Heavy Birthweight Increases Risk of Rheumatoid Arthritis
People with a birthweight of 10 pounds or more are twice as likely to develop rheumatoid arthritis when they are adults compared to people who were of average birthweight. Researchers are unclear about the exact mechanism that would explain the association between birthweight and disease risk but the study does suggest there is a modifiable risk factor (a risk factor that can be changed).
The study from Hospital of Special Surgery, a study to be published in the Annals of the Rheumatic Diseases, played out the results of a 2003 study that forumulated similar conclusions. The HSS study was on a larger population and researchers explained that patients with rheumatoid arthritis have a dyregulated HPA (hypothalamic-pituitary-adrenal) axis. The axis can be affected in utero. “The HPA axis is the neuroendocrine system — responsible for handling stress by regulating production of cortisol, neurotransmitters, and key hormones.” Knowing all of this, researchers believe it gives more pieces of the puzzle — what causes or contributes to rheumatoid arthritis.
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10 Most Popular Arthritis Drugs Prescribed by Rheumatologists
What are the 10 most popular arthritis drugs prescribed by rheumatologists? A rheumatologist is a medical doctor (M.D.) who specializes in the diagnosis and treatment of arthritis and related conditions. Based on an analysis of 7,945,910 prescriptions written by rheumatologists from January to March 2008, published in the journal Rheumatology News, Vol.7 No.6 June 2008, study results show that the top 10 drugs prescribed by rheumatologists are:
- Methotrexate and Folic Acid
- Prednisone
- Plaquenil (hydroxychloroquine)
- Vicodin (hydrocodone and acetaminophen)
- Ultram (tramadol)
- Mobic (meloxicam)
- Celebrex (celecoxib)
- Flexeril (cyclobenzaprine)
- Lyrica (pregabalin)
Related Resources:
- How Is Arthritis Treated?
- First Visit to the Rheumatologist
- 10 Ways to Ensure Drug Safety
- Arthritis Medications: What Are My Options?
- Are You Taking Medication You No Longer Need?
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2008 ACR Rheumatoid Arthritis Treatment Guidelines Released
Rheumatoid arthritis treatments include medication options that have expanded over the last decade. The American College of Rheumatology (ACR) has released its 2008 guidelines for rheumatoid arthritis treatments -- an update of the 2002 guidelines. The 2008 recommendations focus on the use of non-biologic DMARDs (disease-modifying anti-rheumatic drugs) and biologic DMARDs to treat the disease.
The 2008 guidelines were developed by an expert panel of doctors, researchers, and patient representatives following extensive review of scientific evidence related to non-biologic and biologic treatments. The recommendations are not to be used like a cookbook, or to replace a doctor's judgment regarding an individual patient.
The ACR expects to regularly update the recommendations as new scientific evidence becomes available. To reiterate an important point, these are only recommendations. Individual patients may require a different treatment plan. Read more in Rheumatoid Arthritis Treatments - 2008 ACR Recommendations.
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- Rheumatoid Arthritis Screening Quiz
- Test Your Knowledge: Rheumatoid Arthritis
- Signs and Symptoms of Rheumatoid Arthritis
- Rheumatoid Arthritis: Explained With Pictures
- 10 Things You Should Know About Rheumatoid Arthritis
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Is the Arthritis Painkiller Darvocet Really Dangerous?
Darvocet is a popular medication prescribed to relieve arthritis pain. Darvocet is a combination of acetaminophen and propoxyphene. According to Public Citizen, a National Non-Profit Public Interest Organization, "Darvocet, Darvon, and all medications that contain propoxyphene should be withdrawn from the market". The organization has actually sued the FDA because it failed to act on a petition submitted February 28, 2006. In that petition, Public Citizen stated that propoxyphene:
- is physically and psychologically addictive
- is no more effective than safer alternatives
- has been associated with more than 2,000 accidental deaths in the U.S. since 1981
Propoxyphene was one of the 25 most prescribed generic drugs last year. There were 22 million prescriptions for propoxyphene filled in 2007. According to Public Citizen, "A large proportion of the deaths from propoxyphene occurred because most of the drug is converted into a metabolite that is highly toxic to the heart, lasts longer in the body than the original compound and results in cardiac depression. Adverse cardiac events associated with propoxyphene include an interruption of heart transmission of electrical impulses, slowed heartbeats and a decreased ability of the heart to contract properly." Public Citizen’s book, “Worst Pills, Best Pills,” has listed propoxyphene as a DO NOT USE drug since its first edition in 1988. Public Citizen states in its complaint that darvocet is a relatively ineffective painkiller -- and the pain relief is comparable to ibuprofen.
