June 2002

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Posted Wednesday, June 26, 2002 by Rick
A DGReview of :"The different patterns of blood pressure elevation by rofecoxib and nabumetone"
Journal of Human Hypertension

06/26/2002
By Robert Short


The selective non-steroidal anti-inflammatory drug (NSAID), rofecoxib, increases nighttime systolic and diastolic blood pressure, leading to a disappearance of the normal diurnal variation in patients with arterial hypertension.

The NSAID nabumetone causes a moderate increase of day and night blood pressure, without changes in diurnal variation.

These were the findings of a study of the effects on arterial blood pressure elevation by the two NSAIDs in patients with stable arterial hypertension and knee osteoarthritis. Two groups of patients received either 25 mg rofecoxib once daily or namebutone 2000 mg once daily during the first week of treatment and 1000 mg for the following three weeks.

During the day, no changes were found in the mean systolic and diastolic blood pressure among the rofecoxib group. At night, nocturnal blood pressure increased significantly; systolic increased by 15.7 mmHg and diastolic increased by 8.5 mm Hg.

In the nabumetone group, the mean systolic arterial pressure was raised by 2.9 mmHg in the daytime and 5 mmHg during the nighttime. Similarly, the mean diastolic arterial pressure was raised by 3.2 mmHg during the day and 4.9 mmHg during the night.

The study was carried out by Dr. T Reitblat and colleagues at the Rheumatology Outpatient Clinics, Barzilai Medical Centre, affiliated with the Faculty of Health Science, Ben-Gurion University of the Negev, Ashkelon, Israel.

Dr Reitblat concludes from the study, "Rofecoxib treatment did not change arterial blood pressure during day time hours. However, there was a distinct increase in night-time systolic and diastolic blood pressure leading to a disappearance of the physiological diurnal variation."

Regarding the findings on nabumetone, he says, "Nabumetone caused a moderate increase of day and night blood pressure, without changes in biological diurnal variation."


All contents Copyright (c) 1995-2002 Doctor's Guide Publishing Limited. All rights reserved.

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Posted Wednesday, June 26, 2002 by Rick
Muhammad Asim Khan, MD, FRCP
Pages 896-907

Spondyloarthropathies are a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases that primarily include ankylosing spondylitis, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases. The primary pathologic sites are the entheses (the sites of bony insertion of ligaments and tendons); the axial skeleton, including the sacroiliac joints; the limb joints; and some nonarticular structures, such as the gut, skin, eye, and aortic valve. Although spondyloarthropathies are not associated with rheumatoid factor, they show a strong association with HLA-B27; however, this association varies markedly among various spondyloarthropathies and among ethnic groups. The most widely used classification criterion, from the European Spondyloarthropathy Study Group, encompasses the currently recognized wider disease spectrum, with a sensitivity and specificity that generally exceed 85%. Spondyloarthropathies occur in genetically predisposed persons and are triggered by environmental factors, but the cellular and molecular mechanisms of inflammation are not yet fully understood. Chlamydial and many enterobacterial infections can trigger reactive arthritis, but an infectious trigger for ankylosing spondylitis has not yet been established. HLA-B27 itself is involved in enhancing genetic susceptibility, but the underlying molecular basis is still unknown; additional genes include the putative susceptibility genes for Crohn disease, ulcerative colitis, and psoriasis. A specific susceptibility gene for Crohn disease, NOD2, is located on chromosome 16q12, and one of the candidate genes for psoriasis, PSORS1, has been mapped to a 60-kb fragment on chromosome 6p, which is telomeric to the HLA-C locus. This paper reviews the efficacy of anti–tumor necrosis factor- therapy and other therapeutic advances.

Ann Intern Med. 2002;136:896-907.

Copyright ©2002 American College of Physicians – American Society of Internal Medicine





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Posted Wednesday, June 26, 2002 by Rick
Anti-Vaccine Web Sites Use Emotion to Convey Info new
... that they cause sudden infant death syndrome (SIDS), autism or Crohn's disease-...-
Jun 25 6:20 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020625/hl_nm/vaccine_websites_1

Living with Crohn's disease new
When Bridgett Brennan was diagnosed with Crohn s disease 13 years ago, she had no understanding of the battle her body was facing. Today, she is well versed in every aspect of the debilitating disease.
Found by: FAST Search (alltheweb.com)
http://www.journalenterprise.com/cgi-bin/view.cgi?/200206/26+crohn-sdisease06262002_news.html+20020626+news

Looking at Disease in a New Way new
...And, instead of treating asthma or psoriasis or Crohn's disease separately, they'll deal with a newly conceived group of diseases called Immune-...- Jun 22 12:00 AM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/hsn/20020622/hl_hsn/looking_at_disease_in_a_new_way

The ABCs of IBS new
WBZ - Jun 18 2002 11:31PM GMT
Found by: Moreover
http://wbz4.com/Healthwatch/StoryFolder/story_1556504992_html

FDA walks fine line on drug approvals new
Corey Miller was diagnosed with irritable-bowel syndrome when he was 10 years old, suffering from terrible bouts of abdominal pain and diarrhea. By his late-20s, his pain was so severe he feared he would have to give up his career as an architect.
Found by: FAST Search (alltheweb.com)
http://www.boston.com/dailyglobe2/177/business/FDA_walks_fine_line_on_drug_approvals+.shtml

Aspirin May Cut Risk of Lung Cancer Risk - Study new
... Medicine have discovered that taking aspirin regularly may have a protective effect against the disease, which is a top cancer killer....... cancer ( news - web sites) and researchers are also conducting studies into its impact on bowel and esophageal cancers....... not know how aspirin reduces the risk of cancer, they suspect it could be do with its anti-inflammatory effects....- Jun 25 2:02 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020625/sc_nm/health_cancer_lung_dc_1

