Treatment With Tremfya® (Guselkumab) Improved Psoriatic Arthritis Symptoms Through One Year

MedicalResearch.com Interview with:

Atul A. Deodhar, MD, MRCP, FACP, FACR Professor of Medicine Division of Arthritis & Rheumatic Diseases Medical Director, Rheumatology Clinics Medical Director, Immunology Infusion Center Oregon Health & Science University (OHSU) 

Dr. Deodhar

Atul A. Deodhar, MD, MRCP, FACP, FACR
Professor of Medicine
Division of Arthritis & Rheumatic Diseases
Medical Director, Rheumatology Clinics
Medical Director, Immunology Infusion Center
Oregon Health & Science University (OHSU) 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Phase 2, randomized, double-blind, placebo–controlled, multicenter trial was designed to evaluate the efficacy and safety of guselkumab (Tremfya®) compared with placebo in adults with active psoriatic arthritis, despite having received treatment with standard-of-care therapies, including anti-tumor necrosis factor (TNF)-alpha agents.

In an observed analysis presented at ACR 2017, more than 70 percent of patients receiving guselkumab achieved at least a 20 percent improvement in signs and symptoms of disease (ACR 20) at week 56.  Findings also showed that improvements in tender and swollen joints, skin clearance, pain and physical function, and patient-reported quality of life outcomes reported at week 24, were maintained through week 56 in patients receiving guselkumab maintenance therapy (subcutaneous injections every eight weeks).  Continue reading

African Americans Do Worse After Joint Replacements, But Only In Disadvantaged Neighborhoods

MedicalResearch.com Interview with:

Susan M. Goodman, MD Director of the Integrative Rheumatology and Orthopedics Center of Excellence Hospital for Special Surgery

Dr. Goodman

Susan M. Goodman, MD
Director of the Integrative Rheumatology and Orthopedics Center of Excellence
Hospital for Special Surgery 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously reported that African Americans who have poorer health outcomes, may be disproportionately impacted by community factors. For African Americans undergoing knee replacement, no difference in pain and function was seen compared to whites in communities with little poverty, while in poor communities, African Americans had poorer outcomes. We wondered if this was generally true or if this only applied to knee replacements.

We found similar results; African Americans in richer neighborhoods have comparable outcomes to whites, but as poverty increases- in this study measured as percent with Medicaid coverage- outcomes worsen in a step wise fashion.

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Oral Glucosamine Found No More Effective Than Placebo For Osteoarthritis Pain

MedicalResearch.com Interview with:

Jos Runhaar, PhD Erasmus MC Department of General Practice Rotterdam The Netherlands

Dr. Runhaar

Jos Runhaar, PhD
Erasmus MC
Department of General Practice
Rotterdam
The Netherlands 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages.

For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding.

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Oral Treatment Option for RA Includes Tofacitinib (XELJANZ®) Plus Methotrexate

MedicalResearch.com Interview with:

Roy Fleischmann, MD MACR Medical Director Metroplex Clinical Research Center Clinical Professor of Medicine University of Texas Southwestern Medical Center Dallas, TX 75231

Dr. Fleischmann

Roy Fleischmann, MD MACR
Medical Director
Metroplex Clinical Research Center
Clinical Professor of Medicine
University of Texas Southwestern Medical Center
Dallas, TX 75231

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the phase 3 studies of tofacitinib, it was noted that the clinical responses to tofacitinib monotherapy were higher than the responses to tofaciotinib plus MTX and that tofacitinib plus methotrexate had numerically higher clinical responses compared to adalimumab plus methotrexate. This study was a non-inferiority design which compared tofacitinib monotherapy to tofacitinib + MTX and to adalimumab +MTX and tofacitinib monotherapy to tofacitinib +MTX in MTX incomplete responders. It was found that tofacitinib + MTX is non-inferior to adalimumab + MTX (and vice versa) and neither was superior to the other. The results of tofacitinib to either combination was non-conclusive showing neither non-inferiority or inferiority, but suggesting that either combination will be effective in more patients in a group of patients.

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SIMPONI ARIA (golimumab) Improved Sleep and Pain in Ankylosing Spondylitis Trial

MedicalResearch.com Interview with:

Atul A. Deodhar, MD, MRCP, FACP, FACR Professor of Medicine Medical Director, Rheumatology Clinics Medical Director, Immunology Infusion Center Oregon Health & Science University 

Dr. Deodhar

Atul A. Deodhar, MD, MRCP, FACP, FACR
Professor of Medicine
Medical Director, Rheumatology Clinics
Medical Director, Immunology Infusion Center
Oregon Health & Science University 

MedicalResearch.com: What is the background for this study?

Response: The GO-ALIVE study (CNTO148AKS3001) is a multicenter, randomized, double-blind, placebo-controlled study of golimumab, an anti-TNFα monoclonal antibody, administered intravenously (IV), in adult patients with active ankylosing spondylitis (AS). The primary objective is to evaluate the efficacy of golimumab 2 mg/kg in patients with active AS by assessing the reduction in signs and symptoms of AS. The secondary objectives include assessing efficacy related to improving physical function, range of motion, health-related quality of life, and other health outcomes.

A total of 208 patients who had a diagnosis of definite  ankylosing spondylitis (per modified New York criteria) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4, total back pain visual analogue scale (VAS) ≥4, and CRP ≥0.3 mg/dL were randomized.  Patients were treated with IV golimumab (n=105) at Weeks 0, 4, and every 8 weeks through Week 52 or placebo (n=103) at Weeks 0, 4, and 12, with crossover to IV golimumab at Week 16 and through Week 52.

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Lifetime Risk of Symptomatic Hand Osteoarthritis Higher in Whites

MedicalResearch.com Interview with:

Jin Qin, ScD, MS Epidemiologist Centers for Disease Control and Prevention Chamblee, GA 30341

Dr. Jin Qin

Jin Qin, ScD, MS
Epidemiologist
Centers for Disease Control and Prevention
Chamblee, GA 30341 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The hand is one of the sites most commonly affected by osteoarthritis (OA) but is often understudied compared with knee and hip OA. Many people with hand OA have significant symptoms, impaired hand strength and function, and disability in activities of daily living, like using a smart phone or a computer keyboard, and opening a jar. Lifetime risk is the probability of developing a condition over the course of a lifetime.

In this study, we estimated that 40% of adults will develop symptomatic hand OA in their lifetimes. Nearly one in two women (47%) and one in four men (25%) will develop the condition. Whites have a 41% lifetime risk, compared with 29% for blacks. The lifetime risk among individuals with obesity is 47%, which is 11 percentage points higher than those without obesity.

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Noisy Knees May Indicate Risk of Osteoarthritis

MedicalResearch.com Interview with:

Grace H. Lo MD MSc Department of Medicine, Baylor College of Medicine Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey Medical Center, Houston, TX

Dr. Grace H. Lo

Grace H. Lo MD MSc
Department of Medicine, Baylor College of Medicine
Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey Medical Center, Houston, TX

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Osteoarthritis is the most common form of arthritis. Many people who have signs of osteoarthritis on x-rays do not necessarily complain of pain. Presently, there are no known strategies for preventing the development of pain in this group of people.

This study suggests that if these people have noisy knees (otherwise known as “crepitus”), they are at higher risk for developing pain within the next year compared to the people who do not have noisy knees. Future studies that target people who have x-ray signs of osteoarthritis, who do not complain of pain, but do report noisy knees, hold the promise of identifying interventions that can prevent knee pain.

