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Serum iron and serum hepcidin levels are directly and indirectly associated with osteoporosis in patients with rheumatoid arthritis (RA), according to study results published in Scientific Reports.1

Previous research has reported lower serum hepcidin and higher serum iron levels in patients with osteoporosis.2 In this study, investigators aimed to determine the correlation between serum hepcidin levels and degree of osteoporosis in patients with RA.

A total of 262 patients with RA were included in the study (77.5% women; mean age, 67.511.4 years), a majority of whom had low disease activity (82.4%) or were in remission (77.1%), according to disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) and Clinical Disease Activity Index. Data on disease characteristics indicated a mean disease duration of 13.610.6 years, with mean disease activity scores of DAS28-CRP and erythrocyte sedimentation rate of 2.21.5 and 2.61.0, respectively. Measurements of mean serum hepcidin (14.319.7 ng/mL), fibroblast growth factor (FGF23; 59.332.9 pg/mL), and 25(OH)D levels (16.56.9 ng/mL) were also collected. Study participants were categorized into 4 groups based on these levels and associations with disease parameters were analyzed.

Higher hepcidin levels were related to increased inflammation, higher ferritin and iron levels, lower unsaturated iron binding capacity, and higher 25(OH)D levels. In addition, RA inflammation and 25(OH)D levels were significantly related to serum hepcidin levels. Higher serum 25(OH)D levels were associated with older age, lower estimated glomerular filtration rate (eGFR), higher ferritin and hepcidin levels, and higher Z score of femoral activity. Higher serum FGF23 levels were associated with older age, lower eGFR, higher body mass index, and 25(OH)D levels.

Overall, results indicated that serum iron levels were positively correlated to bone mineral density (BMD), and serum hepcidin and ferritin levels were positively related to 25(OH)D levels, which were positively associated with the femoral Z score. Serum hepcidin levels and iron metabolism were shown to both directly and indirectly affect osteoporosis in patients with RA.

Study limitations included the use of data from a single center and the absence of control participants. In addition, lifestyle factors such as diet, smoking, and alcohol intake were not analyzed.

References

1. Sato H, Takai C, Kazama JJ, et al. Serum hepcidin level, iron metabolism and osteoporosis in patients with rheumatoid arthritis [published online June 18, 2020]. Sci Rep. doi:10.1038/s41598-020-66945-3

2. Liu B, Liu C, Zhong W, Song M, Du S, Su J. Reduced hepcidin level features osteoporosis. Exp Ther Med. 2018;16:1963-1967.

More:
Serum Iron and Hepcidin Levels Associated With Osteoporosis in Patients With Rheumatoid Arthritis - Rheumatology Advisor

Suffering from arthritis? Youre not the only one since studies show that it affects over 10 million people in the U.K. Thankfully, you can help reduce your symptoms by adding certain fruits to your everyday diet.

Top Fruits That Could Help Ease Arthritis Symptoms

Affecting mostly the knee, hip, hands and feet joints, arthritis is a common condition all across the world and affects several age groups. In fact, statistics show that the chronic musculoskeletal disorder is the most common cause of disabilities in the U.S. Characterized by the involvement of all joint structures in our body, it usually gives joint pain, reduced participation in daily activities and a generally poorer quality of life for those who are suffering from it.

Fortunately, changing your diet and making healthier food choices can do a lot to help alleviate these symptoms. One such way is by eating nutrient-rich fruits. Here are some of the best ones that can help your condition:

Tart Cherries

Per the Arthritis Foundation, tart cherries get their red and vibrant color from the antioxidant anthocyanin, which has anti-inflammatory benefits that can help your joints. Theyre also incredibly tasty and can be enjoyed as a healthy snack to munch on instead of the usual processed sweets. "One study found that drinking tart cherry juice two times per day for three weeks resulted in considerable reductions in vital inflammation markers, especially for participants who had the highest inflammation levels at the start of the study," wrote the foundation.

Avocado

Essentially considered as a superfruit, avocados are easily available, cheap and host tons of health benefits. As for people suffering from arthritis, however, theyd be glad to know that avocados are filled with vitamin E, which is a macronutrient with anti-inflammatory capabilities that can help decrease the risk of joint damage thats usually seen in early stages of osteoarthritis.

Watermelon

Mostly made up of water, watermelons are not only refreshing but are also filled with the carotenoid beta-cryptoxanthin, which helps reduce the risk of rheumatoid arthritis. Additionally, the lycopene in watermelon also has anti-inflammatory effects and can contribute to heart health.

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Fruits To Eat To Reduce Arthritis Symptoms - MSN Money

Background:The concomitant presence of two autoimmune diseases systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in the same patient is known as rhupus. We evaluated a group of patients with rhupus to clarify further their clinical, serological and immunogenic features in a multi-centre cohort. In addition, the study aimed to explore the utility of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in our group of patients with rhupus.

Methods:This was a cross-sectional study. We included rhupus patients from 11 different rheumatology departments, and compared them to SLE and RA patients at a ratio of 2:1. All information was recorded following a pre-established protocol.

Results:A total of 200 patients were included: 40 rhupus patients and 80 each of SLE and RA patients as controls. Disease duration was similar among SLE and rhupus groups (around 13 years), but the RA group had a significantly lower disease duration. Main clinical manifestations were articular (94.2%), cutaneous (77.5%) and haematological (72.5%). Rhupus patients had articular manifestations similar to those expected in RA. Only 10% of rhupus patients had renal involvement compared with 25% of those with SLE (p< 0.05), while interstitial lung disease was more common in patients affected by RA. The 2019 EULAR/ACR SLE criteria were met in 92.5% of the rhupus patients and in 96.3% of the SLE cohort (p> 0.05). Excluding the joint domain, there were no differences between the numbers of patients who met the classification criteria.

Conclusion:Rhupus patients follow a particular clinical course, with full expression of both SLE and RA in terms of organ involvement, except for a lower prevalence of kidney affection. The new 2019 EULAR/ACR SLE criteria are not useful for differentiating SLE and rhupus patients. A new way of classifying autoimmune diseases is needed to identify overlapping clusters.

Keywords:Arthritis; poly-autoimmunity; rheumatoid arthritis; rhupus; systemic lupus erythematosus.

Read more:
A Comparative Study on Clinical and Serological Characteristics Between Patients With Rhupus and Those With Systemic Lupus Erythematosus and...

New York, July 9, 2020: Market Research Engine has published a new report titled asSmall Molecule Therapies for Rheumatoid Arthritis MarketSize, By Product (Disease Modifying Anti-Rheumatic Drugs, Non-Steroidal Anti-Inflammatory Drugs, Corticosteroids), By Region, Market Analysis Report, Forecast 2018-2024.

FYI, you will get latest updated report as per the COVID-19 Impact on this industry. Our updated reports will now feature detailed analysis that will help you make critical decisions.

Increasing ageing population and healthcare expenditure will expand the small molecule therapies for rheumatoid arthritis market size over the forecast time line. Rising investments in drug development program and drug discovery will further support in stimulating industry size. Stringent regulations related to efficacy in clinical development may affect the industry revenue generation till 2024.