Arthritis patients and their doctors have the difficult task of finding the best combination of medications that relieve arthritis pain. When a medication is found to be effective, it becomes part of the patient's arthritis treatment regimen. For those who have found darvocet to be an effective pain reliever, the complaint from Public Citizen is alarming. The benefits and risks of all medications must be considered. Discuss the benefits and risks of darvocet or other drugs that contain propoxyphene with your doctor. Your doctor may or may not believe the Public Citizen complaint has merit.
Related Resources:
- The Facts of Painkillers
- 10 Ways to Increase Your Pain
- Pain Management: Ways to Manage Your Pain
- 10 Things You Should Know About Darvocet
- When Are Pain Medications Appropriate for Arthritis Patients?
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Rheumatoid Arthritis Drug Methotrexate Raises Cancer Risk
Methotrexate has been tied to an increased risk of melanoma, as well as other malignancies, for rheumatoid arthritis patients treated with the medication. An Australian study compared 459 rheumatoid arthritis patients (309 women and 150 men who started taking methotrexate before June 1986) to the general population to determine cancer risk.
According to study results, published in the June 2008 Arthritis Care and Research, rheumatoid arthritis patients who were treated with methotrexate were found to have a 50% increased risk of developing any form of cancer. The risk of non-Hodgkins lymphoma was more than 5 times greater in rheumatoid arthritis patients than in the general population. Rheumatoid arthritis patients also were found to have triple the risk of lung cancer and triple the risk of melanoma.
The findings for non-Hodgkins lymphoma and lung cancer agreed with findings from other previous related studies. However, this was thought to be the first study that reported an increased risk of melanoma in rheumatoid arthritis patients treated with methotrexate when compared to the general population. Researchers need to further study whether the findings are unique to Australia and its environmental factors. If further studies confirm a risk of melanoma with methotrexate use, perhaps skin cancer screenings (especially for rheumatoid arthritis patients taking disease-modifying anti-rheumatic drugs like methotrexate) will become an important consideration. According to rheumatologist Scott J. Zashin MD, "Because the rheumatoid arthritis patients were on methotrexate, one does not know if the increased risk was due to rheumatoid arthritis or that the patients were on methotrexate. There are signals that indicate an increased risk of melanoma exists with the TNF blockers (Enbrel, Remicade, and Humira). Hopefully more research will clarify that. Until then, it is good idea for rheumatoid arthritis patients to get a regular skin exam."
In addition to treating rheumatoid arthritis, methotrexate is a treatment option for other conditions including:
The medicine is available as an injectable solution or as oral tablets. Methotrexate injection is given under the skin (subcutaneously). Oral methotrexate is available in 2.5 mg tablets. It's important to remember that the drug is administered once a week for arthritis. The medicine is not taken daily like most medications.
Related Resources:
- The Facts of Methotrexate
- Methotrexate for Rheumatoid Arthritis
- Methotrexate: 10 Facts You Should Know
- In-Depth Report: Melanoma and Other Skin Cancers
- Is Methotrexate Injection Better Than Oral Methotrexate?
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10 Ways to Ensure Drug Safety - Advice for Arthritis Patients
Drug safety is partly the patient's responsibility. Arthritis patients should take certain measures to ensure drug safety. Patients should learn about their medications so they can make informed decisions with their doctor. It's important for patients to fully understand the arthritis medications they have been prescribed.
According to a study of 243 doctor-patient interactions that was published in the Archives of Internal Medicine, when prescribing new drugs, doctors often fail to communicate essential elements of medicine use such as:
- medication name
- dosing information
- potential side effects
- why the drug is being prescribed
- when you may notice improvement
- how long the drug should be taken
- how you will be monitored (i.e., will you need routine blood tests?)
Study researchers reported only 62% of the needed information was shared with patients. Misunderstandings about directions can lead to patients not taking medicine as prescribed. Patients should never take medications if they are unsure about the directions. If you fully understand, you are more likely to be compliant with your arthritis treatment plan.
Don't be shy about getting the answers you need and having the conversations you need to have with your doctor and pharmacist. Read more in 10 Ways to Ensure Drug Safety.
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- Guide to Arthritis Medications
- Arthritis Medications: What Are My Options?
- Traveling With Medications: What You Need to Know
- Reduce the Risks of Using Medicine: Follow S.A.F.E.R.
- 10 Things You Should Do When Given a New Prescription
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Lupus Severity Greater With Southern European Ancestry
There is a correlation between lupus severity and ancestry, according to a presentation at EULAR (the annual congress of the European League Against Rheumatism) and a report from the Arthritis Foundation. From a genetic analysis that involved 1,270 patients with SLE (systemic lupus erythematosus), researchers found that study participants with northern European ancestry were more affected by photosensitivity and discoid lupus rash compared to those of southern European descent who tended to have more severe complications of lupus, including antinuclear antibodies, anticardiolipin antibodies, arthritis, and lupus nephritis (kidney disease).
