new medication for psoriatic arthritis

Janssen, a Johnson & Johnson company, announced that it has submitted a supplemental Biologics License Application to the United States Food and Drug Administration (FDA) and a Type II Variation to the European Medicines Agency requesting approval of Stelara (ustekinumab) for the treatment of adults with active psoriatic arthritis. Stelara is a human interleukin (IL-12 and IL-23) antagonist. IL-12 and IL-23 are naturally-occurring cytokines thought to be associated with immune-mediated inflammatory diseases.

Stelara was approved by the FDA in 2009 for the treatment of moderate to severe plaque psoriasis in adults. The drug is currently approved in 69 countries for the treatment of plaque psoriasis. The applications requesting approval of Stelara for psoriatic arthritis are backed by Phase III clinical trials that evaluated the safety and effectiveness of 45 mg. and 90 mg. Stelara administered by subcutaneous injection.

tea helpful for osteoporosis

Research has long shown the antioxidant properties and health benefits of drinking tea, but new findings suggest that tea may also have significant preventative properties against chronic disease.

Recent findings were discussed Wednesday at the Fifth International Scientific Symposium on Tea and Human Health in Washington, D.C.

"If there's anything that can confidently be communicated to the public, it's the ability of tea to be associated and demonstrated in the primary prevention of chronic disease," says meeting chair Jeffrey Blumberg, a professor in Friedman School of Nutrition Science and Policy at Tufts University, Boston.

One of those is osteoporosis, the "brittle bone" disease. Green tea in particular may help reduce the risk for fractures and improve bone mass, a leading health concern as people age, suggests a study by researchers at the Texas Tech University Health Sciences Center. "Osteoporosis is a non-curable disease and prevention is key," said Chwan-Li "Leslie" Shen, associate professor of pathology.

In a six-month trial of 171 postmenopausal women with low bone mass, researchers found participants had improvements in bone formation by consuming 500 mg of green tea polyphenol capsules a day, the equivalent of four to six cups of tea, alone or in conjunction with practicing tai chi. Tai chi is a gentle form of exercise based on Chinese martial arts.

Green tea promoted bone remodeling within three months of consumption and reduced oxidative stress damage, Shen said. "Bone loss can be slowed. You can slow the progression. You can delay the onset of osteoporosis."

New medicine rheumatoid arthritis

This is an oral therapy – only avaiable in Japan:
In a clinical study of iguratimod administered as a monotherapy in patients with rheumatoid arthritis, the agent demonstrated superiority over placebo and non-inferiority compared to an existing DMARD (salazosulfapyridine). In addition, in a trial of iguratimod in combination with methotrexate (MTX), the standard of care, conducted in rheumatoid arthritis patients who did not achieve satisfactory benefit with MTX alone, patients who were administered a combination of the two agents demonstrated favorable tolerability as well as significant improvements compared to those treated with placebo (MTX-only arm) in the study’s primary endpoint of ACR20 response rate at Week 24. Out of all the orally-administered anti-rheumatic drugs currently approved in Japan, iguratimod is the first agent evaluated in domestic clinical trials to demonstrate efficacy as an add-on therapy to MTX in patients who did not achieve satisfactory benefit with MTX alone

Anti-inflammtory diet for arthritis

Many types of foods can lessen inflammation in the body.  Examples are foods containing ginger, garlic , turmeric.  In addition diets high in Omega oils are good.  These include fish especially salmon, tuna and tilapia, cod, avocados, nuts such as walnuts and almonds.  Lean proteins such as chicken and fish and soya are advisable.  dairy products, especially low fat yogurt are beneficial.  Include at least 5 servings of fresh vegetables and fruits.  It is preferable to eat the vegetables closer to a raw or undercooked state.  Dark green and brightly colored vegetables have phytochemicals that are useful.  Avoid processed foods and meats, foods high in sodium, white breads, excessive starchy foods, and sugars.  There is no real evidence that night shade plants such as tomatoes, potatoes, egg plant or citrus fruits worsen arthritis. 

