatic Diseases.

Researchers conducted a phase 2, proof-of-concept, randomized, placebo-controlled, double-blind, international, multicenter study of patients with moderate to severe anticitrullinated protein antibody-positive RA who previously demonstrated an inadequate response to methotrexate therapy. The study included adults with active RA 6 months who fulfilled the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria.

In total, 250 patients were screened for eligibility and 90were randomly assigned to receive either placebo (n=29) or 5 mg/kg NI-0101 afirst-in-class humanized monoclonal antibody-blocking TLR4 every 2 weeks for12 weeks (n=61). All participants also continued methotrexate therapy. Fromeach group, 57 and 29 patients (from treatment and control group, respectively)completed both the 12-week visit and the follow-up phase through week 24.

Overall, no major differences were noted between groups interms of individual disease parameters, although patients in the NI-0101 grouphad a longer RA duration (8.5 vs 5.4 years) and were younger at the time ofdiagnosis (45.7 vs 51.2 years). The mean C-reactive protein (CRP) level wasalso higher in this group at baseline (18.3 mg/L vs 13.4 mg/L).

Both treatment groups demonstrated similar decreases frombaseline to week 12 disease activity scores in 28 joints with CRP, with nosignificant between-group differences noted. Both Clinical Disease ActivityIndex and Simplified Disease Activity Index scores decreased approximately 40%from baseline to 12 weeks, and the proportion of patients who achieved good ormoderate EULAR responses increased with treatment.

By week 12, 27.6% and 26% of patients in both groups(placebo and NI-0101, respectively) achieved good EULAR responses whereas 55.2%and 53.6%, respectively, achieved EULAR moderate responses. Similarly, nosignificant between-group differences were noted in ACR responses at week 12,with 55.2% in the placebo group and 58.9% in the treatment group achieving improvement of 20% in ACRcriteria responses, 20.7% and 14.3% achieving improvement of 50% in ACR criteria (ACR50)responses, and 10.3% and 10.7% achieving improvement of 70% in ACR criteria responses. Asubgroup analysis found no significant effects on stratification by either CRPor FcRIIa genotype for either disease activity score in 28 joints with CRP orACR50 response.

A pharmacokinetics profile of NI-0101 showed expectedconcentrations and elimination consistent with simulations. NI-0101concentrations were maintained above the targeted threshold of 10,000 ng/mL ina majority of patients. In terms of pharmacodynamics, no significantdifferences between treatment groups were noted for all evaluated biomarkers.

NI-0101 infusions every 2 weeks demonstrated an acceptablesafety and tolerability profile in patients with RA, with similar proportionsof treatment-emergent adverse events occurring in both the placebo andtreatment groups (51.7% and 52.5%, respectively). The most frequently reportedadverse events were infections (13.8% in the placebo group and 11.5% in theNI-0101 group).

The lack of significant effect of NI-0101 in thiswell-controlled prospective clinical trial indicates that blocking the TLR4pathway alone is unlikely to benefit patients with established RA, theresearchers concluded. The good NI-0101 safety and [pharmacokinetic]profiles support further exploration in other diseases.

Disclosure: Thisclinical trial was supported by Novimmune SA. Please see the original referencefor a full list of authors disclosures.

Reference

Monnet E, Choy EH, McInnes I, et al. Efficacy and safety of NI-0101, an anti-toll-like receptor 4 monoclonal antibody, in patients with rheumatoid arthritis after inadequate response to methotrexate: aphase II study [published online December 31, 2019]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2019-216487

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FDA Approves Opioid Treatment Option – Rheumatology Network

Wednesday, February 26th, 2020

The U.S. Food and Drug Administration has approved the use of an intravenous form of the pain reliever meloxicam (Anjeso, Baudax Bio) for the relief of moderate to severe pain.

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) currently available in tablet form as Mobic by Boehringer Ingelheim. It is approved for the relief of pain associated with osteoarthritis and rheumatoid arthritis in adults, and in children two years and older who have juvenile rheumatoid arthritis.

Now, it can be administered as a once a day, 24-hour intravenous NSAID treatment for patients with moderate to severe pain.

The active ingredient in meloxicam is a long-acting, preferential COX-2 inhibitor with analgesic, anti-inflammatory and antipyretic activities, which inhibits COX-2 thereby reducing prostaglandin biosynthesis.

The approval of Anjeso marks a major advancement in the treatment landscape for managing moderate to severe pain. With our nation currently in the midst of a national opioid epidemic, we are thrilled to be able to offer a novel, non-opioid therapeutic option with the potential to meaningfully impact the acute pain treatment paradigm," said Gerri Henwood, president and chief executive officer of Baudax Bio, in a press statement.

