April 2002

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Posted Thursday, April 25, 2002 by Rick
From Doctors Guide.
Co-occurrence of spondyloarthropathy and connective tissue disease: Development of Sjögren's syndrome and mixed connective tissue disease (MCTD) in a patient with ankylosing spondylitis

J. Brandt1, T. Maier2, M. Rudwaleit1, U. Kühl3, F. Hiepe4, J. Sieper1,5, J. Braun1,6

1Medical Department I, Rheumatology, 2Medical Department IV, Nephrology, and 3Medical Department II, Cardiology, Benjamin Franklin Hospital, Free University of Berlin; 4Rheumatology, Charité, Humboldt University, Berlin; 5Epidemiology Department, German Rheumatism Research Center Berlin, Berlin; 6Center of Rheumatology Ruhrgebiet, Herne, Germany.

ABSTRACT
Spondylarthropathies (SpA) and connective tissue diseases (CTD) are clinically distinct entities which, at first glance, seem to have little in common. However, a link between SpA and CTD has recently been suggested by a study in which a higher prevalence of Sjögren.s syndrome (SS) and sicca symptoms was reported in patients with ankylosing spondylitis (AS) and undifferentiated SpA (1). Another link between SpA and CTD is a possible side effect of a DMARD widely used to treat SpA: sulfasalazine (SAS). SAS was reported to induce antinuclear antibodies (ANA) and systemic lupus erythematosus (SLE)-like syndromes such as drug-induced lupus.
This report describes a 54-year-old white male, HLA B27-positive AS patient with some syndesmophytes who, after 15 years of disease, developed SS with salivary gland involvement, Raynaud's syndrome and anti-Ro antibodies. Then, 20 years after the onset of AS, he became acutely ill, suffering severe myositis and myocarditis along with swollen hands and highly elevated autoantibody titers recognizing U1RNP; his condition was interpreted as mixed connective tissue disease (MCTD).
The patient had been treated with SAS and azathioprine (AZA) alone several times during the last years because he had not tolerated other DMARDs. A combination of both drugs had been prescribed 3 weeks before a severe flair because of progredient high disease activity with painful peripheral arthritis of the MCP and PIP joints which, however, had not shown radiographic erosions. We describe the rare development of MCTD in an AS patient and report, for the first time, the onset of MCTD potentially triggered by sulfasalazine.





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Posted Wednesday, April 24, 2002 by Rick
TNF-alpha blocker Infliximab highly effective for patients with ankylosing spondylitis - new 72%
UVentures - Apr 6 2002 7:52PM GMT
Found by: Moreover
Subscription Only

Merck's Arcoxia Receives Approval in the United Kingdom - new 74%
...The new application will include new efficacy data to support an indication for ankylosing spondylitis - a disease that affects joints in the spine. The company believes this indication...
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/dowjones/20020415/bs_dowjones/merck_s_arcoxia_receives_approval_in_the_united_kingdom

Immune System Balance Avoids Autoimmune Diseases - new 76%
UniSci - Apr 17 2002
Found by: Yahoo! News Full Coverage
http://unisci.com/stories/20022/0417023.htm

Treating Celiac Disease May Reverse Liver Failure - new 76%
... disorders caused by immune system dysfunction, including immune system-related liver diseases like autoimmune hepatitis....
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http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020424/hl_nm/celiac_liver_1

MedImmune Licenses Two New Cancer Technologies - new 70%
... develops and commercializes products to prevent or treat infectious disease, autoimmune disease and cancer. Shares of MedImmune recently traded at $...
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/dowjones/20020419/bs_dowjones/medimmune_licenses_two_new_cancer_technologies

Biologists Track Down Central Cause Of Lupus - new 68%
Science Daily - Apr 24 2002 9:43AM GMT
Found by: Moreover
http://www.sciencedaily.com/releases/2002/04/020423075815.htm

Stem cells may keep MS from advancing - new 70%
Stem-cell transplants, first developed to cure blood cancers, may halt the progression of multiple sclerosis, University of Washington researchers reported yesterday. Most scientists believe multiple...
Found by: Seattle Times
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=multiple17m&date=20020417

