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People with painful chronic conditions such as arthritis tend to experience more pain on humid days than on dry ones, according to a British study published Thursday in the journal NPJ Digital Medicine.

When days are windy and have low atmospheric pressure, pain is also more likely to increase, although to a lesser extent than when the humidity is high, the study also reports.

No evidence was found linking cold days with more pain unless those days were also damp and windy.

The results of this study could be important for patients in the future for two reasons, said William Dixon, the lead author of the research and an epidemiologist at the University of Manchester, in a released statement. Given we can forecast the weather, it may be possible to develop a pain forecast knowing the relationship between weather and pain. This would allow people who suffer from chronic pain to plan their activities, completing harder tasks on days predicted to have lower levels of pain.

The dataset will also provide information to scientists interested in understanding the mechanisms of pain, which could ultimately open the door to new treatments, he adds.

As Dixon and his co-authors point out in their paper, people with arthritis have blamed weather for worsening their symptoms since at least the fifth century BCE, when the Greek physician Hippocrates was writing his medical treatises. Today, about three-quarters of individuals living with arthritis believe weather affects their pain.

Past studies have investigated these claims, but with conflicting results most likely because such studies have tended to involve a small number of people (fewer than 100) and/or a short time frame (a month or less).

The current study, according to its authors, is the first to use a large dataset one collected from smartphones to look at the relationship between local weather and daily pain among people with chronic conditions over a long period of time.

For the study, Dixon and his colleagues analyzed data collected from 2,658 people, aged 17 and older, from across the United Kingdom. All had a painful, chronic medical condition, such as arthritis, fibromyalgia, migraine or neuropathy. Most, however, had arthritis.

At the start of the study, participants were asked to download a smartphone app, which asked them each evening to answer a series of questions about symptoms they had experienced that day. The participants did so on most days for about six months.

The researchers used the smartphones GPS to determine the local weather for each patient on each day. They then looked for correlations between various weather factors and the patients reported symptoms.

High humidity had the strongest link with increased pain, although high wind and low atmospheric pressure also showed significant associations.

And when all three of those weather elements occurred together, there was a kind of pain trifecta, the data revealed.

The analysis showed that on damp and windy days with low pressure the chances of experiencing more pain, compared to an average day, was around 20 percent, says Dixon. This would mean that, if your chances of a painful day on an average weather day were 5 in 100, they would increase to 6 in 100 on a damp and windy day.

That may seem like a small increase, but, as Dixon and his colleagues note, it could be a meaningful change for many people living with chronic pain.

The study found no link between temperature alone and pain symptoms.

And although weather is known to affect day-to-day mood and physical activity, those factors were not found to have much of an impact on the studys findings.

The research comes with caveats. Most notably, it involved only people living in the United Kingdom, so its findings may not be applicable to other populations. In addition, the study began with about 10,000 participants, but most failed to complete enough of the daily questionnaires to be included in the final analysis. There may be something different between the people who stayed in the study and those who dropped out a difference that may make the studys results less reliable.

Still, the findings are intriguing. They may also offer some reassurance to people who struggle with controlling chronic pain.

So many people live with chronic pain, affecting their work, family life and their mental health. Even when weve followed the best pain management advice, we often still experience daily pain, says Carolyn Gamble, one of the authors of the study and a graduate student at the University of Manchester, in a released statement. Gamble has a form of arthritis known as ankylosing spondylitis.

Knowing how the weather impacts on our pain can enable us to accept that the pain is out of our control, it is not something we have done, or could have done differently in our own self-management, she adds.

FMI: You can read the study in full on NPJ Digital Medicines website. The study was funded by Versus Arthritis, a British nonprofit.

The rest is here:
Weather, or not? Study finds chronic pain tends to be worse on humid, but not cold, days - MinnPost

The CDC estimates that more than 1 in 4 adults age 65 or older will fall each year. Out of these falls, 1 in 5 will result in serious injury, such as broken bones and head injuries.

In addition, the Arthritis Foundation estimates that over 50 million adults suffer from one of the many forms of arthritis resulting in pain, stiffness, swelling and decreased ability to perform normal daily tasks.

The "Tai Chi for Arthritis and Fall Prevention" is an evidence-based program recommended by both the Arthritis Foundation and the National Council on Aging to manage arthritis and reduce fall risk, increase balance and flexibility, and decrease stress.

The program was developed by Dr. Paul Lam, a family physician in Sydney, Australia who developed arthritis while still in his teens due to the malnutrition he experienced while growing up in China. Dr. Lam used tai chi to manage his own arthritis and eventually worked with tai chi, medical and education experts to create this program.

The Tai Chi for Arthritis and Fall Prevention program uses the Sun style of tai chi which has been modified to make it gentle on the joints, easy to learn, and significantly safer for older adults than other forms of tai chi. Often described as "meditation in motion," it consists of slow, continuous movements with a focus on body awareness, posture, weight shifting, and calming the mind. While the movements appear gentle and graceful, they contain a surprising internal power. Dr. Lam describes it as being like a calm, flowing river that has the power and strength to reshape the earth under its surface.

The power of the "Tai Chi for Arthritis and Fall Prevention" program has been demonstrated in numerous medical studies by showing a significant decrease both in falls and in the pain and stiffness of arthritis.

It is performed using a higher stance than most other forms of tai chi and martial arts moves with higher risk have been modified or replaced with safer alternatives. This makes it both easier and safer for arthritis sufferers and those at risk for falls.

Instructor Diana Nielsen, certified teacher of the "Tai Chi for Arthritis and Fall Prevention" program, says, "I love introducing people to this program and watching their balance and confidence improve. I have practiced other styles of tai chi for years but find this form is best for my own arthritis."

Each class consists of warm up and cool down exercises, a review of previously learned moves, and the learning of one or two new moves in a positive learning atmosphere. Over the course of the program, participants will build the balance and muscular strength that is important in both preventing falls and in stabilizing and protecting arthritic joints. The slow movement against gentle resistance also develops strength in the body's core stabilizer muscles which is critical to good posture and back health.

One does not need to have arthritis or a history of falls to benefit from this program. It is geared toward adults age 55 and older who would like a gentle, low-impact program that will increase their balance, mobility, flexibility, and lower body strength while decreasing stress.

Tai chi student Beverly Adams of Elk Grove Village states that this program has been "very rewarding" and that the "classes have been extremely helpful in my rehabilitation from knee and hip replacement surgery."

The Tai Chi for Arthritis and Fall Prevention program is being offered at the Amita Health Alexian Rehabilitation Hospital, 935 Beisner Road in Elk Grove Village.

It consists of 6 one-hour class sessions and is taught by Diana Nielsen, a licensed occupational therapy assistant and a certified instructor of the Tai Chi for Arthritis and Fall Prevention program.

A new class will be starting at 11 a.m. Tuesday, Nov. 5. Register in advance by calling (847) 981-5556, option 2. All participants for this program must be able to walk unassisted for at least 100 feet for safety.

For questions on this program including additional class times and locations, please email TCAFP.DN@gmail.com.

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Learn how to curb the pain, stop the falls with tai chi program this fall - Chicago Daily Herald

People with arthritis are more likely to feel pain on humid, windy days, new research suggests.

Scientists from the University of Manchester found sufferers were 20% more likely to be in pain on days that are humid and windy with low atmospheric pressure than on days with average weather.