News - Takayasu arteritis: Utility and limitations of magnetic resonance imaging in diagnosis and new
Magnetic resonance imaging in Takayasu arthritis is at its most useful in providing asafe, noninvasive method of assessing changes in vascular anatomy. Found by: FAST Search (alltheweb.com)
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256BD70059FD2E?OpenDocument&id=48DDE4A73E09A969852568880078C249&c=Rheumatology%20Other&count=10

Chlamydia cases up 50 per cent as students shun condoms new
Local News - The Kingston health unit is investigating a startling increase in sexually transmitted chlamydial infections clustered in two area high schools.
Found by: FAST Search (alltheweb.com)
http://www.kingstonwhigstandard.com/content.asp?contentid=1887

NASD Fines Piper Jaffray, Exec new
...New York-based Antigenics develops drugs to fight cancer, infectious diseases, and autoimmune and degenerative disorders....- Jun 25 2:28 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020625/ap_on_bi_ge/piper_jaffray_fine_1

Health Care Companies Form Alliance new
... to detect and manage infectious diseases and chronic conditions such as cardiovascular and autoimmune diseases, central nervous system disorders and cancer....- Jun 24 8:46 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020625/ap_on_bi_ge/abbott_celera_diagnostics_1

Scientists Find Marker for Post-Partum Depression new
...The presence of the thyroid peroxidase antibodies also indicated an autoimmune thyroid disorder, but the affected brain receptors were similar to those involved in depression,...- Jun 24 6:36 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020624/hl_nm/depression_marker_1

Book Ties Chronic Fatigue to Mild Polio new
FRIDAY, June 21 (HealthScoutNews) -- Could the roots of chronic fatigue syndrome be found in the polio epidemic of a half-century ago? - Jun 22 12:00 AM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/hsn/20020622/hl_hsn/book_ties_chronic_fatigue_to_mild_polio

Study finds CFS patients have low serotonin levels new
OSAKA  People who suffer from Chronic Fatigue Syndrome (CFS), an illness characterized by debilitating fatigue, have decreased levels of the neurotransmitter serotonin in their brains, according to recent findings by a joint research team.
Found by: FAST Search (alltheweb.com)
http://www.japantoday.com/e/?content=news&cat=1&id=220277





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Posted Wednesday, June 19, 2002 by Rick
'No new drugs' fear: Govt new
DIABETICS, people crippled by rheumatoid arthritis and sufferers of Crohn's disease could miss out on breakthrough new treatments if the Senate blocks a rise in prescription drug charges.
Found by: FAST Search (alltheweb.com)
http://www.themercury.news.com.au/common/story_page/0,5936,4536446^421,00.html

THE SYSTEM new
Advocacy, for a Price His teenage daughter suffered from Crohn's disease, a chronic digestive disorder. Compounding the problem was his insurance ...
Found by: Washington Post
http://www.washingtonpost.com/wp-dyn/articles/A1406-2002Jun17.html

USATODAY.com - Eugene Levy gets serious about IBD new
Eugene Levy gets serious about IBD By Mike Falcon, Spotlight Health With medical adviser Stephen A. Shoop, M.D. Eugene Levy's performances in the two American Pie movies helped establish the Second City veteran as one of Hollywood's funniest comic...
Found by: USA TODAY
http://www.usatoday.com/news/healthscience/health/2002-06-17-ibd.htm

Officials Confront Gray Areas of Smallpox Policy new
... infected with the human immunodeficiency virus (HIV ( news - web sites)) and those with autoimmune diseases such as lupus....- Jun 17 10:30 AM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020617/hl_nm/smallpox_policy_1

Arthritis drug born here 'improved patients' lives' new
WORCESTER -- A rheumatoid arthritis drug developed in Worcester was safe and effective when used alone or with other drugs for up to two-and-a-half years, according to study results released yesterday in Europe.
Found by: FAST Search (alltheweb.com)
http://www.telegram.com/news/page_one/abbott.html





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Posted Wednesday, June 19, 2002 by Rick
http://www.docguide.com/

Confirming mycobacterial involvement in arthritis
A DGReview of :"Detection of mycobacteria in joint samples from patients with arthritis using a genus-specific polymerase chain reaction and sequence analysis"
Rheumatology Online

06/23/1999
By Robert Short


Mycobacterial genus-specific PCR may be useful in confirming clinical suspicion of a mycobacterial infection in a joint.

This was the conclusion of a study involving 100 patients.

The study was designed to examine the diagnostic potential of molecular biological techniques as well as to investigate the pathogenetic role of mycobacteria in chronic arthritis.
Myocobacteria have been previously implicated in the pathogenesis of some forms of arthritis.
Says Dr IM van der Heijden, Department of Rheumatology, Leiden Unviersity Medical Centre, The Netherlands:"The results
suggest that the mycobacterial genus-specific PCR applied on DNA extracts isolated directly from joint samples may be
employed as an additional diagnostic tool in the case of clinical suspicion of a mycobacterial infection."
Dr van der Heijden added that no evidence of a pathogenetic role of mycobacteria in seronegative spondyloarthropathies,
undifferentiated arthritis or rheumatoid arthritis was found in this study.