Nurse brings attention to 'ignored' disease - new 64%
Nurse brings attention to 'ignored' disease By JAMES McGINNIS Courier Times Apr 21, 2002 - Breast cancer, multiple sclerosis and Lou Gehrig's disease are medical conditions that draw the public spotlight. More Philadelphia Suburbs news Celebrities
Found by: MSNBC
http://www.msnbc.com/local/phlburbs/phl0421nurses.asp

Celltech, Biogen link up on Crohn's treatment - new 70%
iWon - Apr 24 2002 9:32AM GMT
Found by: Moreover
http://money.iwon.com/jsp/nw/nwdt_rt.jsp?section=news&news_id=reu-l24198076-u1&feed=reu&date=20020424&cat=INDUSTRY

McLellan prescribes clinical trials for medical marijuana - new 72%
The Herald - Apr 24 2002 7:51AM GMT
Found by: Moreover
http://www.herald.ns.ca/stories/2002/04/23/f249.raw.html





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Posted Wednesday, April 24, 2002 by Rick
Following is a paragraph from the American Pain society related to
my statement about ten days ago regarding the complications
possible from the non-treatment or undertreatment of pain. I
reccommend that everyone read the complete article on arthritis and
pain treatment: http://www.ampainsoc.org/whatsnew/031502.htm

"Research shows that the under treatment of pain in adults and
children can have many serious consequences, including
physiological complications, such as muscle breakdown and weakness;
psychosocial impairments, including anxiety and depression; and an
overall decrease in quality of life," said APS president Michael
Ashburn, MD. "The APS Guideline, therefore, will help practitioners
and patients better understand acute and chronic pain brought on by
this disease and learn when to use various treatments to manage the
their patients' pain."

Posted to RISG-L List by Ray@risg.org





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Posted Wednesday, April 24, 2002 by Rick
New clinical guidelines for the treatment of arthritis pain were
released in March by the American Pain Society.

Guideline for the Management of Pain in Osteoarthritis, Rheumatoid
Arthritis and Juvenile Chronic Arthritis is the first
multidisciplinary, evidence-based clinical guideline treating
arthritis pain.

Among the recommendations are:

All treatment for arthritis should begin with a comprehensive
assessment of pain and function.

For mild-to-moderate pain, acetaminophen is the choice because of
its mild adverse effects, over-the-counter availability, and low
cost.

For moderate-to-severe pain from both osteoarthritis and rheumatoid
arthritis, cyclooxygenase 2 (COX-2) nonsteroidal anti-inflammatory
drugs (NSAIDs) are the medications of choice. Use of nonselective
NSAIDs should be considered only if a patient is nonresponsive to
acetaminophen and COX-2 drugs and is not at risk for NSAID-induced
gastrointestinal adverse effects.

Opioid medications, such as oxycodone and morphine, are recommended
for treating severe pain for which COX-2 drugs and nonspecific
NSAIDs don't provide substantial relief.

Copies of the guideline can be obtained from the American Pain
Society, 4700 W Lake Ave, Glenview, IL 60025-1485 or through the
Web site: http://www.ampainsoc.org.

Mike Mitka


© 2002 American Medical Association. All rights reserved.
http://jama.ama-assn.org/issues/v287n16/ffull/jqu20004-1.html

Posted to RISG-L List by Ray@risg.org





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Posted Thursday, April 18, 2002 by Rick
DGReview

Gastrointestinal Problems/Nonsteroidal Antiinflammatory Use Linked
A DGReview of :"A Metaanalysis of Severe Upper Gastrointestinal Complications of Nonsteroidal Antiinflammatory Drugs"
Journal of Rheumatology

04/09/2002
By Anne MacLennan

Doctors must now view with caution earlier pooled estimates of the effects of patient and drug variables on risk of serious upper gastrointestinal complications from nonsteroidal anti-inflammatory drug use.