The company cited the success several mid to late stage clinical trials on Anjeso, plus a recent phase three safety trial that showed the treatment was well tolerated as an option to opioids.

While traditional opioid medications have proven effective at providing pain relief, the associated adverse side effects, including sedation and respiratory depression, have driven physicians to employ a multi-modal approach to treating post-operative pain. With 24-hour, durable pain relief and a safety profile comparable to placebo, Anjeso has the potential to serve as a meaningfully differentiated analgesic alternative, said the University of Miami's Keith Candiotti, M.D., in a written statement.

The Anjeso approval is supported by two phase three efficacy studies, one double-blind, placebo-controlled phase three safety study and four phase two clinical studies. A randomized multicenter, double-blind, placebo-controlled phase three study of 379 orthopedic surgery patients showed that patients receiving once-daily intravenous meloxicam 30 mg for seven days required fewer opioids. Total opioid consumption (36.8 mg versus 50.3 mg IV morphine equivalent dose) and opioid consumption from zero to 24 hours, 2448 hours, zero to 48 hours, and zero to 72 hours were statistically significantly lower in the meloxicam treatment group. The side effects were reported as mild to moderate and affected 65 percent of patients.

The most common adverse reactions reported in at least 2 percent of patients treated with Anjeso and at a greater frequency than placebo included: constipation, gamma-glutamyl transferase increased and anemia.

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Is It Too Late to Buy High-Flying Galapagos? – Motley Fool

Wednesday, February 26th, 2020

Galapagos(NASDAQ:GLPG) galloped to all-time highs heading into this week. Although a pullback in the overall market has caused the biotech to give up some of its gains, Galapagos is still up close to 20% year to date and up around 150% over the past 12 months.

Some investors could view Galapagos as valued at a steep premium after its big run-up. But is it really too late to buy the high-flying biotech stock?

Image source: Getty Images.

The primary catalyst behind Galapagos' meteoric rise over the last year was its major collaboration deal signed with Gilead Sciences (NASDAQ:GILD) in July last year. Gilead forked over $5.1 billion for the 10-year agreement, with a $3.95 billion upfront payment and a $1.1 billion equity investment in Galapagos.

Gilead and Galapagos were already partnering on immunology drug filgotinib. The new deal gave Gilead the rights to Galapagos' other late-stage pipeline candidate, idiopathic pulmonary fibrosis (IPF) drug GLPG1690. In addition, Gilead can exercise an option to license any of Galapagos' other candidates.

You can attribute Gilead's interest in Galapagos to the tremendous promise for filgotinib. The experimental drug sailed through late-stage clinical studies targeting rheumatoid arthritis with flying colors. Gilead and Galapagos filed for U.S. and European regulatory approvals for filgotinib in treating rheumatoid arthritis in 2019. Approvals are anticipated later this year in the indication.

And that could be just the start. Gilead and Galapagos are also evaluating filgotinib in other late-stage clinical studies in treating Crohn's disease, psoriatic arthritis, and ulcerative colitis. It's also in phase 2 clinical studies targetingankylosing spondylitis and other inflammatory diseases.

Just how successful filgotinib could be if it wins approval remains to be seen. But peak annual sales of close to $3 billion in treating rheumatoid arthritis and another $3 billion in treating other immunology indications could be possible. Filgotinib's safety profile and convenience (it's an oral medication instead of an injection) could boost its commercial success.

That kind of market potential might make Galapagos' current market cap of under $16 billion seem like a steal. However, it's important to remember that the biotech won't rake in all of the money that filgotinib could make.

Galapagos will market filgotinib on its own inBelgium,the NetherlandsandLuxembourg. It willsplit profits generated by filgotinib equally with Gilead in France,Germany,Italy,Spain, and theUnited Kingdom. In other countries, Galapagos stands to receive tiered royalties between 20% and 30%.

Based on AbbVie'sexperience with blockbuster drug Humira prior to it losing exclusivity in Europe, I expect somewhere around two-thirds of filgotinib's sales will be made in the U.S. If we use a peak annual sales estimate of $6 billion, that would give Galapagos a maximum of $1.2 billion from U.S. sales of the drug. Outside of the U.S., my back-of-the-napkin estimate is that Galapagos would make a little under $1 billion annually.

It's more difficult to predict the financial impact for Galapagos' other drugs. Galapagos thinks that the global market for IPF could be $5 billion by 2025. If we assumedGLPG1690 could capture half of that market, Galapagos would probably make around $750 million annually at peak sales due to its licensing deal with Gilead.