===================================================

A new look at reactive arthritis
A DGReview of :"Two forms of reactive arthritis?"
Annals of the Rheumatic Diseases

01/21/2000
By Mark Greener


Infections outside the joint can trigger inflammatory arthritis. Currently, these are known as either "reactive" or
"post-infectious" arthritis, with the classification usually based on HLA-B27 status and the causative agent. A recent
paper, however, proposed a new classification.
The authors suggest describing all cases as "reactive arthritis" for greater clarity. They propose further dividing this
broad class according to the trigger's association with HLA-B27.
The authors note that factors other than the causative agents and HLA-B27 association distinguish the two forms of reactive
arthritis. For example, HLA-B27-associated arthritis may lead to a manifestation identical to Reiter's syndrome, including
uretheritis and conjunctivitis.
This contrasts with the non-associated form, where no studies describe this similarity. Moreover, the authors note that only
B27-associated arthritis belongs to the spondyloarthropathies.

Two forms of reactive arthritis?
Paavo Toivanen, Auli Toivanen
Turku Immunology Centre, Departments of Medical Microbiology and Medicine, Turku University, Turku, Finland
Correspondence to: Dr P Toivanen, Department of Medical Microbiology, Turku University, FIN-20520 Turku, Finland
Accepted for publication 26 August 1999

Inflammatory arthritides developing after a distant infection have so far been called reactive or postinfectious, quite often depending on the microbial trigger and/or HLA-B27 status of the patient. For clarity, it is proposed that they all should be called reactive arthritis, which, according to the trigger, occurs as an HLA-B27 associated or non-associated form. In addition to the causative agents and HLA-B27, these two categories are also distinguished by other characteristics.
Most important, HLA-B27 associated arthritis may occur identical to the Reiter's syndrome with accompanying uretheritis and/or conjunctivitis, whereas in the B27 non-associated form this has not been clearly described. Likewise, only the B27 associated form belongs to the group of spondyloarthropathies.

========================================================

Understanding Juvenile Spondyloarthropathy
A DGReview of :"Juvenile spondyloarthropathies"
Current Opinion in Rheumatology

08/17/2000
By Mark Greener


Juvenile spondyloarthropathy is a potentially disabling condition, so diagnosis and treatment needs to be rapid and effective.
Against this background, a recent review considered the diagnosis, immunology and treatment of children with spondyloarthropathies.
Clinical manifestations of spondyloarthropathies arise, at least in part, through the balance of cytokines expressed by the patient. For example, anti-inflammatory cytokines contribute to the milder forms of juvenile arthritis, including juvenile spondyloarthropathies.

Nevertheless, the patients' genotype is influential in determining outcome. Studies of Mexican spondyloarthropathy patients, including 80 suffering with juvenile spondyloarthropathy, for instance, linked the low-molecular-weight polypeptide gene polymorphism with increased susceptibility to acute anterior uveitis.

Against this background, rapid diagnosis and treatment helps optimise outcome. For example, the authors note that magnetic resonance imaging enhances the detection of sacroiliitis among children with spondyloarthropathies.
Currently, sulfasalazine is the first-line therapy. The review concluded that sulfasalazine is safe and effective for children suffering with arthritis, including juvenile spondyloarthropathy. Nevertheless, a study that enrolled children whose spondyloarthropathy was in remission suggested that physical fitness declined as they got older.

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High Soluble Human Leucocyte Antigen Molecules Identified In Rheumatoid Arthritis
A DGReview of :"Soluble HLA class I antigens in serum and synovial fluid from patients with rheumatoid arthritis and other arthropathies"
Rheumatology Online

01/04/2002
By Veronica Rose

There is a notably higher presence of soluble human leucocyte antigen molecules in serum and synovial fluid from patients with rheumatoid arthritis (RA) compared with whose with osteoarthritis.
Spanish clinicians say that this correlated inversely with variables of disease activity in-patients with rheumatoid arthritis.
Researchers from the Hospital Universitario La Paz at the Universidad Autonoma de Madrid, undertook studies of clinical and
analytical data, together with serum samples from 300 patients to investigate the presence of soluble human leucocyte
antigens (s-HLA) class-1 in serum and synovial fluid (SF). The group comprised 122 patients with RA, 38 with osteoarthritis
or osteoporosis, 29 who had seronegative spondyloarthropathies, and 45 with other rheumatic diseases. The control group consisted of 66 healthy subjects.
There were slightly higher mean concentrations of s-HLA molecules identified in the serum of patients with RA (1.2 µg/m) by
comparison with the other groups (1.08,1.011, 1.09 and 0.94 µg/ml) respectively. There was no correlation seen between serums-HLA levels and variables of inflammatory disease activity in patients with RA.
Researchers noted the presence of s-HLA molecules in serum fluid at levels correlating with those in serum. (P=0.04;r=0.4).
Soluble-HLA levels were also noted to be higher in the SF from patients with RA (1.3 µg/ml) or crystal-induced arthritis
(0.98 µg/ml) than in the SF of those with osteoarthritis (0.38 µg/ml) (P <0.05 and P <0.005 respectively.
These levels correlated inversely significantly with the visual analogue scale of pain score (P=0.02), the number of painful
joints (P=0.05) and the C-reactive protein level (P=0.03) in patients with RA Soluble HLA class I antigens in serum and synovial fluid from patients with rheumatoid arthritis and other arthropathies
S. Muńoz-Fernández, J. Martín1, E. Martín-Mola, M. C. García-Rodriguez1, M. Cantalejo, G. Fontán1 and A. Ferreira1
Rheumatology and
1 Immunology Units, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
Objectives. To investigate the presence of soluble HLA class I (s-HLA) antigens in serum and synovial fluid (SF) from a large cohort of rheumatic patients.
Methods. We studied clinical and analytical data and serum samples from 300 patients [122 patients with rheumatoid arthritis
(RA), 38 with osteoarthritis or osteoporosis, 29 with seronegative spondyloarthropathies, 45 patients with other rheumatic
diseases] and 66 healthy controls. In addition, we studied 25 paired samples of serum and SF from these groups of subjects.
In RA patients, we examined whether the levels of s-HLA in serum and SF were related to the activity of the disease.
Results. The mean concentrations of s-HLA molecules in serum were slightly higher in RA patients (1.2 µg/ml) than in the
other four groups (1.08, 1.01, 1.09 and 0.94 µg/ml respectively). We found no correlation between serum s-HLA levels and any
variable of inflammatory disease activity in RA patients. s-HLA molecules were found in SF and at levels that correlated
with those found in serum (P=0.04; r=0.4). Furthermore, s-HLA levels were higher in SF from patients with RA (1.3 µg/ml) or
crystal-induced arthritis (0.98 µg/ml) than in SF from those with osteoarthritis (0.38 µg/ml) (P<0.05 and P<0.005 respectively), and these levels were correlated inversely and significantly with the score on the visual analogue scale of pain (P=0.02), the number of painful joints (P=0.05) and the level of C-reactive protein (P=0.03) in RA patients.
Conclusions. This is the first report to demonstrate the presence of s-HLA molecules in SF at levels that correlate with
serum levels. The mean levels of s-HLA molecules were significantly higher in SF from patients with RA and crystal-induced
arthritis than in SF from cases of osteoarthritis, and correlated inversely with certain variables of disease activity in RA
patients.