Browse Full Report: https://www.marketresearchengine.com/small-molecule-therapies-for-rheumatoid-arthritis-market

Regulatory approvals for leflunomide and etanercept has led to various developments in the disease modifying anti-rheumatic drugs (DMARDs) which are used for the treatment of rheumatoid arthritis. Of which leflunomide is a small molecule and non-biological DMARD, whose usage will support in promoting industry growth rate during the study period.

The small molecule therapies for rheumatoid arthritis market is segmented on the lines of its product and regional. The basis of product the market is segmented into Disease Modifying Anti-Rheumatic Drugs, Non-Steroidal Anti-Inflammatory Drugs, and Corticosteroids. The small molecule therapies for rheumatoid arthritis market on geographic segmentation covers various regions such as North America, Europe, Asia Pacific, and Rest of World. Each geographic market is further segmented to provide market revenue for selected countries such as the U.S., Canada, Germany, UK, France, Italy, China, India, Japan, Brazil, South Africa and others.

Competitive Rivalry

AbbVie, Amgen, Johnson & Johnson, Novartis, Pfizer, and UCB Pharma are among the major players in the global small molecule therapies for rheumatoid arthritis market share. The companies are involved in several growth and expansion strategies to gain a competitive advantage. Industry participants also follow value chain integration with business operations in multiple stages of the value chain.

The Small Molecule Therapies for Rheumatoid Arthritis Market has been segmented as below:

The Small Molecule Therapies for Rheumatoid Arthritis Market is segmented on the lines of Small Molecule Therapies for Rheumatoid Arthritis Market, By Product and Small Molecule Therapies for Rheumatoid Arthritis Market, By Region.

Small Molecule Therapies for Rheumatoid Arthritis Market, By Product this market is segmented on the basis of Disease Modifying Anti-Rheumatic Drugs, Non-Steroidal Anti-Inflammatory Drugs and Corticosteroids. Small Molecule Therapies for Rheumatoid Arthritis Market, By Region this market is segmented on the basis of North America, Europe, Asia Pacific and Rest of World.

The report covers:

Report scope:

The scope of the report includes a detailed study of small molecule therapies for rheumatoid arthritis market with the reasons given for variations in the growth of the industry in certain regions.

The report covers a detailed competitive outlook including the market share and company profiles of the key participants operating in the global market. Key players profiled in the report include AbbVie, Amgen, Johnson & Johnson, Novartis, Pfizer, and UCB Pharma. Company profile includes assigning such as company overview, product landscape, financial overview, and recent developments.

The top company reports are intended to provide our buyers with a snapshot of the industrys most influential players.

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Table of Contents:

1. Introduction

2. Research Methodology

3. Executive Summary

4. Market Overview 4.1. Introduction 4.2. Drivers 4.2.1. Ageing population 4.2.2. Attrition of new small molecule drugs in RA clinical development 4.3. Restraints 4.3.1. High cost of RA drugs 4.3.2. Approval of the drug by regulatory authorities 4.4. Opportunities 4.4.1. Drug discovery and drug development program 4.4.2. Unmet medical need 4.5. Challenges 4.5.1. Need for rheumatologists 4.5.2. Market dominance by TNF-alpha inhibitors

5. Small Molecule Therapies for Rheumatoid Arthritis Market, By Product

6. Competitive Landscape

7. Company Profile 7.1. AbbVie 7.1.1. Company Overview 7.1.2. Product/Service Landscape 7.1.3. Financial Overview 7.1.4. Recent Developments 7.2. Amgen 7.2.1. Company Overview 7.2.2. Product/Service Landscape 7.2.3. Financial Overview 7.2.4. Recent Developments 7.3. Johnson & Johnson 7.3.1. Company Overview 7.3.2. Product/Service Landscape 7.3.3. Financial Overview 7.3.4. Recent Developments 7.4. Novartis 7.4.1. Company Overview 7.4.2. Product/Service Landscape 7.4.3. Financial Overview 7.4.4. Recent Developments 7.5. Pfizer 7.5.1. Company Overview 7.5.2. Product/Service Landscape 7.5.3. Financial Overview 7.5.4. Recent Developments 7.6. UCB Pharma 7.6.1. Company Overview 7.6.2. Product/Service Landscape 7.6.3. Financial Overview 7.6.4. Recent Developments

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Small Molecule Therapies for Rheumatoid Arthritis Market to Register Impressive Growth Rate as Demand Rambles during Lockdown - Cole of Duty

Although the adverse effects of systemic glucocorticosteroids (GCs) are well known, their association with hypertension in rheumatoid arthritis (RA) has been unclear. Now, a large population-based study shows that the drugs are linked to a 17% overall increased risk for incident hypertension among patients with RA.

Further, when the researchers stratified participants by dose category, they found that doses higher than 7.5 mg were significantly associated with hypertension. Cumulative dosage was not tied to any clear pattern of risk.

The authors, led by Ruth E. Costello, MSc, a researcher at the Center for Epidemiology Versus Arthritis in the Center for Musculoskeletal Research at the University of Manchester, United Kingdom, conclude that patients who are taking these drugs for the treatment of RA should be monitored for high blood pressure, which is an important but modifiable cardiovascular risk factor, and treated appropriately.

The results of Costello and colleagues' study were published June 27 in Rheumatology.

"While fractures associated with these steroid drugs are well studied, hypertension is a side effect that seems to have been less well studied, and yet it is an important cardiovascular risk factor that can be managed," Costello told Medscape Medical News.

To better understand the possible association, Costello and colleagues identified 17,760 patients who were newly diagnosed withRA between 1992 and 2019 and were included in the Clinical Practice Research Datalink, which represents about 7% of the UK population. None of the patients had hypertension at initial RA diagnosis. Slightly more than two thirds were women (68.1%), and the mean age was 56.3 years.

Of those patients, 7421 (41.8%) were prescribed GCs during post-diagnosis follow-up. Most patients (73%) were followed for at least 2 years.

Patients who used GCs were slightly older than never-users (mean age, 57.7 vs 55.3 years), were predominantly women, had a history of smoking, and had more comorbidities.

The overall incidence rate (IR) of hypertension was 64.1 per 1000 person-years (95% CI, 62.5 65.7). There were 6243 cases of incident hypertension over 97,547 person-years of follow-up.

Among those exposed to GCs, 1321 patients developed hypertension, for an IR of 87.6 per 1000 person-years. Among unexposed participants, the IR for hypertension was 59.7 per 1000 person-years. In Cox proportional hazards modeling, GC use was associated with a 17% increased risk for hypertension (hazard ratio, 1.17; 95% CI, 1.10 1.24).

The researchers note that 40% of GC users with hypertension were not prescribed an antihypertensive agent at any point during the study. "Whilst some may have been offered lifestyle advice, left untreated this has important implications in terms of addressing modifiable risk factors in an RA population already at increased risk of CV disease," they write.

They note that cardiovascular disease is a major driver of the elevated mortality risk seen among adults with RA compared with the general population and that recent treatment recommendations address management of cardiovascular risks in these patients.

"There are several routes by which GCs may promote cardiovascular disease, including hypertension, metabolic changes, diabetes, and weight gain. We don't currently know the extent to which each of these individual mechanisms may be increasing cardiovascular disease," said Costello.