My numbers are admittedly very rough. However, I think that peak revenue from filgotinib andGLPG1690 could bring in somewhere in the ballpark of $3 billion for Galapagos in the future. The company's other earlier-stage programs could boost its sales. In addition, Galapagos is eligible to receive some hefty milestone payments from Gilead if all goes well.

Still, though, we're looking at a stock that currently trades at more than five times sales that it might achieve sometime in the future. I like the potential for Galapagos' products. However, I think that there are other biotech stocks with more room to run. My view is that it is a little too late to jump on the Galapagos bandwagon.

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Tis the Season? Study Examines Effect of Time of Year on Primary Sjgrens Syndrome Symptoms – DocWire News

Wednesday, February 26th, 2020

A new study examined whether season has an impact on symptoms of fatigue, pain, and dryness in primary Sjgrens syndrome.

Seasonality in rheumatic diseases is an issue frequently perceived and voiced by patients. Several studies have identified weather-related flares in rheumatoid arthritis (RA). Weather conditions might also influence pain and function in osteoarthritis, and a seasonal pattern in gout incidence has been described, the researchers wrote.

However, seasonality has not been investigated in primary Sjgrens syndrome (pSS) yet.

The present study evaluated patient data from the French nationwide multicenter pSS cohort Assessment of Systemic Signs and Evolution in Sjgrens Syndrome (ASSESS) (n=395). ASSESS was created in 2006 and houses five-year prospective follow-up data as well as data from three randomized, placebo-controlled trials of infliximab (TRIPSS) (n=103; 22 weeks of follow-up; seven visits), rituximab (TEARS) (n=120; 24 weeks of follow-up; six visits), and hydroxychloroquine (JOQUER) (n=120; 48 weeks of follow-up; four visits). In each study, visits included data collection on visual analog scale (VAS) scores for pain, fatigue, and dryness. In the ASSESS group, objective assessments of dryness were taken at baseline and again at two and five years. Data were assessed by the day, month of the year, and season.

Final analysis included 632 Sjgrens syndrome patients and a total of 2,858 VASs observations spanning the four studies. VASs collected for Sjgrens syndrome patients by season were: spring, 744; summer, 584; fall, 848; and winter, 682. VAS scores for pain were as follows: spring, 52.2; summer, 55.1; fall, 51.0; and winter, 51.7. VAS fatigue scores were 61.9, 62.2, 60.0, and 61.9, respectively; VAS scores for dryness were 58.9, 61.2, 56.9, and 57.9, respectively.

The EULAR Sjgrens Syndrome Patient Reported Index scores did not significantly differ by season: spring, 57.7; summer, 59.5; fall, 55.9; and winter, 57.2.

The results of the study were published in Arthritis Research &Therapy.

The researchers concluded, This first large study on seasonality in [primary Sjgrens syndrome] provides new evidence that fatigue, pain and dryness, as well as the ESSPRI score, do not have meaningful fluctuations according to months or seasons. In [primary Sjgrens syndrome], seasonality does not affect patient-reported outcomes (PROs) on fatigue, pain and dryness.

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Equine Back Pain: Dr. Kent Allen’s Bag of Diagnostic and Treatment Tricks – TheHorse.com

Wednesday, February 26th, 2020

Compelling, controversial, and complicated. Thats how Kent Allen, DVM, of Virginia Equine Imaging, in The Plains, describes the equine back. The veterinary community continually debates equine back pain, which he said can be difficult to diagnose with standard approaches and imaging techniques.

Allen knows equine backs well. He has extensive experience treating high-performance horses in his practice and leadership roles at the Olympic, Pan American, and World Equestrian Games. Hes presented diagnostic and treatment methods for many International Society of Equine Locomotor Pathology (ISELP, for which he serves as vice president and executive director) modules around the world and at the American Association of Equine Practitioners convention.

Allen shared his back-pain workup and treatment recommendations with equine veterinarians at the 11th annual Northeast Association of Equine Practitioners (NEAEP) symposium, held Sept. 25-28, 2019, in Saratoga Springs, New York.

First Allen reviewed spinal anatomy, reminding veterinarians about variation in the thoracic and lumbar vertebrae running from the withers to the pelvis. Typically, horses have 18 thoracic (sometimes 19 and rarely 17) and six (occasionally five) lumbar vertebrae. He doesnt use markers on back radiographs to identify specific vertebrae, opting rather to look for the anticlinalthe vertebra at which the spine orientation changeswhich is usually the 15th thoracic vertebrae (T15, though occasionally T14).