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Earlier Onset of Arthritis in More Recent Generations Linked to Obesity

MedicalResearch.com Interview with:

Elizabeth Badley PhD Professor Emeritus Dalla Lana School of Public Health, University of Toronto Director: The Arthritis Community Research and Evaluation Unit and Head, Division of Health Care and Outcomes Research Krembil Research Institute Toronto Western Hospital Toronto, Ontario

Dr. Elizabeth Badley

Elizabeth Badley PhD Professor Emeritus
Dalla Lana School of Public Health, University of Toronto
Director: The Arthritis Community Research and Evaluation Unit and
Head, Division of Health Care and Outcomes Research
Krembil Research Institute
Toronto Western Hospital
Toronto, Ontario 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The aging of the baby boomer population is focusing attention on the health experience of this sector of the population.  Arthritis is one of the most frequent chronic health problems in the population.  Our research question was to investigate whether the prevalence of arthritis differs between generations (also called birth cohorts) and what might be associated with any differences. Using data collected in a longitudinal Canadian population health survey between 1994 and 2011, we looked at 4 generations: the World War II generation born 1935-1944, older baby boomers born 1945-1954, younger baby boomers born 1955-64, and Generation X born 1965-1974.
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Musculoskeletal Symptoms May Mark Onset of Arthritis in Psoriasis Patients

MedicalResearch.com Interview with:

Lihi Eder MD PhD Rheumatologist, Women’s College Hospital Scientist, Women’s College Research Institute Assistant Professor of Medicine, University of Toronto Toronto, ON, Canada

Dr. Lihi Eder

Lihi Eder MD PhD
Rheumatologist, Women’s College Hospital
Scientist, Women’s College Research Institute
Assistant Professor of Medicine, University of Toronto
Toronto, ON, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There significant delays in the diagnosis of psoriatic arthritis (PsA) among patients with psoriasis. Many patients with psoriasis experience musculoskeletal symptoms. The majority of them do not have PsA, but other non-inflammatory conditions such as fibromyalgia or osteoarthritis.

In this study, we aimed to assess whether the presence and the degree of musculoskeletal symptoms in psoriasis patients predict the development of psoriatic arthritis. We analyzed a cohort of 410 psoriasis patients who were followed over a period of 9 years. These patients did not have arthritis at baseline. The patients were assessed annually by a rheumatologist for signs of PsA. A total of 57 patients developed psoriatic arthritis during the follow-up period.
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Weak Thigh Muscles Contribute to Knee Arthritis in Women

MedicalResearch.com Interview with:

Adam Culvenor, PT, PhD

Dr. Adam Culvenor

Adam Culvenor, PT, PhD
Research Fellow,Institute of Anatomy
Paracelsus Medizinische Privatuniversität
Strubergasse Salzburg, Austria

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thigh muscle weakness, particularly of the knee extensors (quadriceps), is a common feature of people with knee osteoarthritis. Thigh muscle weakness could be a consequence of knee osteoarthritis, or precede knee osteoarthritis development. There is conflicting evidence regarding the role of thigh muscle weakness as a risk factor for incident knee osteoarthritis in both men and women. Thigh muscle specific strength is a measure of muscle quality incorporating both the capacity of the muscle to produce force as well as muscle structure (ie. size, cross-sectional area), and preliminary data suggests this may be a more relevant measure of strength in relation to knee osteoarthritis development.

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Intestinal E. coli Linked to Arthritis in Inflammatory Bowel Disease

MedicalResearch.com Interview with:

Randy Longman, M.D. / Ph.D. Assistant Professor of Medicine Jill Roberts Center and Institute for Research in Inflammatory Bowel Disease Weill Cornell Medicine Division of Gastroenterology and Hepatology Joan and Sanford I. Weill Department of Medicine Department of Microbiology and Immunology New York, NY 10021

Dr. Randy Longman

Randy Longman, M.D. / Ph.D.
Assistant Professor of Medicine
Jill Roberts Center and Institute for Research in Inflammatory Bowel Disease
Weill Cornell Medicine
Division of Gastroenterology and Hepatology
Joan and Sanford I. Weill Department of Medicine
Department of Microbiology and Immunology
New York, NY 10021 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Inflammatory bowel disease is not limited to intestinal inflammation.  Up to 1/3 of patients with active disease suffer from extra-intestinal manifestations.

The most common extra-intestinal manifestations in IBD is joint inflammation or spondyloarthritis.  Peripheral joint spondyloarthritis  carries a prevalence of 20% in Crohn’s Disease and 10% in Ulcerative Colitis, predominantly affecting joints of the lower limbs.  It has long been suggested that gut bacteria can drive this systemic joint inflammation, but microbial targets have not been characterized.

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45 Minutes of Exercise Per Week Maintains Function in Adults With Arthritis

MedicalResearch.com Interview with:

Dorothy D. Dunlop Ph.D. Professor of Medicine and Preventive Medicine Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine Center for Healthcare Studies Chicago, IL 60611

Dr. Dorothy Dunlop

Dorothy D. Dunlop Ph.D.
Professor of Medicine and Preventive Medicine
Northwestern University Feinberg School of Medicine
Institute for Public Health and Medicine
Center for Healthcare Studies
Chicago, IL 60611 

MedicalResearch.com: What is the background for this study?

 

  • We know is being active is good for health.
  • Good evidence supports the current federal guidelines of doing 150 minutes of moderate physical activity each week to prevent serious conditions such as heart disease
  • But only 1 in 10 older US adults with arthritis in their lower limb joints (e.g., knees) meet federal physical activity guidelines
  • Inadequate physical activity is a major public health concern because It can lead to poor function, which threatens a person’s ability to live independently.

These issues motivated our study to investigate the minimum time commitment needed to improve function (or sustain high function) for adults with lower joint osteoarthritis.

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Gum Disease Linked to Autoimmunity in Rheumatoid Arthritis

MedicalResearch.com Interview with:

Maximilian F. Konig, MD Department of Medicine Massachusetts General Hospital Harvard Medical School

Dr. Maximilian F. Konig

Maximilian F. Konig, MD
Division of Rheumatology,
Johns Hopkins University School of Medicine
Current affiliation:
Department of Medicine
Massachusetts General Hospital
Harvard Medical School

MedicalResearch.com: What is the background for this study?

Response:The idea that rheumatoid arthritis (RA), an autoimmune disease that leads to chronic joint inflammation and destruction, may be initiated by a bacterial infection is not novel, but has been posited for more than a century. Based on the clinical observation that patients with RA frequently have severe periodontal disease (gum disease), gum inflammation has long been thought to contribute to disease development in RA. However, limited understanding of the mechanisms that fuel and sustain the autoimmune attack in RA made it difficult to pinpoint a specific bacterial trigger.

In recent years, our understanding of the abnormal immune response that attacks the joints in patients with RA has grown exponentially, and we now know that disease-specific autoantibodies (ACPAs) target modified self-proteins (this modification is known as citrullination). It is this abnormal immune response against citrullinated proteins that appears to drive the joint (and sometimes lung) inflammation seen in rheumatoid arthritis. Recent studies from our laboratory at The Johns Hopkins University (led by principle investigator Felipe Andrade, MD, PhD) suggested that an immune cell called the neutrophil, which normally protects us from infection at sites like the oral cavity or anywhere else in the body, also appears to be the source of the proteins attacked in RA. We were therefore interested to understand what drives the association of gum disease, an inflammation commonly triggered by bacteria, with RA.

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No Increased Risk of IBD Among Secukinumab-Treated Patients with Moderate to Severe Psoriasis in Phase 2 & 3 Clinical Studies

MedicalResearch.com Interview with:

Atul Deodhar, M.D., M.R.C.P. Rheumatology Oregon Health and Science University

Dr. Atul Deodhar

Atul Deodhar, M.D., M.R.C.P.
Rheumatology
Oregon Health and Science University 

MedicalResearch.com: What is the background for this study?

Response: Patients with psoriasis, psoriatic arthritis (PsA), or ankylosing spondylitis (AS) are at an increased risk of developing inflammatory bowel disease (IBD) compared with the general population. It is important that we assess whether new therapies, including the recently approved interleukin-17A (IL-17A) inhibitor, secukinumab, have an acceptable profile in terms of the risk of IBD in patients with psoriasis, PsA, or AS.

