StemCell Therapy

December 13, 2019, 6:46 PM

3 min read

Eerie X-rays portray a rare condition nicknamed "telescoping fingers," in which bone loss causes the fingers to buckle back into the hand, like a collapsing telescope.

A female patient, age 69, was diagnosed with rheumatoid arthritis 18 years prior and presented at a rheumatology clinic in Turkey with the condition, according to a case study published in the New England Journal of Medicine this week.

Her fingers could be stretched to their original length, but then retreated back into her hand when released. She could not completely flex her fingers, nor make a fist.

X-rays revealed that her bones had been reabsorbed as a late-state consequence of her severe arthritis.

A 69-year-old woman in Turkey developed a rare condition known as "telescoping fingers."

Doctors treated her with a series of arthritis drugs, which reduced her pain and swelling but did not improve her hand functionality.

While an estimated 23% of Americans have some form of doctor-diagnosed arthritis, according to the Centers for Disease Control and Prevention, developing telescoping fingers is extremely rare, even among people with arthritis.

The first case of the telescoping condition, described in the Journal of Bone and Joint Surgery, was documented in 1913, and referred to it as "la main en lorgnette," or opera-glass hand.

Read more:
Rare 'telescoping fingers' condition caused woman's bones to reabsorb - ABC News

A recently published report presented at the 2019 AIBD Annual Meeting in Orlando, FL, discussed the case of a patient who developed ulcerative colitis (UC) following treatment with Secukinumab for her psoriatic arthritis and highlighted a novel approach for the management of both of her conditions simultaneously.

The patient, a 52-year-old female with a long history ofpsoriatic arthritis, presented complaining of bloody diarrhea over the pastmonth. Stool studies and biopsies as well as a CT Scan of Abdomen and Pelvis wereperformed and revealed normal results. A colonoscopy, however, revealed thatthe patient had ulcerative colitis (UC) extending from the hepatic flexure torectum. Biopsies showed crypt abscesses consistent with inflammatory boweldisease (IBD) alone with a positive serum p-ANCA, the authors explained. Thepatient stated that she had no history of UC or IBD but did note that herpsoriatic arthritis had been unsuccessfully treated with Etanercept,Leflunomide, Adalimumab, and Methotrexate in the past.

The patients Secukinumab was discontinued and she wasinitiated on prednisone 40mg daily and mesalamine 4.8g daily. The patientimproved and was, therefore, discharged. To allow for a prednisone taper, shewas later initiated on Tofacitinib 10mg twice daily for treatment of bothpsoriatic arthritis and UC. In addition to complete resolution of her bloodydiarrhea, objective improvement of the patients psoriatic arthritis was alsoobserved.

In their discussion, the authors stated that, although therehave been case reports of Secukinumab-induced UC published in the past,treatment typically involves infliximab, a monoclonal TNF-alpha antibody, ifsteroids initially fail. For this patient, however, optimizing immunologic therapywas difficult since she was resistant to multiple forms of THF-alpha inhibitionwith Adalimumab and Etanercept. Because of this, a novel approach of initial steroidtherapy followed by treatment with Tofacitinib provided excellent resolution ofthe patients symptoms and conditions.

Nonetheless, psoriatic arthritis cases on Secukinumab who develop ulcerative colitis and have failed prior TNF-alpha antibody treatment merit this novel approach to therapy with Tofacitinib, the authors concluded. They added, We might consider Tofacitinib even in cases who have not failed prior TNF-alpha antibody treatment given greater acceptance by patients of oral medical therapy.

Reference

Sethi V, Jacobs A, Sethi A. Secukinumab induced ulcerative colitis in a patient with psoriatic arthritis: A novel approach to refractory cases. Presented at: 2019 AIBD Annual Meeting; December 12-14 in Orlando, FL.

See the rest here:
Case Highlights Novel Approach to Treatment of UC, Psoriatic Arthritis - Monthly Prescribing Reference

It may have been a rainy day, but the dreary weather did little to dampen Sharon Stolbergs enthusiasm when speaking about SPARC (Sport, Art, and Recreation of Chattanooga) to the Civitan Club.

The teacher at Hunter Middle School, who has suffered from a severe form of arthritis for her entire life, has devoted herself to helping children with disabilities. She does so by encouraging disabled students to participate in adaptive sports.

Adaptive sports, such as wheelchair basketball, use unique equipment to make those activities accessible to people with disabilities. Possessing the ability to play these sports has several benefits to children and adults, said the middle school teacher.

Adaptive sports really increase confidence, said Ms. Stolberg on the benefits of adaptive sports, Theyre a good bridge builder between the disabled and the non-disabled population, and they help with strength and weight control.

Ms. Stolberg has been a proponent of adaptive sports for almost 15 years. Although they did not exist when she was a child, nothing stopped her from enjoying them as an adult.

I started horseback riding in 2005 in Cleveland, and then I got into adaptive water skiing, and it sort of avalanched after that, said the speaker on how she got into adaptive sports.

Ever since she started with SPARC, which is focused on adaptive sports, she has seen it grow from small beginnings into a widely accepted organization. And with growth, it has made her job much easier.

I think the demand has grown, and the acceptance has grown, said Ms. Stolberg, The willingness of people to work and modify has grown too. Going from having to scrounge for volunteers, and now we have many more volunteers than we would have a few years ago. Its just more public now, and more of an accepted thing, which is huge.

While adaptive sports are a blessing for many children, they can be a pricey endeavor for families. Organizations such as the Civitan Club often provide the funds necessary to make the crucial equipment needed for adaptive sports.

With the kids in the area, the Civitan Clubs are really essential to get things like adaptive bikes for them, said Ms. Stolberg.

Read more:
Teacher With Severe Arthritis Urges Others With Disabilities To Stay Active - The Chattanoogan

Halloween has passed, but the scariest time of the year has just begun: cold and flu season. Winter can be unsettling when you have juvenile arthritis. Some medications used to treat JA can weaken the immune system, making it easier to catch any viruses going around. Getting sick can be hard on kids with JA; they might feel extra soreness, and it may take them longer to feel better than their peers. They may even need to put JA treatments on hold until they recover.

Its natural to feel anxious at this time of year. Its especially worrying because kids often spend hours together in tight quarters such as day care, locker rooms, and classrooms. But there are many precautions you can take to help prevent the spread of disease.

Youngsters with JA should get a flu vaccine, especially if theyre using immunosuppressants. The best line of defense is to have everyone in your house get a flu shot, to reduce the risk of someone getting sick and spreading germs.

Keep communal spaces in the house clean and wash shared blankets frequently. Remind your children to wash their hands after gym classes and sports practices. Older kids and teens should keep sanitizer sprays on hand for use on personal sports equipment.

Even when youre taking all the precautions possible, it can be hard to avoid worrying. The last thing you want is for your child to get sick. It can be tempting to want to put them in a bubble.

But try to have faith in the flu shot; its an excellent first line of defense. And other options, such as antiviral medication, can make the flu easier to cope with. While its not a cure, it can reduce flu symptoms by one day, which is nothing to sneeze at. If your child is showing signs of an infection, such as a fever, its important to call the doctor right away. The doctor may recommend using one of these medications as a precaution.

Have faith in your children to do their part to stay clean. Encourage them to wash their hands before eating and to keep their hands to themselves. Older kids and teens often understand that these precautions are necessary. Even little ones can come around to the idea when you incorporate it into a routine.

I think its important to note that though its easy to get sick, it might not happen. Its entirely possible to stay healthy. While some years I felt as if Id caught every cold going around, some flu seasons passed without a hitch. Youll never know how the season will go, so try to be as positive as possible. With the right precautions, your family might do just fine this cold and flu season.