"Glucocorticoids increase fluid retention and promote obesity and hypertension," said Rajat S. Bhatt, MD, a rheumatologist at Prime Rheumatology and Memorial Hermann Katy Hospital in Richmond, Texas, who sees hypertension in GC users in his clinical practice. "So patients need to be monitored for these risk factors," he told Medscape Medical News.

Although hypertension may be a significant factor in the increase in cardiovascular disease in the RA population, Bhatt said the major driver is likely the intrinsic inflammatory state caused by the disease itself. As to why the GC-hypertension connection has flown under the radar in RA, he added, "That specific link has been difficult to tease out since RA patients are often on multiple medications."

In regard to the role of dosage, Bhatt said that hypertension risk increases with higher GC doses, as the UK study indicates, and usually subsides when patients stop using GCs.

"Whether the observed dose association is causal or influenced by the underlying disease severity, our results suggest we should be vigilant in patients on all doses of GC, especially higher doses," Costello added.

In regard to using drugs that are less cardiotoxic than CGs, Bhatt said that there are clinical scenarios in which GC therapy is the best choice, so just switching to nonsteroidal drugs is no panacea. "All RA drugs have adverse side effects, and anyway, the goal of rheumatology treatment is always to get patients off corticosteroids as soon as possible," he said.

Costello and colleagues note that their results are consonant with earlier research, including a single-center cross-sectional study in which less than 6 months' use of prednisolone at a median dose of 7.5 mg was associated with hypertension. In a German registry study, among patients who received doses of less than 7.5 mg for less than 6 months, there were higher rates of self-reported elevations in blood pressure.

The findings are at odds, however, with a recent matched-cohort study, which also used data from the Clinical Practice Research Datalink. That study found no association between GC use and hypertension.

GCs have come under increasing scrutiny in regard to several diseases. A study published this week found that even short-term courses of a few days' duration entail risks for serious adverse events.

Costello's group says that an estimate of GC-related incident hypertension in RA should allow more informed treatment decisions and that their findings highlight the ongoing need to monitor for and address this risk.

The study was supported by the Center for Epidemiology Versus Arthritis and by the National Institute for Health Research Manchester Biomedical Research Center. Coauthor Dixon has received consultancy fees from Google and Beyer unrelated to this study. Bhatt has disclosed no relevant financial relationships.

Rheumatol. Published online June 27, 2020. Full text

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

More:
Steroids Linked to Increased Hypertension in RA - Medscape

Osteoarthritis is a degenerative joint disease that is the most common type of arthritis. Usually, it occurs among people of advanced age. But it can begin in middle age or even sooner, especially if theres been an injury to the joint.

While there are treatments available exercise, braces or canes, loss of excess weight, various pain relievers and anti-inflammatory medicines these are no cures, and none of the treatments are predictably effective. In fact, often they dont work at all, or help only a little. Injected steroids or synthetic lubricants can be tried as well. When all else fails, joint replacement surgery can be highly effective. In fact, about a million joint replacements (mostly knees and hips) are performed each year in the U.S.

So, its no surprise that people with osteoarthritis will try just about anything that seems reasonably safe if it might provide relief. My patients often ask about diet, including anti-inflammatory foods, antioxidants, low-gluten diets and many others. Theres little evidence that most of these dietary approaches work. When there is evidence, it usually demonstrates no consistent or clear benefit.

Thats why one study is noteworthy: It suggests that curcumin, a naturally occurring substance found in a common spice, might work for osteoarthritis.

In the study, researchers enrolled 139 people with symptoms of knee osteoarthritis. Their symptoms were at least moderately severe and required treatment with a nonsteroidal anti-inflammatory drug (NSAID). For one month, they were given the NSAID diclofenac (50 mg, twice daily) or curcumin (500 mg, three times daily).

Why curcumin? Its a naturally occurring substance, found in the spice turmeric, that has anti-inflammatory effects. Its use has been advocated for cardiovascular health, arthritis and a host of other conditions. However, well-designed studies of its health benefits are limited.

Heres what this study found:

Ready to start taking curcumin?

Not so fast. Its rare that a single study can change practice overnight, and this one is no exception. A number of factors give me pause:

Studies of this sort are vitally important in trying to understand whether dietary changes can be helpful for arthritis. While this new study provides support for curcumin as a treatment for osteoarthritis of the knee, Id like to see more and longer-term studies in osteoarthritis and other types of joint disease, as well as more extensive testing of its safety, before recommending it to my patients.

Go here to read the rest:
Curcumin for Arthritis: Does it Really Work? - Chicago Health

Global Psoriatic Arthritis Treatment Market: Overview

The demand within the global psoriatic arthritis treatment market has been rising on account of advancements in the field of healthcare and biosimilar analysis. The occurrence of psoriatic arthritis can place an extremely negative toll on the overall health of individuals. This is because psoriatic arthritis is more severe than any other form of arthritis. Under psoriatic arthritis, patients suffering from a skin condition called psoriases start to exhibit extreme symptoms of arthritis. This results in excessive pain, uneasiness, and discomfort for the sufferer, often necessitating emergency dosage of steroids. Hence, there is a dire need to ensure that psoriatic arthritis is controlled which in turn gives an impetus to the growth of the global market. The revenue scale of the global psoriatic arthritis treatment market shall improve alongside advancements in the field of geriatric care.

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There is no permanent treatment for psoriatic arthritis, and it can only be controlled with proper medication. The discomfort suffered by people affected with psoriatic arthritis is abysmal. Owing to the aforementioned factors, the global psoriatic arthritis treatment market is projected to attract the attention of the medical fraternity in the years to follow. The demand for psoriatic arthritis is projected to reach new heights in the years to follow.

The global psoriatic arthritis treatment market can be segmented on the basis of the following parameters: drug class, route of administration, and region. Based on drug class, the global psoriatic arthritis treatment market can be segmented into Disease-modifying Antirheumatic Drugs (DMARDs), Nonsteroidal Antiinflammatory Drugs (NSAIDs), and biologics. Based on route of administration, the global psoriatic arthritis treatment market can be segmented into orals, topical, and injectables.

Global Psoriatic Arthritis Treatment Market: Notable Developments

Several advancement in the competitive landscape have become a key characteristic of the global psoriatic arthritis treatment market in recent times.

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Global Psoriatic Arthritis Treatment Market: Growth Driver

The occurrence of psoriatic arthritis is preceded by the severity of psoriasis in individuals. Hence, the field of dermatology needs to be work in conjunction with other medical departments in order to treat and control psoriatic arthritis. Hence, the global psoriatic arthritis treatment market shall expand alongside advancements in the field of dermatology. Furthermore, the availability of over-the-counter drugs for treatment of psoriatic arthritis propelled demand within the global market.

The joints suffer severe pain during psoriatic arthritis treatment, and the patients need to be quick recourse treatments. In a lot of cases, psoriatic arthritis poses a risk of permanent damage of joints. For this reason, the demand for psoriatic arthritis treatment has been rising at a stellar pace.

Global Psoriatic Arthritis Treatment Market: Regional Outlook

On the basis of geography, the global psoriatic arthritis treatment market can be segmented into North America, Europe, Asia Pacific, the Middle East and Africa, and Asia Pacific. The psoriatic arthritis treatment market in North America is expanding alongside advancements in the field of regional healthcare.