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How Does Gout Affect Risk of Colon Cancer?

MedicalResearch.com Interview with:

Michael Pillinger, MD Professor of Medicine and Biochemistry and Molecular Pharmacology NYU School of Medicine

Dr. Michael Pillinger

Michael Pillinger, MD
Professor of Medicine and Biochemistry and Molecular Pharmacology
NYU School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We are interested in the co-morbidities of gout and the fact that gout is accompanied by multiple cardiovascular, renal and other events. The implications of gout for cancer are less clear, but the basic biology suggests that either:

1) the acute and chronic inflammation of gout could contribute to a pro-cancer environment;
2) the anti-oxidant effects of urate could have anti-cancer properties;
3) the ability of uric acid to serve as a “danger signal” released from dying cells (potentially including cancer cells” could promote anti-cancer immunity.

The clinical literature is murky at best.

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Juvenile Arthritis: TNF Inhibitor Use Doesn’t Appear To Increase Malignancy Risk

MedicalResearch.com Interview with:

Timothy Beukelman, MD, MSCE Associate Professor of Pediatrics Division of Rheumatology and Division of Clinical Immunology & Rheumatology University of Alabama at Birmingham

Dr. Timothy Beukelman

Timothy Beukelman, MD, MSCE
Associate Professor of Pediatrics
Division of Rheumatology and
Division of Clinical Immunology & Rheumatology
University of Alabama at Birmingham

MedicalResearch.com: What is the background for this study?

Response: In 2009 the US FDA issued a boxed warning about malignancies reported in children treated with TNF inhibitors but their analysis did not account for a possible malignancy risk from other medications of from the Juvenile idiopathic arthritis (JIA) disease process itself.

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Increased Cardiovascular Risk in Rheumatoid Arthritis Comparable to Diabetes

MedicalResearch.com Interview with:
Prof.dr. M.T. Nurmohamed, MD, PhD
and
Rabia Agca MD
Dept. of Rheumatology | VU University Medical Center
Amsterdam Rheumatology & immunology Center
EULAR center of excellence in rheumatology

MedicalResearch.com: What is the background for this study?

Response: About 20 years ago the increased mortality in rheumatoid arthritis (RA) was well known, but not the causes. In daily clinical practice it seemed that RA patients more frequently suffered from myocardial infarctions than general population persons. Therefore, we started this study more than 15 years ago as at that time there were only sparse data with respect to cardiovascular morbidity in rheumatoid arthritis.

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High Intensity Statins Linked To Lower Risk of Rheumatoid Arthritis

MedicalResearch.com Interview with:

Marie Hudson, MD MPH FRCPC Jewish General Hospital and Lady David Research Institute Montreal, QC

Dr. Marie Hudson

Marie Hudson, MD MPH FRCPC
Jewish General Hospital and Lady David Research Institute
Montreal, QC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Statins are widely used to treat hypercholesterolemia. In addition to their effect on cholesterol levels, statins also attenuate inflammation and have immunomodulatory properties. Whether this translates into meaningful differences in health outcomes, though, remains uncertain. We therefore undertook this study to determine whether people exposed to high doses of statins were at a lower risk of developing rheumatoid arthritis compared to those at lower doses. We studied a large population-based cohort of over half a million people exposed to statins for the first time and followed them on average for 3 years.

We found that those exposed to the highest intensity statin quintile had a 33% lower risk of developing rheumatoid arthritis compared to those in the lowest intensity quintile (adjusted HR 0.77; 95% CI: 0.63-0.95). We conducted several additional secondary analyses that all pointed in the same direction and suggested that statins reduce the risk of rheumatoid arthritis.

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Non–TNF-Targeted Biologic Found Superior to Second Anti-TNF Drug to Treat Rheumatoid Arthritis in Patients With Insufficient Response to a First Anti-TNF Drug

MedicalResearch.com Interview with:
Jacques-Eric Gottenberg, MD, PhD Department of Rheumatology National Reference Center for Systemic Autoimmune Diseases Strasbourg University Hospital, Université de Strasbourg Strasbourg, FranceJacques-Eric Gottenberg, MD, PhD
Department of Rheumatology
National Reference Center for Systemic Autoimmune Diseases
Strasbourg University Hospital, Université de Strasbourg
Strasbourg, France

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is no recommendation for the choice of the second biologic in patients with rheumatoid arthritis and insufficient response to a first anti-TNF, which is a common situation in our daily practice (approximately one third of patients treated with anti-TNF). We therefore conducted the first randomized trial to date to investigate the best strategy in such a setting.

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ALPROLIX – Recombinant Factor IX Fc Fusion Protein – Resolved Joint Bleeds in Hemophilia B

MedicalResearch.com:
Nisha Jain, Director
Global Medical at Biogen

Regarding: Post Hoc Analysis to Evaluate the Effect of Recombinant Factor IX Fc Fusion Protein (rFIXFc) Prophylaxis in Adults and Adolescents with Target Joints and Hemophilia B being presented at the World Federation of Hemophilia (WFH) 2016 World Congress

MedicalResearch.com: What is the background for this study?

Response: People with hemophilia B experience prolonged bleeding episodes that can cause pain, irreversible joint damage and life-threatening hemorrhages. For people with severe hemophilia, most bleeding events occur in joints, with joint damage being the most common complication of the condition.(1) Over time, joints can become severely damaged and an individual can suffer from acute pain as well as restricted range of motion in those joints.(1)

MedicalResearch.com: What are the main findings?

Response: The B-LONG and B-YOND trials evaluated ALPROLIX® [Coagulation Factor IX (Recombinant), Fc Fusion Protein] in hemophilia B patients. In this post-hoc analysis of 37 patients with target joints in B-LONG and B-YOND, most (98.9%) target joints were considered resolved using the International Society on Thrombosis and Haemostasis (ISTH) definition of resolution as ≤ 2 bleeds into the joint within a consecutive 12-month period.

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DASH Diet For Hypertension May Also Lower Uric Acid in Gout Patients

MedicalResearch.com Interview with:

Stephen P. Juraschek, MD, PhD Fellow, Division of General Internal Medicine Johns Hopkins Hospital

Dr. Stephen Juraschek

Stephen P. Juraschek, MD, PhD
Fellow, Division of General Internal Medicine
Johns Hopkins Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Diet has long been viewed as an important way to lower uric acid levels to prevent gout attacks; however, there is little evidence about whether a particular dietary pattern might be effective for lowering uric acid. For the first time we show that the DASH diet, an effective diet for lowering blood pressure, it lowers uric acid levels substantially in people with abnormally high uric acid levels.

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Gut Bacteria May Play Role in Rheumatoid Arthritis Activity

MedicalResearch.com Interview with:

Veena Taneja, Ph.D Immunologist Mayo Clinic Rochester MN

Dr. Veena Taneja

Veena Taneja, Ph.D
Immunologist
Mayo Clinic
Rochester MN

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Gut bacteria have been suggested to be involved in pathogenesis of rheumatoid arthritis. We used new technology to sequence the bacteria in patients with rheumatoid arthritis and first degree relatives and healthy individuals. We found that patients had lower diversity of bacteria than healthy individuals and the composition of the gut microbiota differed between patients and healthy people. We could identify some bacteria that have expanded in patients though those are generally observed with low numbers in healthy individuals. We could define certain metabolic signatures that associated with microbial profile. For the first time, we could show a direct link between the arthritis-associated bacteria we identified and enhancement of arthritis using a mice carrying the RA-susceptible HLA gene.

