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The Truth About Adult Vaccines and RA

September 2, 2010

True or false? Getting a flu shot can increase your chances of developing rheumatoid arthritis (RA). If you answered, "true," you're not alone. Many people believe that vaccinations can trigger RA. But a large study from Swedish researchers helps put that myth to rest.

The investigators reviewed the 5-year vaccination histories of 4,250 people, ranging in age from 18 to 70. Nearly half the people had RA.

The vaccines investigated were for the flu, tetanus, diphtheria, tick-borne encephalitis, polio, pneumococcus, and hepatitis A, B, and C.

The findings, which were reported online in the Annals of the Rheumatic Diseases, showed that neither the type nor the number of commonly administered adult vaccinations a person receives increases the chances that he or she will develop RA. The findings hold true even for people at increased risk of developing RA, such as those who are genetically predisposed to it and smokers. However, the investigators caution that their findings don't rule out the possibility that rare or previously taken vaccines (such as childhood vaccinations) could trigger the development of RA.

For a list of recommended adult vaccinations, go to the Centers for Disease Control and Prevention (CDC). Many of these vaccines, including flu shots, are recommended for people with RA. However, if you do have RA, it's important to avoid any vaccine that contains live viruses or bacteria as well as attenuated vaccines, which use weakened, but not killed organisms. These include nasally administered vaccines for the flu (FluMist) as well as shots for herpes zoster, Bacillus Calmette-Guérin (BCG), varicella (chickenpox), smallpox, yellow fever, and measles, mumps, and rubella (MMR). To be safe, make sure any health care provider you see for immunizations (for example, at a workplace clinic or free-standing medical center in a retail store) knows that you have RA as well as all of the medications you're currently taking.

Source: Bengtsson C, et al. Common vaccinations among adults do not increase the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Annals of the Rheumatic Diseases. Published online July 5, 2010.

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Alcohol: Rx for RA Symptom Relief?

September 2, 2010

If you're experiencing pain from rheumatoid arthritis (RA), a glass of wine, a beer, or a cocktail might help. A new study reports that drinking alcohol appears to reduce the severity of RA symptoms.

The study, which was published online in the journal Rheumatology, compared the frequency of alcohol consumption by 873 people with RA and 1,004 healthy people.

People who drank alcohol most frequently (more than 10 days in the previous month) had less joint pain, swelling, and disability than those who never drank alcohol or drank it less frequently. In addition, x-rays showed that frequent drinkers had less joint damage, and their blood tests showed lower levels of inflammation. What's more, the study also found that healthy people who were regular drinkers were less likely to develop RA.

It's not clear why alcohol seems to influence susceptibility to RA or the severity of symptoms. It's also unknown whether different types of alcohol might produce different effects and whether drinking behavior over a longer time might produce different results. This study looked only at drinking behavior in the month before the study began.

The bottom line: While these findings suggest that alcohol may have beneficial effects on the development of rheumatoid arthritis and symptoms, they are in no way meant to suggest that drinking is a treatment for RA or a way to prevent it. And if you do drink alcohol for pleasure, do so in moderation. According to the Dietary Guidelines for Americans, that means consuming no more than 1 drink per day for women and no more than 2 drinks per day for men.

Sources: Maxwell JR, et al. Alcohol consumption is inversely associated with risk and severity of rheumatoid arthritis. Rheumatology. Published online July 28, 2010.; and
Dietary Guidelines for Americans 2005

First RA, Next Diabetes?

July 28, 2010

If you have rheumatoid arthritis (RA), you're at risk of developing diabetes, too, say Canadian researchers. The good news is you can take steps to reduce your diabetes risk.

For the study, researchers reviewed data from more than 48,000 people with RA and 40,000 with psoriatic arthritis or psoriasis and compared it with findings from more than 442,000 people who didn't have a rheumatic disease. They found that people who had RA or psoriatic arthritis or psoriasis were 40 to 50% more likely to develop type 2 diabetes.

This doesn't mean that just because you have RA, you're going to develop diabetes. Still, it's smart for everyone to try to prevent it—and it's especially important if you're at increased risk for diabetes. Studies have shown that diet and exercise can help. The largest and best known of these studies, the Diabetes Prevention program, found that people who followed a low-calorie, low-fat diet; exercised 30 minutes a day; and lost and average of 15 lbs. were almost 60% less likely to develop type 2 diabetes than people who didn't follow such a program.

Exercise can be a challenge for people with rheumatoid arthritis, so talk to your doctor about when it's safe for you to exercise and what exercises you should perform. Also ask about getting a fasting plasma glucose test to check for diabetes. The test is typically recommended for people 45 or older and for those under 45 who are overweight or obese (body mass index [BMI] greater than 25).

Source: Solomon DH, et al. "Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis." Annals of the Rheumatic Diseases. Published online June 28, 2010.

The Exercise Paradox: Exercise for Less Pain

July 28, 2010

When you have rheumatoid arthritis (RA), just about the last thing you want to do is exercise. But more and more research suggests that that's exactly what you should be doing.

The most recent evidence comes from French researchers who reviewed 14 studies involving more than 1,000 people with RA. About half of the people regularly performed aerobic exercises like walking, swimming, or bicycling, while the others did conventional nonaerobic activities. The researchers found that the aerobic exercisers had less joint pain and stiffness and greater mobility than the nonaerobic group and their x-rays showed less joint damage. What's more, the aerobic exercisers also reported feeling less fatigued, had a greater sense of well-being, and were better able to cope with life's stresses. The authors note that although the effect of aerobic exercise was small, their findings show that it is safe and helps improve some of the most important issues faced by people with RA.

The American College of Rheumatology recommends 150 minutes of moderate aerobic exercise per week spread out over several days. But before you strap on your gym shoes, talk to your doctor. She or he can refer you to a physical therapist who can design a safe, well rounded program that includes aerobic as well as muscle flexibility and strengthening exercises to increase your range of motion and strengthen your joints. One caveat: if you've been leading a sedentary lifestyle, be sure to start your exercise program slowly, and gradually increase the amount of time you exercise to avoid damaging your joints.

Source: Baillet A, et al. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: Meta-analysis of randomized controlled trials. Arthritis Care and Research. July 2010.

Fewer Pills, More Stomach Protection

June 23, 2010

If you take diclofenac (Voltaren®) for rheumatoid arthritis (RA) pain and have been using omeprazole (Prilosec®) to protect your stomach from gastrointestinal (GI) damage, you might want to rethink that strategy. Results from a new study, released online in advance of publication in The Lancet, suggest that there is a simpler, safer way to achieve both goals.