For Rheumatologists, Orthopedic doctors, Family doctors taking care of Bone and joint problems in Dubai , Abu Dhabi UAE

The 2nd Bone & Joint Conference is coming back to the Primary Healthcare Congress during the Abu Dhabi Medical Congress on the 16th of October, 2012.  After a successful conference last October, this This October 15th 2012, Abu Dhabi UAE This year’s program is looking to provide a comprehensive and in-depth one day agenda once again.   Covering new topics and the latest advances, there will be four sessions throughout the day: Orthopaedics Workshop, Back Pain Session, Rheumatology and General Rheumatology.  The presentations are geared towards GPs, who often see such cases and would benefit from learning the appropriate methods of diagnoses and treatment from specialists. Accreditation Statement The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Cleveland Clinic Foundation Center for Continuing Education designates this live activity for a maximum of 7.25 AMA PRA Category 1 CreditsTM.   Physicians should claim only the credit commensurate with the extent of their participation in the activity. Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit. Advisory Board: Dr. Donald Ford, Cleveland Clinic Dr. Humeira Badsha, Dr. Humeira Badsha Medical Center Dr. Chris Whately, Medcare Hospital What are the main topics covered in this event? Orthopaedics Workshops Back Pain Session Physiotherapy Rheumatology Lupus

Arthritis in Arab patients (Rheumatology Dubai)

There is limited published data about arthritis in Arab patients.  A research study led by Drs. Thuraya Arissi in Doha , Robert Plenge in Harvard, and supported by Dr. Badsha in Dubai and others in jordan, SA, Syria, is attempting to determine which genes are associated with Rheumatoid arthritis in Arabs.  If you are of Arab ancestry, have rheumatoid arthritis and wish to participate please contact Dr. Badsha at info@drbadshamedical.com.

Rheumatologist in Dubai, UAE

Dr Badsha new location : Dr. Humeira Badsha Medical center, Beach Park Plaza , Jumeira Beach Road Next to Neurospinal hospital.  Phone +9714-3856009.  Email info@drbadshamedical.com

website: www.drbadshamedical.com

New Oral medication for Rheumatoid Arthritis!!

An FDA advisory committee has voted 8-2 in favor of recommending approval of the oral JAK inhibitor tofacitinib for the treatment of rheumatoid arthritis.
The agency's Arthritis Advisory Committee voted Wednesday that the efficacy and safety data support the use of tofacitinib for adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs.
The panel was unanimous in its assessment of the drug's overall efficacy. "The evidence was compelling and was at least as good as for other biologics," said panelist Maria E. Suarez-Almazor, MD, PhD, of MD Anderson Cancer Center in Houston.
The efficacy was demonstrated in five phase III studies in which the primary endpoint was met, showing American College of Rheumatology 20% response rates ranging from 17% to 33% for the 5 mg dose and from 23% to 39% for the 10 mg dose.
"Statistically significant increases were seen on ACR20, 50, and 70 response rates in all five studies," said Nikolay Nikolov, MD, an FDA clinical reviewer.
Less clear was the efficacy as demonstrated on radiographic outcomes, which were assessed in only one study.
Analysis of this structural outcome was hampered by the fact that very little radiographic progression was seen in the placebo group.
In addition, the change in modified total Sharp scores seen in the 10 mg group appeared to be driven by one or more statistical outliers, and the small effect size was influenced by missing data and imputation methods.
"Radiographic outcome studies are difficult to do with limitations on the duration of placebo controls," said panel member David Blumenthal, MD, of Case Western Reserve University in Cleveland.
"We don't need certainty about radiographic outcomes today. That can be followed during postmarketing," Blumenthal added.
There also was considerable discussion about safety concerns that were raised in the phase III trials.
One area of concern was serious infections, which were seen at a rate of three per 100 patient-years, and most commonly were pneumonia and skin and soft tissue infections.
There also were 12 cases of tuberculosis, mostly in countries where the incidence is high, and 19 cases of serious herpes zoster.
Richard Riese, MD, PhD, of Pfizer noted that the company intends to have an action plan for zoster, in which immunization will be encouraged and follow-up data collected.