The study, funded by the charity Versus Arthritis, examined data from 2,658 people, who provided daily data on pain levels on most days for around six months via their smartphones.

The group had a range of different health issues, predominantly arthritis, but also including fibromyalgia, migraine and neuropathic pain.

According to the research, humid days were the most likely to be painful, whereas dry days were the least likely.

Low pressure and higher wind speed were also linked to more painful days, although to a lesser extent than humidity.

The researchers found no solid link with changing temperature or rainfall, although cold days that were also damp and windy could be more painful.

As part of the study, participants used a dedicated smartphone app to record daily symptoms which were then compared with local weather reports based on the phone's GPS.

Professor Will Dixon, from the University of Manchester, who led the study, said: "Weather has been thought to affect symptoms in patients with arthritis since Hippocrates.

"Around three quarters of people living with arthritis believe their pain is affected by the weather.

"Yet, despite much research examining the existence and nature of this relationship, there remains no scientific consensus.

"Our analysis showed that on damp and windy days with low pressure the chances of experiencing more pain, compared to an average day, was around 20%.

"Given we can forecast the weather, it may be possible to develop a pain forecast knowing the relationship between weather and pain.

"This would allow people who suffer from chronic pain to plan their activities, completing harder tasks on days predicted to have lower levels of pain."

Dr Stephen Simpson, director of research at Versus Arthritis, said: "We know that of the 10 million people in the UK with arthritis, over half experience life-altering pain every day.

"Supporting effective ways of self-managing pain can make all the difference for people with arthritis, helping them to get and stay in work, to be full members of the community and simply to belong.

"This research will help us understand the bigger picture of the complexity of pain caused by arthritis and how people with the condition can take control of it."

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Arthritis pain is linked to the weather, new study confirms - Gloucestershire Live

Early treatment with infliximab sold under the brand name Remicade, among others leads to lower inflammation and fewer joints showing active disease over 12 months in children and adolescents with polyarticular idiopathic arthritis (pJIA), a single center study in China suggests.

But to be effective for a full year, treatment soon after disease onset seems essential, its researchers wrote.

The study, Infliximab therapy and outcomes in patients with polyarticular juvenile idiopathic arthritis: a single-center study in China, was published in the World Journal of Pediatrics.

Advances in the development and approval of biologic therapies over the last two decades have had a significant impact on the outcome of children with pJIA.

Compared to other disease types, pJIA patients are more likely tofail to respond to initial treatment withdisease-modifying anti-rheumatic drugs (DMARDs). But biologic DMARDs have helped to manage disease activity and lessen symptoms.

Among JIA patients, pJIA patients especially those withhigh risk factors [that include]arthritis of the hip or cervical spine, and radiographic damage have more aggressive disease and worse functional outcomes, the team wrote.

Infliximabis a biologic DMARD designed to specifically target and block TNF-alpha, a protein that promotes inflammation and is involved in autoimmunity. This type of therapy has shown efficacy in people with pJIA, but differences exist as to an optimal treatment regimen, the researches noted.

The teamreviewed the long-term impact of treatment with infliximab in 40 children (ages 2 to 13 at diagnosis) with pJIA. All were treated and followed at ChildrensHospital of Chongqing Medical University over an eight year-period starting in January 2010.

Patients were divided into three groups based on their disease course and when they started on infliximab. Nine (group A) started treatment within three months of disease onset, 13 (group B) between three months and one year of onset, while the remaining 18 (group C) initiated treatment more than one year after disease onset.

All patients were given at least four doses of infliximab (36 mg/kg) over three months. Twenty-six received six doses (over six months), and eight patients had nine doses of infliximab, which corresponds to a 12-month treatment period.

Results showed that the erythrocyte sedimentation rate (ESR) an indicator of active inflammation was significantly lower in all groups after three and six months of therapy, compared to pre-treatment values. But this benefit, after 12 months, was only maintained in patients with early treatment (group A).

Children in group A were also the only ones to show stable decreases over 12 months in the number of joints with active disease defined as joints that were tender or painful to move, were swollen, or had limited motion. Also used was the 27-point juvenile arthritis disease activity score (JADAS-27), which includes a physician assessment, a parent/patient global evaluation, ESR rates, and an active joint count.

Patients in groups B and C alsoshowed fewer joints with active disease and a lower JADAS-27 score up to six months of treatment, but experienced increases in both assessments at 12 months. These increases were statistically significant when treatment was started more a year after disease onset (group C).

Overall, infliximab can dramatically improve the outcomes in polyarticular JIA patients, and it should be introduced early during the clinical course, the team wrote.

Total Posts: 11

Jos is a science news writer with a PhD in Neuroscience from Universidade of Porto, in Portugal. He has also studied Biochemistry at Universidade do Porto and was a postdoctoral associate at Weill Cornell Medicine, in New York, and at The University of Western Ontario in London, Ontario, Canada. His work has ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimers disease.

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Polyarticular JIA Patients Show Lesser Inflammation, Affected Joints with Early Use of Infliximab, Study Says - Juvenile Arthritis News

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Mouse studies show effects can linger at least two generations

Multiple generations of mice studied in the lab of Farshid Guilak, PhD, at Washington University School of Medicine in St. Louis indicate obesity has an impact on arthritis risk of future generations.

Arthritis affects one in five Americans, but according to the Centers for Disease Control and Prevention, that number jumps to one in three among people with obesity. Now, new research from Washington University School of Medicine in St. Louis suggests obesity may increase arthritis risk not only in obese people but in their children and grandchildren, too.

Studying mice that became obese after being fed a high-fat diet, the research team found that the animals had an elevated risk for osteoarthritis, a condition that causes cartilage in the joints to break down and is the most common type of arthritis.

Surprisingly, they also found that the mices offspring, even when fed a diet lower in fat, tended to gain nearly 20% more weight than the offspring of their littermates that had never been overweight. In addition, they were at higher risk for arthritis. The same was true for the next generation of mice as well, which gained up to 10% more weight.

The study is published online Oct. 24 in the journal Arthritis & Rheumatology.

This study tells us that environmental factors can influence how genes behave and influence the risk for arthritis for multiple generations, said senior investigator Farshid Guilak, PhD, a professor of orthopedic surgery. Arthritis prevalence is affecting many more people than it used to, more than 250 million people worldwide, and these findings suggest that obesity may help explain why the disorder is becoming so much more common.

Guilak and his team analyzed more than 120 mice whose parents had consumed a high-fat diet. The researchers found that the offspring despite having eaten a low-fat diet were significantly heavier and had more body fat than the offspring of mice that hadnt consumed a high-fat diet.

Then, when those mice had pups the grandchildren of the original mice that third generation of mice also had higher levels of inflammatory molecules and cells in their systems than their littermates, despite never having been fed a high-fat diet. Higher amounts of those molecules, called cytokines, are linked to a variety of problems, including arthritis. In fact, the third-generation mice had higher levels of molecules that cause inflammation, and lower levels of molecules that protect against inflammation. The children and grandchildren of the obese mice in the study also were more likely to have bone and cartilage changes that put them at risk for osteoarthritis.

We cant assume everything we found in these mice will turn out to be true for people, said first author Natalia S. Harasymowicz, PhD, a postdoctoral fellow in Guilaks lab. But theres more and more evidence that when parents eat a bad diet or smoke or abuse alcohol, the next generation is more likely to inherit a predisposition for diabetes, cancer or other diseases. Here, weve shown the same appears to be true for arthritis.