For the study, investigators randomly assigned nearly 4,500 people with RA or osteoarthritis (OA) to receive either 75 mg of slow-release Voltaren plus 20 mg of Prilosec or 200 mg of celecoxib (Celebrex®) for six months. At the end of the study, they found that patients taking the two-drug regimen were more than four times as likely to have experienced serious GI troubles, such as ulcers, bleeding, or hemorrhage, as those taking only Celebrex—3.8% compared with 0.9%.

One important caveat: This study did not include any patients taking aspirin, which is recommended for individuals at increased risk for heart attack and stroke but also increases the risk of GI damage. Consequently, the findings may not be applicable if you're also on aspirin therapy. The best plan of action: Talk to your doctor about which treatment is most beneficial for your particular situation.

Source: Chan FKL, et al. "Celecoxib versus Omeprazole and Diclofenac in Patients with Osteoarthritis and Rheumatoid Arthritis (CONDOR): A Randomised Trial," Lancet. Published online June 17, 2010. DOI:10.1016/S(10)60673-3

Many RA Patients Need a Vitamin D Boost

June 23, 2010

It's well known that many people with rheumatoid arthritis (RA) suffer from a vitamin D deficiency. But according to findings presented recently at the annual meeting of the European League Against Rheumatism (EULAR), you'll probably need to consume more than the recommended daily allowance (RDA)—currently 200 IU for adults age 19–50, 400 IU for those age 51–70, and 600 IU for people over 70.

A group of Italian researchers identified 100 people with an inflammatory autoimmune disease, such as RA, or a non-inflammatory condition, such as osteoarthritis (OA), who had levels of vitamin D that were below normal. The patients were treated with 800 to 1,000 IU of vitamin D daily for six months. Surprisingly, 70% still had abnormally low vitamin D levels at the end of the study.

This study did not examine whether normalizing vitamin D levels will help alleviate RA symptoms. But there are still lots of good reasons to be sure you're getting enough of this vitamin. One of the most important—vitamin D promotes strong bones by aiding the absorption of calcium, which in turn reduces the risk of osteoporosis. This is critical because studies have shown an increased risk of bone loss and fracture in people with RA. Ask your doctor to check your vitamin D level; it's a simple blood test. If you have a vitamin D deficiency, you may need a prescription-strength supplement to achieve a normal level.

Source: Sainghi PP, et al. "Response to Vitamin D Supplementation in Inflammatory Autoimmune Diseases. A Retrospective Study," Abstract SAT0506. Presented at EULAR 2010. Annual Congress of the European League Against Rheumatism. Rome, Italy. June 19, 2010.

Can You Ever Stop Taking Your RA Medicine?

May 4, 2010

Recent findings from a study involving the rheumatoid arthritis (RA) drug infliximab (Remicade®) suggest that it can induce remission—and that the remission can be maintained in some people for a year after they stop using the medication.

For the study, 102 people with highly active RA (mean disease activity score, 5.5) were treated with Remicade for at least 24 weeks. During treatment, all of the participants achieved a disease activity score below 3.2, indicating that they were in remission, and at that point, they stopped receiving Remicade infusions. One year after discontinuing Remicade, more than half of the participants (56) still had a disease activity score below 3.2, and 43% had a score below 2.6.

Of the 46 remaining patients, 29 experienced a flare within one year, and 17 had disease activity scores higher than 3.2. However, re-treatment was successful in 32 of those patients, and the majority achieved disease activity scores less than 3.2 within six months.

The researchers, who recently reported their findings online in the Annals of Rheumatic Diseases, noted that patients who stayed in remission were more likely than those who didn't to be younger (mean age, 49.5 vs. 56 years) and to have had RA for a shorter time (nearly 5 years vs. almost 8 years). In addition, those who stayed in remission were more likely to have lower disease activity scores (less than 2.225) before discontinuing treatment.

These findings suggest that some patients may be able to discontinue use of these expensive medications—even if they have had rheumatoid arthritis for some time—and that re-treatment is still effective after a drug-free interval.

Hormone Therapy May Prevent Devastating Drug Side Effect

May 4, 2010

Corticosteroid medications, such as prednisone, can produce dramatic improvement in rheumatoid arthritis (RA) pain and inflammation. However, long-term use of corticosteroids is discouraged because, among other things, it increases the risk of bone tissue death (osteonecrosis). The area most commonly affected is the hip bone. Now, however, a new study reports that treatment using the hormone adrenocorticotropic hormone (ACTH) may help prevent this devastating side effect. ACTH is a natural hormone produced by the pituitary gland.

Researchers at the Mount Sinai School of Medicine in New York gave rabbits 10 mg/kg of the corticosteroid methylprednisolone daily for 28 days. Five of the rabbits received injections of a synthetic form of ACTH, cosyntropin (Cortrosyn) in addition to methylprednisolone. ACTH appeared to protect the bone; rabbits that received the combination treatment had half as much dead tissue on the surface of the bone as the corticosteroid-only rabbits. While all of the rabbits had necrotic areas deeper inside the bone, there was less damage in the hormone-treated group.

One major caveat—because the study, which was reported in the Proceedings of the National Academy of Sciences, was performed in animals, it's not clear if the results would be duplicated in humans. However, if results from human clinical trials confirm these findings, doctors could have an effective way to prevent osteonecrosis. Currently, there is no way to prevent the condition, and the only treatment once it develops is hip replacement surgery.

A Surprising Cause of Rheumatoid Arthritis?

April 19, 2010

Could getting too little vitamin D increase your chances of developing rheumatoid arthritis (RA)? That's the intriguing question posed by researchers at Boston University's School of Public Health after they found that women who live in northern latitudes—where there is less exposure to vitamin-D-creating sunlight—are at a significantly increased risk of developing RA.

Using data from the Nurses' Health Study, the investigators compared the health information from 461 women with RA to that from more than 9,000 healthy females. The researchers were surprised to find that women who lived in the northeastern U.S., specifically, Vermont, New Hampshire, and southern Maine, were much more likely to have RA than were women in sunnier regions. It also appeared that the longer a woman lived in those areas, the greater her risk of developing RA.

More studies are needed to confirm these findings, which were reported in the journal Environmental Health Perspectives. In the meantime, it's important to be sure you're getting an adequate amount of vitamin D no matter where you live. How much is adequate depends on your age, where you live, and other factors. Up to age 50, the recommended daily intake is 200 international units (IU). If you're age 51 to 70, shoot for 400 IU, and if you're 71 or older, you should get 600 IU. Keep in mind that some doctors recommend even more, particularly for people who are older, have darker skin, live in northern climates, or are housebound.

To boost your intake, spend 10 to 15 minutes without sunscreen in the sun two to three times a week. Also, eat more foods that are naturally rich in vitamin D, such as salmon, mackerel, and sardines, and fortified foods like milk and orange juice. Still not sure if you're getting enough of the "sunshine vitamin?" Ask you doctor if you should take a vitamin D supplement.