The global psoriatic arthritis treatment market can be segmented as:

Route of Administration

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Psoriatic Arthritis Treatment Market Competitive Landscape Analysis with Forecast by 2028 - 3rd Watch News

A condition that has no cure. A condition that has very generic risk factors. And, a condition that could make your life living hell.

Rheumatoid Arthritis (RA), is a condition that causes a person's immune system to attack their body cells, leading to severe damage to bones and cartilage. Symptoms include joint pain, weakness and inflammation around joints. RA affects over 400,000 people in the UK and is an autoimmune disease. As mentioned, an overactive immune system leads to it, but the reason behind such activity is something we yet do not know.

RA has no cure so far. And so, the only way to treat it is by giving immunosuppressants (medicine that reduces the activity of the immune system) or physiotherapy to ease joint pain. However, AI has been introduced to the RA landscape and so far, there have been studies on how it could help detect signs of RA early on, so minimal damage is done.

A study in 2019 from an American medical journal, JAMA Network Open was conducted, with a cohort of 116 and 117 RA patients. These were across a university hospital and a safety-net hospital. The model aimed to predict disease activity for a patient the next time they visited an RA clinic. Though the way of measurement is quite complex, the way the model performed was measured by calculating the area underneath a receiver operating characteristic curve (AUROC). This is a graphical plot that shows how well a system can distinguish between two groups. The conclusion came out to be 0.91 (university hospital) and 0.74 (safety-net hospital). Though to us, these results may not seem as much, to the researchers they showed that forecasting RA is possible with AI if data and AI models can be shared across hospitals.

Another very important advancement in the RA field was accomplished by healthcare start-up Living With, at the University of Bath, alongside the Royal United Hospitals Bath NHS Foundation Trust (RUH). A flare-up in medical terms is where the symptoms for a disease get worse, and that's when the disease is most active. These flare-ups can be difficult to predict. Living With have developed a Flare Profiler using smartphone technology and thermal imaging to stop the long-term harm from RA. A side-goal for Living With, is for RA patients to not always see a consultant each time they want to know how their body is coping up. They could see a specialist nurse, who would just need to interpret the data coming from the profiler. The profiler comes in the form of an app and will use AI to recognise disease patterns and then provide different routes for treatment.

Link:
How AI Is Slowly, But Steadily, Affecting The Treatment Of Rheumatoid Arthritis. - AI Daily

Last week I wrote about arthritis, the type that happens as we age and our joints become victim to the usual wear and tear that comes with use.

Following on from that, Id like to talk about some of the other types of arthritis that can affect us.

Rheumatoid arthritis is not caused by wear and tear, but rather our own immune system attacking the joints. Unlike osteoarthritis, rheumatoid arthritis is not something that comes to most of us as we age although if you do suffer with it, then your joints may become gradually worse over time.

The immune system is triggered into acting as though we are being attacked at the site of the joints, causing swelling, redness and inflammation. This inflammation can be quite aggressive and in some cases the swelling itself causes the joint to mis-align, becoming painful and deformed permanently.

A common area for this to happen is in the finger and wrist joints. The fingers can start to bend in ways that are abnormal, making every day tasks like opening jars difficult and painful.

If you have rheumatoid arthritis, then nutrients like glucosamine, MSM, collagen and chondroitin are not the remedies to turn to. While these nutrients are used to repair and protect joints over time, in rheumatoid arthritis, the most important method of protecting your joints is to manage the inflammation and keep it under control.

Herbs that manage inflammation are too numerous to list in a single article but there are a few that are very specific to joint pain. One of these is devils claw, a herb that I was taught in my early years of training is especially helpful for arthritis that has begun to warp the fingers.

Since people with RA (rheumatoid arthritis) can end up with their fingers bent and curled at the joint, I was taught to remember devils claw for hands that are curled like claws.

Not everyone with RA has joint damage to this extent and managing the condition can help to avoid serious or more permanent changes to the joints. Devils claw is an anti inflammatory herb which acts by blocking some of the chemical pathways that lead to inflammation.

By blocking these pathways, the inflammatory response of the immune system is reduced, leading to less pain and a longer life for joints that would otherwise be damaged.

Unlike other pain medicines, devils claw should be taken over a period of eight weeks before you assess how well it is or isnt working for you. Rather than a temporary action that gets to work immediately but fades after a few hours, the effect of devils claw is gradually built up. Once it is working the anti inflammatory effect should be consistent and it is safe to take long term.

In a trial over eight weeks, patients with various rheumatic conditions were given a dose of devils claw. Results concluded that pain was significantly reduced by up to 58 per cent, so even though it can take a while to get to work, it is worth sticking out that eight week period.

If you suspect that you have an arthritic condition, getting a clinical diagnosis from your GP is very important. Your doctor can provide a blood test if they suspect that your arthritis is rheumatoid. If you test positive, then treatment can be provided that is specific to your condition, making it more likely to be effective and lengthening the life of your joints.

In some cases, autoimmune medicines are offered to stop your body from attacking itself. A big concern, especially during current times, of people on immune suppressants is that they may not be as able to fight off colds, bugs and viruses as they otherwise would be.

In this instance, you can help yourself with herbs but it is important to avoid anything stimulating like echinacea which can work against your medicine.

Instead, take immune nutrients like zinc, vitamin C and vitamin D to support your body more gently through nourishment.

For more information on arthritis and ways to manage it naturally, contact Nicola at her clinic on 01524 413733.

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Medical herbalist Nicola Parker explains the treatment for different types of arthritis - Clitheroe Advertiser

Pfizers immunology portfolio includes the JAK inhibitor Xeljanz and a pipeline of five mid- to late-stage experimental drugsa huge stable of assets that seems well-positioned to fuel strong growth over the next five years.

But one influential Wall Street firm took a deep dive into that immunology portfolio and found a troublesome undercurrent that made its analysts wonder just how much it will really contribute to Pfizers future growth.

Analysts at SVB Leerink warned clients in a note on Wednesday that our review of the competitive landscape suggests Pfizers compounds could be beaten on speed to market, or better clinical data, in nearly all indications.

One challenge is that Pfizer is heavily dependent on JAK inhibitors, SVB Leerink said. Xeljanz is approved to treat rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. Pfizers nearest-term prospect in its immunology portfolio is JAK inhibitor abrocitinib, which is in phase 3 trials to treat atopic dermatitis.

The SVB Leerink analysts expect abrocitinib to be bringing in $2 billion in sales by 2027. Another phase 3 JAK inhibitor, PF-06651600 for alopecia, should peak at $500 million a year, they added.

But abrocitinib will likely carry the Black Box warning that the FDA has slapped on the JAK class, which warns of a high risk of serious infections, cancer, blood clots and other issues. That warning should relegate the drug to [second-line] behind Regenerons Dupixent until physicians gain experience and confidence in the product.

RELATED: AbbVie's Rinvoq scores pivotal trial win in eczema. But do dermatologists trust JAK inhibitors?

Dupixent is far from the only rival drug that could pose challenges for Pfizer. AbbVies JAK inhibitor Rinvoq, approved to treat rheumatoid arthritis last year, could score a green light in atopic dermatitis before abrocitinib does, SVB Leerink analysts predicted. In this situation, abrocitinib would not offer as much safety as Dupixent, or the efficacy of Rinvoq, and we'd expect it to struggle to gain market share, they said.