Guilak, who also is director of research at Shriners Hospitals for Children St. Louis, said that in the past, scientists had assumed that the relationship between obesity and osteoarthritis was a mechanical one: More weight puts stress on joints, eventually leading to the pain and stiffness of arthritis.

Weve known for years that obesity is the No. 1 preventable risk factor for osteoarthritis, Guilak said. It turns out, however, that obesity also increases arthritis risk in body parts that dont bear weight, like the hand or the thumb.

Guilaks lab has determined that inflammation plays a much more important role.

What we find is that changes in mechanical loading that occur with obesity dont seem to be the primary risk factors for arthritis, he said. Almost all of the risk is coming from either metabolic or dietary influences, and that risk is then passed down to subsequent generations.

The animals genetic makeup doesnt change to cause increased risk of arthritis. Rather, scientists refer to the changes as epigenetic, meaning that behavior in this case, consuming a high-fat diet changes the way genes work. Its those changes that are passed on.

Poor diet and bad habits may affect not only the individual who has such habits but also future generations, Harasymowicz said. However, recognizing that potential risk may convince people to take steps to be healthier and to reduce their weight, potentially lowering risks for their children and grandchildren.

Harasymowicz NS, Choi YR, Wu CL, Iannucci L, Tang R, Guilak F. Intergenerational transmission of diet-induced obesity, metabolic imbalance, and osteoarthritis in mice. Arthritis & Rheumatology, published online Oct. 24, 2019.

This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, and the Office of the Director of the National Institutes of Health (NIH). Grant numbers AR50245, AR48852, AG15768, AR48182, AG46927, AR073752, OD10701, AR060719, AR057235. Additional funding was provided by Shriners Hospitals for Children, the Arthritis Foundation and the Nancy Taylor Foundation for Chronic Diseases.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Arthritis risk linked to obesity may be passed down through generations - Washington University School of Medicine in St. Louis

The CDC estimates that more than 1 in 4 adults aged 65 years and older will fall each year. Out of these falls,1in 5 will result in serious injury, such as broken bones and head injuries. In addition, the Arthritis Foundation estimates that over 50 million adults suffer from one of the many forms of arthritis resulting in pain, stiffness, swelling and decreased ability to perform normal daily tasks.

Tai Chi for Arthritis and Fall Prevention is an evidence-based program recommended by both the Arthritis Foundation and the National Council on Aging to manage arthritis and reduce fall risk, increase balance and flexibility, and decrease stress. The Tai Chi for Arthritis and Fall Prevention program was developed by Dr. Paul Lam, a family physician in Sydney, Australia who developed arthritis while still in his teens due to the malnutrition he experienced while growing up in China. Dr. Lam used tai chi to manage his own arthritis and eventually worked with tai chi, medical and education experts to create this program.

The Tai Chi for Arthritis and Fall Prevention program uses the Sun style of tai chi which has been modified to make it gentle on the joints, easy to learn, and significantly safer for older adults than other forms of tai chi. Often described as "meditation in motion," it consists of slow, continuous movements with a focus on body awareness, posture, weight shifting, and calming the mind. While the movements appear gentle and graceful, they contain a surprising internal power. Dr. Lam describes it as being like a calm, flowing river that has the power and strength to reshape the earth under its surface.

The power of the Tai Chi for Arthritis and Fall Prevention program has been demonstrated in numerous medical studies by showing a significant decrease both in falls and in the pain and stiffness of arthritis. It is performed using a higher stance than most other forms of tai chi and martial arts moves with higher risk have been modified or replaced with safer alternatives. This makes it both easier and safer for arthritis sufferers and those at risk for falls. Instructor Diana Nielsen, certified teacher of the Tai Chi for Arthritis and Fall Prevention program, says, "I love introducing people to this program and watching their balance and confidence improve. I have practiced other styles of tai chi for years but find this form is best for my own arthritis."

Each class consists of warm up and cool down exercises, a review of previously learned moves, and the learning of one or two new moves in a positive learning atmosphere. Over the course of the program, participants will build the balance and muscular strength that is important in both preventing falls and in stabilizing and protecting arthritic joints. The slow movement against gentle resistance also develops strength in the body's core stabilizer muscles which is critical to good posture and back health.

One does not need to have arthritis or a history of falls to benefit from this program. It is geared towards adults age 55 and older who would like a gentle, low-impact program that will increase their balance, mobility, flexibility, and lower body strength while decreasing stress. Tai chi student Beverly Adams of Elk Grove Village, IL states that this program has been "very rewarding" and that the "classes have been extremely helpful in my rehabilitation from knee and hip replacement surgery."

The Tai Chi for Arthritis and Fall Prevention program is being offered at the AMITA Health Alexian Rehabilitation Hospital located at 935 Beisner Road in Elk Grove Village, IL. It consists of 6 one-hour class sessions and is taught by Diana Nielsen, a licensed occupational therapy assistant and a certified instructor of the Tai Chi for Arthritis and Fall Prevention program. A new class will be starting on Tuesday, November 5th at 11 am; please register in advance by calling 847-981-5556, option 2. All participants for this program must be able to walk unassisted for at least 100 feet for safety. For questions on this program including additional class times and locations, please email TCAFP.DN@gmail.com.

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Curb the Pain, Stop the Falls (Session starting Nov 7) - Chicago Daily Herald

Keith Roach, To Your Health Published 12:00 a.m. ET Oct. 22, 2019

Dear Dr. Roach: What is known about arthritis later in life for someone who had early treatment for Lyme disease? I had it as a teenager in the late 1980s and was told by my doctor that arthritis could be an issue later. I was treated with an IV antibiotic, which I believe was the go-to treatment at the time.

J.A.

Dear J.A.: Lyme disease, a bacterial infection transmitted by the deer tick, causes arthritis in about half of people with untreated Lyme disease. Among those who are recognized and treated early, joint and muscle pains are common, but inflammation of the joints, along with the possibility of joint damage, is unusual. So, if you were recognized and treated early, the likelihood of developing any joint problems should be no different from your risk if you had never had Lyme disease.

Lyme arthritis most commonly affects one knee, but it can affect other joints, such as the shoulder, ankle, elbow or jaw (TMJ). Eleven percent of untreated Lyme disease patients developed permanent joint damage, but only 2% developed permanent joint disability. This study comes from a time when Lyme disease frequently went unnoticed and untreated.

Diagnosing Lyme disease can be a challenge, especially when a rash has gone unnoticed or was never present at all. A doctor needs vigilance and appropriate laboratory testing to find undiagnosed Lyme disease. Conjunctivitis, damage to the nerves of the face or eyes, Lyme meningitis and abnormal electrocardiograms (including heart block) all are occasional manifestations of Lyme disease and should prompt a clinician to consider the diagnosis.

Early treatment of Lyme disease was, and is still, most commonly oral doxycycline.

Dear Dr. Roach: I just completed a bone density scan that showed that I have osteopenia. My doctor has suggested that I take both vitamin D and calcium. I read your recent column that said this can increase stroke risk, which my doctor did not tell me. I am confused that she would suggest I take vitamin D and calcium if it would increase risk of stroke.

L.B.