***

Note: Juvenile Arthritis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Juvenile Arthritis News, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to juvenile arthritis.

Elizabeth Medeiros is a young adult who has dealt with juvenile arthritis since she was a small child. However, her pain hasnt stopped her from working on a product design degree in Boston. Her passion is to create products that make life easier for the chronically ill, such as shoes and walking canes. When shes not in class, Elizabeth enjoys writing about how shes coped with arthritis at such a young age. You can find more of her writings at ArthritisGirl.Blogspot.com and on Instagram @GirlWithArthritis.

See the article here:
Flu Season Is the Scariest Time of the Year When You Have JA - Juvenile Arthritis News

'Were expanding the [biosimilars] initiative to make sure that our drug programs in Alberta are going to be sustainable,' Alberta Health Minister Tyler Shandro, seen here, said in an exclusive interview.

Jason Franson/The Canadian Press

Alberta will force 26,000 patients on government-sponsored drug plans to switch from expensive drugs that are known as biologics to cheaper near-copies of the medications, a move that will save the province hundreds of millions of dollars in the coming years.

The major policy change in favour of the less-expensive versions, called biosimilars, will take effect by next summer and is expected to save $227-million to $380-million over the next four years. Alberta will become the second province after British Columbia to stop covering some of the brand-name biologic drugs that have driven significant increases in prescription-drug spending across the country.

But the provincial government intends to go even further than B.C., including more drugs in the first phase of its plan and introducing a tiered framework that will limit drug choices for patients with rheumatoid arthritis and Crohns disease who are starting biologics for the first time.

Story continues below advertisement

Were expanding the [biosimilars] initiative to make sure that our drug programs in Alberta are going to be sustainable," Alberta Health Minister Tyler Shandro said in an exclusive interview. We committed in the last election that we would find efficiencies and make sure that we were investing those savings.

The government is working to rein in Albertas health-care spending more broadly, an effort that has already drawn the ire of health-care workers unions and the Alberta Medical Association.

The provinces initiative is likely to earn plaudits from those who see promoting the less-expensive medications as a sensible way to free up money for other health-care priorities.

However, some gastroenterologists and patient advocacy groups, including Crohns and Colitis Canada, have expressed concern that inflammatory bowel disease patients forced to switch wont do as well on the cheaper drugs.

Health Canada and drug regulators around the world say biosimilars are as safe and effective as the original drugs they mimic.

Biologics are complex medications produced from living organisms and injected or infused into patients. They have dramatically improved the health of people with debilitating diseases such as rheumatoid arthritis and Crohns disease chronic illnesses for which there used to be few good treatment options.

In Alberta, government spending on biologics skyrocketed to $238-million in 2018-19, up from just $21-million a decade earlier.

Story continues below advertisement

Four of the top five drugs in terms of public spending in Alberta are biologics. At the top of that list is Remicade, also known as infliximab, an intravenous infusion for rheumatoid arthritis, Crohns disease and ulcerative colitis, which cost the provincial government as much as $91.2-million last year more than any other single drug.

The list price for Remicade in Alberta is $962.68 a vial, while the biosimilar versions, Inflectra and Renflexis, sell for $525 and $493 a vial, respectively. (List prices dont reflect the confidential discount deals that are now commonplace in the global pharmaceutical industry, meaning the Alberta government could be paying less.)

Biosimilars are almost like generics: They are cheaper near-copies of original biologic drugs whose patents have expired. However, biologics, unlike simple chemical pills, cant be replicated perfectly from batch to batch, even within the same brand.

That complexity has allowed some opponents to argue that biosimilars arent as safe or effective as original biologics, especially for patients who are being asked to switch for financial instead of health reasons.

But the bulk of the international evidence mainly from Europe, where more than 40 approved biosimilars are available has shown no significant differences in safety or efficacy after switching.

Albertas plan will require existing patients on government-sponsored drug plans to switch to the biosimilar versions of Remicade and four other drugs: Enbrel, which treats rheumatoid arthritis; Lantus, a long-acting insulin for diabetics; and Neulasta and Neupogen, both of which boost white-cell counts for chemotherapy patients.

Story continues below advertisement

Existing users of a drug called Copaxone for multiple sclerosis will be switched to a complex generic at the same time. The government is including the drug in its initiative even though it is not technically a biologic.

The changes are expected to affect about 22,000 Albertans with diabetes, 2,000 with Crohns disease or ulcerative colitis, 1,400 with rheumatic diseases, 750 with multiple sclerosis, 450 with low white-blood cell counts and 35 with plaque psoriasis.

The changes, which kick in July 1, 2020, do not apply to patients with private insurance or patients who pay out of pocket for their prescription drugs.

Children and pregnant women will be exempt. Physicians who believe there is a medical reason why a patient should not switch will be allowed to apply to the province for an exemption.

For patients with Crohns disease, rheumatoid arthritis and related rheumatic diseases who are either starting biologics for the first time or switching away from a biologic that has stopped working, a new tiered framework means they will have to try cheaper biologic options first.

For example, Crohns patients new to biologics will first have to try one of the two Remicade biosimilars or another IV drug called Entyvio before they are allowed to access public coverage of Humira, an expensive treatment that patients can self-inject but for which biosimilar alternatives are not yet available in Canada.

Story continues below advertisement

Current Humira patients will be allowed to retain government coverage for the drug.

Read more:
Alberta will force patients to switch from biologics to cheaper biosimilar medications - The Globe and Mail

Post Views: 364

The endocrine system is a collection of glands all over the body that is responsible for the secretion of hormones into the bloodstream. An endocrine disorder happens when this system is no longer able to function properly.

The endocrine system is composed of a set of glands responsible for the production of hormones that play a vital role in the regulation of body signals. These include appetite, sleep, weight, breathing, and even puberty. Almost every aspect of the body has something to do with hormones.

Diseases such as diabetes, Graves Disease, and Cushings Syndrome are all endocrine disorders. Each of them is a unique disease treated in different ways, but CBD and endocrine diseases have become tangled one as a remedy for the other in the recent past.

How endocrine system disorders occur

Endocrine disorders occur when one or more endocrine glands no longer functions properly. If even one gland starts to produce too much or too little of a particular hormone, chances of an endocrine disorder occurring go up. Such a disorder can either be generic, or due to tumors, nodules or lesions inhibit an endocrine glands normal functioning.

In diabetes, for example, the pancreas does not produce enough insulin; and in hypothyroidism, the thyroid gland doesnt produce enough thyroid hormone. Hyperthyroidism is the opposite of this.

All in all, most endocrine disorders dont have a specific cure and can last with the patient for years or even their whole lives. If left untreated, they can result in the poor quality of life, general body pain, loss of weight, total inability to move, work or function and death.

However, there exist medications and therapies that can be used to manage the symptoms they exhibit. One of the ways these symptoms can be suppressed and managed is through the use of CBD.

CBD and the endocrine system

According to recent studies, CBD has the potential to regulate the endocrine system and manage harmful symptoms exhibited by some endocrine disorders. One case that stands out, in particular, is when the disorder is caused by the presence of a tumor on endocrine glands. CBD and endocrine diseases caused by cancer cells can be inhibited and, possibly have an invasion of prostate tumors prohibited.

There is also some evidence available that suggests CBD has some degree of influence over the production of hormones in some glands in the body, including the thyroid gland. Keep in mind that research into the effect of CBD on the endocrine system is in very preliminary stages, however.

What we are sure of, though, is the effect CBD has when it comes to keeping the symptoms of certain endocrine disorders under control. The most common of these are insomnia and anxiety.