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Checkpoint Inhibitor Biologics Linked To Inflammatory Arthritis and Sicca Syndrome

MedicalResearch.com Interview with:

Laura C. Cappelli, M.D Johns Hopkins University School of Medicine

Dr. Laura Cappelli

Laura C. Cappelli, M.D
Johns Hopkins University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We had been referred several patients with inflammatory arthritis or dry mouth and dry eyes after being treated with immune checkpoint inhibitors. When searching the literature for information on how to evaluate and treat these patients, we realized that there was minimal information available. We wanted to describe our experience and inform the medical community about these events so that recognition could increase.

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Chewing Gum Test Unmasks Jaw Claudication of Giant Cell Arteritis

MedicalResearch.com Interview with:
Chih-Hung Kuo, M.B., B.S.
Peter McCluskey, M.D.
Clare L. Fraser, M.B., B.S.
University of Sydney
Sydney, NSW, Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Giant cell arteritis is a life and sight threatening systemic inflammatory condition, which remains difficult to diagnose. Jaw claudication (cramping of muscle from ischemia) is a highly specific symptom with significant diagnostic and prognostic (risk of permanent blindness) values. The reporting of jaw symptoms may be affected by many factors, such as diet. There remains no standardized clinical test available for clinicians. We study the use of chewing gum as a standardized test (like a stress test for angina pain) to better characterize this critical symptom.

The pilot study of two cases with abnormal results were published in the New England Journal of Medicine. Chewing gum at a rate of 1 chew/second can reproduce the jaw claudication symptom around 2-3 minutes. In one case, the jaw claudication was unmasked by the test with a subsequent positive biopsy result. The test result became negative after corticosteroid treatment.

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Study Finds Lupus Doubles Risk of Dementia

MedicalResearch.comcom Interview with:
Hui-Wen Lin MD, PHD
Department of Mathematics, Soochow University
Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University
Taipei, Taiwan

MedicalResearch.com: What is the background for this study?

Dr. Hui-Wen Lin: Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder that affects multiple organ systems and it predominantly affects women aged 20 to 40 years, and clinical symptoms caused by autoantibody deposition that triggers subsequent inflammatory reactions vary between individuals. There were 30~80% of SLE patients present neurological symptoms, and it is referred to as neuropsychiatric SLE (NPSLE). However there is no research about risk of dementia for SLE patients. Therefore we investigated this issue by analyzing the National Health Insurance Research Database in Taiwan.

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Patients with Psoriatic Arthritis are at Increased Risk of Cardiovascular Disease

MedicalResearch.com Interview with:

Lihi Eder, MD, PhD Assistant Professor of Medicine, University of Toronto Scientist, Women’s College Research Institute,Room 6326 Women’s College Hospital Toronto, ON, Canada

Dr. Lihi Eder

Lihi Eder, MD, PhD
Assistant Professor of Medicine
University of Toronto
Scientist, Women’s College Research Institute,Room  6326
Women’s College Hospital
Toronto, ON, Canada 

MedicalResearch.com: What is the background for this study?

Dr. Eder: Psoriasis is a chronic immune-mediated skin disease affecting 2-3% of the general population. Psoriatic arthritis (PsA) affects 15-30% of patients with psoriasis. Until recently, only few studies assessed the risk of developing cardiovascular events in patients with PsA and while most studies found a higher cardiovascular risk in these patients, others reported cardiovascular rates that were similar to the general population.

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Screening for Hearing Impairment: A critical issue in patients with Rheumatoid Arthritis

MedicalResearch.com Interview with:

Dr-Amir-Emamifar

Dr. Emamifar

Dr. Amir Emamifar, MD
Department of Rheumatology
Odense university Hospital
Svendborg Hospital, Denmark

Associate Professor Inger Marie Jensen Hansen, PhD, DMsci Department of Rheumatology, Odense university Hospital, Svendborg Hospital, Denmark. University of Southern Denmark.

Dr. Hansen

 

Associate Professor
Dr. Inger Marie Jensen Hansen, PhD, DMsci

Department of Rheumatology
Odense university Hospital
Svendborg Hospital
University of Southern Denmark

 

MedicalResearch.com: What is the background for this study?

Response: Rheumatoid arthritis is a systemic, inflammatory disease that affects 1% of the general population. Apart from main articular manifestations, rheumatoid arthritis may involve other organs including heart, lung, skin, and eye. The auditory system can be affected during the course of the disease as well; however the association between rheumatoid arthritis and hearing impairment has not been clearly defined. It seems that hearing impairment in rheumatoid arthritis is a multifactorial disease affecting by environmental factors and disease and patient characteristics. We did a comprehensive review of all published data to reveal the potential link between rheumatoid arthritis and hearing impairment.

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Osteoarthritis Raises Risk of Cardiovascular Death

MedicalResearch.com Interview with:

Nicola Veronese, MD University of Padova Department of Medicine (DIMED)-Geriatrics Section Padova, Italy

Dr. Nicola Veronese

Nicola Veronese, MD
University of Padova
Department of Medicine (DIMED)-Geriatrics Section
Padova, Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Veronese: Osteoarthritis (OA) is the most common rheumatic disease. Although an increasing research is showing that OA, particularly of lower limbs, is associated with an increased risk of cardiovascular diseases (CVD) the association with overall mortality seems to be less clear. Continue reading

Vitamin D Supplements Did Not Slow Knee Cartilage Loss in Osteoarthritis

MedicalResearch.com Interview with:

Changhai Ding, MBBS, MMED, MD Australian Research Council Future Fellow Associate Director (International), Menzies Institute for Medical Research Professor, University of Tasmania, Australia Honorary Professor, University of Sydney, Australia

Dr. Changhai Ding

Changhai Ding, MBBS, MMED, MD
Australian Research Council Future Fellow
Associate Director (International), Menzies Institute for Medical Research
Professor,  University of Tasmania, Australia
Honorary Professor, University of Sydney, Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Ding: Vitamin D can reduce bone turnover and cartilage degradation, thus potentially preventing the development and progression of knee osteoarthritis. Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current evidence from clinical trials is contradictory.

We  conducted a randomised clinical trial in Hobart, Tasmania and Melbourne, Victoria in Australia. We randomly assigned 413 patients with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D to receive monthly treatment with oral vitamin D3 (50,000 IU; n = 209) or an identical placebo (n = 204) for 2 years.

Of 413 enrolled participants (average age, 63 years; 50 percent women), 340 (82 percent) completed the study. Vitamin D supplementation significantly increased blood 25-hydroxyvitamin D levels over 2 years compared with placebo treatment; however, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or a measure of knee pain over 2 years. There were also no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions.

Post-hoc analyses indicated that vitamin D supplementation might improve knee physical function and reduce another measure of knee pain and increases in bone marrow lesion.

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Lupus Linked To Higher Risk of Pregnancy and Neonatal Complications

MedicalResearch.com Interview with:
Dr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of Medicine
Dr. Julia Fridman Simard ScD
Assistant Professor
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
Division of Epidemiology, Department of Health Research & Policy
Division of Immunology & Rheumatology, Department of Medicine
Stanford School of Medicine 

Medical Research: What is the background for this study? What are the main findings?

Dr. Simard: A number of studies have shown that women with lupus who get pregnant have more complications and adverse outcomes, although the methodologies across studies vary considerably. Using population-based data we were able compare the occurrence of these pregnancy complications in mothers with lupus to pregnancies from the general population. We were also interested in whether women in our data set who first presented with lupus up to five years post-partum had more pregnancy-related adverse events. Our descriptive study showed that preterm delivery, infant infection, and preeclampsia were more common in the first singleton pregnancies of women with lupus compared to the general population.  These outcomes were also observed more often among women who appeared to present with lupus up to five years post-partum.

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Immunotherapy with IL-17 Blocker Secukinumab Improves Ankylosing Spondylitis

MedicalResearch.com Interview with:
Prof. dr. D.L.P. Baeten MD
Clinical Immunology and Rheumatology
Academic Medical Center
University of Amsterdam
Amsterdam, The Netherlands

Medical Research: What is the background for this study? What are the main findings?