Dear L.B.: Taken together, calcium and vitamin D reduce the risk of fracture in women with osteoporosis. Naturally, your doctor is concerned about your bones and wants to prevent a fracture, which can be devastating.

However, there is a substantial and growing body of literature suggesting that calcium supplements, but not dietary calcium, increase the risk of heart disease, and a new study showed an increased risk of stroke among those taking calcium supplements and vitamin D. However, there are other studies that have NOT shown an association between calcium supplements and heart attack or stroke. Experts are divided.

There is then a question of competing risks: The benefit of a decreased fracture risk you get in taking the calcium and vitamin D versus the possible harm in stroke and heart disease. Your doctor may have balanced the risk and felt the calcium was more benefit than harm. She may also be in the school that feels calcium supplements have little or no risk.

I am risk-averse for my patients and feel that, when possible, taking calcium through food, not supplements, gives the best of both worlds: reduced fracture risk without increasing the risk of heart disease and stroke. This may require a broader change in diet, which may be inconvenient to some. Calcium-fortified foods are another option.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

Read or Share this story: https://www.detroitnews.com/story/life/advice/2019/10/22/keith-roach-health/40354979/

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Dr. Roach: The link between Lyme disease and arthritis - The Detroit News

Janssen has submitted a Type II Variation Application to the European Medicines Agency (EMA), seeking first-in class approval of its Tremfya (guselkumab) for adult patients with active psoriatic arthritis (PsA).

If approved, it will mark the second approved indication for the human monoclonal antibody in the European Union.

Janssen, a division of Johnson & Johnson, says the submission is based on data from the Phase III DISCOVER-1 and DISCOVER-2 studies, a programme that comprises the first-ever Phase III studies evaluating a human monoclonal antibody targeting the p19 subunit of IL-23 in patients with active PsA.

Previous to this submission, the medicines was approved in the European Union for the treatment of adult patients with moderate to severe plaque psoriasis in November 2017, and has also been approved in the US, Canada, Japan and several other countries worldwide.

Its estimated that up to a third of the 14 million people who are living with psoriasis in Europe will also develop PsA, a chronic, immune-mediated inflammatory disease characterised by both joint inflammation and the skin lesions associated with psoriasis.

Because of this, the submission the toe EMA is an important milestone for people with psoriatic arthritis, who currently have limited treatment options that improve the signs and symptoms of the condition, said Alyssa Johnsen, vice president, rheumatology disease area leader, Janssen.

She continued, With this filing, we hope to offer clinicians a new and innovative treatment option for people living with psoriatic arthritis.

Psoriatic arthritis is a chronic, immune-mediated inflammatory disease characterised by both joint inflammation and the skin lesions associated with psoriasis.

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Janssen seeks to expand Tremfya in arthritis - PharmaTimes

Certolizumab pegol (CZP) may be safe and effective in the long-term treatment of psoriatic arthritis (PsA), according to results of a post hoc analysis presented at the 28th European Academy of Dermatology and Venereology Congress, held October 9 to 13, 2019, in Madrid, Spain.

Researchers presented 4-year data from the RAPID-PsA trial (ClinicalTrials.gov Identifier: NCT01087788) that evaluated the long-term safety and efficacy of CZP in PsA.

RAPID-PsA, a double-blind, placebo-controlled trial to 24 weeks, dose-blind to 48 weeks, and open-label to 216 weeks, included data from patients with active PsA and failed previous treatment with 1 disease-modifying antirheumatic drug. All patients received a loading dose of CZP 400 mg at weeks 0, 2, and 4, and were randomly assigned to receive either CZP 200 mg every 2 weeks or 400 mg every 4 weeks. These assigned doses were continued up to week 216.

In this analysis, data from patients receiving CZP 200 mg or 400 mg were collected, and PsA severity was assessed by 7 minimal disease activity criteria: tender and swollen joint counts 1, Psoriasis Area Severity Index 1 or body surface area affected 3%, patient pain visual analog score 15, patient global disease activity visual analog score 20, Health Assessment Questionnaire Disability Index 0.5, and tender entheseal points 1.

In total, 273 patients were randomly assigned to receive either dose of CZP at baseline. At 24 weeks, 95 patients achieved minimal disease activity, and 37 achieved very low disease activity. At baseline, 166 patients had an affected body surface area 3%; 39 of these patients achieved minimal disease activity plus affected body surface area 3% at 24 weeks.

For all 3 composite outcome measures, patient response rates remained high up to week 216 in patients who had a response at week 24.

In this analysis, a high [percentage] of patients [treated with CZP] demonstrated durability of their initial week 24 response to week 216, the researchers concluded. The greatest durability was observed for [minimal disease activity], although both [very low disease activity] and [minimal disease activity] plus [body surface area] 3% were achieved by over 80% of week 24 responders at week 216.

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

Reference

Gottlieb AB, Gisondi P, Eells J, Peterson L, Kavanaugh A. Durability of response in patients with psoriatic arthritis treated with certolizumab pegol over 216 weeks: post-hoc analyses from the RAPID-PsA study. Presented at: 28th European Academy of Dermatology and Venereology Congress; October 9-13, 2019; Madrid, Spain. Abstract #P0432.

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Durable Response to Long-Term Treatment With Certolizumab in Psoriatic Arthritis - Rheumatology Advisor

Magnetic resonance imaging (MRI)-detected inflammation may predict treatment response in patients with early, poor prognosis rheumatoid arthritis (RA), according to study data published in Arthritis Care & Research.

Investigators conducted a post hoc analysis of the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) study (ClinicalTrials.gov Identifier: NCT01142726), a phase 3b randomized controlled trial of patients with early RA (persistent symptoms, 2 years). Patient eligibility criteria included Disease Activity State (DAS) 28 (C-reactive protein [CRP]) 3.2, active clinical synovitis of 2 joints for at least 8 weeks, and anticitrullinated peptide-2 positivity. Patients included in the study had never received methotrexate or had received 10 mg/week methotrexate for 4 weeks up to a month prior to enrollment.

During the 12-month treatment period, researchers randomly assigned patients 1:1:1 to abatacept plus methotrexate, abatacept monotherapy, or methotrexate monotherapy. They performed an MRI assessment of each patients most clinically active hand and wrist at baseline, 6 months, and 12 months. High baseline MRI-detected inflammation indicated poorer RA prognosis. Investigators compared disease activity at 12 months across treatment groups and stratified them according to baseline MRI inflammation levels. Disease activity measures included Simple Disease Activity Index remission, Clinical Disease Activity Index remission, Boolean remission, and DAS28 (CRP).

Of 351 patients enrolled in the AVERT study, 119 received abatacept plus methotrexate and 116 received methotrexate monotherapy. Among these 235 patients, 225 (95.7%) had baseline MRI data available. At baseline, 125 (55.6%) patients were classified as having low MRI inflammation and 100 (44.4%) as having high inflammation. Disease activity scores were significantly greater in the high inflammation group compared with the low inflammation group. Among patients with high baseline inflammation, the percentage of patients achieving remission at 12 months was significantly greater in the abatacept plus methotrexate group than in the methotrexate group. Specifically, compared with the methotrexate monotherapy group, more patients in the abatacept plus methotrexate group achieved remission on the Simple Disease Activity Index (45.1% vs 16.3%; P =.0022), Clinical Disease Activity Index (47.1% vs 20.4%; P =.0065), and Boolean (39.2% vs 16.3%; P =.0156) indices. In addition, a greater percentage of the abatacept plus methotrexate group achieved DAS28 (CRP) <2.6 compared with the methotrexate group (60.8% vs 40.8%; P =.0667), although the difference was not significant. Researchers observed similar trends in the low inflammation group, although abatacept plus methotrexate was not significantly higher than methotrexate monotherapy.

