New Study Shows Positive Results with Bone Marrow Concentrate (BMC) Injection for Knee Osteoarthritis

April 22nd, 2014

In the next video I’ll report on another study showing the effectiveness of stem cells in the treatment of osteoarthritis…

New Study Shows Positive Results with Bone Marrow Concentrate (BMC) Injection for Knee Osteoarthritis

Bone Marrow Concentrate (BMC) has evolved in recent years as a one of the most promising therapies for Osteoarthritis (OA). The anti inflammatory and regenerative properties of BMC have been shown in early studies to relieve pain and stiffness, as well as improve joint function, in patients suffering from degenerative arthritis.

A recent study, reported by Julie Patchis, published in the European Journal of Surgery and Traumatology evaluated 41 patients (75 knees) with a mean age of 60.7 years old, diagnosed with degenerative arthritis, who underwent intra articular injection of BMC with adipose tissue. Each patient was assigned a radiologic arthritis score (I-IV) via the Kellgren-Lawrence grading scale, and Pre/Post operative Visual Analogue Score (VAS) and functional scores were used for evaluation at 3, 6, and 12 months.

The study revealed a decrease in the mean VAS from 7.0 preoperatively to 4.1, 3.5, and 3.3 at the 3, 6, and 12 months follow up appointments. Functional improvements were also illustrated via the International Knee Documentation Committee score, SF-36 score, Knee and Osteoarthitis Outcome score, and the Lysholm Knee Questionnaire.

The results contribute to the growing research trends supporting the treatment of OA with intra articular injections of BMC. However, less impressive improvements were seen in Grade IV arthritis patients and this suggests BMC to be more effective in early to moderate phases of degenerative arthritis. Although, further studies are needed to more thoroughly evaluate the efficacy of BMC therapy, this study adds further support to the regenerative potential of bone marrow for degenerative joint diseases such as arthritis.

The newest treatment for psoriatic arthritis.

April 21st, 2014

Psoriatic arthritis is a very different condition from rheumatoid arthritis. Yet many of the arthritis treatments used for RA have also been used for psoriatic arthritis without the realization that they are very different diseases. The attempt, then, has been to identify treatments that might be more specific for psoriatic arthritis. Stelara was one of the first drugs aimed at doing that. Another is Otezla or apremilast, the newest arthritis treatment for psoriatic arthritis.

Risk of Infection when using Arthritis Drugs

April 18th, 2014

What arthritis drugs cause the most risk for infection… next

Infection risk in Rheumatoid Arthritis and Spondyloarthropathy patients under treatment with disease modifying drugs, Corticosteroids and TNF-alpha antagonists

Reported in the Journal of Translational Medicine was an article from Germano and colleagues from the University of Rome describing incident infection risk in patients treated with a variety of medicines.

The most frequent infection site was respiratory tract, and bacteria were responsible for three quarters of all infections.

The combination anti-TNFalpha with corticosteroids was found to be the most pro-infective treatment, whereas DMARDs alone were relatively safe.

Physicians, therefore, should be aware that there may be an increased risk of infection when using anti-TNFalpha and CS therapy together. Anti-influenza vaccination appears to provide broad protection, adding evidence to support its use in these patients, and deserves further study.

Conclusion: A cautionary note when using these medicines.

TNF inhibitors reduce coronary artery disease risk in rheumatoid arthritis?

April 17th, 2014

A significant benefit of using TNF inhibitors in patients with rheumatoid arthritis. Discover more next…

Tumor necrosis factor inhibitor use associated with a decrease in heart attacks

Cardiovascular disease is the leading cause of death in patients with rheumatoid arthritis.  A study from the Geisinger Clinic provides some good news for rheumatoid arthritis sufferers.  The investigators took a retrospective look at 2,101 rheumatoid arthritis patients.  The groups were categorized into those who had received methotrexate alone, methotrexate with TNF inhibitors, and those who had received neither.  After adjusting for various factors, the scientists found that the use of TNF inhibitors was associated with a 55% reduction in the risk of heart attack compared with the group not receiving these drugs.  Methotrexate users also had a reduction in coronary events but the reduction was not significant.

Comment: A definite plus to using TNF inhibitors in rheumatoid arthritis.

Low birth weight infants predict increased likelihood of rheumatoid arthritis in the mother

April 16th, 2014

A totally unexpected risk factor for rheumatoid arthritis…

Low birth weight infants predict increased likelihood of rheumatoid arthritis in the mother

Kimberly Ma and colleagues from the University of Washington Medical Center studied 202 pregnant patients with rheumatoid arthritis and 1,102 pregnant controls. The found that comparing those with uncomplicated pregnancies, women with very low birth weight or extremely low birth weight infants had a higher risk of rheumatoid arthritis.  The authors concluded that this association may reflect common factors for pregnancy complications and rheumatoid arthritis or possibly the fact that complicated pregnancies themselves might confer a risk for developing rheumatoid arthritis.

Comment: Very interesting study and more data is needed.

Medication use and rheumatoid disease activity… the possible effect on offspring.

April 15th, 2014

Here’s an interesting question… does drug treatment in pregnancy affect the bone density of offspring? The answer next.