Last month, AbbVie released clinical trial data showing that Rinvoq was better than placebo at producing a 75% drop in atopic dermatitis symptoms and clear or almost clear skin after 16 weeks. At the time, SVB Leerink predicted Rinvoq could become the standard of care for patients who dont do well on Dupixent.

Pfizer has produced some positive data of its own, though it hasnt yet been impressive enough to convince analysts that abrocitinib will shoot to the top of the competitive class of JAK inhibitors. Last October, Pfizer said the drug produced clear or almost clear skin in 43.8% of eczema patients participating in a phase 3 trial, versus 7.9% of those taking a placebo. More recently, Pfizer reported a statistically significant improvement in symptoms among teenagers in a phase 3 trial.

RELATED: Pfizer's JAK abrocitinib comes through in teen eczema test

Pfizer is also testing a TYK2 inhibitor in psoriasis, but its facing stiff competition there, too. Bristol Myers Squibb is working on a TYK2 inhibitor, BMS-986165. SVB Leerink analysts pointed out that BMS recently posted clinical trial data suggesting its drug could offer double the effectiveness of Otezla, the drug BMS had to sell to Amgen in order to consummate its Celgene takeover. Add to that the fact that Pfizer is roughly two years behind BMS, and its hard to imagine it could make much of a mark in TYK2 inhibition, SVB Leerink said.

All in all, the analysts are projecting that Pfizers immunology sales will be flat this year and next at about $4.3 billion. From there, sales could grow 5% to 10% a year, they saidbut only if the companys JAK inhibitors are successful.

Ultimately, though, Pfizer may not be well-positioned to grab a significant piece of a rapidly growing market. Global JAK inhibitor sales could grow from $2.7bn to $19.3bn with additional launches and indications, SVB Leerink predicted, but if it materializes, Pfizer might get only a small share.

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Pfizer may have a lot going on in immunology, but all its drugs could be beaten by rivals: analyst - FiercePharma

Global Rheumatoid Arthritis Stem Cell Therapy Market Growth Projection

The new report on the global Rheumatoid Arthritis Stem Cell Therapy market is an extensive study on the overall prospects of the Rheumatoid Arthritis Stem Cell Therapy market over the assessment period. Further, the report provides a thorough understanding of the key dynamics of the Rheumatoid Arthritis Stem Cell Therapy market including the current trends, opportunities, drivers, and restraints. The report introspects the micro and macro-economic factors that are expected to nurture the growth of the Rheumatoid Arthritis Stem Cell Therapy market in the upcoming years.

The report suggests that the global Rheumatoid Arthritis Stem Cell Therapy market is projected to reach a value of ~US$XX by the end of 2029 and grow at a CAGR of ~XX% through the forecast period (2019-2029). The key indicators such as the year-on-year (Y-o-Y) growth and CAGR growth of the Rheumatoid Arthritis Stem Cell Therapy market are discussed in detail in the presented report. This data is likely to provide readers an understanding of qualitative and quantitative growth prospects of the Rheumatoid Arthritis Stem Cell Therapy market over the considered assessment period.

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Rheumatoid Arthritis Stem Cell Therapy Market Trends, Outlook and Opportunity Analysis 2018 to 2028 - Cole of Duty

The next few months could bring the first gene therapy for hemophilia, a new type of multiple myeloma drug and an additional treatment option for a devastating muscular condition.

The Food and Drug Administration is set to make decisions on approval of all three, as well as on a closely watched arthritis pill and the first oral drug for spinal muscular atrophy, between July and September.

A regulatory OK for Roctavian, BioMarin Pharmaceutical's experimental hemophilia A treatment, would be a particularly significant milestone the first gene therapy for one of the world's most well-known inherited diseases. Approvals for Roche's risdiplam, NS Pharma's viltolarsen, Gilead's filgotinib and GlaxoSmithKline's belantamab mafodotin would also be notable.

The list of experimental drugs slated for the FDA's review during the third quarter was originally longer, but the agency cleared three targeted cancer therapies months ahead of schedule. (Seattle Genetics' Tukysa, Novartis' Tabrecta and Eli Lilly's Retevmo were all approved in April and May.)

Even as it's moved quickly to approve new drugs, the FDA has acknowledged the strain resulting from the work the agency is doing to oversee COVID-19 vaccine and drug development. So far, new drug reviews haven't been heavily affected, but the FDA has warned they could be slowed.

The five experimental drugs are listed in order of the currently scheduled date by which the FDA has agreed to make a decision on approval.

Around a dozen drugmakers are developing multiple myeloma treatments that target a protein known as BCMA, which is found on nearly all malignant cells. GlaxoSmithKline looks to be in a position to get there first.

GSK's drug, called belantamab mafodotin, is an antibody-drug conjugate, designed to bind to the BCMA target and deliver a small chemotherapy payload to attack cancerous cells. The conjugate approach is employed by Seattle Genetics' Adcetris and Roche's Kadcyla for other types of blood cancer.

Behind belantamab mafodotin, however, several other BCMA-targeting therapies are nearing key milestones, including a CAR-T cell therapy from Bristol-Myers Squibb and Bluebird bio, as well as a bispecific antibody from Regeneron.

They would trail belantamab mafadotin if the GSK drug is approved by the FDA's target decision date sometime this month. But the rival therapies could potentially offer advantages in greater effectiveness or more manageable side effects. Notably, balantamab mafadotin is associated with an eye-related side effect called keratopathy.

The FDA's decision to approve Sarepta Therapeutics' Exondys 51 for Duchenne muscular dystrophy in 2016 was one of the most controversial in the agency's recent history. The drug, a type of genetic treatment known as "exon-skipping," was the first specifically cleared for patients with DMD.

Approval late last year of Sarepta's second drug Vyondys 53 for a different segment of DMD patients was nearly as dramatic, with the FDA reversing an initial rejection after the company appealed to more senior agency officials.

The FDA's review of a DMD treatment developed by NS Pharma, a little-known subsidiary of Japan's Nippon Shinyaku, promises to be less eventful.

NS' drug, called viltolarsen and designed to treat the same group of DMD patients as Vyondys 53, works similarly to both of Sarepta's drugs. Study results published in JAMA Neurology this past May suggest it might even work better than Vyondys 53, although comparing drugs across trials can be misleading.

Like Sarepta, however, NS is offering the FDA limited evidence to go on. The study supporting the drugmaker's application primarily tested whether viltolarsen increased the production of a key protein that's largely missing in children with DMD and, notably, lacked a placebo comparison.

Having cleared Exondys 51 and then Vyondys 53, however, the FDA seems to have signaled it will accept early data as compelling enough to merit approval. A decision is expected sometime in August.

For Gilead and partner drugmaker Galapagos, much is riding on filgotinib. The drug is at the center of a research collaboration between the two companies, first inked in 2015 and then expanded with a $5.1 billion pact last year.

Part of a class of drugs called JAK inhibitors, filgotinib is aimed first at rheumatoid arthritis, a chronic condition for which it will have much competition. Three other JAK inhibitors, Pfizer's Xeljanz, Eli Lilly's Olumiant and AbbVie's Rinvoq, are already approved for rheumatoid arthritis, which is also commonly treated with biologic drugs like Humira.

Some analysts on Wall Street see filgotinib as safer than its JAK-blocking rivals, but the FDA appears to be viewing the risk of blood clots as characteristic of the drug class.