Contrary to earlier indications, these complications and use of nonsteroidal anti-inflammatory drugs (NSAIDs) are linked, a massive analysis has found.

Until now, meta-analyses in this area have focused on published English-language epidemiologic literature and/or only a portion of the relevant evidence; these are restrictions now known to be linked with bias in this type of analysis.

To determine the least biased estimates of risks of perforations, ulcers, and bleeds (PUB) linked with NSAID use, this meta-analysis synthesized published and unpublished evidence from all study designs and all languages between 1966 and 1998.

As well as using NSAID studies reporting primary data on GI complications, researchers hand-searched new drug application reviews from the United States Food and Drug Administration to identify unpublished studies with inclusion criteria identical to those used for published reports.

Selected studies had to assess use of oral NSAID use for more than four days in subjects more than 18 years of age and report on the clinically relevant upper GI outcomes of PUB. Most clinical trials were found to be of good quality, but observational studies had methodologic limitations.

The pooled odds ratio (OR) from 16 NSAID versus placebo clinical trials (4,431 patients) was found to be 5.36. Pooled relative risk of PUB from nine cohort studies (more than 750,000 person-years of exposure) was 2.7.
From 23 case control studies using age and sex matching (representing 25,732 patients) the pooled OR of PUB was 3.0.

Although data were insufficient to justify subgroup analyses stratified by age, comorbid conditions, drug or dose, they do support an association between NSAID use and serious upper GI complications, including estimates from different study designs.





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Posted Wednesday, April 17, 2002 by Rick
Genentech will manufacture Immunex's Enbrel - new 70%
Eastside Business Journal reg - Apr 16 2002 5:42PM GMT
Found by: Moreover
http://www.bizjournals.com/seattle/stories/2002/04/15/daily1.html

Immunex has need, Genentech has space to produce Enbrel - new 70%
Immunex has turned to Genentech, one of the world's few experienced biotech manufacturers, to help solve the Enbrel shortage.
Yesterday, Immunex said it inked a deal with the South...
Found by: Seattle Times
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=enbrel16&date=20020416

Drug Firms Target Arthritis Treatment - new 70%
By the end of 1998, Jeanne Harrison thought she had lost a 20-year battle with rheumatoid arthritis. Her wrists had fused and her right elbow had locked at a 45-degree angle. She couldn't dress without help from her husband. The medication she took to ...
Found by: Los Angeles Times
http://www.latimes.com/business/la-000026541apr14.story

Pathway Kicks Off Autoimmune Response - new 83%
In a finding that suggests a new approach for treating autoimmune diseases, researchers have uncovered the mechanism by which immune cells sometimes turn against the body's own cells.
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020410/hl_nm/autoimmune_pathway_1

Stem Cell Transplant May Slow Severe MS - new 76%
...MS is thought to be an autoimmune disease, meaning that it occurs because the body's immune system has turned against its own...
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020416/hl_nm/stemcell_ms_1

Arthritis drugs: effective but risky - new 70%
... on Remicade, she developed the second known case of another autoimmune disease, lupus, linked to the drug. Now she's on Vioxx, Tylenol with codeine and methotrexate,...
Found by: Yahoo! News
http://dailynews.yahoo.com/h/azstar/20020412/lo/arthritis_drugs_effective_but_risky_1.html

Isotechnika/Roche -3: Jt Decision-Making Structure - new 66%
Isotechnika Inc. (T.ISA) said ISA247 is a novel calcineurin inhibitor in early Phase II clinical development as immunosuppressive therapy in organ transplantation and in the treatment of autoimmune diseases. It said early studies indicate that ISA247 is "considerably more potent and far less toxic" compared to other immunosuppressants in this class.
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/dowjones/20020409/bs_dowjones/isotechnika_roche__3__jt_decision_making_structure

Doctors warn of too many pills for "non-diseases" - new 72%
... with a number of doctors questioning whether debilitating conditions such as obesity and chronic fatigue syndrome -...
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020412/wl_india_nm/india_68827_1