Osteoporosis gaps in treatment

I spoke at the Musculoskeletal conference in Vienna Austria on May 5th at the Osteoporosis symposium along Prof Ferrari and Resch.  The topic explored missed opportunities in the diagnosis and treatment of osteoporosis and new guideline by the French Society 2012 to address these.

New guidelines For Rheumatoid Arthritis Treatment

The 2008 American College of Rheumatology guidelines for the treatment of rheumatoid arthritis have been updated for 2012, according to a special article published in the May issue of Arthritis Care & Research.

(HealthDay News) — Jasvinder A. Singh, M.B.B.S., M.P.H., from the University of Alabama at Birmingham, and colleagues conducted a systematic literature review to update the 2008 ACR guidelines for the use of disease-modifying antirheumatic drugs (DMARDs) and biologic agents in the treatment of RA.

The panel of authors recommend targeting low disease activity or remission in all patients with early RA and patients with established RA receiving any DMARD or biologic agent. In patients with early RA, DMARD monotherapy is recommended for low and moderate/high disease activity in the absence of poor prognostic features, and combination therapy is advised for patients with moderate/high disease activity and poor prognostic features. After three months of DMARD therapy for established RA, patients with moderate or high disease activity could add or switch among DMARDs or switch from DMARDs to biologic agents. The panel also offers recommendations for treating RA patients who have additional complications, including hepatitis, cancer, and chronic heart failure.

"These recommendations, which focus on common clinical scenarios, should be used as a guide for clinicians treating RA patients, with the clear understanding that the best treatment decision can only be made by the clinician in discussions with patients," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Women's health Conference Dubai UAE

Dr. Humeira Badsha, Activity Director, Women's Health Conference, Dubai, UAE (second from left) with Dr. Scott Butsch, Weight Management Clinic, Massachusetts General Hospital, Harvard MediCal School, Dr. Latha Dulipsingh, Director Joslin Diabetes Center, Connecticut USA, Dr. farroqi, Director Dubai Diabetes Centre, Dubai UAE.

Women's health issues in Dubai, UAE

Gender-based approach needed to broaden understanding of women's health problems in Arab world

April 02, 2012

Dubai, UAE: On average women live six to seven years longer than men. However, the leading causes of death in women such as ischemic heart disease, stroke, lung disease, breast and cervical cancer can be easily prevented through simple screening tests and lifestyle modifications. In the past, work on women's health was focused on the health problems of women during pregnancy and childbirth. A gender-based approach has broadened our understanding of women's health problems and helped identify ways to address them for women of all ages.

The Obs-Gyne Exhibition & Congress 2012, organised by Informa Exhibitions in association with Arab Association of Obstetrics and Gynaecology Societies' (AAOGS), is a platform dedicated to the scientific debate of women's health in the Middle East. Taking place at the Dubai International Convention & Exhibition Centre, the event will continue tomorrow (3 April) with more than 800 industry professionals returning for another day of lectures on the latest practices in midwifery, Obstetrics & Gynaecology, women's healthcare and breast cancer.

According to Dr. Humeira Badsha, Consultant Rheumatologist, Al Biraa Arthritis and Bone Clinic in Dubai, and Advisory Board Member of the Women's Health Programme at Obs-Gyne 2012, cardiovascular disease, for example, is now known to be a major cause of death among women.

"The problem is that this is not well recognised leading to delays in treatment-seeking and diagnosis among women. The identification of gender differences in cardiovascular disease has made it possible to develop more effective health promotion and prevention strategies that have improved women's health in many countries," she says.

At the symposium, stroke and lung disease were also discussed as a major cause of death for women all over the world.

"About nine million women have a stroke each year and three million of these die as a consequence. High blood pressure, diabetes and high cholesterol are the main factors contributing to stroke. Although in this part of the world, women smoke less than their western counterparts, testing and controlling high blood pressure is the only way to prevent this killer disease," Dr. Badsha explains.