Prof. Baeten: Ankylosing spondylitis is a debilitating rheumatic condition which affects young adults and with NSAIDS and TNF inhibitors as only therapeutic option. Over the last years, we generated evidence that IL-17 is an important inflammatory mediator in this condition. In the two studies reported here in the NEJM, we demonstrate that IL-17 inhibition with secukinumab has a very profound and long-lasting effect on signs and symptoms as well as inflammation in ankylosing spondylitis patients, even in those patients that failed a TNF blocker before.

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MRI Study Shows Weight Loss Preserves Knee Cartilage

Alexandra S. Gersing, MD Department of Radiology and Biomedical Imaging University of California, San Francisc

Dr. Gersing

MedicalResearch.com Interview with:
Alexandra S. Gersing, MD
Department of Radiology and Biomedical Imaging
University of California, San Francisco

Medical Research: What is the background for this study? What are the main findings?

Dr. Gersing:  This study is part of a larger NIH-funded project focusing on the effects of weight change in individuals at risk for and with osteoarthritis. Our group has previously shown that weight gain causes substantial worsening of knee joint degeneration in patients with risk factors for osteoarthritis and now we aimed to show that weight loss could protect the knee joint from degeneration and osteoarthritis. Osteoarthritis is one of the major causes of pain and disability worldwide; and cartilage plays a central role in the development of joint degeneration. Since cartilage loss is irreversible, we wanted to assess whether lifestyle interventions, such as weight loss, could make a difference at a very early, potentially reversible stage of cartilage degradation and whether a certain amount of weight loss is more beneficial to prevent cartilage deterioration. To measure these early changes we used a novel Magnetic Resonance Imaging (MRI) technique, called T2 mapping, which allows us to evaluate biochemical cartilage degradation in the patient on a molecular level. The most relevant finding of this study is that patients with more that 10% of weight loss benefited significantly more from losing weight compared to the obese controls that did not lose weight or only lost little weight.

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Smoking Increases Complications After Hip or Knee Arthroplasty

Jasvinder Singh MD MPH Professor of Medicine UAB Division of Clinical Immunology and Rheumatology MedicalResearch.com Interview with:
Jasvinder Singh MD MPH
Professor of Medicine
UAB Division of Clinical Immunology and Rheumatology 

Medical Research: What is the background for this study? What are the main findings?

Dr. Singh: A systematic review of the effect of smoking on outcomes after total joint replacement showed that current smoking increased the risk of overall post-operative complications but that there were scarce data for smoking and specific surgical outcomes of arthroplasty. We performed a study using data from an institutional Total Joint Registry to answer this question.   In a study of for 7,926 patients who underwent hip or knee arthroplasty, 7% were current tobacco users. We found that compared to current non-users, current tobacco users had higher hazard ratios (95% CI) for deep infection, 2.37 (1.19, 4.72; p=0.01) and implant revision, 1.78 (1.01, 3.13; p=0.04) after total hip or knee arthroplasty. No significant differences were noted for periprosthetic fractures or superficial infections.

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MBDA Biomarker Score Predicts Rheumatoid Arthritis Disease Activity

Ron Rogers Executive Vice President, Corporate Communications Spokesman, Myriad Genetics, Inc. Salt Lake City, Utah 84108

Ron Rogers

MedicalResearch.com Interview with:
Ron Rogers

Executive Vice President, Corporate Communications
Spokesman, Myriad Genetics, Inc.
Salt Lake City, Utah 84108

Medical Research: What is the background for the MBDA test? What types of biomarkers are included in the score?

Response: Vectra DA is an advanced blood test for adults with rheumatoid arthritis (RA). It helps you and your doctor better understand your rheumatoid arthritis disease activity.  Vectra DA blood test for RA gives physicians a more complete look at your disease activity by measuring 12 markers of RA disease activity. Some other tests, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR or “sed rate”), only measure one marker.

Vectra DA test scores can help track your disease activity over time with an objective measure that complements your doctor’s exam and your own assessment.  Patients with high Vectra DA scores have 7-fold higher risk for rheumatoid arthritis-related joint damage than patients with low or moderate Vectra DA scores.

You can learn more about the specific biomarkers at: http://vectrada.com/health-care-professionals/biomarkers/

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Acute Gout Episodes Peaks in November

MedicalResearch.com Interview with:
Paras Karmacharya, MD
Internal Medicine Reading Health System
West Reading, PA 19611
Co-Authors: Ranjan Pathak MD, Madan Raj Aryal MD,
Smith Giri MD, Anthony A Donato MD MHPE

Medical Research: What is the background for this study?

Response: Studies describing seasonal variations in acute gouty arthritis note a seasonal trend, but disagree on timing, with most showing a peak in spring months while others showing peaks later in the year. However, serum uric acid (SUA) levels seem to peak in the summer months. This disparity has led to the hypothesis that the flares might be related to factors other than elevated serum uric acid levels. Various theories on the effects of weather and immune system changes on the chronobiology of the equilibrium and precipitation of monosodium urate crystals have been proposed. We aimed to shed light on this question by examining the seasonal variation in the incidence of acute gouty arthritis in the US using a large inpatient database.

Medical Research: What are the main findings?

Response: We used the Nationwide Inpatient Sample (NIS) database, a large national database that represents 20% of all hospital admissions, to identify adult patients with a primary diagnosis of acute gouty arthritis from 2009-2011 during their hospitalization. A total of 28,172 hospitalizations with primary diagnosis of acute gouty arthritis were reported from 2009-11. The peak incidence of acute gout was seen in the month of November (peak/low ratio 1.34, 95% CI 1.29-1.38, p<0.05) (Figure 1). The highest number of hospitalizations was observed in autumn months, while the lowest incidence was observed in spring (28.12% vs. 23.13%, p<0.001).

Medical Research: What should clinicians and patients take away from your report?

Response: Unlike previous studies, our analysis found the peak incidence of acute gout in the fall with its peak in the month of November. Various environmental (temperature, humidity, diet, physical activity) and biochemical factors (low cortisol levels, high absolute neutrophil counts and plasminogen activator inhibitor-1) have been implicated for the seasonal variation, but the data on this is conflicting. Whether our findings are reflective of purine and alcohol intake over the US holidays in November and December is a hypothesis that requires further testing.

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Majority of Gout Patients Do Not Achieve Target Uric Acid Level

Marsha A. Raebel, PharmD Senior Investigator Kaiser Permanente Colorado's Institute for Health Research

Dr. Raebel

MedicalResearch.com Interview with:
Marsha A. Raebel, PharmD
Senior Investigator
Kaiser Permanente Colorado’s Institute for Health Research

Medical Research: What is the background for this study? What are the main findings?

Dr. Raebel: Gout is an inflammatory arthritis that affects at least 7.5 million American adults. A hallmark of gout is high serum uric acid that can result in urate crystals being deposited in joints, causing pain and joint damage. The American College of Rheumatology (ACR) guidelines recommend lowering serum uric acid to target values in patients with gout to prevent urate crystal deposition in joints and to promote crystal dissolution. For most patients, serum uric acid levels should be reduced to < 6mg/dL and maintained below that level. Measuring serum uric acid is a necessary step when titrating urate-lowering medications using a treat to target approach, but little is known about either serum uric acid measurement practices or attainment of target serum uric acid levels outside of clinical trials. We set out to characterize uric acid measurement and target serum uric acid attainment in patients with gout in the usual ambulatory care settings of the Kaiser Permanente integrated health system in the United States.