Parkridge Among First In Nation To Offer "Camera In A Pill" - new 70% Found by: FAST Search (alltheweb.com)
http://www.chattanoogan.com/articles/article_20693.asp

Groups Sue Pharmaceutical Cos. - new 63%
... allowed doctors to see how much they could earn by prescribing Remicade, which is used to treat Crohn's disease and rheumatoid arthritis....
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020412/ap_on_bi_ge/pharmaceutical_lawsuit_2

ABCNEWS.com : Pot Smoker Demands Apology From Delta - new 56%
Irvin Rosenfeld needs marijuana. Found by: ABCNews.com
http://abcnews.go.com/sections/us/DailyNews/potsmoker010816.html

Magnetic Fluid Puts Detached Retinas in Their Place - new 76%
... lattice degeneration, x-linked retinoschisis, degenerative myopia and uveitis, the eye institute says....
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http://story.news.yahoo.com/news?tmpl=story&u=/hsn/20020411/hl_hsn/magnetic_fluid_puts_detached_retinas_in_their_place





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Posted Wednesday, April 10, 2002 by Rick
A DGReview of :"A Metaanalysis of Severe Upper Gastrointestinal Complications of Nonsteroidal Antiinflammatory Drugs"
Journal of Rheumatology

04/09/2002
By Anne MacLennan


Doctors must now view with caution earlier pooled estimates of the effects of patient and drug variables on risk of serious upper gastrointestinal complications from nonsteroidal anti-inflammatory drug use.

Contrary to earlier indications, these complications and use of nonsteroidal anti-inflammatory drugs (NSAIDs) are linked, a massive analysis has found.

Until now, meta-analyses in this area have focused on published English-language epidemiologic literature and/or only a portion of the relevant evidence; these are restrictions now known to be linked with bias in this type of analysis.

To determine the least biased estimates of risks of perforations, ulcers, and bleeds (PUB) linked with NSAID use, this meta-analysis synthesized published and unpublished evidence from all study designs and all languages between 1966 and 1998.

As well as using NSAID studies reporting primary data on GI complications, researchers hand-searched new drug application reviews from the United States Food and Drug Administration to identify unpublished studies with inclusion criteria identical to those used for published reports.

Selected studies had to assess use of oral NSAID use for more than four days in subjects more than 18 years of age and report on the clinically relevant upper GI outcomes of PUB. Most clinical trials were found to be of good quality, but observational studies had methodologic limitations.

The pooled odds ratio (OR) from 16 NSAID versus placebo clinical trials (4,431 patients) was found to be 5.36. Pooled relative risk of PUB from nine cohort studies (more than 750,000 person-years of exposure) was 2.7.
From 23 case control studies using age and sex matching (representing 25,732 patients) the pooled OR of PUB was 3.0.

Although data were insufficient to justify subgroup analyses stratified by age, comorbid conditions, drug or dose, they do support an association between NSAID use and serious upper GI complications, including estimates from different study designs.

Thus prior pooled estimates about the effect of patient and drug variables on increased risk must be viewed with caution, these authors conclude.

J Rheumatol 2002;29:804-12





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Posted Wednesday, April 10, 2002 by Rick
Rheumatoid Arthritis Drug May Extend Survival - new 61%
...It is an autoimmune disease, meaning it arises from an abnormal immune system attack on the body's own tissue....
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020405/hl_nm/arthritis_drug_1

Spinal Disorder Therapy Identified - new 70%
German researchers have identified the first effective therapy for anklyosing spondylitis, a degenerative spinal disorder that affects more than 300,000 Americans. The team found that the immune blocker infliximab--already used for treating rheumatoid ...
Found by: Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-000024409apr05.story

Inspire tries again with clinical study of dry-eye treatment - new 70% Raleigh Business Journal - Apr 3 2002 10:52PM GMT
Found by: Moreover
http://www.bizjournals.com/triangle/stories/2002/04/01/daily30.html