The Benefits of Group Tai Chi for RA

April 19, 2010

Tai chi, a traditional Chinese martial art that combines slow and gentle movements with deep breathing and relaxation, is increasingly being recommended as a good form of exercise for people with rheumatoid arthritis (RA). Now, a new study suggests that taking part in group tai chi may provide even greater benefits.

For the study, Norwegian researchers recruited 15 people with RA to participate in an exercise class known as "Twelve Movement Tai Chi for Arthritis." The class met for one hour, twice weekly for 12 weeks. The disease activity and physical performance of each participant was assessed at the start and end of the study and again three months after the study ended. In addition, two weeks after the study ended, all participants were invited to a focus group to discuss how they felt about the classes.

The results, which were reported in the journal BMC Family Practice, showed that although there was no improvement in disease activity, class participants had improved lower-limb muscle strength and endurance and fewer swollen joints at the three-month follow up. The focus group comments also were positive. The participants felt that the group class helped increase their confidence in their ability to move and that the support and encouragement offered by group members contributed to enhanced enjoyment during exercise.

The findings from this small study must be confirmed by other researchers, but they are encouraging. The exercise program used in this study is the basis for tai chi classes offered by the Arthritis Foundation. If you think you might benefit, check with your local chapter to see if they offer a class near you.

A Drink a Day Might Keep RA Damage at Bay

April 5, 2010

We've all heard that a daily glass of wine is good for the heart. Now, new research suggests that a daily drink may slow the progression of rheumatoid arthritis (RA). The findings were recently reported in the journal Arthritis & Rheumatism.

For the study, Swiss researchers followed nearly 3,000 adults with RA for an average of four years. To monitor disease progression over time, all of the participants had at least two sets of x-rays of their hands and feet during the study. Participants were classified as nondrinkers, occasional drinkers, daily drinkers (1 alcohol-containing drink per day), or heavy drinkers (several drinks per day).

The investigators found that RA progressed more slowly in people who were occasional or daily drinkers compared with nondrinkers and heavy drinkers. Those who were considered to be heavy drinkers showed the greatest progression. Males appeared to benefit more from drinking than females. Interestingly, while light to moderate drinking appeared to slow rheumatoid arthritis progression, it did not significantly improve ability to function.

Although this research needs to be confirmed in additional studies, the findings do suggest that drinking in moderation slows progression of rheumatoid arthritis. This doesn’t mean that nondrinkers with RA should start drinking, but it appears that if you have RA and are a light to moderate drinker with no other alcohol-related problems, there's no reason to give up your daily glass.

A Disturbing Trend?

April 5, 2010

After four decades of sharp decline, rheumatoid arthritis (RA) appears to be on the rise among Caucasian women in the U.S. The news is somewhat better for Caucasian men. Among that group, the rate is holding steady. The reasons why women are taking the hit may surprise you.

The findings are from researchers at the Mayo Clinic who analyzed data from the Rochester Epidemiology Project, a large database of medical records from patients in Olmsted County, Minnesota. Because the majority of the population in Olmsted County is Caucasian, the researchers were not able to estimate the incidence of RA among other racial groups. However, the findings are believed to be reflective of the Caucasian population in the U.S.

An earlier analysis of Olmsted County data obtained from 1955 to 1994 showed a steady decline in the rates of RA among men and women. But, analysis of the most recent data from 1995 to 2007 showed a modest (2.5%) yearly increase in incidence among women, with an average annual incidence of 53 diagnoses per 100,000 women for the entire 12-year period. The actual percentage of women with RA in Olmsted County rose from about .75% in 1995 to nearly 1% in 2005.

During the same period, the rate of RA was stable among men, showing a 0.5% reduction. Approximately 28 men were diagnosed annually for every 100,000 men in the general population, and, during both periods, fewer than .50% of the men had RA.

The researchers postulate that a number of environmental factors could be responsible for the increase among women.

  • Oral contraceptives. Studies have shown that oral contraceptives, which contain synthetic estrogen, protect women against RA. However, because newer oral contraceptives contain considerably less estrogen, they may also offer less protection.
  • Smoking. Cigarette smoking is a known risk factor for RA. Although rates of smoking have declined sharply since 1955, the rates have been declining at a slower pace for women than men.
  • Vitamin D deficiency. A number of studies have suggested that getting too little vitamin D may be associated with the development of RA. Over the past several decades, a growing number of people, particularly women, have been identified as having a vitamin D deficiency.

Does What's On Your Mind Matter?

March 18, 2010

When it comes to your beliefs about medications for rheumatoid arthritis (RA), what's on your mind could matter a lot, particularly if you're worried about the medications you take. That's the word from a group of German researchers who found that people who worry about their medications' side effects are actually more likely to have a drug-related problem than users who aren't concerned. The findings were reported recently in the journal Arthritis Care & Research.

For the study, investigators surveyed 100 people with RA about their beliefs pertaining to the need for their arthritis medication and the risks associated with its use. In addition, they answered questions about drug-related side effects, and they reported how much the symptoms bothered them.

Initially, 77 patients said they had been bothered by side effects. Six months later, 87 of the original participants were available for follow up and more than half (45) of that group said they had experienced side effects, most commonly headaches, gastrointestinal discomfort, and rashes. Interestingly, those who had expressed concerns about their medications at the beginning of the study were more likely to have reported experiencing side effects initially and at six months, particularly if they began taking a new medication during that time.

If you have concerns about a medication your doctor has prescribed, don't hesitate to discuss them with your doctor or pharmacist. A thorough understanding of the true risks associated with the medication may help alleviate some of your worries.

Wound Complications After Ankle Replacement Surgery

March 18, 2010

If you're going to have ankle replacement surgery, there's an important risk you should be aware of: People with inflammatory arthritis, particularly rheumatoid arthritis (RA), may be nearly 10 times more likely to develop major surgical wound complications than people with other risk factors such as diabetes or smoking. This finding is from a study presented recently at the 2010 Annual Meeting of the American Academy of Orthopedic Surgeons.

The investigators reviewed the records of 110 people who had undergone total ankle replacement surgery. The patients' incision site wounds were classified as being uncomplicated, which meant it healed normally without treatment; or as having minor complications, defined as requiring local care and/or oral antibiotics; or as having major complications, requiring a return to the operating room for management. The investigators then assessed the seriousness of complications in relation to several risk factors known to affect wound healing, including age, body mass index (BMI), the presence of diabetes, and smoking.