We identified 72,803 patients newly-diagnosed with gout in three Kaiser Permanente regions; 61% had at least one serum uric acid measurement within the baseline year prior to their gout diagnosis. Over each 12 month interval after the gout diagnosis, fewer patients had a serum uric acid measured. For example, serum uric acid measurement decreased to 40% of the patients the first year after the gout diagnosis, and to 26% of patients the second year after the gout diagnosis. While median serum uric acid levels across all patients decreased from 8.0 to 6.6 mg/dL over the entire 12 years of follow-up, almost 60% of patients never achieved a serum uric acid level less than 6 mg/dL. Achievement of this target serum uric acid level was more frequent in those who had a lower serum uric acid at baseline. Less than 12% of patients achieved all follow-up serum uric acid levels in the target range.

Medical Research: What should clinicians and patients take away from your report?

Dr. Raebel: Clinicians should be aware that, although most patients had at least one serum uric acid measured at some time, regular serum uric acid assessment was infrequent. Infrequent serum uric acid assessment impedes optimal use and monitoring of urate-lowering therapy. More than half of patients did not achieve any serum uric acid value within the target range of less than 6mg/dL. Given that the majority of patients with new-onset gout never reach the target serum uric acid level, more frequent serum uric acid measurement is urged.

Specifically, patients should adhere to having serum uric acid monitored as recommended by their physician and should request that their physician periodically order laboratory serum uric acid testing for them at frequencies based on treatment guidelines. To assist in reaching serum uric acid target levels, patients should take their urate-lowering medication as prescribed by their doctor. Furthermore, they should not stop their urate-lowering therapy without having been so advised by their doctor.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Raebel: We recommend developing interventions that support physicians and patients with gout in monitoring serum uric acid and treating to target serum uric acid levels. For example, best practice alerts could be developed and implemented in electronic health records that prompt physicians to order serum uric acid laboratory testing when more than a year has passed between measurements for any patient with gout or more frequently for patients who are not in the target range.

Citation:

Abstract presented at the 2015 ACR meeting November 2015

Treating to Target in Gout: The Epidemiology of Serum Urate Measurement Among Patients with Incident Gout in Usual Care Settings in the United States

Marsha A. Raebel, PharmD (2015). Majority of Gout Patients Do Not Achieve Target Uric Acid Level 

microRNAs in Joint Fluid As Biomarker For Antibiotic Refractory Lyme Arthritis

MedicalResearch.com Interview with:
Robert B. Lochhead PhD
Clinical Fellow in Medicine 
Division of Rheumatology, Allergy & Immunology
Massachusetts General Hospital
Harvard Medical School, Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Lochhead: Lyme arthritis (LA), caused by the tick-borne spirochete Borrelia burgdorferi, usually resolves appropriately with antibiotic treatment, called antibiotic-responsive Lyme arthritis. However, in some patients, arthritis persists for months or years after spirochetal killing with oral and IV antibiotic therapy, called antibiotic-refractory Lyme arthritis. Synovial lesions in these patients show marked synovial proliferation, inflammation, and vascularization, accompanied by autoimmune T and B cell responses. MicroRNAs (miRNAs) regulate many biological processes including inflammation, immune responses, and cell proliferation, and are effective biomarkers that may reveal molecular mechanisms of disease. Our objective here was to identify extracellular miRNAs (ex-miRNAs) in synovial fluid (SF) that distinguish regulated (responsive) from dysregulated (refractory) immune responses in Lyme arthritis, thereby providing insights into underlying biological processes and potential diagnostic biomarkers to distinguish between  these disease courses.

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Pilot Study Tests High Intensity Exercise in Women With Rheumatic Disease

Anja Bye, PhD, Senior Researcher Cardiac Exercise Research Group (CERG) K.G. Jebsen Center of Exercise in Medicine National Council of Cardiovascular Disease Department of Circulation and Medical Imaging Medical Faculty Norwegian University of Science and TechnologyMedicalResearch.com Interview with:
Anja Bye, PhD, Senior Researcher
Cardiac Exercise Research Group (CERG)
K.G. Jebsen Center of Exercise in Medicine
National Council of Cardiovascular Disease
Department of Circulation and Medical Imaging
Medical Faculty
Norwegian University of Science and Technology

Medical Research: What is the background for this study? What are the main findings?

Dr. Bye: The background was that we know that this type of training is superior to exercise at lower intensities in cardiovascular risk reduction in several patients groups. As it was not tested in patients with rheumatic disease, we set out to determine if this type of exercise would be tolerated in these patients, and of they would experience the same benefits on the cardiovascular system as other patients groups, and healthy young and elderly individuals. Hence the main goal was not to treat the rheumatic disease, but to study whether the exercise training would be tolerated, as we assumed they would have equal benefits from this type of exercise as everyone else. I think the most interesting findings were that all of the participants were capable of participating in this type of high-intensity exercise program, without reporting any negative side-effects. Of course the great increase in VO2max, and  the trend towards a reduction in the inflammation after the exercise intervention was very interesting.

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Biomarkers Can Help Determine Lupus Patients At Risk During Pregnancy

Jane E. Salmon, MD Division of Rheumatology Hospital for Special Surgery, and Weill Cornell Medical College, New York, NY MedicalResearch.com Interview with:
Jane E. Salmon, MD
Division of Rheumatology
Hospital for Special Surgery, and
Weill Cornell Medical College, New York, NY 

Medical Research: Background on lupus and antiphospholipid antibodies – what are they?
Dr. Salmon: Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that predominantly affects women and presents during their childbearing years. In SLE, the immune system which normally protects one from infection, turns reacts against the self and can cause damage of multiple organs.

Antiphospholipid antibodies (APL) occur in some people with SLE and some without SLE. They are autoantibodies that can damage the placenta and cause arterial and venous thromboses. Patients with APL can have fetal deaths, miscarriages, preeclampsia and/or growth restricted babies.

Pregnancy in patients with SLE, particularly those with antiphospholipid antibodies (APL), and in patients with APL alone, is associated with an increased risk for maternal and fetal morbidity due to preeclampsia (PE) and insufficient placental support of the developing fetus. PE and placental insufficiency are, in turn, associated with adverse pregnancy outcomes (APOs), including maternal complications of PE, intrauterine fetal death, and fetal growth restriction, as well as indicated preterm delivery. Given that APOs affect over one fifth of pregnancies in SLE and/or APL, the ability to identify patients early in pregnancy who are destined for poor outcomes would significantly impact care of this high risk population.

Medical Research: Two bullets about your PROMISSE study:

Dr. Salmon: The PROMISSE Study (Predictors of pRegnancy Outcome: bioMarker In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus). PROMISSE is the largest multi-center, multi-ethnic and multi-racial study to prospectively assess the frequency of APO, clinical, laboratory and biomarker variables that predict APO, in women with SLE and/or APL with inactive or mild/ moderate activity at conception.

Pregnant patients with SLE and/or APL were enrolled at <12 weeks gestation into PROMISSE between September 2003 and August 2013 at 7 sites (n=497) along with matched healthy controls (n=207) and followed every month of pregnancy. 

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Creatine Supplement Increased Muscle Mass But Not Strength or Function in RA Patients

Prof. Andrew B Lemmey School of Sport, Health and Exercise Sciences Bangor University Bangor, Gwynedd, Wales, UKMedicalResearch.com Interview with:
Prof. Andrew B Lemmey

School of Sport, Health and Exercise Sciences
Bangor University
Bangor, Gwynedd, Wales, UK

Medical Research: What is the background for this study?