Of all the uses CBD has found in the modern age, the most well-documented is its ability to reduce feelings of anxiety. This is thought to be as a result of its ability to bind directly with CB1 receptors in the brain and affect the production of cortisol and serotonin.

Serotonin is a mood-regulating hormone, whose deficiency is usually manifested via feelings of anxiety and depression. A high level of cortisol also leads to feelings of stress and impending doom, as exhibited by people with anxiety.

Another well-known property of CBD is getting rid of insomnia. Sleep is yet another part of human life thought to be controlled, at least in part, by the endocannabinoid system. This is done via the circadian rhythm, which keeps wakefulness and sleepiness in check. In people with anxiety, this rhythm can be thrown off, making them unable to fall asleep.

On the other hand, another common symptom of endocrine disorders is unsatisfying sleep. REM sleep is the part of sleeping where, if experienced properly, a person feels well-rested. In people with certain endocrine disorders and anxiety, REM sleep may be lacking. A CBD dropper or CBD tincture right before bed is a good way to

More:
Benefits of CBD and Arthritis in the Human Body - MMJ Reporter

Ru-Yin Hu,13,* Xiao-Bin Tian,3,* Bo Li,3 Rui Luo,3 Bin Zhang,3 Jin-Min Zhao1

1Department of Orthopaedics, Guangxi Medical University, Nanning 530021, Peoples Republic of China; 2Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Peoples Republic of China; 3Department of Orthopaedics, Guizhou Provincial Peoples Hospital, Guiyang 550002, Peoples Republic of China

*These authors contributed equally to this work

Correspondence: Jin-Min ZhaoDepartment of Orthopaedics, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, Guangxi 530021, Peoples Republic of ChinaTel +86 771 13985048001Email zhao948586007@126.com

Background: Existing drugs are far from enough for investigators and patients to administrate the therapy of rheumatoid arthritis. Drug repositioning has drawn broad attention by reusing marketed drugs and clinical candidates for new uses.Purpose: This study attempted to predict candidate drugs for rheumatoid arthritis treatment by mining the similarities of pathway aberrance induced by disease and various drugs, on a personalized or customized basis.Methods: We firstly measured the individualized pathway aberrance induced by rheumatoid arthritis based on the microarray data and various drugs from CMap database, respectively. Then, the similarities of pathway aberrances between RA and various drugs were calculated using a KolmogorovSmirnov weighted enrichment score algorithm.Results: Using this method, we identified 4 crucial pathways involved in rheumatoid arthritis development and predicted 9 underlying candidate drugs for rheumatoid arthritis treatment. Some candidates with current indications to treat other diseases might be repurposed to treat rheumatoid arthritis and complement the drug group for rheumatoid arthritis.Conclusion: This study predicts candidate drugs for rheumatoid arthritis treatment through mining the similarities of pathway aberrance induced by disease and various drugs, on a personalized or customized basis. Our framework will provide novel insights in personalized drug discovery for rheumatoid arthritis and contribute to the future application of custom therapeutic decisions.

Keywords: rheumatoid arthritis, drug repositioning, individualized pathway aberrance, differential pathway

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

View original post here:
Individualized Drug Repositioning For Rheumatoid Arthritis Using Weigh | PGPM - Dove Medical Press

COLUMBUS (WCMH) Did you know the No. 1 cause of disability in the United States is arthritis?

More than 54 million Americans live with arthritis including 2.8 million people in Ohio.

On Saturday, at Genoa Park by COSI over 1,000 people came together to rally behind the arthritis foundation.

The annualJingle Bell Run for arthritis is bringing holiday cheer to downtown Columbus. Theirgoal was to raise $205,000 this year.

There is often a misconception that arthritis only affects older people, but thats far from the truth.

Five months ago I was diagnosed with rheumatoid arthritis, my life was miserable in the mornings, said 18-year-old, Colten Phay.

When I would wake up my whole body would be aching with pain, miserablewith pain and I couldnteven eat breakfast or put on clothes on, Colton said.

With the help of the research from the Arthritis Foundation, Colten went on a medication they helped discover and now his life is back to normal. It changed my life, expressed Colten. It helps so much. I feel fine now.

Christopher Haverlock with the Arthritis Foundation says that this is something that is a big deal.

It affects more people in the country than any other disease.

He also told us the Jingle Bell Run is more than just a way to raise money.

An event like this is great because they can be around other people who understand what theyre going through. They can celebrateliving and saying yes to doing more things, explained Haverlock.

Taking place in more than 100 cities nationwide, with Columbus being a Top Five Race, the Arthritis Foundations Jingle Bell Run benefits the more than 54 million Americans (1 in 4 adults), including 300,000 children (1 in every 250), living with arthritis every day.

From funding cutting-edge research for new treatments and ultimately a cure, to advocating for health care access, the Arthritis Foundation helps those living with arthritis score everyday victories, one step at a time.

To learn more visit JBR.org/Columbus or contact the Arthritis Foundation at 614-362-7370

Continued here:
More than 1,000 participate in annual Jingle Bell Run for arthritis - NBC4 WCMH-TV

Joint pain in winter can be reduced by keeping yourself covered with layers of warm clothes

Joint pain in winter: Arthritis is surely a difficult time for people suffering from arthritis. Not only does joint pain worsen during the cold winter months, patients also experience more joint stiffness and reduced range of motion. Proper health care, diet and lifestyle measures can together help arthritis patients deal with worsening symptoms this time of the year. The link between temperature drop and worsening of joint pain is still unclear and needs more research. However, a few tips and tricks can help improve quality of life and day-to-day functioning in arthritis patients in winter.

Dressing up appropriately by covering yourself top to bottomwith proper layers, can help you keep warm and reducedebilitating joint pain. Wear gloves and extra layers on your knees and legs to keep them warm and protected. Wearing multiple layers protect you from fluctuations in temperature.

Keep yourself warm and covered during the cold winter monthsPhoto Credit: iStock

Also read:Start Your Day With This Golden Drink To Prevent Bloating, Lose Weight And Reduce Joint Pain

Well, this is one important step in all seasons. Drinking sufficient water can prevent muscle cramps, keep your immunity in check and also prevent incidence of diseases. Drinking water time to time can help you be more active. Also, even mild dehydration can make you more sensitive to pain so make sure your water intake is optimum. Apart from drinking water, you can also include chicken soups, bone broth, vegetable soups, bone broth, etc in your diet to keep your hydration in check.

Being overweight or obese can make you feel lazier and less active. An effective way to deal with arthritis pain is by keeping yourself active and alsolosing weight if required. Make sure you exercise regularly. Include both cardio and weight training exercises in your routine. They will keep you warm and prevent worsening of arthritis symptoms. If going to the gym in cold weather seems too difficult a task, then exercise indoors. The idea is to not skip exercising for better management of arthritis.

Also read:Achieve Your Weight Loss Goals This Winter By Adding These Seasonal Fruits To Your Diet

There is nothing more comforting than a warm bath in winter. Warm baths can provide relief to arthritis patients, according to the Arthritis Foundation. Warm baths can relax your muscles and help you feel calm. Just don't step directly in cold after taking the bath. Your body needs some time to normalise temperature after a warm bath. Cover yourself properly before you come out of the bathroom. Similarly, you can also opt for warm compresses in to deal with worsened joint pain.

Warm baths in winter can help in reducing joint pain in arthritis patientsPhoto Credit: iStock

Low levels of Vitamin D in the body can make you more sensitive to pain, especially in winter. Vitamin D deficiency also puts you at risk of osteoporosis. It is recommended to spend some time under the sun. Anything from 15 minutes to half an hour can help your body synthesise some amount of the sunshine vitamin.Besides, include Vitamin D-rich foods like eggs, mushrooms, fatty fish, milk and milk products in your diet. You can also opt for supplements, but only under the supervision of your doctor.