While diabetes was found to be an independent risk factor for minor wound complications, only inflammatory arthritis, especially RA, was a significant independent predictor of major wound complications. In fact, 57% of patients with inflammatory arthritis required a return visit to the operating room for wound-related problems compared with only 3% of those who didn't have arthritis.

Steven Raikin, M.D., a foot and ankle surgeon and lead investigator for the study, noted that the findings don't suggest that people with RA shouldn't have this operation. However, it's important to discuss this risk with the surgeon.

Feeling Old? It May Be Your RA

March 8, 2010

If you have rheumatoid arthritis (RA) and are feeling beyond your years, it might not be all in your mind. Mayo Clinic researchers report that people who have RA appear to age faster than people who don't have it. Their findings were published recently in the journal Arthritis & Rheumatism.

The researchers examined the medical records of 755 adults with RA diagnosed between 1995 and 2008. During that 12.5-year period, 315 of them died. Although people of similar age and gender would be expected to live to age 82, the median age of death for the RA group was 77 years. According to the research team's statistical estimates, at the time of their RA diagnosis, the physical age of those with RA was two years older than their chronological age. After the diagnosis, for every 10 years of chronological age, people with RA physically aged 11.4 years.

It's not completely clear why RA seems to accelerate aging, but experts believe that damage at the molecular level may be responsible. More studies are needed to determine if treatment that slows disease progression might also impact the mortality rate of people with rheumatoid arthritis.

The Benefits of Yoga for RA Sufferers

March 8, 2010

Yoga is often recommended as a way to relax and improve flexibility, but a new study from researchers at Ohio State University suggests that it offers another benefit for people with RA—it reduces inflammation.

The researchers studied 50 healthy women; half were yoga experts and the other half were novices. Because stress is known to provoke inflammation, the women were asked to participate in a variety of stress-inducing activities, such as solving a difficult math problem without using a pencil and paper. Blood tests revealed that markers of inflammation, particularly, C-reactive protein (CRP) and interleukin-6 (IL-6), were much higher in the yoga novices than they were in the experts. IL-6 levels were 41% higher in the novices, and the inexperienced women were nearly five times more likely than the experts to have a detectable CRP level.

More studies are needed to confirm these findings, but, the researchers conclude that if yoga is indeed able to reduce inflammation, regular practice could have substantial health benefits.

Reassuring News About Leflunomide During Pregnancy

February 23, 2010

Women with rheumatoid arthritis (RA) are counseled not to take leflunomide (Arava®) if they're pregnant, and those who could become pregnant must be using a reliable form of contraception before they start taking it. That's because studies have shown that Arava can cause birth defects in animals. But the safeguards are not 100% reliable, and sometimes a human embryo is inadvertently exposed to this medication. When that occurs, what can the parents expect? Findings from a study conducted by researchers at the University of California, San Diego (UCSD), provide a bit of reassurance about the outcome.

The investigators identified 64 women with RA or juvenile RA who had taken one or more doses of Arava before realizing they were pregnant. All of the women stopped using the drug as soon as they discovered their pregnancy, typically within three weeks of conception. In addition, to reduce the risk to the baby, the women went through a recommended "washout" procedure that rapidly lowers the level of the drug in the bloodstream.

The investigators found that the rate of major birth defects among Arava users was not significantly different from the rate among healthy women and among those with RA who hadn't used Arava. Babies with major birth defects (spinal, urologic, and cranial abnormalities) were born to 5% of Arava users and to 4% of both groups of women who hadn’t used it. On the other hand, babies born to Arava users were significantly more likely to have three or more minor abnormalities (for example, a missing finger or toe or protruding earlobes) than were those born to other women with RA and to healthy women; the rates were 47%, 32%, and 29%, respectively.

While these findings offer some reassurance to women who find themselves in this situation, it's important to note that they apply only to those who stop using Arava early on. Risks associated with use of Arava over the entire period of embryonic development remain unknown.

New Oral RA Drugs in the Pipeline

February 23, 2010

Biologic disease-modifying antirheumatic drugs (DMARDs), such as adalimumab (Humira®) and etanercept (Enbrel®), have been a boon for many rheumatoid arthritis (RA) sufferers who haven't been helped by older nonbiological DMARDs. But one drawback has been their mode of administration: They're given by intravenous (IV) infusion or by injection. Now researchers are investigating new types of nonbiological DMARDs that are also for people who have not been helped by older medications. The good news is that these new drugs can be taken orally. An added plus: If these new medications prove to be safe and effective, they're also likely to be less expensive than the biologics.

Here are two in the drug development pipeline that show promise:

  • CP-690,550. This drug, from Pfizer Pharmaceuticals, belongs to a new class of RA drugs known as janus kinase-3, or JAK3, inhibitors. To date, CP-690,550 has been tested in more than 1,000 people. Preliminary reports suggest that it is as effective as biologic DMARDS and is generally well tolerated. The most common adverse effects were headaches, infections, and gastrointestinal (GI) upset. Phase 2 trial results showed that a 15-mg dose taken twice a day caused liver function test abnormalities. Consequently, phase 3 studies are testing 5- and 10-mg doses, given twice daily.
  • Fostamatinib disodium (R788). This drug, from AstraZeneca, belongs to another new class of RA drugs known as spleen tyrosine kinase (Syk) inhibitors. Preliminary reports from a recent phase 2 study indicate that a 100-mg dose given twice daily reduced RA symptoms in 66% of tested patients. Earlier studies reported that the drug increased blood pressure and liver enzymes and caused GI disturbances and a blood disorder known as neutropenia. However, according to the investigators, all of these adverse effects were reversible.

Health Care Reform: It's Personal

February 8, 2010

Given all the mud slinging, name calling, misinformation, and misperceptions surrounding efforts to reform health care, not to mention the burgeoning Federal deficit, you may have concluded that we should forget the whole thing—that we can't afford it now anyway. But if you or a family member has rheumatoid arthritis (RA), there are many reasons why you can't afford not to support those efforts. That's the word from this country's premier organization for rheumatologists, the American College of Rheumatology (ACR).

