Treating Ra Patients With Anti-Tnf Drugs May Lessen Their Likelihood Of Alzheimer’s.
John Gever reporting in MedPage Today stated that, according to research presented at the American College of Rheumatology’s annual meeting, “treating rheumatoid arthritis (RA) patients with anti-tumor necrosis factor (TNF) drugs appears to lessen their likelihood of developing Alzheimer’s disease.” After analyzing claims data from “a large medical and pharmacy claims database that included 8.5 million US adults,” researchers found that “use of anti-TNF therapy was associated with a lower risk of Alzheimer’s disease. Both rheumatoid arthritis and Alzheimer’s disease seem to be caused by inflammatory chemicals called cytokines. Very important finding.
What Do I Do With A Woman Who Is Pregnant And On Biologics?
Dr. Sunanda Kane at the Mayo Clinic recently presented this important information… biologic drugs are protein antibodies, and most cross the placenta. They do not begin to cross until the second trimester, around week 20 of pregnancy. Maximal transfer occurs between weeks 30 and 38 of pregnancy. Thus, if a pregnant woman is on Remicade, we instruct her to time her last dose around week 30-32 of pregnancy, and then re-dose her after delivery. Women on Humira should be instructed to self- inject their doses until around week 33-34 of pregnancy. Interestingly, data suggests Cimzia does not cross the placenta at all. The above recommendations are for patients who are in remission.
Experts do not endorse switching biologics during pregnancy If a pregnant woman has active RA, then we continue her biologic therapy. The first trimester has the lowest risk for transfer of antibodies and the highest for disease flare. The benefits of controlling disease outweigh the risks to the unborn baby. There does not appear to be any increased risk for infection following caesarean section if biologics are given right after delivery, as long as there is assurance that no placenta has been retained, which could be a source for infection. Furthermore, there’s data to show that biologics do not cross into breast milk, so breastfeeding is permitted for women on most biologic therapy.
I’d like to add that fortunately, many women with RA go into spontaneous remission during pregnancy.
Uric Acid May Increase Likelihood Of Severe Osteoarthritis
Mary Jane Gore writing for the Duke University News reported that the amount of uric acid in one’s joints may increase the likelihood of severe osteoarthritis, the most common form of arthritis worldwide, according to researchers at Duke University Medical Center. Osteoarthritis is a debilitating joint degeneration for which no drug has been proven to slow or halt its progression. Physicians can only offer to treat the symptoms associated with osteoarthritis, and people with the condition are often subject to a reduced quality of life.
Dr Virginia Byers Kraus senior author of the study published in PNAS, stated, “This research is a step towards identifying uric acid as a risk factor for osteoarthritis.” The researchers looked at 159 people, who had knee osteoarthritis but no history of gout, a type of arthritis triggered by uric acid crystals in the joints. The researchers found the severity of osteoarthritis in their knees to be strongly correlated with the amount of uric acid in their knees. Good Stuff!
Lifetime Risk of Adult Rheumatoid Arthritis Determined
From Science Daily, Mayo Clinic researchers have determined the lifetime risk of developing rheumatoid arthritis and six other autoimmune rheumatic diseases for both men and women. The findings appeared in Arthritis and Rheumatism. “We estimated the lifetime risk for rheumatic disease for both sexes, something that had not been done before,” says Cynthia Crowson first author. The adult lifetime risk in the United States of having some kind of inflammatory autoimmune disease is 8.4 percent for women and 5.1 percent for men. That means one woman in 12 and one man in 20 will develop one of the conditions in their lifetime. The authors consider that a substantial risk. And so do I…
Should We Stop Using Local Injections Of Corticosteroids For Treatment Of Tendonitis?
Dr. HS Diamond stated that a recent extensive systematic review of randomized controlled clinical trials of local corticosteroid injections for tendinitis published in the Lancet found short-term benefit from local corticosteroid injection but no long-term benefit He goes on to say…the low toxicity associated with local corticosteroids and the rapid pain relief in some types of tendinitis justifies their use in selectively in settings where short-term pain relief is the goal. If used for this purpose in patients with chronic or recurrent tendinitis local corticosteroid injection should be combined with other treatment aimed at longer term benefit. I agree… maybe… in that both severe tendonitis as well as chronic tendonitis should be treated with tenotomy and PRP
From the UK’s Daily Express we have this nugget… scientists at Imperial College London have found a protein called IRF5 that acts as a switch, telling immune system cells, called macrophages, to promote or stop inflammation. Blocking the production of IRF5 could help in a range of diseases including RA, lupus and even MS. A treatment called anti-TNF drugs developed at the college previously is ineffective in 30 percent of cases. Senior researcher Dr. Irina Udalova said: “This is really exciting.” I think it is too.
FDA To Limit Amount Of Acetaminophen In Common Prescription Drugs
Andrew Zajac writing in the LA Times states that the Food and Drug Administration will limit the amount of the pain reliever, acetaminophen, allowed in commonly-used prescription drugs such as Percocet and Vicodin to reduce the danger of harm to the liver. But the announcement, setting a maximum of 325 milligrams per prescription pill, will not affect over-the-counter products containing acetaminophen, which is best known by the brand name Tylenol. The FDA also will require boxed warnings – its strongest labeling requirement – about possible liver damage on acetaminophen prescription products. Acetaminophen is usually paired with pain-killing opioids like hydrocodone or oxycodone and these products are prescribed nearly 200 million times per year, making them among the most widely used prescription drugs.
Acetaminophen overdose is the leading cause of liver failure and the leading cause of death from liver failure in the U.S. Overdoses accounted for 56,000 hospital emergency room visits and were linked to an average of 458 deaths annually during the 1990s, according to FDA data.