Arthritis

The rate of cancer is 4 times higher in children with juvenile idiopathic arthritis compared to kids without the disease. While the primary suspect might seem like it would be treatment with TNF blockers, researchers reported that the increased rate of cancer appeared not to be linked to treatment.

The study, published online in the February 2012 Arthritis & Rheumatism, used Medicaid data from 2000-2005 and identified 7,812 children with juvenile arthritis. Two other groups were used for comparison; they had asthma and ADHD rather than juvenile arthritis. Researchers categorized patients as having "ever" or "never" been treated with methotrexate or TNF blockers. Then they classified incident malignancies as "possible", "probable", or "highly probable".

While the higher rate of cancer for kids with juvenile arthritis seems not to be related to treatment, larger scale and longer term studies would help confirm these conclusions.

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The New York Times reported on February 10, 2012 that methotrexate, a drug used to treat childhood leukemia (specifically, acute lymphoblastic leukemia) and rheumatoid arthritis, is in critical short supply. The supply of injectable methotrexate is not meeting the demand. Hospitals across the U.S. may deplete their existing stock within the next two weeks.

Ben Venue Laboratories was one of the largest suppliers of injectable preservative-free methotrexate, but the company suspended operations at its Ohio plant in November due to manufacturing and quality concerns. Four other drug manufacturers in the U.S. that also supply methotrexate are attempting to boost production and stave off the problem. The FDA is reportedly seeking a foreign supplier to provide emergency imports, too, until the situation improves in the U.S.

For rheumatoid arthritis patients, oral methotrexate is an alternative to injectable methotrexate for some patients. Discuss your concerns with your doctor and your pharmacist. Follow along with the FDA list of Current Drug Shortages. Information about the methotrexate shortage is on the list and was last updated 2/2/12. Another shortage, Voltaren gel 1% (Diclofenac Sodium Topical Gel), was posted to the list on 2/8/12 and may affect some arthritis patients.

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More information has surfaced about adverse effects associated with PPI drugs (proton pump inhibitors such as Nexium, Prevacid, Protonix, Aciphex). A study published in the January 31, 2012 issue of the British Medical Journal concluded that chronic use of PPIs is associated with increased risk of hip fracture, especially among women who smoked. The report backs the U.S. FDA's decision to revise labeling of PPI drugs to include information about increased risk of fracture among patients treated with high doses or treated with a PPI for one year or more.

On February 8, 2012, the FDA warned the public that the use of PPIs may be associated with an increased risk of Clostridium difficile-associated diarrhea (CDAD). Patients are being advised to "use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated."

What exactly are PPIs? Why are some arthritis patients who take NSAIDs (nonsteroidal anti-inflammatory drugs) also prescribed PPIs? Learn more in What Are PPI Drugs (Proton Pump Inhibitor)?

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According to a report published online January 15, 2012 in the Journal of Rheumatology, the rates of joint surgery continue to decrease for rheumatoid arthritis patients, especially those who have been more recently diagnosed. Previous studies recognized declining rates of joint surgery among patients diagnosed with rheumatoid arthritis since 1985. In the study published online in January, researchers accessed medical records of patients diagnosed with rheumatoid arthritis from 1980-2007, using data from the Rochester Epidemiology Project, and evaluated whether the trend continued since 1995.

Of the 813 patients in the study, the proportion of patients needing rheumatoid arthritis-related joint surgery dropped between the two time frames, 1980-1994 and 1995-2007. The cumulative incidence of any joint surgery at 10 years after rheumatoid arthritis onset dropped from 27.3% to 19.5% between the time frames 1980-1994 and 1995-2007. The greatest reduction occurred in soft tissue surgeries, such as synovectomy, tendon repair, tendon transfer, meniscus repair, ligament release, and cartilage repair. Surgery on weightbearing joints (hips and knees) did not exhibit the big reduction between the time frames. The increased use of disease-modifying drugs (DMARDs) may account for decreased joint damage and consequently less need for joint surgery. It was also noted in the study results that joint reconstructive surgery was associated with increased mortality.

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According to a Mayo Clinic study published in the February 2012 issue of Arthritis Care & Research, there is an association between body mass index (BMI) and severity of symptoms in fibromyalgia patients. There were 888 fibromyalgia patients involved in the study. Patients were asked to complete questionnaires about their symptoms and ability to function. Obesity (BMI more than 29) was common in half of the study group, while one-fourth were severely obese (BMI more than 35).