You're probably aware that late last year in an effort to rectify many of the problems with our health care system, the U.S. House of Representatives passed the Affordable Health Choices for America Act (H.R. 3962), and the Senate followed by passing the Patient Protection and Affordable Care Act (H.R. 3590). However, you may not know that the ACR supports several provisions of these acts, including efforts to:

  • Prohibit discrimination against people with pre-existing conditions, such as RA. Rationale: People who must buy an individual health insurance policy (because group coverage is not available through an employer) typically find that such policies exclude or severely limit coverage of pre-existing conditions like RA. Worse, an insurer may refuse to sell a health insurance policy to a person with a pre-existing condition.
  • Encourage faster development of generic biologics. Rationale: A number of people with RA benefit greatly from treatment with biologic agents, which slow disease progression. However, these medications are expensive, and many people cannot afford them. Evidence suggests that people who find themselves in this bind will skip their medication, and in the case of RA, the disease will continue to progress. Generic biologics would offer a cost-saving alternative.
  • Eliminate or reduce the Medicare Part D prescription drug coverage gap. Rationale: This year if you're enrolled in a Medicare Part D standard benefit plan, you must pay for your prescriptions until you reach the $310 deductible. After that, you'll pay 25% of the bill for prescriptions until your total drug costs reach $2,830. That's when you reach the "doughnut hole," meaning you must pay 100% of the cost of your prescriptions until your total out-of-pocket costs reach $4,550. The good news is that once that amount is reached, insurance coverage kicks in again. Realistically, however, many older people cannot afford to make the doughnut hole payments, nor can they afford to buy supplemental insurance that would cover those expenses.

What's happening now? Both houses of Congress must come together and pass a single bill that the President can sign into law. If you want to help ensure that these provisions become reality, contact your Senators and your Congressional representative. Tell them that you support health care reform and want it to pass this year. Not sure how to reach them? Go to and click on "Contact Your Elected Officials."

Who Will Benefit From Expensive Biologics?

February 8, 2010

Although biologic agents, such as the tumor necrosis factor (TNF)-blocker etanercept (Enbrel®), reduce symptoms and slow the progression of rheumatoid arthritis (RA), these expensive medications are not effective in up to 50% of people with the condition. But in the future, doctors may be able to tell who will—and who will not—benefit from treatment before initiating therapy.

A study in the February issue of the journal Arthritis & Rheumatism reports that RA patients with higher blood levels of a type of protein known as interferon (IFN) beta were more likely to respond to therapy with TNF blockers than those with lower levels. Patients who had increased IFN-beta/alpha ratios, meaning they had more IFN-beta, were also more likely to respond to therapy. Good responders also had significantly higher levels of another protein known as interleukin-1 receptor antagonist (IL-1Ra).

If these findings are confirmed in a larger study, doctors may soon be able to perform a simple blood test to see who is likely to be a responder to TNF-blocker therapy. People who are less likely to respond can be directed to alternative treatments, sparing them the cost of these drugs and exposure to side effects associated with them.

FDA Approves New Type of Drug for Refractory RA

January 26, 2010

If treatment with a tumor necrosis factor (TNF) inhibitor hasn't improved your rheumatoid arthritis (RA), take heart. The U.S. Food and Drug Administration (FDA) recently approved tocilizumab (Actemra®) for adults with moderate to severe RA who haven't achieved an adequate response to at least one TNF inhibitor. Actemra, which is administered monthly by intravenous infusion, is the first of a new class of RA drugs to be approved by the FDA.

Like TNF inhibitors, Actemra acts directly on the immune system by inhibiting substances called cytokines, which are known to promote inflammation and joint destruction and which are produced in excess in people with RA. Unlike TNF inhibitors, which target the cytokine TNF-alpha, Actemra targets one known as interleukin-6 (IL-6).

As with other medications that suppress the immune system, use of Actemra increases the risk of tuberculosis and other serious fungal, bacterial, and viral infections. Because of the potential for additional serious adverse effects, such as liver damage, hypertension, and gastrointestinal perforation, Actemra should be used only by people who have not improved while taking other approved therapies for RA or who cannot tolerate those treatments.

Actemra's manufacturer, Roche Pharmaceuticals/Genentech, estimates that the monthly cost of the drug will range from $1,060 to $2,125, depending on the dose.

And Speaking of Cost...

January 26, 2010

The economic burden of rheumatoid arthritis (RA) is high. For people with moderate to severe RA, much of that burden can be attributed to a progressive deterioration in their ability to work. But a new study reported recently in the Annals of Rheumatic Diseases suggests that treatment with a tumor necrosis factor (TNF) inhibitor can help RA patients stay on the job and work more hours.

This finding comes from Swedish researchers who analyzed data from nearly 600 adults with RA who were treated with a TNF inhibitor—infliximab (Remicade®), etanercept (Enbrel®), or adalimumab (Humira®)—for up to 5 years. At baseline, the patients worked a mean of 20 hours per week. Six months after beginning RA treatment, the patients were able to work, on average, 2 hours more each week, and by 1 year, they were able to work 4 more hours per week. The number of hours patients were able to work continued to increase through year 5, although the gains were smaller.

The researchers calculate that over 5 years, the increased ability to work among patients who continued to use a TNF inhibitor would offset approximately 40% of the annual cost of these very expensive drugs.

Flu Shot Advice for Rituximab Users

January 12, 2010

If you're being treated with rituximab for rheumatoid arthritis (RA), timing is everything when it comes to the seasonal flu vaccine. A new study from Dutch researchers suggests that when you receive the vaccine in relation to your rituximab infusion can significantly affect the vaccine's efficacy.

The researchers, who recently reported their findings in Arthritis & Rheumatism, administered the 2007–2008 seasonal flu vaccine to 43 people with RA—23 were being treated with rituximab and 20 with methotrexate—and 29 healthy volunteers. Of the people being treated with rituximab, 11 received the vaccine 1 to 2 months after an infusion and 12 received it 6 to 10 months after.

As expected, the healthy volunteers developed sufficient antibodies to the influenza viruses to protect them from the flu. The same was true for those in the methotrexate group. However, the results were not as good for people being treated with rituximab. Those who received the vaccine in the first 2 months after a rituximab infusion failed to develop any protective antibodies against the flu strains included in the vaccine. Those who were vaccinated 6 to 10 months after rituximab treatment did develop some antibodies, but the degree of protection achieved was much lower than normal.

This study is small, but it confirms previous research showing that rituximab decreases the immune response to flu vaccination and provides information about how long that response is dampened.

If you're being treated with rituximab and have already received your flu shot, ask your doctor if you should be re-vaccinated. If you haven't had your flu shot and you're planning to start rituximab treatment or you're due for another infusion, the researchers recommend getting vaccinated first.

RA plus hypothyroidism: A troubling combo

January 12, 2010

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease. But if you add hypothyroidism (a low thyroid hormone level) into the mix, your chances of having a heart attack or stroke climb even higher, according to a recent study in the Annals of the Rheumatic Diseases. Fortunately, medications and lifestyle modifications may help reduce that risk.