Also read:Signs And Symptoms Of Vitamin D Deficiency; Best Sources Of Vitamin D Other Than Sunlight

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

More here:
Joint Pain In Winter: 5 Tips To Deal With Joint Pain And Other Arthritis Symptoms In Cold Winter Months - NDTV News

The prevalence of arthritis in children with Down syndrome may be 2 to 3 times greater than previously reported, according to study data presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

Investigators screened children (aged 0-21 years) with Down syndrome at a regional screening clinic, where a detailed musculoskeletal examination was performed by a pediatric rheumatology clinical fellow. Suspected cases of arthropathy of Down syndrome (A-DS) were confirmed by a second physician at an affiliated clinic. Children with arthropathy received treatment according to existing guidelines for juvenile idiopathic arthritis (JIA). Data from a convenience sample of 21 children newly diagnosed with JIA were collected and compared with the Down syndrome cohort.

Over 18 months, 503 children with Down syndrome were screened for arthritis, among whom 18 were newly diagnosed with A-DS. The total number of A-DS cases was 33, including children with a diagnosis prior to screening. Based on these results, prevalence of A-DS was indicated to be 20 in 1000. Significant delay in A-DS diagnosis was observed.

The majority of A-DS cases presented with polyarticular rheumatoid factor negative arthritis, with small joints of the hands and wrists predominantly affected. No children with A-DS were positive for antinuclear antibodies. Erosive changes were reported on radiographs in a significantly greater number of children with A-DS (42%) than with children with JIA (14%; P <.05). In the majority of A-DS cases, erythrocyte sedimentation rate and C-reactive protein levels were not helpful in arriving at a diagnosis.

These data support the addition of a musculoskeletal examination to the health surveillance guidelines for children with Down syndrome. Investigators also proposed a new clinical term to better capture A-DS: DS-associated arthritis. Further research in a larger cohort is necessary to describe the pathogenesis of DS-associated arthritis and to identify biomarkers.

Reference

Foley C, Deely D, MacDermott EJ, Killeen O. Arthropathy of Down syndrome: an under-diagnosed inflammatory joint disease that warrants a name change. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 1817.

Read more:
Prevalence of Arthropathy in Children With Down Syndrome Higher Than Previously Reported - Rheumatology Advisor

BACKGROUND:

Total hip arthroplasty (THA) is a frequently performed, highly successful orthopedic procedure. Although primary osteoarthritis (PA) is the most common reason for (THA), there are several secondary conditions that lead to degenerative hip disease that are successfully treated with THA. The purpose of this study was to examine the incidence of these secondary causes of arthritis (SA) leading to THA and to compare the relative surgical costs, operating times, and hospital length of stay (LOS) for THA done for PA versus SA.

Electronic medical records from 836 continuous patients undergoing primary THA over a 2-year period were reviewed at a single high-volume joint arthroplasty center. Data obtained included age, sex, laterality, diagnosis leading to THA, surgical costs based on hospital fees, operating room time, and hospital LOS. Using operative reports, office visit notes, and radiology reports or images, patients were categorized into PA or SA groupings. PA was defined as osteoarthritis of no other known etiology, whereas SA was defined when a known underlying diagnosis led to degenerative joint disease of the hip. SA included hip dysplasia, post-traumatic arthritis (PTA), avascular necrosis (AVN), inflammatory arthropathy, Perthes disease, and slipped capital femoral epiphysis (SCFE). Means and proportions of the variables from both groups were analyzed and compared using t-tests and chi-squared tests where applicable.

There were 599 patients in the PA group and 237 patients in the SA group. The SA group was significantly younger than the PA group (54.4 years versus 64.0 years; p = 0.0001). The SA cohort had significantly higher mean surgical costs ($29,662 versus $27,078; p = 0.0005), operating room times (189 minutes versus 179 minutes; p = 0.0042), and LOS (4.2 days versus 3.9 days; p = 0.0312). Within the SA group, the hip dysplasia subgrouping had the lowest cost and operating room time, whereas the PTA subgrouping had the highest cost and operating room time.

More than a quarter of primary THAs are performed due to secondary arthritis, most commonly due to hip dysplasia. Cases of THA due to secondary arthritis are associated with significantly increased hospital costs, operating time, and postoperative length of stay compared to THAs performed for primary osteoarthritis. Patients with post-traumatic hip arthritis may contribute the highest economic burden and present the most complex cases for arthroplasty surgeons.

Visit link:
Total Hip Arthroplasty for Secondary Causes of Arthritis An Increase in Time and Money - DocWire News

Despite a higher overall frequency of pneumonia and greater use of immunosuppressive therapies, the occurrence of serious pneumonias has decreased in Finnish children with juvenile idiopathic arthritis(JIA) over time, a study shows.

The researchers hypothesized that this may reflect better clinical care and early detection of lung infections in these children.

The work also suggested that active JIA, the presence of comorbidities, or simultaneous diseases, and receiving combination therapy may be associated with an increased risk of developing pneumonia. However, there was no link between the use of immunosuppressants and pneumonia severity.

The study, Decreasing trend in the incidence of serious pneumonias in Finnish children with juvenile idiopathic arthritis, was published in the journal Clinical Rheumatology.

The main treatment goals in JIA today include achieving inactive disease as early as possible in childrens lives and preventing joint damage caused by inflammation. The development of disease-modifying anti-rheumatic drugs (DMARDs) which are designed to block inflammation has significantly improved the lives of children with JIA.

Yet, the immune system suppression that occurs with standard JIA medications, such as DMARDs and glucocorticoids along with the disease itself and the presence of comorbidities have been associated with an increased risk of infections in these children.

A recent analysis of the 15-year period between 1999 and 2014 showed that pneumonia one of the most common serious infections in JIA patients has become more frequent in Finnish children with the disease. That increase has been mirrored by a significant jump in the use of DMARDs in this patient population during the same time period.

Now, that same team of researchers set out to determine the severity of pneumonia in these children, and whether it was associated with the use of immunosuppressive therapy.

The team analyzed data from 59,048 JIA patient-years a measure obtained by multiplying the number of persons per time between 1998 and 2014, using a national patient registry that covers the entire hospital network in Finland. The number of children with JIA per year in the registry varied between 2,292 and 3,575 from 1998 through 2006, and between 3,633 and 4,511 in the years 2007 to 2014.

Pneumonia was classified as serious if the child was hospitalized or given antibiotics directly into the bloodstream. It was deemed hospital-acquired if the illness developed 48 hours or later following hospital admission for reasons other than lung infection.

The results showed 157 pneumonia episodes of which 111 (70.7%) were serious in 140 children with JIA. Only one case was hospital-acquired.

The mean age of children with at least one pneumonia episode was 9.4 years; 83 (59.3%) of the children were girls. Most had either oligoarthritis (45%) or polyarthritis (45.7%).

The rate of serious pneumonia decreased from the first time period 1998 through 2006 to the second, from 20072014. The team hypothesized that this trend may be a result of better contact between patients and the health care system, which would promote earlier detection and treatment of lung infections.

It is also worth noting that a decrease in pneumonia rates has been reported after introduction of pneumococcal vaccination into the Finnish national vaccination program in 2010, the researchers said.

Data also showed that nearly half of the children with pneumonia had active disease, comorbidities with asthma (17.9%) and Down syndrome (7.1%) being the most common and were receiving combination therapy.

At the time of the pneumonia episodes, 86% of the children were receiving DMARDs, with 61.8% receiving methotrexate and 25.8% taking TNF inhibitors. This inhibitors block the activity of TNF-alpha, a pro-inflammatory molecule.