Hundreds of millions of women worldwide are affected by chronic lung diseases such as COPD (chronic obstructive pulmonary diseases), asthma and bronchitis with more than three million people worldwide dying from COPD alone. "COPD and asthma are the most common lung diseases in the region although the exact prevalence is unknown, it is under-recognized and the rates are rising," says Dr. Badsha. 

Steroids are a greater risk than methotrexate

In a study published in Annals of Rheumatic disease (feb 2012) the authors conclude that patients who use long term steroids are at a higher risk of non serious infections than patients who use methotrexate.  The risk of infections increases with increased steroid use.

How do you know if your arthritis medications are working?

If you have Rheumatoid Arthritis your Rheumatologist will prescribe medications called disease modifying drus.  In Dubai about 70 percent of Rheumatoid arthritis patients are eventually started on methotrexate.  How do we know if these medications are working?  The Rheumatologist should listen to your symptoms, and ask about you pain levels.  She should then do a thorough joint examination and make a note of how many swollen and inflamed joints you have.  A blood test called ESR and CRP is also used to track inflammation.  All these factors are then put into a computerized scoring system to give a DAS28 or disease activity 28 score.  A score < 2.6 means disease remission and < 3.2 means low disease activity.

Gastritis medications can increase your risk of fracture

According to a National Institutes of Health-funded study published online in the BMJ, "postmenopausal women who use proton pump inhibitors (medicines such as omeprazole, pantoprozole nexium etc) regularly are at increased risk for hip fracture, particularly if they have ever smoked. This is of concern especially in Dubai and the United Arab Emirates where people buy and use these gastritis medications over the counter.  In addition, women here have high levels of vitamin D deficiency and osteoporosis. " In fact, "the risk of hip fracture was increased by 35% among women who used these drugs for at least two years, compared with women who never used them (age-adjusted HR 1.35, 95% CI 1.12 to 1.62, P<0.01 for trend)." What's more, "the risk for fracture rose by more than 50% among women with a history of smoking (multivariate HR 1.51, 95% CI 1.20 to 1.91)," the study found.         For the study, researchers "collected data on almost 80,000 postmenopausal women. "Over the course of eight years, from 2000 to 2008, almost 900 hip fractures occurred -- a 35 percent increased risk for women using PPIs compared to women who didn't take the drugs.

Pomegranate juice good for Rheumatoid arthritis

A new study suggests" that pomegranates "may help relieve symptoms of rheumatoid arthritis. ... In a recent study from Case Western Reserve University School of Medicine," two-thirds of mice given "a daily dose of pomegranate extract" developed chemically induced rheumatoid arthritis (RA), whereas the mice given only water all developed RA. Other research suggests that pomegranate juice "may help reduce the buildup of plaque in arteries and lower blood pressure." and "that when men with prostate cancer drank a cup of pomegranate juice daily, the increase in their levels of prostate-specific antigen (PSA), a marker of disease progress, slowed. Still more preliminary studies hint that pomegranate juice may help manage diabetes and erectile dysfunction." Previous studies have shown that cherry juice concentrate is excellent for gout and decreases flares of gout.

Diagnosing Rheumatoid arthritis

Last week I saw a 50 year old lady from the UK and she had a 6 week history of pain and swelling in her right index finger and also toes.  When I examined her I found swelling and tenderness of 1 joint in the right 2nd finger (PIP) and 2 joints of the toes (MTP).  The signs were so minimal and even though she had a high titer positive Rheumatoid factor I did not believe she had full blown rheumatoid arthritis.  I repeated the rheumatoid factor which came back very high and she also had a positive test for anti- CCP.  Although she had minimal symtoms she was classified as early rheumatoid arthritis and we started her on methotrexate .  In this case the positive tests helped the diagnosis. 

Another patients I saw today had a 6 month history of swelling and tenderness of fingers and toes.  Many joints were involved but she had normal ESR CRP Rheumatoid factor and anti-CCP.  She was told she did not have rheumatoid arthritis.  I told her she has definite rheumatoid arthritis and she was started on treatment.  In this case the clinical signs are more important than the blood tests.