Researchers evaluated 257 people who were participating in a study of risk factors for cardiovascular disease in people with RA. Of this group, 21 had low thyroid hormone levels and the remaining 236 had normal levels. Among those with hypothyroidism, 43% had metabolic syndrome—a cluster of risk factors known to increase the chances of developing cardiovascular disease (abdominal obesity; low HDL cholesterol levels; and elevated triglyceride, blood pressure, and blood sugar levels). By comparison, only 20% of those with normal thyroid levels had metabolic syndrome. In addition, women with hypothyroidism were significantly more likely than those with normal thyroid levels to have a high Framingham risk score (an indicator of the risk of having a heart attack in the next 10 years).

A key message of this study: If you have RA and hypothyroidism, particularly if you're female, your doctor should assess you regularly to determine if you have metabolic syndrome. If you have it, ask your doctor about lifestyle and/or pharmacological interventions that could help reduce your risk of developing cardiovascular disease.

Painkiller Reduces Low-dose Aspirin's Heart Healthy Benefits

December 29, 2009

Has your doctor prescribed Celebrex to help your RA pain? If so, and you're also taking low-dose aspirin to help prevent a heart attack or stroke, you may want to talk to your doctor about putting the Celebrex on hold. Here's why.

It's well known that aspirin helps prevent blood clots that can lead to heart attack and stroke. It does this by reducing the stickiness of blood platelets, preventing them from clumping together and forming dangerous artery-clogging clots. That's why doctors frequently prescribe low-dose (81 mg) aspirin for people at risk of having a heart attack or stroke. But researchers at the University of Michigan report that celecoxib (Celebrex) slows the clot-blocking action of low-dose aspirin.

Because this finding, which was reported online earlier this month in the Proceedings of the National Academy of Sciences, was based on studies in animals, it still needs to be replicated in human clinical trials. If the finding is replicated, one option may be to use a higher dose of aspirin. Studies have shown that using Celebrex with a regular (324 mg) aspirin tablet does not affect aspirin's clot-blocking properties. The downside is that serious gastrointestinal side effects can occur when aspirin at this dose is taken regularly. Another alternative may be to increase the interval between the time the low-dose aspirin and Celebrex are taken, but it's not yet clear whether such a tactic would be effective. A third option: Switch to another pain reliever for your rheumatoid arthritis symptoms.

The bottom line: If you're taking Celebrex and low-dose aspirin, don't make any changes to your treatment regimen without talking to your doctor first. But it's worth asking what you should do—if anything—until more conclusive findings are reported.

Do You Have Early RA?

December 29, 2009

Doctors typically diagnose rheumatoid arthritis based on the presence of at least four of seven RA signs and symptoms. But some people, particularly those with early rheumatoid arthritis, may have the disease even though they don't meet the standard diagnostic criteria. Now, Norwegian researchers say they may have a way to identify early RA without using the standard criteria—and a way to predict the course of the disease.

The criteria doctors consider when making a rheumatoid arthritis diagnosis are morning stiffness, arthritis in three or more joint areas, arthritis in the hand joints, symmetrical arthritis, rheumatoid nodules, elevated rheumatoid factor level, and joint damage or erosion on x-ray. RA is diagnosed if the first four symptoms have been present for at least 6 weeks. More tests are necessary if only two or three symptoms are present. But in the Norwegian study, the researchers followed 395 people whose only symptom was one or more swollen joints for at least 4 weeks.

The researchers found that people who had elevated blood levels of a certain antibody (known as anti-CCP) were nearly 40 times more likely to receive an RA diagnosis within a year than those who had normal levels of this antibody. In addition, people who had swelling in a small joint in their hands or feet were six times more likely to be diagnosed with RA in a year than those who had joint swelling in other areas of the body. Those same factors also predicted a worsening prognosis, as indicated by the need for disease-modifying anti-rheumatic drugs (DMARDs).

The results from this study, which were presented earlier this year at the annual meeting of the American College of Rheumatology, may help doctors define new criteria for the diagnosis of early RA and help identify those who will benefit from early treatment with DMARDs.

Nutritional Supplement Eases Rheumatoid Arthritis Pain

December 15, 2009

We've all heard that chicken soup can help banish colds and flu. Now, researchers have discovered that chicken may offer another benefit—helping to ease joint pain and stiffness associated with rheumatoid arthritis (RA).

Investigators at Anhui Medical University in China compared a nutritional supplement made from chicken type II collagen (a protein extracted from chicken breast cartilage) with methotrexate (the standard treatment for RA) in 503 adults with this type of arthritis.

After 24 weeks of treatment, more than 40% of those who took the collagen supplement reported at least some improvement in their rheumatoid arthritis symptoms. Compared with their status at the beginning of treatment, supplement users had significantly less pain and morning stiffness, fewer tender and swollen joints, and better joint function. Not surprisingly, methotrexate users also showed significant improvement, and the improvement in symptoms was greater than that achieved by the supplement users.

Adverse events, mostly mild to moderate stomach troubles, were reported in both groups, although these side effects were significantly more likely to occur in methotrexate users. These findings were reported in the December issue of Arthritis Research & Therapy.

The bottom line: Chicken collagen supplements are available from a variety of manufacturers. However, because the U.S. Food and Drug Administration (FDA) does not approve dietary supplements, there's no guarantee that they're safe. Studies show that some supplements have been contaminated with metals and other dangerous substances. With regard to the safety and effectiveness of chicken collagen supplements in particular, although the results from this study were promising, more research is needed before they can be recommended to treat the symptoms of RA.

Pregnancy & RA: What It Means for You and Your Baby

December 15, 2009

Is a woman with rheumatoid arthritis more likely to have a premature delivery? Are babies born to mothers with RA more likely to have lower birth-weights? A new study suggests that it's not RA itself—but other factors—that have the greatest impact on labor and delivery.

In the study, which was reported in the November issue of Arthritis and Rheumatism, researchers looked at pregnancy outcomes in 152 women with RA to determine the impact of disease activity and medication use.

Overall, disease activity was well controlled, and the birth-weights of infants born to mothers with RA were comparable to those born to healthy mothers. However, women with greater disease activity (e.g., more severe rheumatoid arthritis symptoms) during the third trimester were significantly more likely to deliver a child with a low birth-weight and to need a caesarean delivery. In addition, women who took prednisone during their pregnancy were more likely to deliver earlier—39 vs. 40 weeks—than those who didn't take the medication. What’s more, women who took prednisone were more likely to deliver before 37 weeks.

What do these findings mean? If you have RA and are pregnant or planning to conceive, you should talk to your rheumatologist about the impact of any medications you may be taking. Also, try to find an obstetrician who is knowledgeable about RA and has experience caring for women with this condition. Last, but not least, try to prepare yourself psychologically and physically for the possibility that you may deliver before your due date and that you may need a C-section.

A Better Way to Find Out if Your RA Treatment Is Working?