As BMI increased, fibromyalgia-related symptoms increased and quality of life decreased. There has been no definite causal link between obesity and fibromyalgia, but among people who have fibromyalgia, obesity may cause increased pain and decreased function. Weight management should be a goal for fibromyalgia patients.

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It is known that oral glucocorticoid therapy, such as prednisone or prednisolone, increases the risk of serious infection (infection leading to hospitalization, intravenous antibiotics, disability or death). There have not been many studies that evaluated the risk of non-serious infection though. Study results published February 1, 2012 in the Annals of the Rheumatic Diseases concluded that glucocorticoid therapy is associated with an increased risk of non-serious infection. The risk was found to increase with dose and is greater than the risk for non-serious infection associated with methotrexate.

The findings are significant since approximately one third of patients with rheumatoid arthritis currently use glucocorticoids and two thirds of rheumatoid arthritis patients have used glucocorticoids at some point. While steroids dramatically improve symptoms, safety has always been a concern.

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Joint deformity is characteristic of certain types of arthritis. Ulnar deviation (joint deformity of the hand) is often associated with rheumatoid arthritis. Since it's visible, it can be a telltale sign that someone has the disease. Other joints may be associated with deformity besides the hands. For example, the knees may have a valgus or varus deformity (knock-kneed or bow-legged).

Have you developed joint deformity since being diagnosed with arthritis? Does the deformity interfere with how well you can use the affected joint? Is the deformity visible or easily concealed? Has it affected how you feel about yourself? Share Your Feelings in Bugged by Joint Deformity Related to Arthritis?

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Blood tests help doctors diagnose arthritis and monitor the effectiveness of treatment. One of the most common tests ordered is the erythrocyte sedimentation rate, also known as ESR or sedrate. Your doctor may order this test during your initial consultation and during follow-up appointments.

If you have a basic understanding of the sedimentation rate -- how it's performed and what the results indicate -- it will be more meaningful than just a random number. Learn more in Sedimentation Rate - What Is It?

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Doctors typically prescribe arthritis medications to help manage symptoms and slow disease progression. There are several categories of arthritis medications: NSAIDs (nonsteroidal anti-inflammatory drugs), analgesics (pain medications), DMARDs (disease-modifying anti-rheumatic drugs), biologics, and corticosteroids.

I don't know anyone who likes to take medication or wants to take it, but people with arthritis tend to be compliant with their treatment regimen. With the best of intentions, they take their prescribed medication hoping it will be effective. It almost becomes robotic. You take your medications or self-inject or go for an infusion on a specified schedule. But, when is the last time you stopped to think about how well your medications are working? Are they working? Did they used to work better and now don't seem quite as effective? How can you tell? Read more in Arthritis Medications - Are They Working?

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According to a study funded by NIAMS (National Institute for Arthritis and Musculoskeletal and Skin Diseases) and published online January 26, 2012 in Arthritis Care & Research, two in five adults with rheumatoid arthritis (42%) are inactive. It's a common misconception that medication and rest alone help to control rheumatoid arthritis symptoms. Not only do many patients believe that, doctors actually recommended rest to their rheumatoid arthritis patients up until the 1980s. More current research supports regular, moderate physical activity or exercise for people with arthritis to help maintain joint flexibility, range of motion, balance, muscle strength -- and to decease joint pain.

While evidence now backs an active rather than sedentary lifestyle for people with rheumatoid arthritis, many patients still don't buy it and many doctors don't take the time to encourage it. In the study, inactivity was defined as participating in no moderate-to-vigorous physical activity periods of 10 minutes or more within a 7-day period. Not only were 42% classified as inactive, 53% of study participants lacked strong motivation to participate in physical activity and 49% lacked strong belief in the benefits.

Researchers concluded that physical inactivity among rheumatoid arthritis patients is a public health concern. Motivation needs to be addressed and the benefits of exercise promoted. Interestingly, just one day before the study was published, I wrote an article for our About.com Osteoarthritis site entitled "How You Can Start to Exercise With Osteoarthritis". The points made in the article apply to patients with any type of arthritis, including rheumatoid arthritis. Check it out.

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