Classification criteria for RA (score-based algorithm: add score of categories A–D; a score of ≥6/10 is needed for classification of a patient as having definite RA)‡
A. Joint involvement §
1 large joint¶	0
2-10 large joints	1
1-3 small joints (with or without involvement of large joints)#	2
4-10 small joints (with or without involvement of large joints)	3
>10 joints (at least 1 small joint)**	5
B. Serology (at least 1 test result is needed for classification)††
Negative RF and negative ACPA	0
Low-positive RF or low-positive ACPA	2
High-positive RF or high-positive ACPA	3
C. Acute-phase reactants (at least 1 test result is needed for classification)‡‡
Normal CRP and normal ESR	0
Abnormal CRP or abnormal ESR	1
D. Duration of symptoms§§
<6 weeks	0
≥6 weeks	1

Milk powder can prevent gout flares. Posted by Rheumatologist in Dubai.

"Daily consumption of enriched skim milk powder could help prevent gout flares," according to a proof-of-conceptstudy published in the Annals of the Rheumatic Diseases. "Compared with patients randomized to receive control treatment with simple powdered lactose, those given enriched skim milk powder had greater reductions in flares of gout during a three-month period (P=0.044), according to Nicola Dalbeth, MD, of the University of Auckland in New Zealand, and colleagues." But "there was no difference in flare frequency for patients given plain skim milk powder rather than the enriched formulation, compared with those given lactose (P=0.81)," the study found.

        "In this study, researchers at the University of Auckland in New Zealand looked at the effects of drinking a skim milk powder enriched with two dairy components, glycomacropeptide (GMP) and G600 milk fat extract (G600), on the frequency of gout attacks in 102 people," WebMD (1/24, Warner) adds. "The people were divided into three groups" and "drank either the enriched milk powder, a plain skim milk powder, or a lactose powder mixed with water as a vanilla-flavored shake each day." The study found that "after three months, the frequency of gout attacks dropped in all three groups" but "those who drank the enriched skim milk had a significantly bigger reduction in gout attacks than those in the other two groups."

Knee replacements on the rise.

A new study published online on 17 January in the journal Arthritis & Rheumatism reports that rates of knee replacement surgery in Finland's 30 to 59-year-olds soared between 1980 and 2006, with women being the more common recipients throughout. Lead author Dr. Jarkko Leskinen, an orthopedic surgeon at Helsinki University Central Hospital, and colleagues also report that the greatest increase was among those aged between 50 and 59.

Knee replacement surgery is the common term for partial and total knee arthroplasty, an operation where part or all of the diseased or damaged surfaces of the knee joint are replaced with metal and plastic parts shaped to allow the patient to move the knee normally.

Arthroplasty is often the only treatment option for people who have severe osteoarthritis (OA) of the knee, as Leskinen explained the press:

"OA risk is shown to increase with age and for severe knee OA arthroplasty is a commonly used treatment option when patients are unresponsive to more conservative therapies."

But although arthroplasty has become increasingly more common, we don't have much information on rates among different parts of the population, and its effects in younger patients.

For their study, Leskinen and collegues looked at records of all unicondylar (partial) and total knee replacements performed between 1980 and 2006 in Finland. These records are kept by the Finnish Arthroplasty Registry.

They looked at how incidence rates of arthroplasty for knee osteoarthritis varied by gender, age, and hospital volume.

Their main findings show that:

• Rates of total knee replacement among those aged 30 to 59 went up 130-fold in the 27-year period.


• The incidence went up from 0.5 procedures per 100,000 of Finland's population to 65 per 100,000.


• The fastest rise happenend between 2001 and 2006 (from 18 to 65 per 100,000).


• There was a similar rapid rise in partial knee replacements: from 0.2 to 10 procedures per 100,000 of the population.


• In the last ten years of the study (1997 to 2006), the rate of total knee replacements was 1.6 to 2.4 times higher in women than in men.


• The rates of total and partial knee replacements were highest among 50 to 59-year-olds.

The researchers conclude that their study demonstrates "the rapid increase in incidences of arthroplasty among patients with primary knee osteoarthritis in Finland, especially in age group of 50 to 59 years of aged."