December 1, 2009

Typically, doctors assess the effectiveness of disease-modifying anti-rheumatic drugs (DMARDs) in much the same way they diagnose rheumatoid arthritis (RA). For example, they check your erythrocyte sedimentation rate (ESR) or C-reactive protein level—both of which are markers of inflammation—examine your joints to see how many are inflamed, and ask how much joint pain you're having and how well you're able to function. The lab test results and your answers help the doctor determine whether to adjust the dose of your medication or, perhaps, try another drug. But a new study in the medical journal Arthritis Research & Therapy suggests there may be a better way.

In this small study, doctors conducted standard lab tests and assessments in 24 patients taking the DMARD infliximab (Remicade®). In addition, they measured the level of the drug in each patient's bloodstream (known as pharmacokinetic monitoring). Based on results from the standard assessment, the doctors reached a preliminary decision about treatment: They could lower, maintain, or increase the dose or discontinue the drug. Surprisingly, however, when the doctors also considered the level of Remicade in the bloodstream, they reached a different decision in 50% of the cases.

Here's how knowing the level of Remicade in your bloodstream could help your doctor determine which treatment is best. If you have persistent active RA and a low concentration of the drug in your bloodstream, you might benefit from a higher dose. If your disease is poorly controlled in spite of a high drug concentration, you could switch to a different drug—and do so sooner rather than later. Or if your disease is well-controlled and you have a high concentration, you might be able to try a reduced dose or a longer interval between doses to decrease the risk of dose-related side effects.

For now, the standard assessment is the standard of care for people with rheumatoid arthritis. But if these results are verified in a large randomized controlled clinical trial, pharmacokinetic monitoring could make its way to your rheumatologist's office.

Where There's Smoke, There's…RA

December 1, 2009

We all understand that smoking may make us short of breath, but until now no one understood that it could also make it nearly impossible to treat rheumatoid arthritis effectively. That's the surprising news out of the 2009 meeting of the American College of Rheumatology. Researchers, lead by Saedis Saevarsdottir, M.D., Ph.D., from the Karolinska University Hospital in Stockholm, presented research that vividly demonstrated how smoking blocks the effectiveness of the most relied-upon drug therapies used to treat rheumatoid arthritis.

Among rheumatoid arthritis patients who were given the gold standard for initial treatment of RA—a disease-modifying drug called methotrexate—smokers were 12% more likely to see treatment failure than nonsmokers. And it didn't matter if they were light or heavy tobacco users.

That's a lot of folks and a lot of extra arthritis pain and mobility problems.

For those who were given anti-TNF therapy (biologics such as infliximab [Remicade®], etanercept [Enbrel®], and adalimumab [Humira®]), 40% of current smokers did not respond, and 25% of those who had never smoked found the therapy ineffective. The lack of response to anti-TNF therapy correlated to the number of cigarettes smoked. Those who had smoked for 15 pack-years (a pack a day for 15 years) had a 31% failure rate; those who had smoked for between 16 and 30 pack-years had a 40% failure rate; and those who had smoked for more than 30 pack-years saw a 43% failure of the anti-TNF drugs.

"Those who needed the immunologically designed anti-TNF drugs, which are now the second-line treatment of choice for those who do not respond to methotrexate, [risk] having poor effect of this expensive medication if they smoke," explained Dr. Saevarsdottir.

Restless Legs Syndrome & Rheumatoid Arthritis

November 17, 2009

If you have rheumatoid arthritis and have noticed that at night or when sleeping your legs feel uncomfortable and you have to move them, you may have restless legs syndrome (RLS). RLS affects people with RA almost 6 times more than the general population—although no one is sure quite what accounts for this.

Problems with iron deficiency, reactions to RA medications, a common neurological disturbance or even, interestingly, activation of the part of the brain that controls crawling in babies, have all been implicated. Whatever the cause of RLS, it is vital that the symptoms be controlled so that sleep patterns do not become totally disrupted and quality of life suffers as a consequence.

Talk to your doctor about medications that may be helpful. And try to find solutions that you can implement yourself. In 2006, a small study found that a combination of moderate aerobic exercise and lower-body resistance training three days a week reduced the severity of RLS symptoms by about 50 percent. The study found that it took six weeks to see maximum benefit from the exercise program. Generally, people with restless leg syndrome have reported that moderate exercise seems helpful and that strenuous exercise may worsen their symptoms. Talk to your doctor about what you can do that will benefit your RA and your RLS problems.

Fighting Gum Disease May Make People with RA Healthier

November 17, 2009

Research suggests that people who have gum disease and also have a severe form of rheumatoid arthritis benefit from having their dental problems addressed. Researchers feel the benefits are a result of reduced systemic inflammation once the gum infection is eliminated. The science of it all focuses on something called tumor necrosis factor (TNF)—an immune system product that helps kill off viruses and tumors, but also can cause runaway inflammation. When the gum disease is squashed, TNF levels in the blood go down.

There are two other important reasons why people with RA should strive to keep their gums as healthy as possible: Rheumatoid arthritis is associated with an increased risk of cardiovascular disease (CVD). And CVD is in turn associated with periodontal disease. Reduce the gum problems and you may reduce the risk of heart disease in patients with RA. Also, poor dental hygiene can increase the risk of infection and rheumatoid arthritis patients have an increased infection risk, especially if they are on immunosuppressants such as TNF blockers (the new biologic RA medicines that have so revolutionized treatment). So you may reduce the risk of infection if you reduce gum problems.

Biologics Don't Increase Cancer Risk

November 8, 2009

Rheumatoid arthritis sufferers who are taking powerful immunosuppressant drugs such as etanercept and infliximab have worried that they may increase their chances of developing cancer. But in the November issue of the journal Arthritis & Rheumatism, a seven-year study of people taking these new biologics, which suppress tumor necrosis factor (TNF), found no increased cancer risk at all.

The study compared people taking the biologics to those who had rheumatoid arthritis but were not taking any medications, those taking methotrexate, and those taking a combination of disease-modifying anti-rheumatic drugs other than TNF-blockers. Over the course of the study, the people taking the TNF-blockers had no increased risk compared to the other groups.

"Our research indicates the overall cancer risk is the same for rheumatoid arthritis patients on immunosuppressant therapies and those not taking medications for the disease," says team leader Dr. Johan Askling, of the Karolinska University Hospital in Stockholm.

Something Fishy? How Omega-3 Fatty Acids May Help RA

November 8, 2009

A new study in the journal Nature reveals how the body converts a chemical found in fish oil into a substance that reduces the inflammation associated with a number of chronic diseases, including rheumatoid arthritis. Fish oil contains DHA, which in the body becomes a substance called Resolvin D2.

Rheumatoid arthritis, and many other conditions, are considered autoimmune diseases. In these cases, the body's natural defenses against infections are mistakenly directed at healthy tissue, triggering inflammation and other problems.