KEY WORDS: s-HLA, Arthritis, Rheumatoid arthritis.

Correspondence to: S. Muńoz Fernández, Servicio de Reumatología, Hospital Universitario La Paz, Paseo de la Castellana 261,

28046 Madrid, Spain.

===============================================================================

Radiological Screening Key For Some Psoriatic Arthritis Patients
A DGReview of :"Prevalence and Predictors of Cervical Involvement in Psoriatic Spondyloarthropathy"
JCR: Journal of Clinical Rheumatology

02/20/2002
By Anne MacLennan

Previous reports of a high frequency of cervical spondylitis among patients with psoriatic spondyloarthropathy have been confirmed.
Furthermore, clinical symptoms of cervical pain and stiffness are not a universal predictor of involvement of the cervical spine, this study shows.
Thus, patients with psoriatic arthritis (PsA) with longer disease duration and erosive disease should be screened

radiologically to detect those cervical lesions (ie, atlantoaxial subluxation) with potential catastrophic complications, these authors underline.
This retrospective cross-sectional study of the prevalence and predictors of cervical involvement in psoriatic
spondyloarthropathy was done by Rubén Queiro and colleagues from Hospital San Agustín, Avilés-Asturias; Hospital Nuestra
Seńora de Aránzazu, San Sebastian-Guipúzcoa; and Hospital Monte Naranco, Oviedo-Asturias, all in Spain.
Cervical spondylitis is reported to occur between 35 and 75 percent of PsA patients, and this likely represents the highest
frequency of cervical involvement among the spondyloarthropathies. However, although two patterns of cervical spondylitis have been recognized in PsA, this may reflect a lack of a satisfactory definition of cervical spondylitis in PsA.
The researchers analysed the clinical records of 100 consecutive patients at a single university hospital who were diagnosed
as having psoriatic spondyloarthropathy on the basis of radiographic sacroiliitis. All of the patients were involved in a
clinicoradiologic study of the cervical column to evaluate the frequency and predictors of this involvement.
Forty-one patients showed radiographic signs of cervical involvement, and 24 of them (58.5 percent) complained of cervical
pain and stiffness, whereas 17 (41.5 percent) had radiologic disease with no symptoms. Both arthritis duration and
peripheral erosive disease were found to be associated with cervical spondylitis development.
None of the patients in this study developed neurologic sequellae.
The finding that clinical symptoms of cervical pain and stiffness are not a universal predictor of involvement of the
cervical spine underline the need for patients with PsA with longer disease duration and erosive disease to be screened
radiologically, these authors conclude.
=====================================================

SAPHO Syndrome Like Yet Distinct From Seronegative Spondyloarthropathies
A DGReview of :"A Study of Musculoskeletal Manifestations in 12 Patients with SAPHO Syndrome"
JCR: Journal of Clinical Rheumatology

02/20/2002
By Anne MacLennan
Sites of chronic infection by the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome need aggressive
antibiotic therapy and, possibly, surgical resection, say researchers.
A study of musculoskeletal manifestations in a group of patients with SAPHO syndrome indicates that it may present with
clinical manifestations similar to those seen with seronegative spondyloarthropathies. However, this syndrome has
distinctive cutaneous, radiographic articular and bone manifestations.