T12 is usually the base of the withers, he explained, and the anticlinal is usually T15. Veterinarians can identify the thoracolumbar junction (between the thoracic and lumbar vertebrae) by looking at the change in rib curvature and the transverse processes, which are the protrusions from the sides of the vertebrae. Other helpful anatomical landmarks include the tuber coxaethe point of the hipwhich blocks veterinarians radiographic view of L4-6 (sometimes 5-6, he said). Thats also where articular processes begin to appear more upright.He pointed out the fused mammillary processes, where horses get arthritic change, off the articular processes and in the facet jointwhere the vertebral bodies come together.

We want to understand (the anatomy) before we start trying to diagnose it and treat it, he said, emphasizing that vets also must thoroughly understand the epaxial musculature, the multifidus muscle, longissimus muscle, intraspinous ligament (in which you can see some bony changes that arent usually associated with pathologydisease or damage), and the supraspinous ligament (which can be injured but usually a relatively minor issue thats easy to treat).

The multifidus, which attaches on the articular areas right beside the mammillary processes and reaches forward two or three vertebrae, is crucial because it is responsible for balancing and tensioning that back, he said. And, so, the more you fatigue or have pathology in the back and the more you get multifidus loss of the musculature, the more pressure and weight you put on the longissimus and the more the entire system fails.

Typical back problems Allen and his colleagues see in their practice include:

Bucking is common in horses with back pain, Allen said. Vets should ask themselves, Is it lame? Does the lameness have anything to do with the back (which is rare)? Usually its a decreased performance complaint.

Allen performs a detailed clinical exam on each horse fitting this description; he palpates the back and mobilizes its structures in a dynamic exam, watching the horse walk and jog. He emphasized that horses with back pain come in all shapes and sizes, and some might be very stoic and not show signs of problems until theyre performing at a very high level, sometimes even very late in their athletic careers.

These horses can jump, they can do their jobs, said Allen, citing an upper-level equine athlete he treatedone with significant overriding dorsal spinous processes that had gone undetected until the horse developed severe back pain late in his eventing career. Once we figured out his problem and gave him some pain relief, he looked a lot better doing his job.

Other horses are more demonstrative and will take your kneecap off if you press around on their backs, he said.

For horses not about to kick you in the kneecap, said Allen, he uses a surcingle weighted with 60 pounds to evaluate pain level while the horse is longed in a round pen. I get to see (the horse) move without the weighted surcingle and with the weighted surcingle without the riders influence, he said.

In videos he showed how a horse wearing the weighted surcingle stiffened, accentuating his lameness.

We use this a lot; we dont go through a day without putting this on several horses, he said.

Once Allen and his colleagues have determined without a doubt the horse is experiencing back pain, he turns to imaging, beginning with lateral radiographic views of the spine. He also uses nuclear scintigraphy (bone scans). But he cautioned that any imaging can reveal irrelevant dorsal articular remodeling. In other words, he and other veterinarians see damage in many backs that never creates pain.

In fact, several good studies show there are a lot of orthopedic back problems in horses that show no pain in the back, he said. And so youre left wondering if these horses have pathology and theyre not back sore, then what the heck are you doing X raying them and bone scanning them if theres no correlation between the imaging and the clinical? And the answer is, its really hard to figure it out.

You have got to tie the clinical to the imaging, he added, telling veterinarians to first ask themselves in back pain cases how the injury happened. (Researchers) proved years ago that kissing spines without a doubt is developmental, and it worsens with time. Now, no one has really proven one way or another about the facet arthritis, but I suspect its the exact same thing.

Whether a horse experiences and shows pain from the pathology depends on what the horse is asked to do, he said. For example, in one study veterinarians found severe bone pathology in a group of racehorses euthanized for reasons besides back pain. But, had the horses all become jumpers, many might have exhibited pain they didnt show as racehorses, he reasoned.

The question is, does the horse have the developmental abnormalities, which most of the time were never going to know, is it old enough to have this problem, does it have a job that is going to exacerbate the problem? he said. And, then, you as clinicians can start putting the picture together.

Additionally, Allen said he and his colleagues commonly see horses that are both lame and back sore, generally for separate problems requiring treatment.

Once Allen has confirmed the pathology in the back is, in fact, the cause of the pain, he applies the following treatments:

Secondary treatments include light ridden or in-hand work for short periods. In fact, Allen said its key to avoid long rest periods, opting instead to avoid muscle wasting by returning horses to work.