Gilead and Galapagos still think filgotinib can stand out and are counting on an August approval from the FDA to prove it. Clearance for rheumatoid arthritis would be the first step in proving the drug's future for other inflammatory conditions, like Crohn's disease, uveitis and psoriatic arthritis.

An approval for BioMarin's Roctavian would be a significant moment for the still-emerging gene therapy field. The experimental hemophilia A treatment wouldn't be the first gene therapy to gain FDA clearance that milestone went to Luxturna for an inherited form of blindness but it would offer thousands of patients long-lasting control of a disruptive and damaging bleeding disorder.

Roctavian also typifies the substantial benefits gene therapy can offer. Studies showed the treatment largely eliminated bleeding episodes, enabling patients to drastically reduce how much they rely on expensive factor replacement therapy that aids blood clotting. Years later, patients who received the treatment are still largely free of both.

BioMarin has suggested a price for Roctavian as high as $3 million, arguing the drug's value is clear when factor replacement therapy can sometimes cost as much as $1 million per year for severe hemophilia patients.

The company recently detailed follow-up data up to four years post-treatment in patients who were enrolled in early clinical trials. While their levels of blood clotting activity appear to decline over time, they are all still producing the Factor VIII protein that's reduced or missing in patients with hemophilia.

Spinal muscular atrophy, or SMA, is an often-fatal neuromuscular condition that primarily affects infants and children. Until three and a half years ago, there was no treatment.

An approval for Roche and PTC Therapeutics' risdiplam, expected by August 24, would bring to market the third treatment for the disease and the first one taken orally, which may be more convenient for some patients.

The companies have played up risdiplam's advantages compared to Spinraza, the first SMA drug, as well as versus Novartis' gene therapy Zolgensma. Spinraza is administered via a spinal injection, while Zolgensma is infused intravenously for treating infants.

Roche and PTC sought to submit to the FDA study data covering a broad range of patients, from infants to adults and across various levels of disease severity. In doing so, however, they caused the agency to extend its approval review by three months in order to take into account results from a study in less severe adolescents and adults.

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5 FDA approval decisions to watch in the 3rd quarter - BioPharma Dive

Health & FitnessSaturday, July 4, 2020 15:03

By DR FREDRICK OTIENO

Many patients with rheumatic diseases especially those presenting witharthritisreport increasing pain and stiffness during cold seasons.

Tales abound of how some patients can actually predict the onset of rain or cold weather from these symptoms. Whether it is a knee acting up when a rainstorm is on the horizon or, worse yet, a full-fledged rheumatoidarthritisflare when a blizzard hits, many of those with rheumatic diseases swear the weather harms their conditions.

The precise mechanism for this observation is not clearly understood, but it is thought that changes in weather can cause expansion and contraction of tendons, muscles, bones, and scar tissues, resulting in pain in the tissues that are affected byarthritis.

Low temperatures may also increase the thickness of joint fluids, making them stiffer and perhaps more sensitive to pain during movement.

What causes autoimmune diseases?

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Before addressing what precautions people living with rheumatic diseases can take during the rainy season, it is important to first understand what causes the condition. Anything foreign or toxic to our body are collectively called anti- gens; mostly some form of proteins or carbohydrate.

The immune system identifies these antigens and produces antibodies to get rid of them. Our cells, which are also made up of proteins and carbohydrates, escape the action of these soldiers due to the presence of specific distinguishing features called self-antigens. The immune cells, during their development in the thymus and bone marrow, are exposed to these self-antigens and made tolerant to them.

In a healthy individual, these tolerant cells go on to mature and become cells of the immune system. The body destroys the intolerant ones.

Many times, due to discrepancies in this process of destruction, the autoreactive immune cells escape the surveillance and can cause autoimmune disorders. These discrepancies can be genetic in origin, there could be a mutation in the self-antigens, or excessive and uncontrolled inflammation can lead to an overactive immune system.

Systemic autoimmune disorders occur when the effect of the autoreactive cells are seen all over the body, in conditions like lupus, rheumatoidarthritis, multiple sclerosis, and ankylosing spondylitis.

Arthritisis a common manifestation of most rheumatic diseases and is usually a result of inflammation.

Typical presentation includes:

What precautions can people living with rheumatic diseases take during the cold season?Patients with rheumatic diseases should be on effective treatment that ensures adequate disease control and suppression of inflammation at all times.

Treatments cannot cure autoimmune diseases, but they can control the overactive immune response and bring down inflammation or at least reduce pain and inflammation. These treatments include; non-steroidal anti-inflammatory drugs (NSAIDS), steroids, immunosuppressive drugs, and newer agents called biologic drugs.

Keeping warm: Dressing warmly, avoiding contact with cold water, take a warm shower, use hand gloves, warm bedding, and eat warm foods and beverages to reduce some of the effects seen when there is a drop in ambient temperature.

Exercise regularly: Exercise is crucial for patients living witharthritis. It is known to ease pain, increase strength and flexibility, and boost energy. The tendency during cold weather is for many people to shy off exercises. Patients should however prioritise exercise as this can ease the pain experience.

Dr Otieno is the assistant professor and consultant physician and rheumatologist at Aga Khan University Hospital, Nairobi.

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Arthritis and the Cold Season - Business Daily

Scientists believe that about 17% of people worldwide dont get enough zinc. This mineral is, however, very important, in particular, with the help of the body formed more than 300 different enzymes.

Who said that a lot of people, about 17% of the population experience zinc deficiency. Among the reasons for this called reducing consumption of animal food, the spread of diarrhoeal disorders and disorders of the intestine, chronic stress.

Zinc performs a very important function when its lack can even cause the fertility this mineral is essential for ovulation, the production of viable sperm, as well as to child bearing and lactation. But this is not all of its functions. Mineral helps preserve collagen in the skin and connective tissues, regulates the production of androgens, which in many cases are the cause of acne and other skin problems, it is involved in the synthesis of leukocytes, thyroid hormones, helps the body regulate the stress response.

Symptoms of zinc deficiency can be diverse, among them we can name:

In the body, zinc is not stored, so it must be regularly supplied in the diet. The daily menu should include seafood, poultry, beef, cocoa, egg yolk, whole seeds of flax, pumpkin and sesame seeds, wheat germ, lentils, almonds, peas, dairy products.

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Skin problems, arthritis, reduced libido Why the body needs zinc and how to get it - The Saxon

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The Rheumatoid Arthritis Treatment market was valued at XX Million US$ in 2019 and is projected to reach XX Million US$ by 2024, at a CAGR of XX% during the forecast period. In this study, 2019 has been considered as the base year and 2020 to 2024 as the forecast period to estimate the market size for Rheumatoid Arthritis Treatment.

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The scope of the report is limited to the application of the type, and distribution channel. The regions considered in the scope of the report include North America Country (United States, Canada), South America, Asia Country (China, Japan, India, Korea), Europe Country (Germany, UK, France, Italy), Other Country (Middle East, Africa, GCC). This report presents the worldwide Rheumatoid Arthritis Treatment market size (value, production and consumption), splits the breakdown (data status 20152019 and forecast to 2024), by manufacturers, region, type and application.