When compared to Southern European lupus patients in the study, Northern European lupus patients had:
- 62% less risk of antinuclear antibodies
- 36% less risk of anticardiolipin antibodies
- 38% less risk of arthritis
- 25% less risk of lupus nephritis
Researchers believe these findings suggest that -- even in a melting pot like the United States -- it may be beneficial to consider a patient's ancestry when choosing the best approach for managing lupus.
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- Do I Have Lupus?
- Lupus Screening Quiz
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- Test Your Knowledge: Lupus
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Cymbalta Approved for Fibromyalgia Treatment
Cymbalta has been approved by the Food and Drug Administration (FDA) for the management of fibromyalgia. Cymbalta, generic name duloxetine HCl, is a medicine developed by drugmaker Eli Lilly and is available only by prescription. Cymbalta is the first serotonin-norepinephrine reuptake inhibitor that has been proven to reduce pain in fibromyalgia patients.
According to Eli Lilly, some researchers believe fibromyalgia may be caused by a combination of alterations in brain and spinal cord chemistry, genetics, and stress. Other researchers emphasize a heightened sensitivity to pain. How Cymbalta works to relieve fibromyalgia pain is not entirely understood but it's thought that by increasing the activity of two naturally-occurring substances -- serotonin and norepinephrine -- it suppresses pain.
Fibromyalgia symptoms can overlap with symptoms of arthritis and other conditions -- making the syndrome difficult to diagnose. In 1990, criteria for fibromyalgia diagnosis was established which includes a history of widespread pain in all four quadrants of the body (above the waist on both sides; below the waist on both sides of the body) for three months or more and pain at 11 of 18 tender points. Approximately 90% of fibromyalgia patients suffer with severe fatigue or sleep disorders. Other than muscular pain, fatigue, and tenderness, patients also may experience:- anxiety
- depression
- headaches
- pelvic pain
- memory problems
- restless leg syndrome
- irritable bowel or bladder
- noise and temperature sensitivity
- temporomandibular joint disorder
Cymbalta is an important new fibromyalgia treatment option for the estimated 5 million Americans who have fibromyalgia, but the medicine is not for everyone. You and your doctor should discuss the benefits and risks associated with Cymbalta and if you decide to start using the medication -- pay attention to possible side effects and do not stop taking the medication without your doctor's supervision.
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- More About Cymbalta
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Flip-Flops Can Cause Orthopedic Problems and Joint Pain
Flip-flops are a huge part of the summer scene. While they may be stylish and initially comfortable, thong-style flip-flops may actually cause orthopedic problems and joint pain. How could a little pair of shoes do so much harm? Thong-style flip-flops can cause problems for your:
Researchers from Auburn University studied how people walk in thong-style flip-flops compared to athletic shoes. The researchers recruited 39 college-age men and women for the study. It was concluded that flip-flops change body mechanics and can lead to painful conditions and joint problems -- especially if they are worn exclusively. According to biomechanics doctoral student Justin Shroyer, “We found that when people walk in flip-flops, they alter their gait, which can result in problems and pain from the foot up into the hips and lower back”. Read more in Flip-Flops Can Cause Orthopedic Problems and Joint Pain.
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- Foot Osteoarthritis
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- An In-Depth Report: Foot Pain
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- Proper Body Mechanics Important for People with Arthritis
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Prednisolone Comparable to Naproxen for Gout Relief
Gout is recognized as an increasingly common inflammatory joint disease. The condition is considered one of the most painful types of arthritis and it requires fast, effective, and safe treatment. Gout treatment typically includes medication. Since nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine have possible gastrointestinal, renal, and cardiovascular side effects, researchers considered whether corticosteroids may be a useful treatment for gout. Naproxen and prednisolone were compared. In the study, 120 patients were randomly assigned to receive prednisolone (35 mg/once a day) or naproxen (500 mg/twice a day) for 5 days.
According to study results published in the May 31, 2008 journal The Lancet, the reduction in pain scores was statistically similar, leading researchers to conclude that oral prednisolone and naproxen are equally effective in the initial treatment of gout. While corticosteroids like prednisolone are not without their own potential side effects, this may be an option for some gout patients, especially in the acute phase of gout symptoms. Larger studies are likely needed to confirm the findings so that doctors may view it as a valid treatment option for gout patients.
- The Facts of NSAIDs
- The Facts of Corticosteroids
- Colchicine: 10 Things You Should Know
- How to Treat Gout With Diet and Medication
Gout accounts for approximately 5% of all cases of arthritis. The condition occurs in nearly 9 of every 1,000 people. Gout is rare in children and young adults. Men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disorder before menopause.
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- Gout Risk Factors
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- Signs and Symptoms of Gout
- 10 Things You Should Know About Gout
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