"There was no single explanatory factor behind this phenomenon though some of the growth might be due to the increase of incidences observed in low and intermediate volume hospitals," they note.

Leskinen said:

"Given that younger patients may be at higher risk of artificial knee joint failure and thus in need of a second replacement surgery, long-term data are needed before widespread use of total knee arthroplasty is recommended for this patient population."

In an accompanying editorial, Dr. Elena Losina, of Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, agrees with Leskinen. She writes that total knee replacement is an effective treatment for OA in older patients, those in their 60s, 70s and 80s.

"However, past performance may not guarantee future success, and with an increasing number of knee replacement recipients under 60 years old, more intensive study of arthroplasty outcomes in younger patients is warranted," she urges.

According to the World Health Organization (WHO), osteoarthritis is the fourth leading cause of years lived with disability worldwide.

Experts estimate that around 10 million people are living with osteoarthritis in the US, where over 600,000 knee replacements were carried out in 2009, according to a report from the Agency for Healthcare Research and Quality. A previous study estimated that by 2030 the number of such procedures could grow by over 670% to nearly 3.5 million a year.

Rheumatoid arthritis treatment in Dubai. Methotrexate, an old drug.

Methotrexate is commonly prescribed and effectively used to treat rheumatoid arthritis andother rheumatic conditions. Methotrexate has the potential for side effects, especially if the drug is not taken exactly as prescribed. Safety warnings about methotrexate should be respected. To enhance patient safety, methotrexate must be taken according to directions. Here are 10 important things you should know about methotrexate.
1 – Methotrexate (brand names Rheumatrex, Trexall) is classified as a DMARD (disease-modifying anti-rheumatic drug).
Methotrexate is classified as a DMARD because it decreases pain and swelling associated with arthritis, and also, methotrexate can lessen joint damage and lower the risk of long-term disability. Improvement from methotrexate may be seen at 6 weeks but it may take 12 weeks or even 6 months of treatment for full benefit to be realized.
2 – Methotrexate was approved by the U.S. Food and Drug Administration in 1988 for the treatment of rheumatoid arthritis.
Methotrexate had been used to treat psoriasis and cancer prior to its approval for rheumatoid arthritis. It is also used to treat other rheumatic conditions including:

• psoriatic arthritis
• lupus
• ankylosing spondylitis (peripheral joint disease)
• vasculitis
• juvenile arthritis (some types)

3 – Methotrexate interferes with certain enzymes which play a role in immune system function.
Methotrexate blocks the enzyme dihydrofolate reductase. By doing so, it affects production of a form of folic acid, which is needed for actively growing cells. It remains unclear exactly how methotrexate decreases arthritis activity.
4 – Methotrexate is taken one day a week for arthritis. It is not taken daily like most pills.
Methotrexate is available in 2.5 mg tablets. The starting dose for most adults with rheumatoid arthritis is 7.5 to 10 mg (i.e. 3 or 4 pills). The 3 or 4 pills are taken together once a week (i.e. the same day each week is optimal). As needed, the dose of methotrexate can be increased to 20 to 25 mg each week. Methotrexate is also available in an injectable form which most patients can self-inject.
5 – It’s important to have liver function blood tests every 8 to 12 weeks to look for any liver-related side effects.
Methotrexate can cause abnormal liver function. It’s important to routinely have blood drawn forliver panels so your doctor can monitor for unwanted side effects.
6 – Alcohol increases the risk of liver damage for people taking methotrexate.
The increased risk of liver damage is significant for people who are drinking alcohol while taking methotrexate. Ideally, you should not drink alcohol if you take methotrexate. At most, with your doctor’s permission, you should have no more than two drinks per month.
7 – Other than abnormalities with liver function, the most common side effects associated with methotrexate are nausea and vomiting.
The side effects already named (nausea, vomiting, liver function) may be dose-dependent. If you have any of these side effects, adjusting the dose may eliminate the problem. Many patients experience no significant side effects while taking methotrexate. Other possible side effects include:

• mouth sores
• rash
• diarrhea
• blood count abnormalities
• cirrhosis of liver (rare)
• persistent cough
• unexplained shortness of breath
• hair loss (gradual)
• sun sensitivity