Clinical Studies Validate Efficacy of Capsule Endoscope - new 70%
GIVEN IMAGING Yoqneam Israel said Monday that its M2A capsule endoscope detects up to 80 percent of small bowel abnormalities a significantly greater percentage than found using traditional methods according to clinical data released at two recent international medical conferences. The data also revealed that physicians are using the capsule to successfully diagnose an expanded list of conditions.German
Found by: RocketNews
http://www.medicaldata.com/Mit/Detail.asp?Art=04090208

Medical marijuana legalization favored in Dutch parliament - new 68%
Nando Times - Apr 9 2002 3:19AM GMT
Found by: Moreover
http://www.nandotimes.com/healthscience/story/349809p-2867049c.html

Marijuana Ruling Sparks New Dispute With Hill - new 64%
In 1992, at the behest of a senator from Alabama, Congress ordered the District to put a death penalty referendum on an upcoming ballot. In 1998, at ... Found by: Washington Post
http://www.washingtonpost.com/wp-dyn/articles/A56890-2002Apr3.html

Abbott applies for US and European approval for rheumatoid arthritis treatment D2E7
09 Apr 2002 - new 70%
Found by: FAST Search (alltheweb.com)
http://www.datamonitor.com/~a78d9c099aeb47c580353472a4f6abac~/all/news/product.asp?pid=BC940EAC-DFFA-4194-AFDE-1C4EE005901C

Self-Transplant for Parkinsons - new 70%
WebMD - Apr 9 2002 8:49PM GMT
Found by: Moreover
http://my.webmd.com/content/article/1833.50803?z=1728_00000_1000_ln_04

Approval Sought for New Rheumatoid Arthritis Drug - new 70%
...It is an autoimmune disease, meaning it arises from an abnormalimmune system attack on the body's own tissue....
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020409/hl_nm/arthritis_approval_1

Canadian drug firm with new transplant drug signs deal with Swiss company Roche - new 68%
... prevent rejection by the immune system after an organ transplant, or for the treatment of auto-immune diseases such as rheumatoid arthritis and psoriasis....
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020409/ap_wo_en_bu/canada_isotechnika_roche_1

First Human Monoclonal Antibody Treatment Nears Market - new 68%
Content-Wire - Apr 9 2002 5:08PM GMT
Found by: Moreover
http://www.content-wire.com/biotek/biotech.cfm?ccs=132&cs=1661

Study Suggests Rheumatoid Arthritis Getting Rarer - new 68%
...It is an autoimmune disease, meaning it arises from an abnormal immune system attack on the body's own tissue....
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020408/hl_nm/arthritis_rheumatoid_2





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Posted Friday, April 5, 2002 by Rick
COX-2 inhibitors - a critical evaluation of side effect data.
Erik Pomp

Tidsskr Nor Lægeforen 2002; 122: 476 - 80.
Background. Celecoxib and rofecoxib have been used in Norway since 2000. These cyclooxygenase 2 inhibitors (COX-2 inhibitors) have no better clinical efficacy than older non-steroid anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis or osteoarthritis, but may possibly lead to a lower incidence of upper gastrointestinal ulcers.

Material and methods. Published and unpublished clinical data on side effects were examined and interpreted. The aim was to evaluate the general safety of these new drugs compared with older NSAIDs.

Results. The incidence of side effects is addressed in two large published studies comparing COX-2 inhibitors with other NSAIDs. Only rofecoxib showed an unequivocal lower incidence of complicated upper gastrointestinal ulcers. However, the incidence of serious side effects was significantly higher in the rofecoxib group. In the other study there was a trend towards more serious side effects in the celecoxib group.

Interpretation. The available clinical data do not suggest that COX-2 inhibitors are safer drugs than other NSAIDs.



American Pain Society Releases New Clinical Guideline for Treatment Of Arthritis Pain
BALTIMORE, MD -- March 15, 2002 -- The American Pain Society (APS), the leading United States professional organization devoted to pain management, today released its new clinical guideline for treating acute and chronic pain associated with arthritis, a chronic disease that afflicts one in six Americans.