Study limitations included the fact that calculations were from a post hoc analyses and that the AVERT study was not specifically designed to investigate the prognostic ability of baseline MRI inflammation.

These post hoc analyses of the AVERT study showed that patients with early RA and a high level of MRI inflammation at baseline were more likely to achieve clinical remission with abatacept plus MTX compared with MTX. MRI as a measure of inflammation can provide added value as an objective assessment of disease to influence clinical decision making and guide the more precise use of therapies to treat RA, the researchers concluded.

Disclosure: This study was supported by Bristol-Myers Squibb Company. Please see the original reference for a full list of authors disclosures.

Reference

Ahmad HA, Baker JF, stergaard M, et al. Baseline objective inflammation by magnetic resonance imaging as a predictor of therapeutic benefit in early, poor prognosis rheumatoid arthritis [published online September 24, 2019]. Arthritis Care Res. doi:10.1002/acr.24072

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Baseline MRI Inflammation May Predict Treatment Response in Early Rheumatoid Arthritis - Rheumatology Advisor

Dear Dr. Roach: What is known about arthritis later in life for someone who had early treatment for Lyme disease? I had it as a teenager in the late 1980s and was told by my doctor that arthritis could be an issue later. I was treated with an IV antibiotic, which I believe was the go-to treatment at the time. J.A.

Dear J.A.: Lyme disease, a bacterial infection transmitted by the deer tick, causes arthritis in about half of people with untreated Lyme disease. Among those who are recognized and treated early, joint and muscle pains are common, but inflammation of the joints, along with the possibility of joint damage, is unusual. So, if you were recognized and treated early, the likelihood of developing any joint problems should be no different from your risk if you had never had Lyme disease.

Lyme arthritis most commonly affects one knee, but it can affect other joints, such as the shoulder, ankle, elbow or jaw (TMJ). Eleven percent of untreated Lyme disease patients developed permanent joint damage, but only 2% developed permanent joint disability. This study comes from a time when Lyme disease frequently went unnoticed and untreated.

Diagnosing Lyme disease can be a challenge, especially when a rash has gone unnoticed or was never present at all. A doctor needs vigilance and appropriate laboratory testing to find undiagnosed Lyme disease. Conjunctivitis, damage to the nerves of the face or eyes, Lyme meningitis and abnormal electrocardiograms (including heart block) all are occasional manifestations of Lyme disease and should prompt a clinician to consider the diagnosis.

Early treatment of Lyme disease was, and is still, most commonly oral doxycycline.

Dear Dr. Roach: I just completed a bone density scan that showed that I have osteopenia. My doctor has suggested that I take both vitamin D and calcium. I read your recent column that said this can increase stroke risk, which my doctor did not tell me. I am confused that she would suggest I take vitamin D and calcium if it would increase risk of stroke. L.B.

Dear L.B.: Taken together, calcium and vitamin D reduce the risk of fracture in women with osteoporosis. Naturally, your doctor is concerned about your bones and wants to prevent a fracture, which can be devastating.

However, there is a substantial and growing body of literature suggesting that calcium supplements, but not dietary calcium, increase the risk of heart disease, and a new study showed an increased risk of stroke among those taking calcium supplements and vitamin D. However, there are other studies that have NOT shown an association between calcium supplements and heart attack or stroke. Experts are divided.

There is then a question of competing risks: The benefit of a decreased fracture risk you get in taking the calcium and vitamin D versus the possible harm in stroke and heart disease. Your doctor may have balanced the risk and felt the calcium was more benefit than harm. She may also be in the school that feels calcium supplements have little or no risk.

I am risk-averse for my patients and feel that, when possible, taking calcium through food, not supplements, gives the best of both worlds: reduced fracture risk without increasing the risk of heart disease and stroke. This may require a broader change in diet, which may be inconvenient to some. Calcium-fortified foods are another option.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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The link between Lyme disease and arthritis - News - Sarasota Herald-Tribune

The Eastland Companion Animal Hospital in Bloomington is asking dog owners if they want to participate in research on using stem cells to treat dogs with arthritis.

Local dogs wouldjoin a double-blind, placebo-controlled studyto show the effectiveness of stem cells in treating large dogs(70 pounds or more) with arthritis in up to two joints of the knee, hip, elbow, or shoulder. The veterinary clinic has partnered with Animal Cell Therapies, who it's worked with before, to bring this study to Bloomington.

Dr. Kathy Petrucci, founder and CEO of Animal Cell Therapies, explained how dogs will receive the treatment.

The dogs that will receive the stem cells will be sedated, Petrucci said. Depending on what joints are affected, they will receive up to two injections in the joint and they will also receive an IV dose of stem cells.

The FDA oversees the cells that are received from donors for the study. Mothers donating these cells are screened for diseases, and cells are tested for any infections to ensure safety.

Stem cell therapy has been controversial, especially related to humans.

I think a lot of the controversy comes from the misunderstanding of the cell types, Petrucci said. The research in stem cells first started centered around embryonic or fetal tissue use. Its controversial to use embryos and fetal tissues for treatment for anything. The fact that we are using a disposable tissue as our cell sources makes it not controversial at all.

Why Umbilical-Derived Cells

Petrucci explained why umbilical-derived cells are more effective in treating arthritis versus other sources.

We looked at fat, bone marrow, embryonic cells, Petrucci said. The embryonic cells are a lot more unpredictable, and the bone marrow cells are more difficult to work with and less predictable. We didnt think the fat cells are as potent as umbilical-derived cells. Umbilical-derived cells are a lot younger and theyre a little bit more predictable. They are more easy to collect. We obtain cells from donors when the tissue would be normally thrown away. Theres no surgery required, no extra biopsies to obtain fat, no bone marrow from research animals. Its a good, ethical source of stem cells.

Umbilical-derived stem cells have proven successful in past studies on treatment for arthritis, according to Petrucci.

We did a study at the University of Florida on elbows only and we had success with that study, Petrucci said. We had good success with dogs under 70 pounds and (less) success with dogs over 70 pounds, so we changed our dose, which is why were testing dogs 70 pounds and over in this study.

Criteria for eligibility includes dogs weighing 70 pounds or more, being one year of age or older, in general good health, no neurologic issues, arthritis in up to two joints of the knee, hip, elbow, or shoulder, and have all four functioning limbs.

Owners must bring their dogs back to the clinic after 30 days to check for progress and complete a questionnaire. About 50 to 100 dogs are expected to participate in the study.

People like you value experienced, knowledgeable and award-winning journalism that covers meaningful stories in Bloomington-Normal. To support more stories and interviews like this one,please consider making a contribution.