Until now, synovium and synovial fluid findings in SAPHO syndrome have not been well characterized and only a few patients
have been described in the Americas. These authors sought to describe clinical, pathologic, and synovial fluid findings in
12 SAPHO patients.
Jeff P. Steinhoff and colleagues from the Department of Medicine, Rhode Island Hospital, The Miriam Hospital, Providence,
Rhode Island, United States, with others from the US and Chile, did this multicentre study.
The 12 patients included seven with hidradenitis suppurativa, three with acne fulminans or conglobata, one with acneiform
folliculitis and one with palmoplantar pustulosis.
The doctors performed routine synovial fluid studies in six patients. Light and transmission electron microscopic studies in
synovium were done with two patients and in bone in one.
The most common musculoskeletal manifestations included erosive or nonerosive oligoarthritis involving metacarpal phalangeal
(MCP) and metatarsal phalangeal (MTP) joints as seen in nine patients, sclerosis of the sacroiliac joints as seen in five
patients, and osteitis pubis as seen in one.
There were signs of skeletal hyperostosis in three of the patients. Those with acne fulminans and acneiform folliculitis had
chronic aseptic multifocal osteomyelitis.
The synovial fluid was found to be sterile in seven patients, mildly inflammatory in five and highly inflammatory in two.
The electron microscopic studies of synovium in two patients and of bone in one were not useful to detect microorganisms.
Three African-American patients with hidradenitis suppurativa presented with pyoderma gangrenosum. Two had leukocytoclastic
vasculitis and a life threatening course unresponsive to antibiotics, corticosteroids and immunosuppressive therapy.
In the Americas, the authors note, SAPHO is most severe in African-Americans with hidradenitis suppurativa, and it presents
with heterogeneous musculoskeletal and cutaneous manifestations, including erosive polyarthritis or oligoarthritis with
nonspecific mild inflammatory fluid.
Leukocytoclastic vasculitis and recalcitrant pyoderma gangrenosum were seen in two of the patients with the most severe
hidradenitis suppurativa.
A Study of Musculoskeletal Manifestations in 12 Patients with SAPHO Syndrome Jeff P. Steinhoff; Ana Cilursu; Gerald F. Falasca; Leonardo Guzman; Antonio J. Reginato Department of Medicine, Rhode Island Hospital, The Miriam Hospital, Providence, Rhode Island, USA (JPS); Atlantic City Medical Center, Atlantic City, New Jersey, USA (AC); Cooper University Medical Center, Robert Wood Johnson School of
Medicine, Camden, New Jersey, USA (GFF); Head Teaching Program, Division of Internal Medicine, Salvador Hospital, University
of Chile, Santiago, Chile (LG); Professor of Medicine, Chief Rheumatology Section, Cooper University Medical Center, Robert
Wood Johnson Medical Center, Camden New Jersey, USA (AJR).
JCR: JOURNAL OF CLINICAL RHEUMATOLOGY 2002;8:13-22

--------

JCR: Journal of Clinical Rheumatology 2002;8:13-22. "A Study of Musculoskeletal Manifestations in 12 Patients with SAPHO Syndrome"
Synovium and synovial fluid findings in SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome have not
been well characterized, and only a few patients have been described in the Americas. We describe clinical, pathologic, and
synovial fluid findings in 12 patients with the SAPHO syndrome: hidradenitis suppurativa (7), acne fulminans or conglobata
(3), acneiform folliculitis (1) and palmoplantar pustulosis (1). Routine synovial fluid studies were performed in 6
patients, and light and transmission electron microscopic studies were performed in synovium in 2 patients and in bone in 1.
The most common musculoskeletal manifestations included erosive or nonerosive oligoarthritis involving metacarpal phalangeal
(MCP) and metatarsal phalangeal (MTP) joints as seen in 9 patients, sclerosis of the sacroiliac joints as seen in 5
patients, and osteitis pubis as seen in 1. Three patients had signs of skeletal hyperostosis. The patients with acne
fulminans and acneiform folliculitis had chronic aseptic multifocal osteomyelitis. Synovial fluid was sterile in 7, mildly
inflammatory in 5, and highly inflammatory in 2. Electron microscopic studies of synovium in 2 patients and of bone in 1
were not useful to detect microorganisms. Three African-American patients with hidradenitis suppurativa presented with
pyoderma gangrenosum, and 2 of them had leukocytoclastic vasculitis, and a life threatening course unresponsive to
antibiotics, corticosteroids and immunosuppressive therapy.
SAPHO in the Americas is most severe in African-Americans with hidradenitis suppurativa, and it presents with heterogeneous
musculoskeletal and cutaneous manifestations including erosive polyarthritis or oligoarthritis with nonspecific mild
inflammatory fluid. Leukocytoclastic vasculitis and recalcitrant pyoderma gangrenosum were seen in 2 of our patients with
the most severe hidradenitis suppurativa. SAPHO syndrome may present with clinical manifestations similar to those seen with
seronegative spondyloarthropathies, but it has distinctive cutaneous, radiographic articular, and bone manifestations. Sites
of chronic infection need aggressive antibiotic therapy and may need surgical resection.
Key words: SAPHO syndrome; Acneiform folliculitis; Hidradenitis suppurativa; Palmoplantar pustulosis; Acne fulminans; Acne conglobata

===========================================================================

FDA Approves Remicade (Infliximab)/Methotrexate Combination to Improve Physical Function in Rheumatoid Arthritis

MALVERN, PA -- February 28, 2002 -- For the first time, the U.S. Food and Drug Administration (FDA) has granted marketing approval for a drug shown to improve physical function in patients with rheumatoid arthritis (RA).
Remicade® (infliximab), in combination with methotrexate, is now the only therapy approved by the FDA to improve physical function, as well as inhibit the progression of structural damage and reduce signs and symptoms in patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to methotrexate therapy alone. Remicade is the worldwide market share leader among tumor necrosis factor alpha (TNF-alpha) therapies and the only biologic drug indicated for the treatment of RA and Crohn's disease, a potentially devastating gastrointestinal disorder.

More than two million Americans are affected by RA, and many c an become disabled from the irreversible joint damage caused by the disease, severely limiting their ability to function -- both in their personal and professional lives. In fact, studies have shown that as many as 50 percent of RA patients experience work disability within a decade of diagnosis.

"According to the American College of Rheumatology's Guidelines for the Management of Rheumatoid Arthritis, the ultimate goal of therapy is to stop disease progression and return patients to normal activity," said David Yocum, M.D., Professor of Medicine, Director, Arizona Arthritis Center. "For the first time we have a therapy that can improve physical function, while positively impacting quality of life activities such as bathing and dressing. This is groundbreaking news for patients and physicians. The results clearly demonstrate that Remicade fulfills a significant unmet medical need in the treatment of RA."