Among the children treated, 15 (10.7%) had recurrent pneumonias; 12 of them had comorbidities. Patients were taking DMARDs during 28 of the 32 (87.5%) recurrent pneumonia episodes.

The team noted that they found no significant association between pneumonia severity and the use of DMARDs or glucocorticoids.

The data showed that, overall, active JIA, comorbidities and combination medication were associated with nearly half of the pneumonias, the researchers said.

Still, future studies are required to confirm these findings and to evaluate the potential association between pneumonia and specific types of JIA, they added.

Clinicians should always keep in mind the possibility of serious infectious complications in these immunocompromised patients, the investigators said.

Less Severe Pneumonias Over Time in Finnish Children With JIA, Study Shows

Marta Figueiredo holds a BSc in Biology and a MSc in Evolutionary and Developmental Biology from the University of Lisbon, Portugal. She is currently finishing her PhD in Biomedical Sciences at the University of Lisbon, where she focused her research on the role of several signalling pathways in thymus and parathyroid glands embryonic development.

Total Posts: 11

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

Original post:
Severe Pneumonia in Finnish Children With JIA Has Decreased Over Time, Study Shows - Juvenile Arthritis News

A working group of rheumatologists and rheumatology professionals convened to update the American College of Rheumatology (ACR) recommendations for rheumatoid arthritis (RA) disease activity measures by identifying 11 measures that met the minimum standard and 5 that were preferred for regular use in clinical settings, according to a systematic literature review published in Arthritis Care & Research.1

Researchers examined articles published between January 2009 and January 2017 on the Ovid Medline, EMBASE, and Cochrane databases. Study details and psychometric properties were abstracted, and study quality was assessed by the Consensus-Based Standards for the Selection of Health Measurement Instruments 4-point scoring template. Psychometric properties for each RA disease activity measure were classified as strong, moderate, limited, conflicting, or unknown level of evidence. Researchers also considered prior literature performed as part of the 2012 ACR RA Disease Activity Recommendations.2 They scored feasibility of RA disease activity measures on a scale of 0 to 4, with scores 1 indicating measures feasible for regular use and scores of 4 indicating the most feasible measures.

During the selection process, researchers identified 2 recommendations on RA disease activity measures for use in clinical settings: measures that met a minimum standard for regular use and measures with the most favorable psychometric properties and feasibility for preferred use.

Of the 5199 articles identified, 110 met the study inclusion criteria. Data included in these studies indicated that patients were mostly women with a mean age 60 years.

The search resulted in 47 disease activity measures, based on patient-reported, provider assessment, laboratory, and imaging data. Clinical Disease Activity Index (CDAI), Disease Activity Score (DAS) 28, Multibiomarker Disease Activity (MBDA) score, Routine Assessment of Patient Index Data (RAPID) 3, and Simplified Disease Activity Index (SDAI) were the most frequently studied RA disease activity measures, with a strong level of evidence. Among 25 measures scored for feasibility of regular use, 11 (44%) received the highest grading score of 4, 6 measures (24%) received a score of 3, 5 (20%) received a score of 2, and 3 (12%) received a score of 1.

Researchers found that 11 measures, including CDAI, DAS, DAS28-erythrocyte sedimentation rate/C-reactive protein (ESR/CRP), Patient Derived DAS28, Hospital Universitario La Princesa Index, MBDA (MBDA score, VECTRA), Rheumatoid Arthritis Disease Activity Index (RADAI), RADAI-5, RAPID3, RAPID5, and SDAI, met the minimum criteria for RA disease activity measures for regular use. Among these, CDAI, DAS28-ESR/CRP, RAPID3, and SDAI were part of the prior ACR recommendations for RA disease activity measures.

According to results from the modified Delphi voting process, 4 measures, including CDAI, DAS28, RAPID3, and SDAI (mean scores, 8.8, 7.6, 7.6, 7.6 [range, 2.6-5.6], respectively), met the criteria for RA disease activity measures for preferred use. The ACR Quality Measures Subcommittee added another recommendation to these measures, based on its feasibility, current use, and strength of inclusion in previous ACR recommendations: Patient Activity Scale-II.

These recommendations can assist clinicians with adhering to a treat-to-target approach for the management of RA but should not be interpreted as dictating the proper measure to be used in individual circumstances or clinical practices. As additional measures are developed and performance of measures is further characterized, these recommendations should again be evaluated, the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

References

1. England BR, Tiong BK, Bergman MJ, et al. 2019 update of the American College of Rheumatology recommended rheumatoid arthritis disease activity measures [published online November 11, 2019]. Arthritis Care Res. doi:10.1002/acr.24042

2. Anderson JK, Zimmerman L, Caplan L, Michaud K. Measures of rheumatoid arthritis disease activity: Patient (PtGA) and Provider (PrGA) Global Assessment of Disease Activity, Disease Activity Score (DAS) and Disease Activity Score With 28Joint Counts (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Activity Score (PAS) and Patient Activity ScoreII (PASII), Routine Assessment of Patient Index Data (RAPID), Rheumatoid Arthritis Disease Activity Index (RADAI) and Rheumatoid Arthritis Disease Activity Index5 (RADAI5), Chronic Arthritis Systemic Index (CASI), PatientBased Disease Activity Score With ESR (PDAS1) and PatientBased Disease Activity Score Without ESR (PDAS2), and Mean Overall Index for Rheumatoid Arthritis (MOIRA) [published online November 7, 2019]. Arthritis Care Res. doi:10.1002/acr.20621

Read the original:
Updated 2019 ACR Recommendations for Rheumatoid Arthritis Disease Activity Measures - Rheumatology Advisor

A research team led by biomedical scientists at the University of California, Riverside, has found that a drug approved by the FDA to treat rheumatoid arthritis and ulcerative colitis can repair permeability defects in the guts epithelium.

Affecting roughly 1 million Americans, ulcerative colitis is a chronic inflammatory bowel disease of the large intestine in which the lining of the colon becomes inflamed and leaky. Affecting more than 2 million Americans, rheumatoid arthritis is an autoimmune disease in which the bodys immune system attacks the joints.

The study is the first to show the drug, tofacitinib, also called Xeljanz, has a direct effect on cells lining the gut by correcting defects that occur in inflammation. Until now, the effects of tofacitinib on intestinal epithelial cell functions were largely unknown.

Our work increases our understanding of how this drug is useful for treating ulcerative colitis, said Declan McCole, a professor of biomedical sciences in the UCR School of Medicine, and the lead author of the study that appears in the journal Inflammatory Bowel Diseases. We now better understand where in the gut the drug is working, and how.

McCole explained that increased intestinal permeability or leakiness is a feature of ulcerative colitis and plays a critical role in promoting inflammation. His team tested tofacitinib in human intestinal epithelial cell lines, as well as in organoids, or colonoids, that were derived from primary human colonic stem cells isolated from human subjects primarily patients undergoing elective colonoscopy for colon cancer screening and found tofacitinib repaired inflammation-induced permeability defects in both.

The epithelium is a thin layer that lines the alimentary canal. The gastrointestinal epithelium is comprised of cells that have gaps between them, making them selectively permeable and providing a barrier that keeps out pathogens, toxins, and antigens from entering the gut, while allowing the absorption of nutrients. In ulcerative colitis, this epithelial permeability becomes leaky, allowing bacterial products to cross into the gut and nutrients and water to leak out. This, in turn, triggers immune responses, resulting in fluid loss and diarrhea.