Prof. Lemmey: Substantial loss of lean mass (LM; mostly skeletal muscle) is common in patients with rheumatoid arthritis (RA), as we and others have shown that even amongst patients with well-controlled disease approximately 67% are significantly muscle wasted. This loss of muscle, termed “rheumatoid cachexia”, is a major contributor to the decreased strength and impaired physical function which continues to characterise RA. Unfortunately, current drug treatments for RA, including use of biologics and the ‘treat-to-target (T2T)’ strategy, do not reverse this LM loss, nor fully restore physical function (Lemmey et al., “Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients”. Submitted to Rheumatology (Oxford), currently under review). Whilst high-intensity exercise (specifically, progressive resistance training (PRT)) has been shown to be highly effective in restoring both  lean mass and function in  rheumatoid arthritis patients (Lemmey et al., Arthritis Care & Research 2009;61(12):1726-34), the lack of uptake and adherence to sufficiently intense training (Lemmey et al., Arthritis Care & Research 2012;64(1):71-5) means this form of therapy is not widely adopted. Anabolic nutritional supplementation offers a potential adjunct treatment intervention for increasing LM, and thereby improving physical function, that could be widely accepted. Indeed, our group (Marcora et al., Clinical Nutrition 2005;24(3):442-54) has previously demonstrated that 12 weeks of daily oral protein supplementation improved lean mass and some measures of strength and function in  rheumatoid arthritis patients.

Creatine (Cr) is a popular dietary supplement generally shown to have greater benefits on both lean mass and physical function than generic protein supplementation. One study (Willer et al., Rheumatology 2000;39(3):293-8) has investigated the efficacy of Cr supplementation in rheumatoid arthritis patients. In this short uncontrolled trial, twelve patients underwent 3 weeks of supplementation, and although strength increased, no changes in function were found, and body composition changes were not investigated.

Using a double-blind, placebo controlled design, the current study aimed to investigate the effects of 12 weeks of oral Cr supplementation on body composition (by DXA; dual energy X-ray absorptiometry), strength (knee-extensor and handgrip) and objectively-assessed physical function (chair and walk tests) in patients with RA. Thirty-five patients (Cr=15, Pl=20) completed the study.  Continue reading

Physical Functioning Comparable To Peers After Total Hip Replacement

Dr. Kristi Elisabeth Heiberg PhD Post.doc Department of Medical Research Baerum Hospital Vestre Viken Hospital TrustMedicalResearch.com Interview with:
Dr. Kristi Elisabeth Heiberg PhD Post.doc
Department of Medical Research
Baerum Hospital
Vestre Viken Hospital Trust

Medical Research: What is the background for this study?

Dr. Heiberg: This study is a long term follow-up of 60 patients who suffered from hip osteoarthritis and were treated with total hip arthroplasty (THA) approximately 5 years earlier. In a prior study, the patients participated in a RCT study, examining the effects of a supervised walking skill training program on physical functioning, pain and self-efficacy (1). The training program was performed between three and five months after surgery, and it was compared to a control group without supervised physiotherapy in the same time span. The results showed that immediately after the walking skill training intervention was completed, several outcome variables were statistically significant more improved in the training group than in the control group, and at one year after surgery the statistically significant effect on walking capacity (measured by the 6-min walk test) still sustained. Few long-term follow-up of RCTs regarding physical functioning in patients after total hip arthroplasty are previously published. Furthermore in another prior study, we examined the recovery of the total group of the same patients from preoperatively to one year after surgery (2). The results showed that the patients were statistically significant improved in all outcomes of physical functioning, pain and self-efficacy during the first year, but they still did not quite reach the level of healthy peers in walking capacity. In line with this, they also reported one year after surgery that they wanted to further improve their ability to walk and to participate in recreational activities (3). However, it seems that patients’ desires regarding physical activity are poorly understood and have received relatively little evaluation, although regular physical activity is considered to be one of the most important lifestyle behaviors affecting health. Only few prior studies have examined the long term recovery of physical functioning and the impact on physical activity.

Therefore, in this present 5-year follow-up study after total hip arthroplasty the aims were threefold.

  • First, to examine the long-term effect from the supervised walking skill training program on physical functioning, pain and self-efficacy;
  • Second, to examine the long-term recovery of physical functioning from one to five years; and
  • Third, to identify predictors of physical activity outcome five years after THA among personal and preoperative variables (4).

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Topical and Injected Placebos More Effective Than Pills

MedicalResearch.com Interview with:
Raveendhara R Bannuru MD, PhD, FAGE
Director, Center for Treatment Comparison and Integrative Analysis (CTCIA)
Asst Professor of Medicine, Tufts University School of Medicine
Special & Scientific Staff, Center for Arthritis and Rheumatic Diseases
Tufts Medical Center Boston, MA

Medical Research: What is the background for this study?

Dr. Bannuru: Placebos are used to determine the efficacy of a wide variety of treatments for medical conditions such as osteoarthritis. A sound understanding of potential differences among placebos is essential for determining the relative efficacy of such treatments.

Medical Research: What are the main findings?

Dr. Bannuru: Our results indicate that different types of placebos do in fact differ in efficacy. Placebo injections and topical placebos were both found to be more effective than orally administered placebos for reducing knee osteoarthritis pain.

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TNF Gene May Link Rheumatoid Arthritis and Heart Disease

MedicalResearch.com Interview with:
Philippe Bouillet, PhD
Walter and Eliza Hall Institute
Parkville, Vic Australia

Medical Research: What is the background for this study? What are the main findings?

Dr. Bouillet: This study was initiated when we discovered mice that developed rheumatoid arthritis as a result of what was obviously a spontaneous dominant genetic mutation. Using several approaches, we identified the mutation as the insertion of a mobile genetic element called retrotransposon into the regulatory sequences of the gene encoding tumor necrosis factor (TNF). The mutation caused excessive amounts of TNF to be produced, a known cause of rheumatoid arthritis. The surprise came when some mice with the mutation died prematurely and suddenly with from heart disease. We showed that excess TNF also led to inflammation of the aortic and mitral valves, causing aortic regurgitation. Depending on the genetic background of the mice, the disease could also culminate in aortic aneurysm and death.

We also investigated the regulatory region of the TNF gene and identified novel regulators and a new genetic element that normally make sure that levels of serum TNF are kept within reasonable limits, high enough to ensure its numerous physiological functions, low enough to prevent its harmful effects such as those described here.

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Family History of Lupus Is Strong Risk Factor For Lupus and Other Autoimmune Diseases

MedicalResearch.com Interview with:
Dr. Changfu Kuo MD PhD

Division of Rheumatology, Orthopaedics, and Dermatology
School of Medicine, University of Nottingham, Nottingham, England
Division of Rheumatology, Allergy, and Immunology
Chang Gung Memorial Hospital, Taoyuan, Taiwan

Medical Research: What is the background for this study? What are the main findings?

Dr. Kuo: Systemic lupus erythematosus (SLE) is a prototype of autoimmune disease with features like autoantibody production and multiple target organ damage. SLE can affect any part of the body and the course of the disease is highly diverse and unpredictable. SLE can occur at any age and affect both females and males with a sex ratio of 9 to 1.

Familial predisposition has been recognised as a risk factor previously and heritability of SLE has been estimated to be 66%. However, previous reports are often based on less robust sampling strategies and case ascertainment which generally depend on hospital records, self-reported diagnosis and disease registries, therefore limiting generalisability. The previous estimates of heritability are overestimated, due to a lack of consideration of shared environmental contribution.

This study utilised a unique health insurance database that provides information on the whole population of Taiwan and permits determination of spouse and first-degree relatives. Over 23 million people were included in this study. Furthermore, through inclusion of SLE status of the spouse in our analyses the study is also able to examine how much of familial clustering results from genetic versus shared environmental factors. Overall the familial relative risk is 16.92. The genetic contribution to SLE susceptibility is estimated to be 44%. In addition to SLE, other autoimmune diseases are also more prevalent in individuals with a family history of SLE.

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Biologics in Rheumatic Disease Reduce Missed Workdays

MedicalResearch.com Interview with:
Cécile Gaujoux-Viala, MD, PhD
Université Montpellier I
Chef de Service de Rhumatologie
CHU de Nîmes Carémeau
France

Medical Research: What is the background for this study?

Response: Chronic inflammatory rheumatic diseases – such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)  – confer significant patient and economic burdens : 1/5 of people with rheumatic conditions has been forced to change career, 1/3 will have stopped working within two years of onset and 1/2 will be unable to work within ten years.