Remicade is a monoclonal antibody that specifically targets and irreversibly binds to TNF-alpha. Overproduction of TNF-alpha is believed to play a role in not only RA and Crohn's disease, but also in a wide range of immune-mediated inflammatory disorders in which Remicade is currently being studied, including ulcerative colitis, psoriasis and spondyloarthropathies, such as ankylosing spondylitis and psoriatic arthritis.

SOURCE: Centocor, Inc.

================================================================================

Remicade (Infliximab) Shows Impact on Severe Spondyloarthropathy

GHENT, BELGIUM -- March 11, 2002 -- For the first time, there may be an effective therapeutic option for severe cases of spondyloarthropathies (SpA), a group of rheumatic inflammatory diseases that affect the spinal column, peripheral joints and tendons.

A study, published in the March 6 issue of Arthritis and Rheumatism, found that patients treated with infliximab (also known as Remicade®) monotherapy, experienced median improvements in disease activity of 73 and 78 percent as determined by validated patient and physician global assessment measurement tools, respectively. In comparison, patients treated with placebo experienced virtually no response.

"The future of patients suffering from spondyloarthropathy is hopeful," stated Professor Eric M. Veys, MD, Ghent University Hospital. "It seems as if all requirements have been met to allow us to hope that this treatment will be able to prevent the stiffening of the spinal column and the destruction of the peripheral joints, and that the quality of life of these patients will improve considerably."

Spondyloarthropathies are a group of chronic related disorders of the joints that include ankylosing spondylitis, psoriatic arthritis, and the arthritis associated with inflammatory bowel disease (Crohn's disease or ulcerative colitis). SpA may also include severe inflammation in the eye (uveitis). These diseases affect about 1 percent of the total population and often develop into seriously debilitating conditions with complete stiffening of the spinal column and destruction of the peripheral joints (hips, knees, wrists and/or fingers).

Thus far, treatment of these diseases has been limited to the administration of non-steroidal anti-inflammatory drugs. While these drugs may help to relieve pain for some patients, they do not impact the progression of the disease.

Tumor necrosis factor (TNF) is a messenger molecule (cytokine) that is released by stimulated immune cells when inflammation occurs and which, in the case of spondyloarthropathy, induces changes in the bone, joints and tendons. The objective of the 12-week double-blind, placebo-controlled study was to confirm the safety and efficacy of infliximab, a monoclonal antibody that specifically targets TNF-alpha, in forty patients with several sub-types of spondyloarthropathies.

"The results were impressive with regard to subjective complaints, symptoms of inflammation of the spinal column and the peripheral joints, and inflammation markers measured in the blood," stated Prof. Veys.

These results confirm the findings of a separate, long-term, open-label study initiated by the department of rheumatology of the RUG [State University of Ghent, Belgium], involving intravenous injections of infliximab in 21 patients suffering from various forms SpA (E. Kruithof et al, Ann Rheum Dis, 2002; 61: 207-212).

SOURCE: University of Ghent





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Posted Saturday, June 15, 2002 by Rick
Standing Up To Pain Of Arthritis new
Plymouth Evening Herald - Jun 8 2002 12:57PM GMT
Found by: Moreover
http://www.thisisplymouth.co.uk/displayNode.jsp?nodeId=99762&command=displayContent&sourceNode=99754&contentPK=1867669

Arthritis can't stop her from competing new
Record-Eagle - Jun 2 2002 9:27PM GMT
Found by: Moreover
http://www.record-eagle.com/2002/jun/2golf.htm

Leeches Take the Bite Out of Arthritis Pain new
A cheap, natural therapy for arthritis was recommended by scientists on Friday--hirudomedicinalis, or more simply, leeches.- Jun 14 1:27 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020614/hl_nm/arthritis_leeches_1

How a rare arthritis hits its targets new
Melbourne Age - Jun 8 2002 2:11PM GMT
Found by: Moreover
http://www.theage.com.au/articles/2002/06/08/1022982783060.html

THE DOCTOR'S WORLD; Experts Re-examine Dr. Reiter, His Syndrome and His Nazi Past new
New attention is being paid to Hans Conrad Reiter, German doctor after whom Reiter's syndrome is named and whose his involvement in Nazi atrocities now appears deeper than previously known; two arthritis experts at University of California at Los Angeles add further evidence of Reiter's role as a Nazi who helped plan and approve 'human experiments' in concentration camps; they say Reiter may have earned highest marks for his teaching and service to community, but ask if a war criminal 'should be rewarded with eponymous distinction'; photos of Reiter, and other individuals after whom diseases were named (M) - Mar 07 2000
Found by: Yahoo! News
http://premium.news.yahoo.com/news?tmpl=story&u=/nytp/20000307/144819&.bail=http://premium.news.yahoo.com/rd?r=Reactive+Arthritis

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

Patents; In the quest for the ideal breast implant substance, a new candidate: hair. new
...Silicone implants were banned in 1991 amid concerns that they caused autoimmune disease....-Apr 28 2002
Found by: Yahoo! News
http://premium.news.yahoo.com/news?tmpl=story&u=/nytp/20020429/786225&.bail=http://premium.news.yahoo.com/rd?r=Autoimmune

Daughter, dad keep dream going new
Daughter, dad keep dream going SALT LAKE CITY — Why? Why now, Tom Wilczak wonders. It is a perfectly understandable question without any discernible answer. Why, after 14 years of worry,
of endless doctors, autoimmune drugs and medical...
Found by: USA TODAY
http://www.usatoday.com/sports/comment/saraceno/2002-02-12-saraceno.htm