Stem Cell Treatment - Excerpt

Stem Cell Research - Full Story

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Bloomington Vet Joins Study For Stem Cell Therapy To Treat Dogs With Arthritis - WGLT News

Rezhna Taha,1 Maria Papadopoulou,1,2 Madeleine Zetterberg,1,2 Solveig Oskarsdottir,3 Marita Andersson Grnlund1,2

1Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 2Department of Ophthalmology, Sahlgrenska University Hospital, Mlndal, Sweden; 3Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

Correspondence: Rezhna TahaDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, SwedenTel +46 31 704 093555Fax +46 31 848952Email rezhna.taha.najim@vgregion.se

Purpose: To evaluate quality of life (QoL) in children with juvenile idiopathic arthritis (JIA).Methods: Forty children with a mean age of 7.9 years were included. The children underwent an ophthalmological examination and completed questionnaires on physical function (CHAQ) and vision-related (VR) QoL (EYE-Q).Results: No differences regarding visual acuity (VA), refraction, intraocular pressure or physical or VRQoL were found between those with JIA without (n=33) and those with JIA-associated uveitis (n=7). When comparing physical function measured by CHAQ disability index and JIA subtype, a difference was found; children with polyarthritis scored the worst (p=0.0098). Children with subnormal VA scored worse on EYE-Q compared with those with normal VA (p=0.013). We found correlations between duration of JIA and CHAQ disability index (r=0.42, p=0.0007) and CHAQ well-being (r=0.34, p=0.022).Conclusion: This study indicates the importance of measuring not only physical function but also VRQoL in children with JIA and JIA-associated uveitis.

Keywords: child arthritis, juvenile idiopathic arthritis, PROM, uveitis, quality of life

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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Visual Function And Quality Of Life In A Cohort Of Swedish Children Wi | OPTH - Dove Medical Press

The PatientReported Outcomes Measurement Information System (PROMIS) is a universally applicable set of itembanks for the evaluation of patientreported health. Both the PROMIS Pain Interference (PROMISPI) and the PROMIS Pain Behavior (PROMISPB) itembanks were found to have good psychometric properties for patients with rheumatoid arthritis and to be useful as computerized adaptive tests (CATs) in clinical practice and research, according to a study published in Arthritis Care & Research.

The objective of the current study was to evaluate the psychometric properties of the PROMIS-PI and the PROMIS-PB item banks (40 and 39 items, respectively) in Dutch and Flemish patients with rheumatoid arthritis. Properties examined in those assessments are unidimensionality, crosscultural validity (Differential Item Functioning [DIF] for language [Dutch vs Flemish]), other forms of measurement invariance, floor and ceiling effects, monotonicity, Graded Response Model (GRM) fit, local dependence, construct validity, and reliability.

Both the PROMISPI and PROMISPB item-banks were found to have sufficient unidimensionality (OmegaH 0.99 and 0.95; ECV 0.95 and 0.78; respectively), to have negligible local dependence (0.3% and 1.4% of itempairs), good monotonicity (scalability coefficient of the scale, 0.75 and 0.46), and a good graded response model fit. Both item-banks also showed good cross-cultural validity (absence of differential item functioning for language), measurement invariance (absence of differential item functioning for age, sex, disease activity, and administration mode), good construct validity, high reliability (>0.90 in the range of patients with rheumatoid arthritis), and absence of floor and ceiling effects (0% maximum or minimum score for both). The PROMIS-PI correlated strongly with the Dutch-Flemish PROMIS Global Health Pain intensity (r=0.80), the Short-Form Health Survey Physical Functioning scale (r=-0.71) and the Health Assessment Questionnaire Disability Index (r=0.71). The PROMIS-PB also correlated strongly with the Dutch-Flemish PROMIS Global Health Pain intensity 266 (r=0.61). These findings add to the evidence that the PROMIS item-banks provide an adequate assessment of pain interference and behavior, respectively.

Both the PROMIS-PI and PROMIS-PB banks showed good psychometric properties in patients with [rheumatoid arthritis]. Using the highly efficient PROMIS-PI and PROMIS-PB CATs in research and clinical practice is considered to be user-friendly and feasible with little administration time, and has the potential for valid and precise standardized and routine patient monitoring of pain interference and pain behavior, concluded the study authors.

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Reference

Crins MHP, Terwee CB, Westhovens R, et al. First validation of the full PROMIS pain interference and pain behavior item banks in patients with rheumatoid arthritis [published online September 28, 2019]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.24077

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Validation of PROMIS Pain Interference and Pain Behavior for Rheumatoid Arthritis - Clinical Pain Advisor

Elevated anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF) titers have been independently associated with increased mortality in patients with rheumatoid arthritis (RA), according to research published in Arthritis Care & Research.

Researchers conducted a retrospective real-world study examining the role of ACPA and RF seropositivity in risk prediction for mortality in RA. Investigators also studied the association between ACPA and RF titers and all-cause mortality, examining whether the use of disease-modifying antirheumatic drugs (DMARDs) affected these associations.

Study data were obtained from 2 US administrative claims databases linked to laboratory data. Patients were followed from the date of the analysis-specific index until death, end of health plan enrollment, or the end of the study period (June 2016).

In total, 133,775 patients with RA were included from both databases (ACPA n=53,849; RF n=79,926). Baseline characteristics were generally balanced between groups, with DMARD use, RA diagnoses, previous or current positive smoking status, and the presence of chronic obstructive pulmonary disease significantly elevated in seropositive patients (P <.001).

The ACPA group had 184,170 patient-years of follow-up. In this group, 5.7% of patients died, and the mortality incidence rate was 16.7 per 1000 patient-years (95% CI, 16.1-17.3). The RF group had 297,830 patient-years of follow-up; 6.5% of patients died, and the mortality incidence rate was 17.5 per 1000 patient-years (95% CI, 17-18). Both ACPA and RF positivity were associated with a significant increase in mortality risk (P <.0001 for both).

In the ACPA group with baseline RF data, ACPA positivity was associated with increased mortality compared with RF positivity; double ACPA and RF positivity were associated with the highest mortality risk (hazard ratio [HR] 1.61; 95% CI, 1.45-1.79). Single ACPA positivity was associated with a higher risk compared with single RF positivity.

In the RF group with baseline ACPA data, the highest mortality risk was also noted in the ACPA and RF double-positive group (HR 1.22; 95% CI, 1.09-1.36). According to the investigators, all other combinations of the presence of ACPA and RF were associated with a significantly increased mortality risk compared with ACPA and/or RF seronegativity.

Also, mortality risk positively correlated with ACPA and RF titers and was the highest in groups of patients with the highest titers for both ACPA and RF (HR 1.60 and 1.78, respectively; 95% CI, 1.45-1.76 and 1.66-1.91). The findings were consistent when the groups were combined.

Survival curves comparing patients with ACPA and RF serostatus showed similar patterns of divergence. Compared with single ACPA and RF positivity, single ACPA and RF negativity was associated with a higher survival rate.

Both ACPA and RF single-positive patients who received conventional synthetic DMARD (csDMARD) therapies had a statistically significant increase in mortality risk (ACPA HR 1.52; RF HR 1.47). Patients who had single ACPA or RF positivity who received csDMARDs had a 46% and 62% increased mortality risk vs patients with double ACPA and RF negativity. No increase in mortality risk was noted in patients receiving biologic DMARDs.

Study limitations included those inherent to the nature of observational studies, including the absence of randomization.

Elevated ACPA and RF titers were independently associated with increased mortality among patients diagnosed with RA, the researchers concluded. Additional analyses are warranted, including evaluation of the association of disease activity and mortality.