The addition of biological agents in treatment strategies for rheumatic diseases have improved the possibility of controlling disease activity and slowing the progression of joint damage. But these treatments are very expensive and their effect on work participation remains unclear.

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Gas Cavity Produces That Sound When You Crack Your Joints

Gregory N. Kawchuk Ph.D. Department of Physical Therapy  Faculty of Rehabilitation Medicine University of Alberta Edmonton, Alberta, CanadaMedicalResearch.com Interview with:
Gregory N. Kawchuk Ph.D.

Department of Physical Therapy  Faculty of Rehabilitation Medicine
University of Alberta
Edmonton, Alberta, Canada

Medical Research: What is the background for this study? What are the main findings?

Response: Jerome Fryer, one of our co-authors, had a new idea for why joints crack. So before delving into this, we went to go to the scientific literature to see if there was anything new in this topic area since it was first studied seriously in 1947. To our surprise, nothing had really been changed in this topic since 1971. It was then we realized there was a real opportunity to use some new technology to see inside the joint in a way that has never been done before.  What we saw was that at the same time the sound is produced, a gas cavity appears. We can’t know for certain that this is the cause of the sound, but it is consistent with what was proposed originally in 1947.

Medical Research: What should clinicians and patients take away from your report? Is there damage to the joints from ‘cracking’ them?

Response: No.  We have known for quite some time from other studies that people who do this habitually do not experience premature joint problems.

Citation:

Real-Time Visualization of Joint Cavitation

Gregory N. Kawchuk , Jerome Fryer , Jacob L. Jaremko , Hongbo Zeng , Lindsay Rowe, Richard Thompson

Published: April 15, 2015

DOI: 10.1371/journal.pone.011947

MedicalResearch.com Interview with: Gregory N. Kawchuk Ph.D. (2015). Gas Cavity Produces That Sound When You Crack Your Joints 

Acetaminophen May Not Be Effective For Osteoarthritis, Low Back Pain

Gustavo C Machado, PhD student The George Institute for Global Health, Sydney Medical School University of Sydney Sydney AustraliaMedicalResearch.com Interview with:
Gustavo C Machado
, PhD student
The George Institute for Global Health, Sydney Medical School
University of Sydney Sydney Australia

(Editor’s note: Paracetamol isalso known as acetaminophen)

MedicalResearch: What is the background for this study? What are the main findings?

Response: Back pain and osteoarthritis are the two major musculoskeletal conditions affecting people worldwide, and paracetamol is the most used over the counter medicine to treat these conditions. Recent debates on the efficacy and safety of paracetamol prompted us to conduct a systematic review of literature on the efficacy of this medication. In our study we included all available clinical trials that compared paracetamol to placebo, and our conclusions are based on data from more than 5,300 patients with low back pain and hip or knee osteoarthritis. We found that paracetamol is ineffective for low back pain and provides small and not clinically important benefits to patients with osteoarthritis.
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Osteoarthritis May Develop Early After ACL Rupture

Adam Culvenor Ι B.Physio(Hons), PhD Division of Physiotherapy School of Health & Rehabilitation Sciences The University of QueenslandMedicalResearch.com Interview with:
Adam Culvenor Ι B.Physio(Hons), PhD
Division of Physiotherapy
School of Health & Rehabilitation Sciences
The University of Queensland

Medical Research: What is the background for this study?

Dr. Culvenor: Knee injury, such as anterior cruciate ligament (ACL) rupture, is a well-recognised risk factor for the accelerated development of knee osteoarthritis (OA). Previous studies report high rates of knee osteoarthritis with radiographs (x-rays) more than 5-10 years following ACL injury and reconstruction (ACLR). However, once OA becomes well-established and visible on radiographs, management options are limited. Potential therapies may be better placed to target the early stages of disease when management strategies, such as optimising knee load, may be more efficacious. Magnetic resonance imaging (MRI) enables the assessment of early osteoarthritis features affecting any joint tissue. Yet, MRI has not previously been used to assess early knee OA within the first year following ACLR.

Medical Research: What are the main findings?

Dr. Culvenor: Of the 111 patients who were one year following an anterior cruciate ligament  rupture, the prevalence of early knee OA assessed with MRI was much higher than previously recognised. Medial and lateral tibiofemoral osteoarthritis was observed in 6% and 11%, respectively, while 17% had patellofemoral OA. These patterns of early OA are similar to previous radiographic findings; the patellofemoral joint is at particular risk of OA. Specifically, the femoral trochlea was the region most affected by bone marrow lesions, cartilage lesions and osteophytes. The prevalence of structural pathology was much higher than the uninjured control group of similar age and activity level, highlighting the impact of knee trauma (injury and/or surgery).

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Blood Test May Distinguish Osteoarthritis From Rheumatoid Arthritis

Dr Naila Rabbani Reader of Experimental Systems Biology Protein Damage and Systems Biology Research Group, Division of Metabolic & Vascular Health, Warwick Medical School, University of Warwick, Clinical Sciences Research Laboratories, University Hospital  U.K.MedicalResearch.com Interview with:
Dr Naila Rabbani
Reader of Experimental Systems Biology
Protein Damage and Systems Biology Research Group, Division of Metabolic & Vascular Health, Warwick Medical School, University of Warwick,
Clinical Sciences Research Laboratories, University Hospital  U.K.

Medical Research: What is the background for this study? What are the main findings?

Dr Rabbani: We performed a study to investigate biochemical markers indicative of early-stage decline in joint health and development of early-stage osteoarthritis OA), rheumatoid arthritis (RA) and other inflammatory joint disease. The main finding was that by combining measures of three substances in blood – citrullinated protein (CPs), antibodies to CPs and hydroxyproline we could detect and discriminate between early-stage osteoarthritis and rheumatoid arthritis.

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Genetic Predisposition to Psoriatic Arthritis Localized To Chromosome 5

psoriasis_kneesMedicalResearch.com Interview with:
Professor Anne Barton FRCP PhD and
Dr John Bowes PhD

Centre for Musculoskeletal Research and
Centre for Genetics and Genomics,
The University of Manchester, Manchester UK

Medical Research: What is the background for this study?

Response: Psoriatic arthritis (PsA) is an inflammatory condition causing pain and stiffness in joints and tendons. Approximately one third of patients with psoriasis will go on to develop PsA resulting in a reduction in their quality of life caused by increasing disability and additional health complications. A key area of research within the Arthritis Research UK Centre for Genetics and Genomics in the Centre for Musculoskeletal Research is the identification of risk factors for the development of Psoriatic arthritis; this will allow us to understand the underlying cause of disease and ultimately help identify psoriasis patients at high risk of PsA, allowing early treatment to be introduced to reduce the impact of PsA.

Our study focuses on the identification of genetic risk factors for Psoriatic arthritis; we compared the frequency of genetic variants, referred to as single nucleotide polymorphisms (SNPs), between large numbers of DNA samples from patients with PsA and healthy control samples. When the frequency of the SNP is significantly different between cases and controls, the SNP is said to be associated with risk of developing Psoriatic arthritis and this association is interpreted as being important in the disease process.

Medical Research: What are the main findings?

Response: When we analysed the data from the study we found a new association to SNPs on chromosome 5, and when we investigated these SNPs for association with skin-only psoriasis, we did not find any evidence for association. In addition, we also found SNPs that were specifically associated with Psoriatic arthritis at a gene on chromosome 1. This gene is known to be associated with psoriasis, but our results show that there are different SNPs associated with PsA and psoriasis at this gene. Hence, our results identify new SNPs that are specifically associated with PsA.

In addition, identifying which cells are the key drivers of inflammation in Psoriatic arthritis will help us to focus on how the genetic changes act in those cells to cause disease. Our results show that many of the PsA associated SNPs occur in regions of the genome that are important in the function of CD8+ cells,  an important cell type in the immune system.
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