Methotrexate should not be taken by people with known liver or kidney disease and may need to be temporarily stopped before having surgery.
8 – Folic acid supplementation is required if you take methotrexate.
Since methotrexate is a folic acid antagonist, it must be replenished by taking a 1 mg folic acid supplement daily. Folic acid supplementation should also minimize side effects associated with taking methotrexate.
9 – Methotrexate should not be taken if you are pregnant or plan to become pregnant.
Methotrexate can cause serious birth defects as well as pregnancy complications. You should be using some form of contraception while taking methotrexate and for 3 months after you stop taking methotrexate. It’s important to note that although a woman should not take methotrexate during pregnancy, taking the drug does not decrease the chance for future pregnancies. Aman who plans to get his partner pregnant should stop methotrexate for 3 months prior to conception.
10 – It’s important to remind your doctor of all the medications you take (prescription and over the counter). Some medications and natural remedies may increase methotrexate toxicity.

Drugs known to increase methotrexate toxicity include the antibiotic Trimethoprim (Bactrim).NSAIDs (nonsteroidal anti-inflammatory drugs, though often prescribed together with methotrexate, can affect the level of methotrexate. Your doctor and pharmacist will be aware of unsafe drug interactions.

Rheumatologist in Dubai discusses RA treatment updates

Dr. Humeira Badsha, Rheumatologist, Dubai, discussed treatment of rheumatoid arthritis at a noon conference in City Hospital, Dubai Health Care City on January 11, 2012.  Dr. Badsha discussed ways to assess a patient presenting with joint pain, including joint examination, testing such as anti-CCP and Rheumatoid factor, and the use of ultrasound to assess joints.  In addition, she discussed newer treatments for Rheumatoid arthritis including ant-TNF drugs, and the biologicals, and assessing their efficacy through measurements such as das28 scores.  the talk was accredited for 2 CME hours.

TNF drugs do not increase infection risk in arthritis patients

“Patients with autoimmune diseases who begin treatment with tumor necrosis factor (TNF) inhibitors are no more likely to develop serious infections than those who start treatment with conventional disease-modifying drugs,” according to research presented at the American College of Rheumatology’s annual meeting and published online Nov. 6 in the Journal of the American Medical Association. Specifically, “among patients with rheumatoid arthritis (RA) who initiated treatment with a TNF inhibitor, the rate of serious infection requiring hospitalizations was 8.16 per 100 person-years,” whereas “the rate among patients with RA who started on a regimen using a conventional agent had a rate of 7.78 per 100 person-years, for an adjusted hazard ratio of 1.05 (95% CI 0.91 to 1.21), which was not significantly different.”

Fibromyalgia , managing this in Dubai

I see many patients in Dubai whose fibromyalgia is not recognized or diagnosed for years.

What Is Fibromyalgia?

Fibromyalgia is a common condition associated with muscular pain and fatigue. It occurs more commonly in women than in men especially in women of childbearing age.

Fibromyalgia is not a form of arthritis nor is it associated with inflammation. Instead, fibromyalgia is a form of soft-tissue rheumatism, a broad term
including a group of disorders that cause pain and stiffness around the joints and in muscles and bones.

Symptoms and Signs

Widespread musculoskeletal pain is the most prominent symptom of fibromyalgia. Most individuals complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas. It generally occurs throughout the body, although it may start in one region, such as the neck and shoulders, and may spread over a period of time.

Fibromyalgia pain has been described in a variety of ways, such as burning, gnawing, aching, or as stiffness or soreness. It often varies according to time of the day, activity level, the
weather, sleep patterns and stress. Most people with fibromyalgia say that some degree of pain always is present. They feel the pain mainly in their muscles.
For some people the pain may be quite severe.

Although the results of a general physical examination usually are normal and individuals may look healthy, a specific examination of the muscles of people with fibromyalgia reveals tender
areas at locations known as tender points. Tender points are areas of the body that are painful when pressed. The presence and pattern of these characteristic tender points separate fibromyalgia from other conditions. People often are not aware of the exact location or even the presence of many of these tender points until a doctor performs a tender point evaluation.