Extracorporeal shock wave therapy is a big part of his treatment approach. What were really doing with it is quite different from what were doing with treating a proximal suspensory (ligament injury in the leg), he said. There, were trying to stimulate all kinds of healing pathways . Here (with backs) what were trying to do is downregulate pain receptors normal bone has very few pain receptors in it, but arthritic bone has a lot.

We tend to use 1,000 to 2,000 pulses, depending on whether we know where the problem is, and typically we repeat it at five- to six-month intervals, but its variable depending on the patient, he added. Weve been very successful with managing these upper-level athletes with ESWT.

Allen and his colleagues commonly use ESWT and mesotherapy synergistically if the back injury is soft-tissue-related only.

As for other treatment approaches, Allen referenced a study Denoix et al. conducted with the bisphosphonate tiludronate disodium (Tildren). It maybe wasnt the greatest in statistical significance, but 80% of the horses treated with Tildren showed improvement by Day 60, compared with 50% of the control group, he said. So definitely on arthritis in that area, this is a study that you can point at and say, Well, theres a rationale for giving these horses Tildren.

Allen said while several studies support acupuncture for treating backs, this approach as well as chiropractic dont last very long. They last about three weeks, he said. We need something that lasts months and months, or longer.

In an unpublished study Allen and his colleagues looked at 314 horses presented for back pain. Of those, 57 were also presented for lameness. When veterinarians examined the horses, they considered only 32% as lame, but 92% as positive to back palpation and 90% as having a positive response to the weighted surcingle. Some other notes he made:

I dont understand why we want to rush to do surgery because you can manage these horses very effectively with medical therapy, he said. Medical management of back pain and pathology is very successful at keeping these horses going and going at their level of work, not dropping down and doing something lesser.

Theres one exception to that the horses that have already presented with avoidance behavior, he added. And if that avoidance behavior includes bucking the riders off now you have a physical problem and a mental problem. Once that horse has decided that his default response to back pain is bucking the rider off, you can treat that horse and you can be very successful. But what you dont know is at what moment four months from now thats all going to wear off and that horse is going to turn into a horse trying to be the star of the Calgary Stampede.

His biggest take-home message? Veterinarians must see horses with back pain in the field, diagnose them, and start medical management early. If you wait till they start bucking, the prognosis plummets, he said.

The (combination of) technology and the education is there to do it now, he added. It wasnt 15 years ago, but it is now. And, so, you can X ray the dorsal spinous processes, you can have (horses) sent to a clinic and you can X ray the entire spine and know what youre looking at, you can do bone scans, and you can learn to ultrasound these articular processes and the osteoarthritis. These horses dont have to keep going, and you have to educate your riders that when this horse starts getting back sore, weve got to see it and weve got to figure it out.

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Equine Back Pain: Dr. Kent Allen's Bag of Diagnostic and Treatment Tricks - TheHorse.com

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I’m taking glucosamine for my arthritis. So what’s behind the new advice to stop? – The Conversation AU

Sunday, February 16th, 2020

The Australian Rheumatology Association this week warned people not to take the supplement glucosamine for their osteoarthritis due to possible allergic side-effects.

Whats the evidence behind this latest advice? And do you really need to stop taking it?

For years, glucosamine has been marketed as a treatment for osteoarthritis, which can occur when the protective cartilage in the joints wears down over time.

This is despite conflicting evidence on whether the supplement works. Yet many patients may buy glucosamine, presuming that even if it doesnt help, at least its natural and so wont do any harm.

Read more: Arthritis isn't just a condition affecting older people, it likely starts much earlier

But an Australian study, which has been online since last year and was cited in one of this weeks media reports, has given us more information about glucosamines safety.

The study found hundreds of allergic reactions to glucosamine have been reported to Australias medicines watchdog, the Therapeutic Goods Administration (TGA).

So is it safe for you to take glucosamine? In short, if it works for you and you havent had any side-effects, and your doctor and pharmacist know you are taking it, it is likely to be safe based on the multiple trials conducted to date.

Glucosamine is a naturally occurring substance the body uses to help build joint tissue, such as cartilage and tendons. In a supplement, the glucosamine can be made from the shells of prawns and other crustaceans, or it can be made synthetically in a factory.

Whether it works to manage osteoarthritis seems open to debate. The most recent evidence suggests little to no clinical benefit.

Read more: Science or Snake Oil: is glucosamine good for joints?

But advice to GPs about how to treat osteoarthritis says the issue isnt just confined to glucosamine.

When the Royal Australian College of General Practitioners looked at about 62 other medicines and possible treatments for osteoarthritis of the knee and hip (which include registered drugs and complementary medicines), none were backed by high-quality evidence to say they worked. Most of the evidence was based on low- or very low-quality studies.