We found tofacitinib fixes the leakiness in the intestinal barrier, McCole said. Specifically, it fixes intestinal epithelial permeability defects caused by interferon-gamma, an inflammatory cytokine involved in autoimmune diseases such as ulcerative colitis and rheumatoid arthritis.

By targeting specific molecules, the drug inhibits a pathway that is activated by inflammation, said Anica Sayoc-Becerra, a graduate student in the Biomedical Sciences Graduate Program, a member of McColes lab, and the first author of the research paper. Our study shows tofacitinib is not just acting on immune cells, as was first thought, but can have a direct effect on the epithelial cells that are the key factor in maintaining gut barrier function.

A major focus of McColes lab is PTPN2, a protein-coding gene associated with autoimmune diseases such as Crohns disease, ulcerative colitis, and rheumatoid arthritis. Individuals with mutations in this gene that cause it to lose function have an increased risk of getting these diseases. McColes research group was the first to identify PTPN2 normally helps to protect the barrier function of the epithelial cells that line the gut.

A patient that has a PTPN2 loss-of-function mutation is predicted to have a leakier gut, McCole said. Rather than trying to repair PTPN2, my lab was successful in inhibiting some of the consequences of the loss-of-function mutation in this gene.

Sayoc-Becerra explained PTPN2 deactivates the same signaling pathway as tofacitinib.

We thought tofacitinib might be a very effective way of correcting the defects that occur from the loss-of-function mutations of PTPN2 without having to introduce new genes into a cell, animal, or patient, she said.

McCole and Sayoc-Becerra were joined in the study by UC Riversides Moorthy Krishnan, Jossue Jimenez, Rebecca Hernandez, Kyle Gibson, and Reyna Preciado; as well as Shujun Fan and Grant Butt of the University of Otago in New Zealand. Sayoc-Becerra expects to graduate with her doctoral degree in December 2019. This is her first paper as first author.

Next, the researchers plan to identify specific patients who may derive the greatest benefit from the drug. This will allow more targeted treatment of patients likely to be good responders to tofacitinib in a personalized medicine approach to treating this disease.

Reference:Sayoc-Becerra, et al. (2019) The JAK-Inhibitor Tofacitinib Rescues Human Intestinal Epithelial Cells and Colonoids from Cytokine-Induced Barrier Dysfunction.Inflammatory Bowel Diseases DOI: https://doi.org/10.1093/ibd/izz266

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

Read more:
Drug Decreases Gut Leakiness Linked to Ulcerative Colitis - Technology Networks

GRAND RAPIDS, Mich.--(BUSINESS WIRE)--Tetra Therapeutics, a clinical-stage biopharmaceutical company developing novel treatments for patients with cognitive impairment and memory loss, today announced a poster presentation at the 12th Clinical Trials on Alzheimers Disease Meeting (CTAD) being held in San Diego, from December 4 7.

The poster, titled Tumor Necrosis Factor (TNF) Blocking Agents Reduce Risk for Alzheimers Disease in Patients with Rheumatoid Arthritis and Psoriasis, highlights data from a retrospective population-based study of 56 million patients in which inflammatory disease in the body is shown to increase risk for Alzheimers disease and that risk can be reduced in these patients by treatment with a TNF blocking drug. The study was conducted in conjunction with Case Western Reserve University.

Our analysis demonstrates the value of a large, population-based database covering 20% of the entire US population. We find that inflammation in the body increases risk for Alzheimers disease across multiple diseases involving the joints, the gut and the skin, said Mark E. Gurney, Ph.D., Chairman and Chief Executive Officer of Tetra Therapeutics and co-author of the study. The study further indicates that the risk for Alzheimers disease can be reduced in patients with rheumatoid arthritis and psoriasis by treatment with TNF blocking agents such as etanercept, adalimumab, and infliximab. The results of our retrospective study need to be validated by well-controlled, prospective studies, but offer the hope that Alzheimers disease can be prevented in some patients in whom an inflammatory disease is a risk factor for developing Alzheimers disease.

The study used the de-identified population-level, electronic health records of 56 million unique patients collected by the IBM Watson Health Explorys Cohort Discovery platform from 360 hospitals and 317,000 providers. The study evaluated patients with inflammatory diseases (including rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, inflammatory bowel disease, ulcerative colitis, and Crohn's disease). The study examined whether these systemic inflammatory diseases - which in part are mediated by tumor necrosis factor (TNF) - increased the risk for Alzheimers disease and whether or not risk could be mitigated by an FDA-approved, TNF blocking biologic drug.

The study findings are exciting in that we clearly see that TNF blocking agents reduce the risk for co-morbid Alzheimers disease in real-world patients diagnosed with rheumatoid arthritis or psoriasis, said Rong Xu, Ph.D., Associate Professor, Department of Population and Quantitative Health Sciences, School of Medicine at Case Western Reserve University and co-author of the study. Given that anti-TNF biologics are powerful drugs, we believe further prospective studies are necessary to understand their potential in treating or preventing Alzheimer's disease.

The analysis compared a diagnosis of Alzheimer's disease as an outcome measure in patients who received at least one prescription for a TNF blocking agent (etanercept, adalimumab, and infliximab) or for methotrexate.

Alzheimer's risk was increased in adults with the following diagnoses (all P<0.0001):

Key findings:

About Alzheimers Disease and Tumor Necrosis Factor (TNF)

Alzheimers disease (AD) is the most common cause of dementia. Multiple lines of evidence indicate that TNF may trigger or amplify aberrant microglia signaling in the brain and thereby contribute to AD pathogenesis. Systemic inflammatory diseases affecting the joints, skin and gut are caused in part by the production of TNF by activated macrophages and these diseases can be treated effectively with a TNF blocking agent. Furthermore, systemic TNF can access the brain through receptor-mediated transcytosis. In the brain, elevation of tumor necrosis factor (TNF) in cerebrospinal fluid collected from subjects with mild cognitive impairment is associated with progression to AD at 6 months follow up.

About Tetra Therapeutics

Tetra Therapeutics is a clinical stage biotechnology company developing a portfolio of therapeutic products that will bring clarity of thought to people suffering from Alzheimers disease, Fragile X Syndrome, traumatic brain injury, and other brain disorders. Tetra uses structure-guided drug design to discover mechanistically novel, allosteric inhibitors of phosphodiesterase 4 (PDE4), an enzyme family that plays key roles in memory formation, learning, neuroinflammation, and traumatic brain injury. Tetra Therapeutics is headquartered in Grand Rapids, Michigan. For more information, please visit tetratherapeutics.com.

Link:
Tetra Therapeutics Announces Presentation of Data from Retrospective Population-Based Study of 56 Million Patients at the 12th Clinical Trials on...

A research team led by biomedical scientists at the University of California, Riverside, has found that a drug approved by the FDA to treat rheumatoid arthritis and ulcerative colitis can repair permeability defects in the guts epithelium.

Affecting roughly 1 million Americans, ulcerative colitis is a chronic inflammatory bowel disease of the large intestine in which the lining of the colon becomes inflamed and leaky. Affecting more than 2 million Americans, rheumatoid arthritis is an autoimmune disease in which the bodys immune system attacks the joints.

The study is the first to show the drug, tofacitinib, also called Xeljanz, has a direct effect on cells lining the gut by correcting defects that occur in inflammation. Until now, the effects of tofacitinib on intestinal epithelial cell functions were largely unknown.

Our work increases our understanding of how this drug is useful for treating ulcerative colitis, said Declan McCole, a professor of biomedical sciences in the UCR School of Medicine, and the lead author of the study that appears in the journal Inflammatory Bowel Diseases. We now better understand where in the gut the drug is working, and how.