Researchers from London University and Harvard knew that a crucial step in the inflammatory process happens when white blood cells stick to the inner lining (endothelial cells) of blood vessels. So, in the laboratory, they looked at the effect of adding Resolvin D2 to endothelial cells. And voila! It kept the white blood cells from sticking to the lining of the blood vessels.

The scientists conjecture that Resolvin D2 could be the basis for a new arthritis treatment. In the meantime, talk to your doctor about taking fish oil supplements—and make sure your supplement meets the International Fish Oil Standard (IFOS) or ranks high in the Environmental Defense Fund ratings for purity.

Scientists Put Copper and Magnets to the Test

October 20, 2009

Trying to untangle the truth behind the oft-repeated claims that wearing a copper and/or magnetic bracelet can ease the joint pain associated with arthritis, researchers from the Department of Health Sciences at the University of York in the UK studied 45 people with arthritis who were 50 years of age or older. In this study, arthritis patients wore a wrist strap with a magnet (they had two different levels of magnetism), a demagnetized wrist strap, or a copper bracelet. Participants were then asked to rate their levels of arthritis pain over the course of the study. The result: The stiffness, pain, and lack of motion associated with arthritis were not reduced by the bracelets.

"It appears," says Stewart Richmond, a research fellow at the University of York, "that any perceived benefit from wearing a magnetic or copper bracelet can be attributed to placebo effects." The conjecture is that folks buy the bracelets when they are in a lot of pain, and as that pain eases over time they attribute the relief to the magic powers of the metal and magnet.

Pros and Cons of the New RA Drug, Abatacept

October 20, 2009

The latest biologic drug to fight rheumatoid arthritis, abatacept, appears to be highly effective in reducing arthritis pain and slowing the progression of the disease. According to a review of seven clinical trials covering almost 3,000 people, the Cochrane Systemic Review found that compared to placebo, people given abatacept were twice as likely to achieve a 50 percent improvement in rheumatoid arthritis symptoms such as pain and the number of tender and swollen joints. In addition, in the year of follow up after the trial administration of the drug, the people who took it reported no progression of joint damage.

There are some serious health concerns about abatacept. First, the researchers cautioned that if the drug were given in combination with other biologics, there could be serious adverse effects. And they felt there is need for long-term studies to make sure the drug is safe and effects are sustained over the long run.

Nonetheless, they were enthusiastic, overall. "Our review shows that abatacept is indeed effective, and generally well-tolerated, but we would strongly recommend that it is not used with other biologics," says the study's lead researcher, Lara Maxwell, of the Institute of Population Health at the University of Ottawa in Ontario, Canada.

Feeling Down? Speak Up!

October 6, 2009

Depression affects people with rheumatoid arthritis twice as often as people without this chronic disease. And, according to researchers from the University of North Carolina School of Pharmacy, fully 11 percent of RA patients they interviewed were suffering from moderately severe to severe depression, a potentially life-threatening illness that requires medical intervention. Yet a huge number—80 percent!—of folks struggling with this double whammy fail to mention it to their doctor. If this describes you, find out why it is so important that you take steps to treat the depression before it seriously compromises your quality of life and interferes with your therapy for RA.

Over the past decade, research into the interplay of chronic pain associated with rheumatoid arthritis and depression has revealed that there is a feedback loop—depression makes pains worse; arthritis pain makes depression worse. In addition, depression also increases the risk for functional problems in people with rheumatoid arthritis. According to researchers in the Department of Psychological Medicine at the University of Manchester in the UK, among patients with rheumatoid arthritis, "a 10 percent reduction in ability to perform...valued activities is followed by a seven-fold increase in depression over the subsequent year." Interestingly, the opposite is also true. "Depression," they point out, "also precedes increases in disability, predicting poorer functional status, more disability days and more RA-related hospitalizations." But this double association provides good news too, since making improvements in a person's ability to move around and enjoy various activities can lessen depression; and lessening depression can make it easier for a person with rheumatoid arthritis to get around.

As the lead scientist of a recent Arthritis Foundation-funded study of depression, Mary Margaretten, M.D., says, "RA affects people both physically and psychologically. Given that having depressive symptoms along with another disease is known to worsen health outcomes, it is useful to figure out the cause(s) of depression in patients with rheumatoid arthritis."

The bottom line? Make an effort to discuss both your mental outlook and your rheumatoid arthritis symptoms regularly with your health care providers and take steps to alleviate depression as soon possible.

Fast Facts:

  • People with rheumatoid arthritis who are also depressed think that their illness is more serious and feel more hopeless about a cure than people with RA who are not depressed. And this happens no matter whether it is objectively true or not.
  • People with rheumatoid arthritis who are depressed have fewer resources to cope with high levels of arthritis pain or with flare-ups of the disease.
  • Because of these negative reactions, these patients are less likely to seek medical help for either their arthritis or their depression—worsening the cycle.
  • Depressed people with rheumatoid arthritis are less likely to take their RA medication as prescribed. Again the cycle is reinforced.

Smile Patrol

October 6, 2009

The chronic joint inflammation that characterizes RA may play a role in triggering gum disease, according to a study out of the University of Queensland, Australia. But breaking the cycle by reducing gum inflammation can actually ease the pain associated with this autoimmune disease. Take time to find out about the association between RA and periodontal problems—and what you can do to break the cycle.

Examining 65 rheumatoid arthritis patients for periodontal disease—including gingivitis (gum disease) and erosion of the bone that supports the teeth—researchers in Brisbane, Australia, found that study participants had deeper pocketing (gaps between gum and tooth that is a sign of periodontal disease) and had lost more teeth than a control group without the chronic autoimmune disease. In fact, some studies indicate that people with rheumatoid arthritis are eight times more likely to have gum disease than people without RA. And, unfortunately, once periodontal problems starts, they may be more difficult for people with arthritis to take care of: Flossing and brushing the teeth, for example, can be hard to do with painful hands and fingers.

The good news is that working with your dentist to treat the inflammation and infection that accompanies gum disease can reduce painful, swollen and stiff joints that are symptoms of rheumatoid arthritis. "It was exciting to find that if we eliminated infection and inflammation in the gums, then patients with a severe kind of active rheumatoid arthritis reported improvement in the signs and symptoms of that disease," says Nabil Bissada, D.D.S., head of Case Western Reserve University School of Dental Medicine's periodontics department, who worked with Ali Askari, M.D., chairman of the department of rheumatology at Cleveland's University Hospital on another recent study. The investigators identified a microbe in inflamed gums that produces a toxin linked to joint inflammation. "It gives us a new intervention," says Bissada enthusiastically.

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