The Australia study found 336 cases of side-effects to glucosamine (and to another supplement used for osteoarthritis called chondroitin) were reported to the TGA over 11 years. Of these, 263 cases were allergies, which ranged from mild to severe.

We dont know if these reactions included those from people with a known allergy to seafood or sulfur, as these would increase their risk of a reaction to glucosamine (glucosamine can come in different formulations, including glucosamine sulfate).

But a large percentage of people take glucosamine daily in Australia, with no ill effects. The cases reported to the TGA amount to just 30 people a year, with 16% of allergic reactions considered severe.

Beyond allergic reactions, there are other safety concerns about glucosamine.

For instance, if you are taking glucosamine and a medicine that thins your blood (such as warfarin after a stroke), this can increase your risk of bleeding.

Read more: Weekly Dose: Warfarin, the blood-thinner that's still used as a rat killer

Glucosamine supplements have also been implicated in chronic liver disease and in worsening underlying asthma. Some patients may also experience digestive symptoms such as heartburn.

The risks of other side-effects seem unclear, including whether it raises blood glucose levels in people with or without diabetes.

While the Australian Rheumatology Association has warned people to stop taking glucosamine, other advice is not so clear-cut.

Arthritis Australia reports glucosamine is a relatively safe treatment option for people with osteoarthritis and has relatively few side-effects compared with traditional medicines.

And the guidelines for GPs on how to manage osteoarthritis of the knee and hip makes a conditional recommendation not to use it, based on uncertainty over the balance of harms with potential benefit.

What should you do if youre taking glucosamine? If it works for you and you want to keep using it, then do so only on the advice of your doctor. Thats especially the case if you have any underlying medical conditions including diabetes, allergies or asthma.

Next, let your pharmacist know so they can check for any possible interactions with your other medicines, which can increase your risk of side-effects. You are most at risk if you are also taking warfarin, or any other type of blood thinning medicine.

Finally, if you do have unwanted side-effects from glucosamine, stop using it immediately and report it to your doctor.

Read more: The best foods for arthritis symptoms new research

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Arthritis and Bipolar Disorder – PsychCentral.com

Sunday, February 16th, 2020

Studies reveal that people with rheumatoid arthritis are at a greater risk of developing bipolar disorder than the general population.

Specifics vary across studies, as does conjecture about the cause, but an analysis of several research filings state that people with RA are nearly 3 times more likely to have bipolar disorder.

Many researchers surmise that inflammation is the cause. RA is an autoimmune disorder, and neurologists are beginning to believe that even BP may be an autoimmune disease.

At 56 Im at an age where everything suddenly hurts, especially my joints. As this pain has spread to my hands and my knuckles have disfigured its time to get checked out for arthritis. I mean, I already have osteoporosis, which may be a result of my bipolar disorder or long-term use of anticonvulsants. Why not RA, too (then theres always hypochondria, which I wrote about here)?

Some of the data is contradictory. One study states that the average person with BP and RA is a 41-year old woman. Another only finds a relationship between the diseases in people under 19 and over 75. But a meta-analysis of a number of studies implies that the co-morbidity holds across populations, and the most common clinical features that co-occur with RA are psychiatric.

Its easy to point to stress as the common factor between the conditions, or even an inflammatory diet. But there may be a smoking gun lurking behind the data and the results.

That smoking gun is smoking.

Its well established that smoking is a contributing factor to RA. And any trip to a psych ward or the patio around the entrance of a building where a support group is meeting will quickly show that many people with bipolar disorder smoke. 68.8% of people with bipolar disorder currently smoke, and 82.5% of people with BP have smoked at some point during their lives. Of those who currently smoke, the average number of cigarettes smoked per day is 30.

So when it comes to the co-morbidity between BP and RA, maybe its not the BP at all. Maybe the true culprit is heavy smoking.

Medical research is hard, and drawing distinctions between correlation and causation is even harder. Just because diseases seem to occur together in lots of people doesnt mean that one causes the other.

The best way we can mitigate co-morbidity is to live as healthy a life as we can.

If you want to prevent or manage RA, you cant decide to not have BP. But you can manage stress, eat an anti-inflammatory diet and, above all else, stop smoking.