Introduced at a news conference at the organization's annual scientific meeting here, the new APS guideline strongly emphasizes that arthritis pain is best treated through a combination of ongoing pain assessment, medication, proper nutrition, exercise and patient and family education.

Developed by a prestigious panel of experts in arthritis pain management, the APS Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis and Juvenile Chronic Arthritis is the first multidisciplinary, evidence-based clinical guideline for treatment of arthritis pain. It is intended for use by physicians, nurses and other healthcare professionals who treat adults and children with arthritis.

"Research shows that the under treatment of pain in adults and children can have many serious consequences, including physiological complications, such as muscle breakdown and weakness; psychosocial impairments, including anxiety and depression; and an overall decrease in quality of life," said Ashburn. "The APS Guideline, therefore, will help practitioners and patients better understand acute and chronic pain brought on by this disease and learn when to use various treatments to manage the their patients' pain."

"Acute arthritic pain should be approached in the same manner as other types of pain by attempting to remove or modify the underlying cause, giving appropriate analgesics and reducing fears that may exacerbate pain," said Ada K. Jacox, PhD, RN, chair of the APS Clinical Guideline Development Committee. "Chronic arthritis pain, however, is more complex since it involves interactions among the biological, psychological and social factors that influence pain and function."

"Arthritis is one of the most expensive and debilitating diseases in the US, and the Guideline recognizes that this condition can adversely impact earning potential, function and lifestyle," said Arthur Lipman, Pharm.D., co-chair of the APS Guideline Committee. "Therefore, accurate assessment and management of pain requires differentiation of the types and causes of pain and an understanding of the patients' willingness to adhere to therapy and remain active."

Arthritis is a generic term that refers to more than 100 conditions, the most common is osteoarthritis (OA), a disease that occurs with aging and affects 8 in 10 men and women older than 75. OA primarily effects cartilage and impairs the function of weight-bearing joints. It can result from excessive or repetitive loading of a joint from work-related activity, trauma, inflammation and joint pressure over time caused by chronic obesity.

Rheumatoid arthritis (RA) is the second most prevalent form of the disease. It is a destructive and debilitating systemic condition in which the body's immune system attacks healthy joint tissue, causing inflammation and subsequent joint damage. RA strikes women more frequently than men, has peak incidence between the ages of 20 to 50 years old, and occurs in up to 2 percent of adults.

Among the major recommendations in the APS Arthritis Pain Management Guideline are:

1. All treatment for arthritis should begin with a comprehensive assessment of pain and function
2. For mild arthritis pain, acetaminophen is the drug of choice for its mild side effects, over-the-counter availability and low cost
3. For moderate to severe pain from both osteoarthritis and rheumatoid arthritis, COX-2 non-steroidal anti-inflammatory drugs (NSAIDS), such as Celebrex and Vioxx, are the drugs of choice for their pain- relieving potency and absence of gastrointestinal side effects. Use of non-selective NSAIDs should only be considered if the patient is non-responsive to acetaminophen and COX-2 drugs and is not at risk for NSAID-induced GI side effects. Due to the high cost of the COX-2 agents, some patients might benefit from taking non-specific NSAIDS and a medication to moderate GI distress.
4. Opioid medications, such as oxycodone and morphine, are recommended for treating severe arthritis pain for which COX-2 drugs and non-specific NSAIDs do not provide substantial relief.
5. Unless there are medical contraindications, most people with arthritis, including the obese and elderly, should be referred for surgical treatment when drug therapy is ineffective and function is severely impaired to prevent minimal physical activity. It is advised that surgery be recommended before the onset of severe deformity and advanced muscular deterioration.

Juvenile chronic arthritis (JCA) is the most common chronic rheumatic condition in children and affects some 285,000 in North America. For patients with juvenile chronic arthritis, the Guideline recommends:

1. Pain assessment should be ongoing in any child with JCA.
2. Analgesia should be the same for children as for adults with arthritis pain.
3. Patient and family education should be emphasized to increase self- care skills.
4. Cognitive-behavioral therapy should be used to help reduce pain and psychological disability and to enhance pain-coping skills.
5. Clinicians should take appropriate measures to minimize pain and anxiety associated with diagnostic and therapeutic procedures for JCA.
6. Guidelines developed by the American Academy of Pediatrics should be followed whenever sedation is required for any procedure.