Disclosure: This clinical trial was supported by Bristol-Myers Squibb. Multiple authors report affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Reference

Alemao E, Bao Y, Weinblatt ME, Shadick N. Association of seropositivity and mortality in rheumatoid arthritis and the impact of treatment with disease-modifying antirheumatic drugs [published online September 17, 2019]. Arthritis Care Res. doi: 10.1002/acr.24071

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Increased Mortality and Seropositivity in Rheumatoid Arthritis - Rheumatology Advisor

Adults with rheumatoid arthritis (RA) are more likely to demonstrate cognitive impairment compared with healthy adults, according to research published in the Journal of Clinical Neuroscience. Researchers highlight the potential burden of cognitive impairment in RA management.

Researchers conducted a cross-sectional, case-control study of consecutive patients to examine the prevalence of cognitive impairment and the specific factors associated with this impairment in RA.

Patients were recruited from the rheumatology unit of a university-affiliated, tertiary referral hospital between January 2016 and December 2018. Eligible patients were aged 18 years or older with an RA diagnosis based on American College of Rheumatology criteria. Patients with diagnosed dementia prior to RA diagnosis were excluded.

The final study cohort included 210 patients with RA and 70 healthy controls (83.8% and 78.6% women, respectively): Both groups were homogenous in terms of age, sex, and education level, although patients in the RA group were more likely to have hypertension, diabetes, and mood disorders.

Investigators found a statistically significant difference between the rates of cognitive impairment between the RA and control groups; 72.4% and 97.65% of patients in the RA group classified as cognitively impaired based on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), respectively. Comparatively, only 20% and 68.6% of patients in the control group were classified as cognitively impaired (MMSE and MoCA, respectively). More patients in the RA group experienced neuropsychiatric impairment (59.5%) or subjective memory complaints (67.1%).

Mean MMSE and MoCA scores were significantly lower in patients with RA, whereas mean Hospital Anxiety and Depression Scale (HADS) Total, HADS Anxiety, and HADS Depression scores were significantly higher. Patients with RA performed significantly worse on MMSE in terms of individual analysis of cognitive domains, particularly in terms of attention, remote memory, repetition, stage command, writing, read and obey, and copy. MoCA results demonstrated statistically significant differences between RA patients and controls in almost all cognitive domains, excluding orientation.

Patients being treated with biologic therapy were less likely to be classified as cognitively impaired according to the MMSE, whereas patients treated with oral glucocorticoid therapies and those who had positive rheumatoid factor were more likely to be classified as cognitively impaired based on the MoCA.

A linear regression analysis found that Health Assessment Questionnaire results were correlated with MMSE scores, MoCA scores, and HADS scores (r=-0.21, -0.27, and 0.46, respectively). Logistic regression analyses found that patients who were older, or who exhibited their first disease symptoms at an older age, had increased odds of being classified as cognitively impaired according to the MoCA.

Limitations to the study included the cross-sectional nature of the design, meaning that despite statistical significance, the causal pathway to cognitive impairment could not be determined. Additionally, this sample is not representative of all patients with RA, and therefore results may not be generalizable.

Patients with RA may present more neurological deficits than is commonly thought, the researchers concluded. For persons with chronic diseases such as RA, intact cognitive function is critical for the successful performance of daily activities based on ones current health condition Further studies are needed to better investigate the epidemiology and the physiopathology of dementia in RA patients.

Reference

Vitturi BK, Nascimento BAC, Alves BR, de Campos FSC, Torigoe DY. Cognitive impairment in patients with rheumatoid arthritis [published online August 22, 2019]. J Clin Neurosci. doi: 10.1016/j.jocn.2019.08.027

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Rheumatoid Arthritis and Cognitive Impairment - Rheumatology Advisor

The European Medicines Agencys (EMA) Committee for Medicinal Products for Human Use (CHMP) agreed on a positive opinion for AbbVies upadacitinib (RINVOQ), according to the company. The JAK inhibitor is a once-daily selective treatment used for adult patients with moderate to severe active rheumatoid arthritis who are intolerant to 1 or more disease-modifying antirheumatic drugs.

CHMP's positive opinion is a scientific recommendation for marketing authorization to the European Commission, which authorizes marketing approval in the European Union. This opinion is supported by data from a global phase 3 SELECT rheumatoid arthritis program. 4400 patients with moderate to severe active rheumatoid arthritis were evaluated in 5 different trials, including SELECT-NEXT, SELECT-BEYOND, SELECT-MONOTHERAPY, SELECT-COMPARE, and SELECT-EARLY.

All primary and secondary endpoints were met, including low disease activity based on Disease Activity Score 28 C-Reactive Protein. Improved response was seen with upadacitinib, both as a monotherapy and in combination with conventional synthetic DMARDs compared to placebo.

The SELECT program showed a consistent safety profile across all five studies, with the most frequent adverse reactions being infections.

REFERENCE

AbbVie receives chmp positive opinion for upadacitinib (rinvoq) for the treatment of adults with moderate to severe active rheumatoid arthritis [news release]. North Chicago, Ill.; PR Newswire: October 18, 2019. https://www.prnewswire.com/news-releases/abbvie-receives-chmp-positive-opinion-for-upadacitinib-rinvoq-for-the-treatment-of-adults-with-moderate-to-severe-active-rheumatoid-arthritis-300940994.html. Accessed October 18, 2019.

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Positive Opinion of Upadacitinib for Active Rheumatoid Arthritis - Pharmacy Times

Nine widely-used medications have experienced substantial price surges over the past 2 years, adding $5.1 billion to overall drug spending during this time period, according to a new report.

Furthermore, 7 of these 9 drugs were found by the Institute of Clinical and Economic Review (ICER) to be lacking sufficient clinical evidence to support such price increases. Not only did adalimumab top the list of best-selling drugs last year, but the anti-inflammatory medication ranked first in terms of the most substantial price hikes from 2016 to 2018.

Of the drugs listed, the ICER indicated that lenalidomide and dimethyl fumarate were the only 2 with new clinical evidence. However, the report noted that this is not a determination that the new evidence necessarily justified these prices increases.

Below are the top 9 drug price hikes based on wholesale acquisition cost (WAC) increase, net price increase, and overall estimated increase in drug spend.

1.Adalimumab (Humira)

WAC increase: 19.1%Net Price increase: 15.9%Drug spending increase: $1.86 billion

Indicated for: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, adult and pediatric Crohn disease, ulcerative colitis, plaque psoriasis, adult and adolescent hidradenitis suppurativa, and adult and pediatric non-infectious uveitis.

2.Rituxan (rituximab)

WAC increase: 17%Net Price increase: 23.6%Drug spending increase: $806 million

Indicated for: non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, pemphigus vulgaris, granulomatosis with polyangiitis, and microscopic polyangiitis.

3. Pregabalin (Lyrica)

WAC increase: 28.3%Net Price increase: 22.2%Drug spending increase: $688 million

Indicated for: Neuropathic pain associated with diabetic peripheral neuropathy, neuropathic pain associated with spinal cord injury postherpetic neuralgia, adjunctive therapy for partial-onset seizures in patients 1 month of age and older, and fibromyalgia.

4. Elvitegravir, Cobicistat, Emtricitabine, Tenofovir (EVG/COBI/FTC/TAF) (Genvoya)

WAC increase: 14.3%Net Price increase: 21.7%Drug spending increase: $651 million

Indicated for: HIV in antiretroviral (ART)-nave adults and pediatric patients aged 12 years and older and to replace the current ART regimen in virologically suppressed patients.