BP is difficult enough. We dont have to make it more difficult to live with by making choices, like smoking, that invite other health problems into our lives.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167853/

https://www.sciencedirect.com/science/article/abs/pii/S0165032715303864

https://mdquit.org/special-populations/bipolar-disorder

Photo by handarmdoc

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Possible link between rheumatoid arthritis and depression – Medical News Bulletin

Sunday, February 16th, 2020

Rheumatoid Arthritis (RA) is the most common autoimmune arthritis caused by the improper functioning of the bodys defense system. Research has shown that depression is among the most common mental health disorders associated with RA. However, the prevalence of concurrence ranges between 14% to 48% due to different factors including measurement methods, frequency of depressive symptoms and diagnosis threshold. Recent advances in clinical rheumatology have developed our understanding of RA and depression at a molecular level. However, several other studies need to be conducted to find the proportion and strong association between RA and depression among the population and find therapeutic treatments.

A recent study, published in the British Medical Journal showed that women suffering from RA exhibited depressive symptoms, which was linked to disease activity and dysfunction. A cross-sectional study comprising 319 female RA patients along with 306 healthy controls was conducted in Austria, based on Becks depression Inventory-Fast Screen (BDI-FS) a self-report to evaluate depression rate in patients suffering from medical disease. Factors including medication, alcohol intake, disease activity, smoking, and occupation were also evaluated in the study.

The results showed that depression was significantly higher in female patients (one-third of patients) suffering from RA as compared to the healthy controls. Furthermore, depressive symptoms were strongly linked with the disease disability and activity despite alcohol intake, age, occupation, and smoking status.

The study provided strong support for the rate of depressive symptoms among RA female patients. It should be noted, however, that pain assessment was not included in the study, and the study group consisted of only females. Further research will be necessary to confirm the findings and extend them further to enable potential treatment strategies.

Written by Sakina Bano Mendha

References:

April Chang-Miller, M. D. (2019, October 18). Is depression a factor in rheumatoid arthritis? Retrieved from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/expert-answers/rheumatoid-arthritis-depression/faq-20119780

Sautner, J., Puchner, R., Alkin, A., & Pieringer, H. (2020). Depression: a common comorbidity in women with rheumatoid arthritisresults from an Austrian cross-sectional study. BMJ Open, 10(1). doi: 10.1136/bmjopen-2019-033958

Image byMabel Amber fromPixabay

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Updated EULAR Recommendations for Rheumatoid Arthritis Management With DMARDs – Rheumatology Advisor

Sunday, February 16th, 2020

Based on emerging new evidence and expert consensus, an international task force put together by the European League Against Rheumatism (EULAR) released updated recommendations for the management of rheumatoid arthritis (RA) with synthetic and biologic disease-modifying antirheumatic drugs (DMARDs). This report was published in Annals of the Rheumatic Diseases.

Investigators performed a systematic review of studies focused on the efficacy and safety of DMARDs as monotherapy or combination therapy, including conventional synthetic, targeted synthetic, and biologic DMARDs. The task force agreed on 5 overarching principles and 12 recommendations by devising related questions, eliciting expert opinions, and reaching consensus by vote.

Overarching Principles for Managing RA

1. According to the researchers, treatment of patients with RA should be based on shared decision-making between the patient and the treating rheumatologist. In addition, patient and provider education should be included in best care practices, which may increase adherence to medications and appropriate assessment strategies, respectively.

2. Researchers indicated that decisions regarding the treatment of patients with RA particularly when considering biologic and targeted synthetic DMARDs should be based on disease activity, safety issues, and other patient factors, including comorbidities and progression of structural damage.

3. Recommendations included that primary care for patients with RA should be provided by rheumatologists; it is especially important for patients with RA to receive specialty care when initiating any type of DMARD therapy.

4. The newest principle in managing patients with RA recognizes the heterogeneity of RA, in which the increasing number of drugs with different modes of action should be made accessible to patients as they may require multiple successive drug options throughout life to reach their therapeutic goal.

5. According to the researchers, RA is associated with a high economic burden to both patients and society; the treating rheumatologist should recommend drugs that are less costly compared with drugs that are more costly if efficacy and safety profiles are therapeutically similar.

Recommendations for Goals of Therapy

Therapy with DMARDs should be immediately initiated upon RA diagnosis as the disease will not remit spontaneously.

Sustained remission or low disease activity should be the primary goal in treating patients with RA, and both the American College of Rheumatology and EULAR agreed on the Boolean- and index-based definitions of remission.

Recommendations included the rapid attainment of the treatment target. It was agreed by the task force that disease activity should be assessed every 1 to 3 months; if no improvement is observed after 3 months or the target has not been achieved after 6 months, the treatment strategy should be adjusted.

Recommendations for First-Line Treatment Strategies

In treating patients with RA, methotrexate was recommended as first-line treatment. Investigators indicated that methotrexate is an efficacious conventional synthetic DMARD used as monotherapy but is also the basis for combination therapies with other DMARDs or glucocorticoids; dose escalation should occur within 4 to 6 weeks to reach a weekly dose of about 0.3 mg per kg.