Market segment by Type, the product can be split into:Product Type Segmentation: Epicel, IntegraIndustry Segmentation: Chemical, Cosmetic, Pharmaceutical

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* Production Analysis Production is analyzed with respect to different regions, types, and applications. Here, the price analysis of various Market key players is also covered.* Sales and Revenue Analysis Both, sales and revenue are studied for the different regions of the global market. Another major aspect, price, which plays an important part in the revenue generation is also assessed in this section for the various regions.* Supply and Consumption In continuation of sales, this section studies the supply and consumption of the Market. This part also sheds light on the gap between supply and consumption. Import and export figures are also given in this part.* Other analyses Apart from the information, trade and distribution analysis for the Market, contact information of major manufacturers, suppliers and key consumers are also given. Also, SWOT analysis for new projects and feasibility analysis for new investment are included.

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Rheumatoid Arthritis Treatment Market Prognosticated For A Ravishing Growth By 2026 - Daily Research Chronicles

The global Reactive Arthritis Treatment market gives detailed analysis about all the important aspects related to the market. The study on global Reactive Arthritis Treatment market, offers deep insights about the Reactive Arthritis Treatment market covering all the crucial aspects of the market. Moreover, the report provides historical information with future forecast over the forecast period. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry. Some of the important aspects analysed in the report includes market share, production, key regions, revenue rate as well as key players.

The study of various segments of the global market are also covered in the research report. In addition to that, for the forecast periods determination of factors like market size and the competitive landscape of the market is analysed in the report. Due to the increasing globalization and digitization, there are new trends coming to the market every day. The research report provides the in-depth analysis of all these trends.

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Key Players

Some of the players in reactive arthritis treatment market includes F. Hoffmann-La Roche Ltd, Teva Pharmaceutical Industries Ltd., Pfizer, Inc., Novartis AG, Amgen Inc., Velcura Therapeutics, Inc., Bayer AG, Geri-Care Pharmaceuticals, Merck Sharp & Dohme Corp, UCB S.A., Johnson & Johnson Services, Inc, Bristol-Myers Squibb Company, and AbbVie Inc., among others.

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The regional analysis includes:

North America (U.S., Canada)

Latin America (Mexico. Brazil)

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Reactive Arthritis Treatment Market to Expand at a Healthy CAGR of XX% Between and 2017 2027 Bulletin Line - Bulletin Line

Ultrasound abnormalities are widespread in patients with rheumatoid arthritis (RA) who are in clinical remission, with no significant association with clinical parameters in remission, according to study results published in Therapeutic Advances in Musculoskeletal Disease.

The study cohort included patients with an established diagnosis of RA who were enrolled in the Biomarkers of Remission in Rheumatoid Arthritis study, which evaluated disease-modifying antirheumatic drug (DMARD) cessation. Patients included this analysis were in clinical remission (Disease Activity Score 28 C-reactive protein [DAS28-CRP], <2.4) and receiving synthetic DMARDs at time of study entry. Patients from the Newcastle Early Arthritis Clinic who were DMARD-naive and undergoing clinical and ultrasonographic evaluation at first presentation with early active RA (DAS28-CRP >2.4) were included in the positive control group and those with seronegative noninflammatory arthralgia (NIA) were included in the negative control group.

Investigators examined the association between clinical parameters and total ultrasound scores with individual dependent variables, which included synovial power Doppler and greyscale, tenosynovial greyscale, and erosions.

Of 294 patients included in the study, 66 with RA were in clinical remission, 146 with early active RA were in the positive control group, and 82 were in the NIA negative control group. Synovial greyscale was common in patients in RA remission and occurred both in patients who did and did not meet the clinical remission criteria irrespective of whether it was the DAS28-CRP <2.4 (n=66) or the American College of Rheumatology/European League Against Rheumatism Boolean criteria (n=40). Other ultrasound abnormalities that occurred frequently included tenosynovial greyscale, erosions, and synovial power Doppler.

There was a significant association between swollen joint count and higher total synovial greyscale score (odds ratio [OR], 1.17; 95% CI, 1.08-1.26; P <.001) in the active RA group. In addition, the investigators observed a significant association between swollen joint count and higher total synovial power Doppler score (OR, 1.20; 95% CI, 1.12-1.30; P <.001). In the NIA group, there were no significant associations between swollen joint count and total synovial greyscale score or synovial power Doppler score. In the RA remission group, there were 6 significant variable-score associations (P <.05) in an adjusted model, but these associations were not significant in the adjusted analysis. In addition, there were no significant associations between the total synovial power Doppler score and clinical parameters in this group.

Study limitations included the reliance on a 7-point scan protocol, the small sample size, and the inclusion of only patients with established disease in the remission group.

Researchers concluded that ultrasound and clinical examination findings do not overlap in RA remission, challenging the proposition of ultrasound-driven management strategies in this setting.

Reference

Baker KF, Thompson B, Lendrem DW, Scadeng A, Pratt AG, Isaacs JD. Lack of association between clinical and ultrasound measures of disease activity in rheumatoid arthritis remission [published online May 11, 2020]. Ther Adv Musculoskelet Dis. doi:10.1177/1759720X20915322

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No Association Between Clinical and Ultrasound Measures of Disease Activity in RA Remission - Rheumatology Advisor

Dual-energy computed tomography (DECT) appears to have limited utility for differentiating between gout and calcium pyrophosphate deposition disease (CPPD), according to a German prospective cohort study. Findings were reported at the annual European Congress of Rheumatology, held online this year because of COVID-19.

Dr Valentin S. Schfer

"Differentiation of gout and pseudogout, or CPPD, is sometimes difficult," said presenting investigator Valentin S. Schfer, MD, associate professor of internal medicine and head of the department of rheumatology and clinical immunology at University Hospital Bonn (Germany).

"Arthrocentesis and subsequent polarization microscopy remains the gold standard," he noted. "Novel diagnostic approaches, such as DECT, have recently been validated for gout, but limited data [are] available on the use of DECT in patients with CPPD."

The investigators studied 30 patients: 22 with suspected gout and 8 with suspected CPPD. All underwent arthrocentesis with subsequent polarization microscopy for definitive diagnosis, plus clinical examination, ultrasound examination, conventional radiography, DECT, and assessment of 12 laboratory parameters.

For diagnosis of gout, DECT had a sensitivity and specificity of 59.1% and 100%, respectively, Dr. Schfer reported, noting that this sensitivity falls considerably short of the 90% previously reported for gout (Figure 1).

Figure 1: Gout tophus formation (curved arrow) shown on 80-kV DECT with color-coded overlay showing monosodium urate crystals in green and calcium in blue, as well as articular and juxta-articular osseous erosions (straight arrow).

Corresponding sensitivity and specificity were 90.9% and 75% for ultrasound, 58.8% and 100% for conventional radiography, and 81.8% and 87.5% for the rheumatologists' suspected clinical diagnosis.

For diagnosis of CPPD, DECT had sensitivity of 37.5% and specificity of 81.8%. Corresponding values were 87.5% and 91% for ultrasound, 0% and 94.1% for conventional radiography, and 75.0% and 100% for suspected clinical diagnosis (Figure 2).

None of the 12 laboratory parameters studied uric acid, C-reactive protein, organic phosphate, and leukocytes, among others significantly differentiated between conditions.