Doctors Advance In Helping Body To Repair Itself new
...It provides the possibility that you could take people with Type 1 diabetes or other autoimmune diseases that are involved in the destruction of tissue and,...- Jan 14 2002
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Chronic Fatigue Syndrome (CFS) & Fibromyalgia Information Exchange, Co. The Co-Cure site exists to provide chronic fatigue syndrome (CFS) and fibromyalgia patients, care-givers and advocates with online access to ...
Found by: CNN Interactive
http://www.cnn.com/HEALTH/links/chronic.fatigue/content.html

Study Targets Chronic Fatigue Syndrome new
Study Targets Chronic Fatigue Syndrome 12:38 p.m. EDT May 15, 2002 - Doctors estimate there are more than 1 million people who suffer from chronic fatigue syndrome. Finding an effecting treatment for the syndrome has been a challenge. But
Found by: MSNBC
http://www.msnbc.com/local/wbal/a1195649.asp

Hysteria Hysteria new
...There are even extreme itch-scratch syndromes in which sufferers fall into a relentless cycle of compulsively scratching some part of their......People who are ill with multiple-chemical sensitivity and chronic-fatigue syndrome -...- Jun 01 2002
http://premium.news.yahoo.com/news?tmpl=story&u=/nytp/20020602/258563&.bail=http://premium.news.yahoo.com/rd?r=Chronic+Fatigue+Syndrome

ABCNEWS.com : Mysterious Diseases Need More Research new
People desperate for explanations of mysterious health problems from chronic fatigue syndrome to multiple chemical sensitivity shouldn't blame the nearest toxic ...
Found by: ABCNews.com
http://more.abcnews.go.com/sections/living/dailynews/mysteriousillnesses010205.html

Pop Stand: Celebrity pill-pushing needs a new RX new
That's how I've been feeling about Debbie Reynolds ever since I saw her image beaming out from behind a stage curtain on the cover of a press kit for a drug that controls "overactive bladder." And Bob Dole, since I saw him extolling the virtues of Viagra. Not to mention Kelsey Grammer and spouse, spokespeople for IBS (irritable bowel syndrome). Found by: Minneapolis Star Tribune
http://www.startribune.com/stories/389/2819835.html

New Treatment For Spinal Disorder Proves Effective In UCSF Study new
Science Daily - May 8 2002 5:44AM GMT
Found by: Moreover
http://www.sciencedaily.com/releases/2002/05/020502073534.htm

Arthritis drug 'could treat spine condition' new
BBC - May 4 2002 1:53AM GMT
Found by: Moreover
http://news.bbc.co.uk/hi/english/health/newsid_1961000/1961971.stm





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Posted Friday, June 14, 2002 by Rick
FDA Oks Limited Reintroduction of Glaxo's Lotronex new
...Patients with irritable bowel syndrome (IBS) had lobbied for the drug's return, arguing that it was safe if used properly....- Jun 10 10:40 AM ET
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Health Highlights: June 9, 2002 new
...But IBS patients who said the drug substantially reduced their suffering pleaded for the drug's return. ...- Jun 09 11:57 PM ET
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http://story.news.yahoo.com/news?tmpl=story&u=/hsn/20020610/hl_hsn/health_highlights__june_nbsp_9__nbsp_2002

FDA Allows Bowel Drug Back on Market new
..." said Jeffrey Roberts of the IBS Self Help Group....- Jun 08 12:09 PM ET
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http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020608/ap_on_he_me/bowel_drug_6'

No evidence' MMR jab is unsafe new
The most in-depth analysis to date has cleared the controversial MMR vaccine of any link to autism or bowel disease. The researchers say their findings provide clear reassurance for patients and health professionals that the combined jab for measles, mumps and rubella is safe.
Found by: FAST Search (alltheweb.com)
http://news.bbc.co.uk/hi/english/health/newsid_2038000/2038135.stm

Health Highlights: June 8, 2002 new
... drug caused fewer ulcers and ulcer complications than such inexpensive, over-the-counter anti-inflammatories as ibuprofen, reports The New York Times. But the research has been disputed and other studies......Allows Return of Bowel Drug, With Restrictions A controversial drug designed to treat irritable bowel syndrome has......-- 'Bait Boxes' May Deter Lyme Disease In ongoing attempts to battle Lyme disease, federal government scientists say they've come...- Jun 08 11:57 PM ET
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http://story.news.yahoo.com/news?tmpl=story&u=/hsn/20020609/hl_hsn/health_highlights__june_nbsp_8__nbsp_2002

Improving Physical Functional Status in Patients with Fibromyalgia: A Brief Cognitive Behavioral Intervention (J Rheumatol)
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&id=8B74FB5E2F132EBC852568FA005CA25A&newsid=8525697700573E1885256BCF004E64F0&u=GOTO//www.jrheum.com/abstracts/abstracts02/1280.html&ref=

From Doctors guide.
Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: Results of a two-year, randomized,
double-blind, placebo-controlled trial (Arthritis Rheum - DGReview)
Trio Of Drugs Works Best For Rheumatoid Arthritics In Study
A DGReview of :"Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: Results of a two-year, randomized, double-blind, placebo-controlled trial"
Arthritis & Rheumatism
05/14/2002
By Anne MacLennan

Patients with rheumatoid arthritis tolerate and respond well to the triple combination of methotrexate, hydroxychloroquine and sulfasalazine.
This three-way mix is superior to a combination of methotrexate (MTX) and sulfasalazine (SSZ) and marginally superior to MTX plus hydroxychloroquine (HCQ), suggests this two-year double-blind study from the University of Nebraska Medical Center, Omaha and other centres in Nebraska and Minnesota, United States.
James R. O'Dell and colleagues compared the efficacy of the three combination therapies in 171 rheumatoid arthritis (RA) patients, none of whom had previously received combinations of any of these drugs. The patients were randomly assigned to one of the three treatments.
HCQ was given at a dosage of 200 mg twice a day. Patients who were not in remission had the MTX dosage accelerated from 7.5 mg/week to 17.5 mg/week and the SSZ dosage from 500 mg twice a day to 1 gm twice a day.