In addition to specific treatment options, the APS Guideline specifies that arthritis patients should maintain an ideal body weight and adhere to a balanced diet. Adults should lose weight if their BMI is greater than 30 and follow a weight-management program. Also, referrals should be made for physical therapy and/or occupational therapy to evaluate and reduce impairments in range of motion, strength, flexibility and endurance.

"Since arthritis is a chronic and progressive disease, clinicians must be sure that regular exercise or physical therapy are important components of a comprehensive management program," said Dr. Jacox. "Staying active is a critical component for managing this disease."

Copies of the Guideline can be obtained by writing the American Pain Society, 4700 W. Lake Avenue, Glenview, IL 60025-1485 or through the APS website, http://www.ampainsoc.org . Other APS clinical guideline publications are Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain and A Guideline for the Management of Acute and Chronic Pain in Sickle Cell Disease.

Founded in 1978, the American Pain Society is a multidisciplinary professional organization with more than 5,000 members in the United States consisting of scientists, physicians, nurses, policy experts and others who study and treat pain. APS seeks to advance pain-related research, education, treatment and team-oriented professional practice. In recent years, the group has gained a reputation as the premiere scholarly scientific society in the field of pain research and treatment. It sponsors an annual scientific meeting and publishes the Journal of Pain, a quarterly peer-reviewed medical journal. APS is headquartered in Glenview, Ill.


SOURCE The American Pain Society

Clinically Asymptomatic Axial Disease in Psoriatic Spondyloarthropathy. A Retrospective Study
R. Queiro (1), J. Belzunegui (2), C. Gonza´lez (2), J. R. De Dios (2), C. Sarasqueta (2), J. C. Torre (3), M. Figueroa (2)


(1) Hospital San AgustÕn, Aviles-Asturias
(2) Hospital Nuestra Sen~ora de Aranzazu, San Sebastian-Guipuzcoa;
(3) Hospital Monte Naranco, Oviedo-Asturias, Spain


Received: 30 October 2000 / Accepted: 6 August 2001

Abstract: The aim of this study was to analyse retrospectively the prevalence and the clinical features of clinically asymptomatic axial involvement in patients with psoriasis and axial radiological features of spondyloarthropathy (PsSpA). We performed a cross-sectional study based on the clinical records of 70 patients, 44 men and 26 women, with a mean age of 48.7 þ 14.2 years. PsSpA was defined by the presence of radiographic sacroiliitis (SI) greater than or equal to grade 2, and/or any other typical radiological sign of spondylitis in patients with psoriasis. When the radiological signs were present in the absence of inflammatory back pain and/or buttock pain, patients were grouped as having asymptomatic axial disease. HLA-B27 was determined by serological methods in the 70 patients and in 82 healthy controls from our general population. Fourteen patients (20%), 11 with radiological SI, two with facet joint erosion-fusion and one with aseptic discitis, showed no evidence of symptomatic spinal disease. Twenty-nine patients (41%) showed cervical spine disease (CSD), but only 17 of them (58.6%) had pain and rigidity at this level, whereas 12 (41.4%) did not show clinical symptoms. CSD was associated with duration of arthritis (P = 0.043) and peripheral erosions (P = 0.037). HLA-B27 correlated well with bilateral SI (P = 0.002) and PsSpA (P<0.0004, RR 6.4), but showed no association with unilateral SI nor with syndesmophytes or asymptomatic disease. Univariate analysis demonstrated associations between symptomatic disease and longer duration of arthritis (P = 0.041) and higher IgM values (P = 0.05). There is a high prevalence of asymptomatic involvement in patients with PsSpA The significance of these asymptomatic changes is not known, but they probably represent a common characteristic of spondyloarthropathies rather than a specific feature associated with psoriasis.





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Posted Thursday, April 4, 2002 by Rick
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