McCole explained that increased intestinal permeability or leakiness is a feature of ulcerative colitis and plays a critical role in promoting inflammation. His team tested tofacitinib in human intestinal epithelial cell lines, as well as in organoids, or colonoids, that were derived from primary human colonic stem cells isolated from human subjects primarily patients undergoing elective colonoscopy for colon cancer screening and found tofacitinib repaired inflammation-induced permeability defects in both.

The epithelium is a thin layer that lines the alimentary canal. The gastrointestinal epithelium is comprised of cells that have gaps between them, making them selectively permeable and providing a barrier that keeps out pathogens, toxins, and antigens from entering the gut, while allowing the absorption of nutrients. In ulcerative colitis, this epithelial permeability becomes leaky, allowing bacterial products to cross into the gut and nutrients and water to leak out. This, in turn, triggers immune responses, resulting in fluid loss and diarrhea.

We found tofacitinib fixes the leakiness in the intestinal barrier, McCole said. Specifically, it fixes intestinal epithelial permeability defects caused by interferon-gamma, an inflammatory cytokine involved in autoimmune diseases such as ulcerative colitis and rheumatoid arthritis.

By targeting specific molecules, the drug inhibits a pathway that is activated by inflammation, said Anica Sayoc-Becerra, a graduate student in the Biomedical Sciences Graduate Program, a member of McColes lab, and the first author of the research paper. Our study shows tofacitinib is not just acting on immune cells, as was first thought, but can have a direct effect on the epithelial cells that are the key factor in maintaining gut barrier function.

A major focus of McColes lab is PTPN2, a protein-coding gene associated with autoimmune diseases such as Crohns disease, ulcerative colitis, and rheumatoid arthritis. Individuals with mutations in this gene that cause it to lose function have an increased risk of getting these diseases. McColes research group was the first to identify PTPN2 normally helps to protect the barrier function of the epithelial cells that line the gut.

A patient that has a PTPN2 loss-of-function mutation is predicted to have a leakier gut, McCole said. Rather than trying to repair PTPN2, my lab was successful in inhibiting some of the consequences of the loss-of-function mutation in this gene.

Sayoc-Becerra explained PTPN2 deactivates the same signaling pathway as tofacitinib.

We thought tofacitinib might be a very effective way of correcting the defects that occur from the loss-of-function mutations of PTPN2 without having to introduce new genes into a cell, animal, or patient, she said.

McCole and Sayoc-Becerra were joined in the study by UC Riversides Moorthy Krishnan, Jossue Jimenez, Rebecca Hernandez, Kyle Gibson, and Reyna Preciado; as well as Shujun Fan and Grant Butt of the University of Otago in New Zealand. Sayoc-Becerra expects to graduate with her doctoral degree in December 2019. This is her first paper as first author.

Next, the researchers plan to identify specific patients who may derive the greatest benefit from the drug. This will allow more targeted treatment of patients likely to be good responders to tofacitinib in a personalized medicine approach to treating this disease.

The research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, as well as inflammatory bowel disease research awards from Pfizer Inc., the maker of tofacitinib.

Go here to read the rest:
Drug decreases gut leakiness associated with ulcerative colitis - UC Riverside

Certain levels of plasma protein adenosine deaminase 2 (ADA2) are sensitive and specific, and can be used as a novel biomarker of macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis (JIA), according to research results published in the Annals of the Rheumatic Diseases.

Researchers sought to evaluate the role and function of ADA2 as a novel biomarker of macrophage activation syndrome because of the overlapping clinical features between macrophage activation syndrome and active systemic JIA.

A reference range for plasma ADA2 activity was first established using samples from 324 healthy individuals (174 children and 150 adults). Spectrophotometric assays showed that patients with biallelic ADA2 mutations had a near absence of ADA2 activity compared with carriers who had approximately half-normal plasma ADA2 activity.

After establishing the reference range, the researchers compared ADA2 levels in children with Kawasaki disease, pediatric systemic lupus erythematosus, and juvenile dermatomyositis with age-matched healthy controls. Investigators established that ADA2 levels did not correlate with markers of disease activity and were not a general marker of systemic inflammation in any of the 3 disorders.

Among the JIA population, most patients showed plasma ADA2 activity levels that were comparable with age-matched healthy controls; however, a small subset had levels well above the upper limit of normal. After stratification by JIA category, investigators found that ADA2 activity was present in children with oligoarticular and polyarticular JIA, enthesitis-related arthritis, and psoriatic arthritis.

Using multiple macrophage activation syndrome biomarkers, researchers compared ADA2 activity in patients with JIA and created a correlation matrix based on Spearman rank correlation r values. The comparisons demonstrated that ADA2 levels correlated with ferritin, interleukin-18, and C-X-C Motif Chemokine Ligand 9. ADA2 activity also correlated well with increased aspartate aminotransferase levels in macrophage activation syndrome, but not with conventional markers of inflammation.

Although the patterns displayed by these markers were different, all the markers were sensitive and specific in discriminating macrophage activation syndrome from systemic JIA using the upper limit of normal as a cutoff.

Seven patients with macrophage activation syndrome had available serum samples. Consistent with previous analyses, investigators found that ADA2 levels were generally higher during a confirmed episode of macrophage activation syndrome compared with other time points. Researchers noted that patients who experienced recurrent episodes of macrophage activation syndrome exhibited ADA2 levels near the upper limit of normal even when macrophage activation syndrome was absent.

Whether ADA2 contributes to the pathophysiology of [macrophage activation syndrome] is not clear, the researchers concluded. The [physiologic] function of ADA2 remains to be determined.

Reference

Lee PY, Schulert GS, Canna SW, et al. Adenosine deaminase 2 as a biomarker of macrophage activation syndrome in systemic juvenile idiopathic arthritis [published online November 9, 2019]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2019-216030

Read the original post:
Novel Biomarker of Macrophage Activation Syndrome Identified in Juvenile Idiopathic Arthritis - Rheumatology Advisor

CHICAGO - About 54 million adults have doctor-diagnosed arthritis, according to The Arthritis Foundation. Almost 300,000 babies and children have arthritis or a rheumatic condition

For Chelsea May, those numbers hit too close to home. Her 14-year-old daughter, Jenna, suffers from Juvenile Psoriatic Arthritis and Uveitis. She was diagnosed four years ago.

To help fight spread awareness of the debilitating disease and raise money for research, Jenna's family will host their third annual bake sale on Dec. 6. The bake sale will take place at the Mt. Greenwood Holiday Stroll from 4 p.m. to 7 p.m.

"We are also looking for donations of baked goods as well," May said.

The donations and money received from the bake sale will be donated to the Arthritis Foundation's Jingle Bell Run which will take place on Dec. 14.

The Arthritis Foundation's Jingle Bell Run is the original festive race for charity, bringing people from all walks of life together to champion arthritis research and resources.

Less than a week after the bake sale, Jenna's family will gear up for the Jingle Bell Run in Chicago. If you would like to donate or join Jenna's run team, click here.

Visit link:
Jingle Bake Sale To Benefit The Arthritis Foundation - Beverly, IL Patch

ATLANTA There is no significant difference in the rate of serious infections in patients with rheumatoid arthritis (RA) receiving upadacitinib 15 mg or adalimumab, according to study results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

However, the results indicated that patients receiving upadacitinib 15 mg and 30 mg had higher rates of herpes zoster compared with patients receiving adalimumab or methotrexate.

The study included data from 5 randomized double-blind, placebo- or active-controlled phase 3 trials of upadacitinib 15 mg (included in all 5 trials) or 30 mg daily (included in 4 trials) in patients with RA.