Figure 2: DECT image with color-coded overlay shows typical findings of CPPD along the medial and lateral menisci (arrow) and calcium in tissues where it's not usually found (e.g., hyaline cartilage).

"Both ultrasound and suspected clinical diagnosis had higher sensitivities than DECT for gout and CPPD," Dr. Schfer concluded. "Further studies with larger patient cohorts and perhaps modified scan protocols are needed in order to determine the diagnostic utility of DECT in CPPD."

"Noninvasive, accurate methods for distinguishing between gout and CPPD will improve clinical care," Sara K. Tedeschi, MD, MPH, predicted in an interview.

"Arthrocentesis is painful in an acutely inflamed joint, can be difficult to perform on small joints, and is underutilized in clinical practice," she elaborated. And ultrasound is operator dependent and does not quantify crystal volume in and around the joint.

The question addressed by the study is therefore clinically relevant, according to Dr. Tedeschi, a rheumatologist at Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School, Boston.

However, among the patients with CPPD, the study did not report specific phenotypes (acute inflammatory arthritis, chronic inflammatory arthritis, and osteoarthritis with calcium pyrophosphate deposits), she noted. "It is difficult to draw conclusions about the sensitivity or specificity of DECT for CPPD without this information, especially among just 8 CPPD patients."

In addition, among the patients with gout, the proportion having new-onset disease with flare duration less than 6 weeks and the proportion with tophi were unknown, both of which affected DECT sensitivity in the previous study that reported 90% sensitivity. "Based on the 95% confidence interval in the present study, it is possible that with a larger sample size, DECT sensitivity for gout would have been higher," she pointed out. "We also do not know the DECT software settings, which impact DECT interpretation as positive or negative for the crystal of interest."

Finally, "it would be relevant to know what joints were aspirated and imaged in each group," Dr. Tedeschi said. "For example, if the first metatarsophalangeal (MTP) joint was aspirated and imaged for half of the gout patients but for none of the CPPD patients, that may affect the study interpretation."

The study did not receive any specific funding. Dr. Schfer disclosed a variety of financial relationships with multiple pharmaceutical companies. Dr. Tedeschi disclosed receiving grant support from the National Institutes of Health to study imaging modalities for CPPD, and being first author on a study comparing the sensitivity of DECT, ultrasound, and x-ray for acute CPP crystal arthritis.

Ann Rheum Dis. 2020;79:196. Abstract

This article originally appeared on MDedge.

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DECT Has Mixed Performance in Differentiating Gout vs CPPD - Medscape

In the early part of the 2014 season, Jason Day missed six weeks with a thumb injury, which he aggravated at that years Masters tournament.

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Arnold Palmer is famous for, among other things, his iconic thumbs up to adoring galleries. (Sorry, Phil.) I was lucky enough to call Arnold a good friend; in 2006, we launched the Arnold Palmer Sports Health Center. He had an abiding interest in keeping people healthy and participating in the game he loved.

The thumb is remarkable, and we ask much of it. Gripping a golf club throughout the swing means positioning the thumb at multiple points in space, and that demands great flexibility. This flexibility is provided by two hinge joints and the very agile basilar joint where the thumb plugs into your wrist plus great strength and stability.

This balancing act can create a problem that manifests as friction at the basilar jointaka arthritis. Almost all golfers will eventually get a little degenerative wear and tear arthritis at the thumb joint. Ive operated on several PGA Tour Champions players, but most of us will have milder cases treatable by conservative measures.

Symptoms: Pain and modest swelling at the thumbs base is common; more advanced cases may lead to a decrease in motion. Your hand may feel weakened as discomfort can lead to protecting the thumb from tasks (e.g., opening jars) in which grip power is necessary and potentially painful.

Self-Care: There is a wide range of nonsurgical managementsice, heat, splints and judicious use of over-the-counter anti-inflammatories. Any splint used should include the thumb to help support the basilar joint.

Doctor Visit: A diagnosis will likely entail the doctor loading the thumbs basilar joint and briefly grinding it you may feel the discomfort and mechanical symptoms that accompany joint irregularity. An X-ray can help establish matters definitively. As for treatment beyond splinting and activity modification, a steroid shot can bring temporary relief. As a last resort, a reliable surgery can be performed that allows you to participate in most activities without restriction including golf. Thumbs up to that!

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Heres how to deal with one of the most dreaded injuries in golf - Golf.com

COVID-19 remains a mystery in many ways, but as it continues to rampage through the worlds population, some things are becoming more clear. One of them is that cytokine storms a deranged immune response to the virus, in which the body literally attacks its own cells instead of the invading coronavirus appear to be one reason some patients end up extremely ill.

A drug developed in St. Louis aims to combat those cytokine storms. Called ATI-450, it was originally developed by Confluence Discovery Technologies in 2013 with the idea of helping people suffering from autoimmune diseases, particularly rheumatoid arthritis.

But as scientists began to understand the way COVID-19 affects the body, the company realized it could potentially help with the new coronavirus as well.

Were actually in a Phase 2 rheumatoid arthritis study, explained Joe Monahan, Confluence Discovery Technologies executive vice president of research and development, on St. Louis on the Air. That started earlier in the year. But when we saw what was happening with COVID back in January or February, and we started to think about the possibility of both COVID being driven by the cytokine storm in the lung, and [rheumatoid arthritis] being driven by a similar storm of cytokines regulated in the joint, we thought maybe we could do some quick studies in the laboratory to validate that ATI-450 may have an impact on these cytokines in the lung, and in particular things driven by the SARS CoV-2.

Added Monahan, It was the right place at the right time.

And so even as most businesses around St. Louis closed their offices and moved to remote work this spring, Confluence doubled down. With staggered shifts and seven-day workweeks, researchers in its headquarters at Cortexs BioSTL building were able to show strong enough results in the lab to receive FDA approval to begin human trials.

Those are to begin in two weeks at the University of Kansas Medical Center, Monahan said. Thirty-six patients will be given the drug in a double-blind, placebo-controlled study.

The company hopes to show that, by blocking the pathways used to make cytokines, ATI-450 stops the cytokine storms that can be so damaging. Explained Monahan, In so doing, we believe that we would reduce the [acute respiratory distress syndrome] observed in these patients, and reduce the need for mechanical ventilation, decrease the hospital stay, and reduce the mortality.

Listen:

Normally, good results in such a study would mean another three to six years before bringing a drug to market. But Monahan has hopes for a speedier process for ATI-450 when it comes to COVID-19.

If this works really well [against] the disease, and we expand it to more people and it continues to work, I think theres an ability to really shorten those timelines, he said.

Confluence was acquired by Pennsylvania-based Aclaris Therapeutics in 2017, but its researchers remain based in St. Louis. Monahan helped to co-found the company as part of BioSTL after spending 28 years at Pfizer and its legacy companies. The pharmaceutical giant was moving a unit to the Boston area, and rather than relocate, Monahan and some colleagues decided to stay in St. Louis and go out on their own.

We had maybe some different ideas on how to do drug discoveries that we had not been able to do at Pfizer, he said.

St. Louis on the Air brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill, and Lara Hamdan. The audio engineer is Aaron Doerr.

Send questions and comments about this story to feedback@stlpublicradio.org.

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COVID-19 Treatment Developed In St. Louis To Begin Human Trials - St. Louis Public Radio