If patients experience early intolerance or have a contraindication to methotrexate, the task force recommended that leflunomide or sulfasalazine be considered as part of first-line treatment strategy.

The EULAR recommended a short-term course of glucocorticoids as a bridging therapy when initiating or changing conventional synthetic DMARD therapies; once the treatment exhibits efficacy, rapidly tapering glucocorticoid use (within 3 months) is important.

Recommendations for Secondary Treatment Strategies

If the treatment target is not achieved after the first-line conventional synthetic DMARD strategy, other conventional synthetic DMARDs should be considered in the absence of poor prognostic factors. These factors include high disease activity and the presence of clinical features, as well as failure to achieve low disease activity after at least 2 conventional synthetic DMARDs.

If poor prognostic factors are present, and the treatment target is not achieved with the first conventional synthetic DMARD strategy, then the task force recommended adding a biologic DMARD or a targeted synthetic DMARD. Patient contraindications, preferences, and cost of care should be considered in deciding on combination therapy.

Recommendations for Combination Therapies

All biologic and targeted synthetic DMARDs are more efficacious in combination therapy compared with monotherapy; EULAR recommends that biologic DMARDs and targeted synthetic DMARDs be combined with a conventional synthetic DMARD. Among patients with contraindications to conventional synthetic DMARDs, interleukin-6 pathway inhibitors and targeted synthetic DMARDs may be used as comedication.

Researchers indicated that if a biologic DMARD or targeted synthetic DMARD therapy fails, treatment with another biologic DMARD or targeted synthetic DMARD should be considered. Similarly, if treatment with tumor necrosis factor inhibitor (TNFi) fails, patients may be effectively treated with a different mode of action or a second TNFi therapy.

Recommendations for Persistent Remission

If persistent remission is achieved after tapering any glucocorticoid bridging therapies, EULAR suggests that clinicians consider tapering biologic DMARDS or targeted synthetic DMARDs, especially when these therapies are combined with a conventional synthetic DMARD. Discontinuation of biologic DMARDs is often associated with flares, and tapering of biologic DMARDs may be preferred just as a dose reduction or interval increase.

Investigators indicated that if persistent remission is achieved with conventional synthetic DMARD monotherapy or if remission can be sustained after cessation of any added therapies from a combination therapy regimen, tapering the conventional synthetic DMARD may be considered.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please refer to the original reference for a full list of authors disclosures.

Reference

Smolen JS, Landew RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update [published online January 22, 2020]. Ann Rheum Dis. doi:10.1136/annrhumdis-2019-216655

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Updated EULAR Recommendations for Rheumatoid Arthritis Management With DMARDs - Rheumatology Advisor

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Real-World Patient Experience of Switching Biologic Treatment in Infla | PPA – Dove Medical Press

Sunday, February 16th, 2020

Karin Luttropp,1 Johan Daln,1 Axel Svedbom,1 Mary Dozier,2 Christopher M Black,3 Amy Puenpatom3

1ICON Clinical Research, Plc., Stockholm, Sweden; 2ICON Clinical Research, Plc., Boston, MA, USA; 3Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA

Correspondence: Amy PuenpatomCenter of Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ Tel +1 267 305 0620Fax +1 215 850 4549Email puenpatom.amy@merck.com

Purpose: To obtain an up-to-date overview of the measurement of patient experience of switching biologic treatment in patients with inflammatory arthritis (IA) or ulcerative colitis (UC). Secondary objectives included summarizing the types of patient-reported outcomes (PROs) used (if any), and related findings; and summarizing medical and non-medical reasons for treatment switch and/or discontinuation.Methods: A systematic literature review (SLR) was performed, searching Medline and Embase for relevant publications.Results: In total, 70 relevant publications were identified. While the majority of these reported reasons for switching and/or discontinuing treatment, only four provided information explicitly regarding patient-reported experience of switching biologic treatment. All four utilized ranking tools to assess patient experience of switching biologic treatment. The most common reason for switching and/or discontinuing treatment was loss of efficacy, while the least common reason was patient preference.Conclusion: Although the number of available treatments in IA and UC have increased, there is a sparsity of information regarding patient-reported experience of switching biologic treatment. Further research regarding patient preference and/or experience would benefit this therapeutic area and help guide treatment choices.

Keywords: arthritis, colitis, ulcerative, biological products, patient reported outcome measures, treatment switch

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Real-World Patient Experience of Switching Biologic Treatment in Infla | PPA - Dove Medical Press

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