The three combination treatments were all well-tolerated.
Primary end point was the percentage of patients with 20 percent response by American College of Rheumatology (ACR) criteria at two years.
Patients on the triple combination responded best; 78 percent achieved an ACR 20 percent response at two years compared with 60 percent of those treated with MTX and HCQ and 49 percent of those on MTX plus SSZ.
Trends were similar for the ACR 50 percent response, with 55 percent of those on the drug trio, 40 percent of those on MTX and HCQ and 29 percent of those on MTX plus SSZ achieving these results at two years.
Similar numbers of patients in each treatment group - totaling 14 people in all - withdrew from the test because of symptoms possibly related to medications.





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Posted Wednesday, June 12, 2002 by Rick
From Doctors guide.
A DGReview of :"A Multinational Randomized, Controlled, Clinical Trial of Etoricoxib in the Treatment of Rheumatoid Arthritis"
BMC Family Practice
06/07/2002
By Anne MacLennan

Etoricoxib (90 mg once daily) is more effective than placebo and similar in efficacy to naproxen (500 mg twice daily) over a 12-week period, for treating patients with rheumatoid arthritis over 12 weeks.

Moreover, patients generally tolerate this dosage well, suggests a multinational randomised, controlled clinical trial for the Etoricoxib Rheumatoid Arthritis Study Group. Etoricoxib is a highly selective COX-2 inhibitor.

Eduardo Collantes and colleagues from the Hospital Reina Sofia, Cordoba, Spain did this 12-week study with others from centres in the United States, Hong Kong, Colombia and Canada, conducted at 67 sites in 28 countries.

Participants were all chronic users of nonsteroidal anti-inflammatory drugs (NSAIDs) who showed a clinical worsening of arthritis on pre-study withdrawal of these drugs.

In total, 1,171 patients were screened. Eight hundred and ninety one were randomised to receive either placebo (357 patients), etoricoxib (353) or naproxen (181). Of these 891, a total of 687 completed 12 weeks of treatment, 242 on placebo, 294 on etoricoxib and 151 on naproxen.
Patients on etoricoxib and naproxen versus those on placebo showed significant improvements in all efficacy endpoints, with responses to treatment similar between the two groups and for all endpoints.

The percentage of patients who achieved ACR20 responder criteria response was 41 percent in the placebo group, 59 percent in the etoricoxib group and 58 percent in the naproxen group.

Etoricoxib and naproxen were both generally well tolerated.

Direct assessment of arthritis by counts of tender and swollen joints and patient and investigator global assessments of disease activity were measures of primary efficacy in this study.

Secondary measures included the Stanford Health Assessment Questionnaire, patient global assessment of pain and percentage of patients who achieved ACR20 responder criteria response (a composite of pain, inflammation, function and global assessments).

Tolerability was assessed by adverse events and routine laboratory evaluations.





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Posted Wednesday, June 5, 2002 by Rick
Gammalinolenic acid treatment of fatigue associated with primary Sjögren's syndrome (Scand J Rheumatol)
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&id=8B74FB5E2F132EBC852568FA005CA25A&newsid=8525697700573E1885256BC800607432&u=GOTO//rosina.catchword.com/cgi-bin/linker?ini=tandf&reqidx=/catchword/tandf/03009742/v31n2/s4/p72&ref=

Newer Immunosuppressive Drugs: Their Potential Role in Rheumatoid Arthritis Therapy (Drugs)
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&id=8B74FB5E2F132EBC852568FA005CA25A&newsid=8525697700573E1885256BC8005761D2&u=GOTO//www.ingenta.com/isis/searching/ExpandTOC/ingenta?issue=3629.600000/2002/{62}/{6}&index=3&WebLogicSession=PBYSIvA1wcsAGzyC55IA|6285224053791793723/-1052814329/6/7051/7051/7052/7052/7051/-1&ref=





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Posted Tuesday, June 4, 2002 by Rick
Eye Laser Glance new
(Published: 06/03/02)
Found by: Baltimore Sun
... other eye diseases or conditions that hinder surgical healing, such as certain medications or autoimmune disorders....-
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=lasik04&date=20020604

The Little Antibody That Could new
A new, more targeted approach to treating autoimmune disorders may stop Type 1 diabetes
Found by: FAST Search (alltheweb.com), TIME.com
http://www.time.com/time/magazine/article/0,9171,1101020610-257124,00.html

Cytokines Hold Promise as MS Therapy new
...They worked with mice that were prone to develop experimental autoimmune encephalomyelitis, or EAE, a condition that also destroys myelin and that is used by researchers...- Jun 03 4:14 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020603/hl_nm/ms_cytokines_1

Silverchair Cancels Concerts Due To Reactive Arthritis new
(6/1/02, 7 a.m. ET) -- Silverchair has canceled all its upcoming concert plans, which included a stint in the U.S., due to singer-songwriter Daniel Johns's severe case of reactive arthritis.
The condition causes Johns's joints to swell up, resulting in pain and impaired movement.- Jun 01 4:56 PM ET
Found by: Yahoo! News
http://story.news.yahoo.com/news?tmpl=story&u=/020601/143/1mprg.html

Arthritis can't stop her from competing new
TRAVERSE CITY - It all started with "golf camp" with her grandparents. That is where Traverse City Central senior Sarah Lewis developed her love for the game of golf. It was nurtured through
junior golf and blossomed during three years on the high school team.
Found by: FAST Search (alltheweb.com)
http://www.record-eagle.com/2002/jun/2golf.htm