Medication use and rheumatoid disease activity… the possible effect on offspring.

Prednisone use and active disease are associated with reduced bone density in patients with rheumatoid arthritis. The question then is this… do these factors also affect the bone density of children born to mothers with either of these issues? A Dutch study from the Erasmus Medical Center in Rotterdam published in Arthritis and Rheumatology followed 255 mothers and 108 children of these mothers.  What the investigators found was that neither medication use nor high rheumatoid arthritis disease activity during pregnancy is associated with low bone density in offspring at an age of 7 years, on average.  The authors concluded the benefit of medication use for rheumatoid arthritis during pregnancy outweighs the effect on bone density in the offspring.

Comment: This is comforting hews for women who are pregnant and need to know about this issue.

Achilles

April 14th, 2014

Achilles

The Achilles tendon is the largest tendon in the body. It can be injured by excessive strain, over pronation of the feet, or a sudden increase in exercise intensity.  The term “Achilles tendinitis” is probably wrong since much of the time Achilles tendon problems are due more to tendon degeneration than to inflammation.  Diagnosis is made through history, physical exam, and imaging procedures such as MRI or ultrasound.  Treatment involves rest, ice, physical therapy, an Achilles boot, and anti-inflammatory medicine.

Steroid injections should be avoided at all cost because they weaken the tendon and make the tendon more likely to rupture.  The treatment of choice is ultrasound guided needle tenotomy with injection of platelet-rich plasma (PRP> A newer form of treatment is Tenex which is a needle that both irrigates and vacuums.

Weather may… or may not affect arthritis symptoms

April 11th, 2014

So… does weather affect arthritis?  The surprising answer next…

Weather may… or may not affect arthritis symptoms

One of the most controversial topics in arthritis is this… Does weather affect symptoms? Well maybe we have an answer to this perplexing issue. Nancy Walsh writing in her blog on Medscape reported on a Dutch study of  712 survey participants who were residents of Germany, Italy, U.K., the Netherlands, Spain, and Sweden… a variety of climates.

Patients’ mean age was 73 years, 72% were women, and 67% considered themselves to be “weather sensitive.”

When the researchers compared the weather-sensitive patients with those who didn’t consider themselves sensitive, they found that women, the less educated, and more anxious and depressed patients were more often sensitive.

Weather-sensitive individuals also had less of a sense of mastery over their lives.

Among the 469 individuals who considered themselves weather sensitive, almost 40% said damp and rainy conditions worsened their symptoms, 30% said only cold bothered them, and 5% said hot weather was worse for their pain. Small numbers reported increased pain with both hot and cold weather, or to rain and cold and heat.

Interestingly, the percentage of patients who were weather sensitive was highest in warm, dry climates like Spain and Italy (77%) and lowest in the cold, wet climate of Sweden (57%). In addition, residents of warm, dry climates reported more intense joint pain than those in cold, wet climates.

Possible explanations suggested by Erik Timmermans, the lead author,  included the biologic:

“Changes in temperature and humidity may influence the expansion and contraction of different tissues in the affected joint, which may elicit a pain response. In addition, low temperatures may increase the viscosity of synovial fluid, thereby making joints stiffer and perhaps more sensitive to the pain of mechanical stresses.”

The exposure theory:

“The climates in both Mediterranean countries are warmer compared to the climate in Sweden. As a result, older people with osteoarthritis in Italy and Spain may be more often outside compared to those in Sweden…. As a consequence, they may be more aware of the effect of weather on their pain and are more likely to report weather sensitivity.”

And the mind:

“The disease course of osteoarthritis is often characterized by a low level or absence of symptoms with periods of flare-up or exacerbation. The uncertainty about the recurrence of pain may lead to anxiety in people with osteoarthritis and this might encourage the desire to have an explanation for the worsening of their pain.”

In any case, “the common belief that joint pain in osteoarthritis becomes worse by living in a cold and damp climate is not supported by our results,” they stated.

They concluded that clinicians’ appreciation of older patients’ potential weather sensitivity — wherever they live — may be key. “Early treatment of weather-sensitive individuals with osteoarthritis using cognitive and psychological interventions may reduce suffering and may help them to maintain a functionally effective lifestyle,” they concluded.

Comment: So there it is… your answer.

Otrexup… a novel methotrexate delivery system

April 10th, 2014

New form of methotrexate making its debut…

Otrexup… a novel methotrexate delivery system

The FDA recently approved a new form of methotrexate.  Otrexupo is an injectable form of the drug administered via an autoinjector. It is hoped that the higher drug levels and ease of administration may help with patient compliance.

Comment Otrexup or throw up.  Not sure I see the value in this product.

First biosimilar biologic approved in Europe.

April 9th, 2014

 

Biologics going down in price? Maybe… coming up next

First biosimilar biologic approved in Europe.

Reported in Value-based Rheumatology, an article indicating the European Commission has approved the first biosimilar biologic for the treatment of rheumatoid arthritis. Two versions, Remsima and Inflectra are copies of the popular drug Remicade. Approval of biosimilars may herald the reduction in costs for these costly drugs.

Comment: Let’s hope these work as well as the brand name drugs.