Researchers calculated the exposure adjusted event rates (EAERs; events/100 patientyears [PY]) of treatment-emergent adverse events (AEs) for the integrated placebo (3 trials; 12/14 weeks), the integrated methotrexate (2 trials; mean exposure, 36 weeks), the originator adalimumab (mean exposure, 42 weeks), upadacitinib 15 mg (mean exposure, 53 weeks), and upadacitinib 30 mg (mean exposure, 59 weeks) groups.

In all 5 phase 3 trials, 3834 patients received 1 dose of upadacitinib 15 mg (n=2630) or 30 mg (n=1204) with no option to switch doses, for a total of 4020.1 PY of upadacitinib exposure.

Similar to patients who received adalimumab, patients who received upadacitinib 15 mg had EAERs of overall serious adverse events (SAEs) and AEs that led to discontinuation. Compared with methotrexate, upadacitinib 15 mg and 30 mg had higher EAERs of both SAEs and AEs.

The most commonly reported AEs were upper respiratory tract infection, nasopharyngitis, and urinary tract infections, all of which occurred more frequently among patients in the upadacitinib groups compared with the placebo group.

Patients in the upadacitinib 15 mg and adalimumab groups had comparable rates of serious infection events (SIEs); however, rates of SIEs were higher among patients receiving upadacitinib compared with methotrexate. Compared with patients receiving methotrexate and adalimumab, patients receiving either dose of upadacitinib had higher rates of herpes zoster.

Among patients receiving upadacitinib, those in the 15-mg group had lower rates of SIEs and herpes zoster compared with the 30-mg group.

All treatment groups had similar rates of malignancies, excluding non-melanoma skin cancer, and adjudicated major adverse cardiovascular events and venous thromboembolic events. In addition, all treatment groups had comparable rates of death.

Compared with the other treatment groups, upadacitinib 30 mg had a higher rate of non-melanoma skin cancer; however, the rates of non-melanoma skin cancer for both the upadacitinib groups fell within the range reported for patients with RA treated with disease-modifying antirheumatic drugs.

Visit Rheumatology Advisor for live coverage and more news from the 2019 ACR/ARP Annual Meeting.

Reference

Cohen S, van Vollenhoven R, Winthrop K, et al. Safety profile of upadacitinib in rheumatoid arthritis: integrated analysis from the SELECT phase 3 clinical program. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 509.

Read more from the original source:
Rates of Serious Infection Events Similar With Upadacitinib, Adalimumab in Rheumatoid Arthritis - Rheumatology Advisor

In September, the world of entertainment news buzzed with word that Kim Kardashian West tested positive for lupus and rheumatoid arthritis. The star underwent further tests, however, resulting in a diagnosis of psoriatic arthritis instead. While all three autoimmune disorders share some signs and symptoms, psoriatic arthritis is generally considered to have a better prognosis than lupus. That said, the conditions can co-exist and lupus has gotten a reputation for being difficult to diagnose, especially in the absence of the butterfly-shaped rash on ones cheeks and nose.

Im so relieved. The pain is going to come and go sometimes, but I can manage it and this is not going to stop me, Kardashian said in an article in response to receiving her psoriatic arthritis diagnosis. Her relief at not having lupus is understandable, given that lupus can affect a greater number of organs and systems in the body and is considered to be life-threatening.

Lupus, rheumatoid arthritis and psoriatic arthritis are examples of some conditions that are often considered when an individual is undergoing diagnosis for certain autoimmune diseases, because they share several symptoms and can trigger positive results in the same diagnostic tests. Kim Kardashian received the initial news that she had lupus or rheumatoid arthritis likely due to positive antinuclear antibody (ANA) test results.

An ANA is a blood test ordered when a doctor, usually a rheumatologist, suspects that a patient has a particular kind of autoimmune disorder. This test checks for the existence of autoantibodies, which are produced when a persons body is, in effect, attacking itself and several areas of the body are affected. A positive ANA test usually indicates that the doctors suspicions are confirmed, and then other factors (like medical and family history) need to be considered and more tests done to arrive at a diagnosis.

Psoriatic arthritis is usually diagnosed between the ages of 20 and 50, and occurs in women and men equally. While there is no cure, appropriate and early treatment can help prevent major damage to affected parts of the body.

Psoriatic arthritis appears in a minority of individuals who have already been diagnosed with psoriasis, an autoimmune skin condition with which Kim Kardashian and her mother, Kris Jenner, had already been diagnosed. Psoriatic arthritis affects around 520,000 individuals in the United States alone.

The autoimmune condition is believed to be caused by a combination of genetic factors and environmental triggers. So while some people inherit psoriatic arthritis-related genes, only a subset of those individuals will go on to develop the condition. In these cases, the disease could be triggered by other illnesses or infections, various forms of extreme stress, poor diet, smoking, and so on.

Around 40 percent of psoriatic arthritis patients have one or more close family members with psoriasis or psoriatic arthritis diagnosis, which strongly indicates that the disease is hereditary. Interestingly, recent research has suggested that psoriasis patients who go on to develop psoriatic arthritis have a different genetic profile than those who do not. And the most well-studied of the psoriatic arthritis genes belong to a family of genes called the human leukocyte antigen (HLA) complex, which help the body tell the difference between its own proteins and viral or bacterial proteins.

According to Genetics Home Reference by the U.S. National Library of Medicine, Variations of several HLA genes seem to affect the risk of developing psoriatic arthritis, as well as the type, severity, and progression of the condition.

Ive been feeling so tired, so nauseous, and my hands are really getting swollen. I feel like I literally am falling apart. My hands are numb, Kardashian said on a recent episode of Keeping Up with the Kardashians.

These kinds of descriptions are common in all three conditions lupus, rheumatoid arthritis, and psoriatic arthritis though each patient presents with a different array of symptoms, and all with varying degrees of severity. The main symptoms of psoriatic arthritis are pain, stiffness, and swelling in affected joints, along with chronic fatigue. Joints near the end of the fingertips and tips of the toes are often affected, as are bones in the spine.

The symptoms of psoriatic arthritis tend to worsen over time, though some patients experience periods of remission when symptoms temporarily improve. Compared to rheumatoid arthritis, psoriatic arthritis is more likely to cause swelling in the smallest joints of the fingers and toes, foot pain (in the heel and/or sole of the foot), and lower back pain caused by inflammation in vertebral joints. Patients with psoriatic arthritis are also more likely to experience symptoms on one side of the body or in different appendages on each side (in other words, it tends to be an asymmetric disease), whereas patients with rheumatoid arthritis are more likely to experience symptoms that affect both sides of the body equally (symmetric disease).

Most if not all patients with psoriatic arthritis also have psoriasis, an autoimmune condition that causes red, scaly patches of skin that can be itchy, painful and embarrassing. Psoriasis usually precedes the onset of psoriatic arthritis by several years. People with psoriatic arthritis commonly experience fingernail changes, too, such as the formation of a pitted or ridged nail surface, or the nails become separated from the nail beds.

There are several treatment options for psoriatic arthritis, which include nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain, immunosuppressants to suppress the immune system, disease-modifying antirheumatic drugs (DMARDs) to slow the progression of the disease, and newer medications that minimize the activity of certain enzymes involved in the inflammatory process. Treatment plans may also involve steroid injections administered directly into affected joints, or joint replacement surgery in cases where the disease has significantly progressed.

Kristen Hovet covers genetics, medical innovations and the intersection of sociology and culture. The North Dakota native is based in Vancouver, Canada, where she is working on a masters degree in health communication at Washington State University. Follow her on her website or Twitter @kristenhovet

See the original post here:
Kim Kardashian West's battle with psoriatic arthritis: Will understanding the genetics of the autoimmune disorder point to a cure? - Genetic Literacy...