5. Emtricitabine/Tenofovir Disoproxil Fumarate (Truvada)

WAC increase: 14.3%Net Price increase: 23.1%Drug spending increase: $550 million

Indicated for: to be used in combination with other antiretroviral agents for the treatment of HIV-infected adults and childred aged 12 yeas and older and for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV in adulst and adolescents at high risk.

5. Pegfilgrastim (Neulasta)

WAC increase: 14.6%Net Price increase: 13.4%Drug spending increase: $489 million

Indicated for: decrease the incidence of infection as manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia and to increase survival in patients acutely exposed to myelosuppressive doses of radiation.

6. Tadalafil (Cialis)

WAC increase: 26.2%Net Price increase: 32.5%Drug spending increase: $403 million

Indicated for: erectile dysfunction and benign prostatic hyperplasia

7.Dimethyl Fumarate (Tecfidera)

WAC increase: 16.7%Net Price increase: 9.8%Drug spending increase: $313 million

Indicated for: relapsing forms of multiple sclerosis

8.Lenalidomide (Revlimid)

WAC increase: 25.8%

According to the report, ICER received public comment that lenalidomide experienced important price increases, but due to uncertainties in the volume of unit sales, they were unable to accurately determine the change in drug spending.

Indicated for: myelodysplastic syndromes, mantle cell lymphoma that has relapsed or progressed after 2 prior therapies, and multiple myeloma.

Reference

Institute for Clinical and Economic Review. Unsupported Price Increase Report. October 8, 2019.https://icer-review.org/wp-content/uploads/2019/01/ICER_UPI_Final_Report_and_Assessment_100819_Final.pdf. Accessed October 9, 2019.

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Top 9 Drugs With the Biggest Price Increases Over 2 Years - Pharmacy Times

Nearly 60% of respondents in a national survey of people with juvenile arthritis and other rheumatic diseases reported struggling to afford their medications in the past year.

The online survey, conducted by the American College of Rheumatology (ACR) in June, with the results recently released, included 1,517 adults living in the U.S. Participants were asked about their lifestyle, access to healthcare, and its affordability.

Results showed that although most of the respondents (90%) had health insurance coverage, nearly 60% had difficulties affording their treatments.

Nearly half reported that insurance companies impose a step therapy, in which patients must take and fail to respond to an insurer-preferred treatment before they are covered for therapy options prescribed by their doctors. This occurred even when a patients doctor doubted the efficacy of the insurer-preferred option.

Out-of-pocket costs greater than $1,000 a year were reported by one in four of the respondents. In 6% of the cases, yearly out-of-pocket costs skyrocketed to over $5,000.

While more than 50% of the respondents are currently followed by or have been referred to a rheumatologist, the waiting period before a first consultation was more than 30 days in approximately 60% of the cases.

Nearly two-thirds of patients (63.81%) reported impairments to their daily lives, with the disease affecting their ability to perform simple tasks such as eating, getting dressed, cooking meals, or running errands.

These findings make clear that Americans living with rheumatic disease regardless of age, gender, or income level struggle to find affordable care, Paula Marchetta, MD, president of the American College of Rheumatology, said in a press release.

To address these challenges, it is crucial for patients, clinicians, and policymakers to work together to improve access to rheumatology care so that patients can live longer, healthier, and more fulfilling lives, Marchetta added.

Together with people with rheumatology, ACR staffers recently attended the annual Advocates for Arthritis event at Capitol Hill, to push for changes to legislation. Specifically, the advocates urged for a stop in the excessive use of step therapy by insurance companies and for legislation that would increase the number of rheumatologists.

The 2019 survey followed last years 2018 ACR survey, which asked patients from all 50 states and the District of Columbia, How easy is it to live with rheumatic disease in my state? This years assessment adds further information on the challenges faced by people diagnosed with a rheumatic disease.

According to the Centers for Disease Control and Prevention, nearly one in four Americans have a rheumatic disease, which includes juvenile arthritis, rheumatoid arthritis, systemic lupus erythematosus, and Sjgrens syndrome. As as many as 300,000 children in the country are estimated to have juvenile arthritis.

Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.

Total Posts: 11

Ana holds a PhD in Immunology from the University of Lisbon and worked as a postdoctoral researcher at Instituto de Medicina Molecular (iMM) in Lisbon, Portugal. She graduated with a BSc in Genetics from the University of Newcastle and received a Masters in Biomolecular Archaeology from the University of Manchester, England. After leaving the lab to pursue a career in Science Communication, she served as the Director of Science Communication at iMM.

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US Survey Finds 60% of Americans Struggle to Afford Medications for JA, Other Rheumatic Diseases - Juvenile Arthritis News

Although liver fibrosis and liver stiffness are more common in patients with rheumatoid arthritis (RA) compared with the general population, methotrexate (MTX) treatment does not appear to be a contributing factor, according to research published in the European Journal of Internal Medicine.

Using data from consecutive patients with RA, researchers sought to determine the role of MTX therapy in the development of liver stiffness and liver fibrosis. Categorically, patients who were MTX-nave and MTX-treated were assessed via real-time 2-dimensional shear wave elastography technology (2D.SWE.SSI).

The total cohort included 140 MTX-treated, 33 MTX-nave, and 100 healthy controls with a similar mean age and gender distribution across all groups. However, MTX-nave patients had a significantly shorter disease duration and higher Health Assessment Questionnaire compared with patients who were treated with MTX. In the MTX-treated group, the mean cumulative dose of MTX was 37153560 mg, with a mean time of treatment exposure of 71.366.4 months.

Liver stiffness (kPa) values were significantly lower in healthy controls compared with both patients who were MTX-nave and MTX-treated (4.320.7 vs 4.920.8 and 4.850.9, respectively). The difference in kPA values between the 2 MTX groups was not statistically significant.

Researchers, through the results of a multiple linear regression analysis, found that RA diagnosis, older age, and being a man were independently associated with higher liver stiffness values. An additional multiple linear regression analysis found that increasing age and being a man, but not treatment with and cumulative dose of MTX, were independently associated with increasing liver stiffness in patients with RA.

Based on a proposed cutoff of 7.1 kPa, only 4 out of 173 patients with RA were classified as having significant liver fibrosis (kPa values range 7.1-7.6). All 4 of these patients were in the MTX-treated RA group. However, these patients did not have liver function abnormalities or clinical signs of hepatic failure.

One study limitation is the lack of histological confirmation of hepatic fibrosis, which researchers note would have been difficult to justify from an ethical point of view. Additional limitations include the possibility of selection bias and the cross-sectional nature of the study design.

Significant liver fibrosis and liver stiffness in RA patients appear to be independent of MTX use, the researchers concluded. [The] 2D.SWE.SSI technique could be a promising tool to assess the severity of and to follow-up liver stiffness in RA patients and other chronic inflammatory conditions under MTX treatment.

Reference

Erre GL, Cadoni ML, Meloni P, et al. Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: a cross-sectional controlled study with real-time two-dimensional shear wave elastography [published online August 29, 2019]. Eur J Intern Med. doi: 10.1016/j.ejim.2019.08.022

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Liver Fibrosis, Stiffness Rates in Rheumatoid Arthritis and Methotrexate Therapy - Rheumatology Advisor