Fatigue and Sleep Disturbances

Most people with fibromyalgia have fatigue, decreased endurance, or the kind of exhaustion felt with the flu or lack of sleep. Sometimes the fatigue is severe and a much greater problem than
the pain. Most people with fibromyalgia experience sleeping problems. Although they may be able to fall asleep without major difficulty, they sleep lightly and wake up frequently during the night. They often wake up feeling tired, even after sleeping through the night. The tiredness can range from listlessness and decreased endurance to exhaustion, and can vary from one day to the next.

Nervous System Symptoms

Changes in mood are a common symptom of fibromyalgia. Feelings of sadness or being down are common and some people with fibromyalgia have depression. People with fibromyalgia also may feel anxious. Some researchers think there is a link between fibromyalgia and certain forms of depression and chronic anxiety. However, any person with a chronic illness -
not just fibromyalgia – may feel depressed at times while struggling with their pain and fatigue.

People with fibromyalgia may have difficulty concentrating or performing simple mental tasks. These problems tend to come and go and are often most prominent at times of extreme fatigue or
anxiety. Similar problems have been noted in many people with mood changes, sleep disturbances or other chronic illnesses.

Other Problems

Headaches, especially tension headaches and migraine headaches, are common in people with fibromyalgia. Abdominal pain, bloating and alternating constipation and diarrhoea (called irritable bowel syndrome or spastic colon) also are common. Bladder spasms and irritability may cause urinary urgency or frequency. Additional problems may be associated
with fibromyalgia include cramps, dizziness, pain in the temporomandibular joint (TMJ), hands, arms, feet, legs or face.

How Is Fibromyalgia Diagnosed?

Fibromyalgia cannot be diagnosed with laboratory tests. The results of X-rays, blood tests and muscle biopsies look normal. Therefore, the diagnosis is based on a careful history and physical
examination. According to the American College of Rheumatology (ACR) criteria, a person has fibromyalgia if he or she has a history of widespread pain of at least three months’ duration, and pain in at least 11 or more of 18 specific tender point sites.

Common conditions that may mimic fibromyalgia include hypothyroidism, lupus, rheumatoid arthritis and infections. These can usually be excluded by examination and laboratory tests.

Because the complaints of fibromyalgia are so general and often bring to mind other medical disorders, many people undergo complicated and often repeated evaluations before they are diagnosed
with fibromyalgia. It is important to see a physician or rheumatologist who knows how to diagnose and treat the condition.

What Causes Fibromyalgia?

The cause of fibromyalgia is unknown.
There are many different factors, alone or in combination, may cause fibromyalgia. For example, factors such as an infectious illness, physical trauma, emotional trauma or hormonal changes, may contribute to the generalized pain, fatigue and sleep disturbances that characterize the condition.
Studies have suggested that people with fibromyalgia have abnormal levels of several of the different chemicals that help transmit and amplify pain signals to and from the brain. Whether these
abnormalities are a cause or a result of fibromyalgia is unknown.
How Is Fibromyalgia Treated?

There is no known cure for fibromyalgia. Patients may be reassured that the condition, while painful, does not damage tissues and that it can be managed successfully in many cases.

Treatment options for fibromyalgia include:

Medications to diminish pain and improve sleep;

exercise programs that stretch muscles and improve cardiovascular fitness;

relaxation techniques to ease muscle tension and anxiety;

educational
programs to help you understand and manage fibromyalgia.


Your doctor can create a treatment plan specifically for you. Some people with fibromyalgia have mild symptoms and need very little treatment once they understand what fibromyalgia is and how to
avoid what worsens their condition. Other people, however, require a comprehensive care program, involving medication, exercise and pain coping skills training.

Managing Fibromyalgia

Frequently, people with fibromyalgia have undergone many tests and have seen several specialists in their search for answers. They often are told that because they look well and their tests are
normal, there is nothing wrong with them. Their family and friends, as well as physicians, may doubt the reality of their complaints, increasing their
feelings of isolation, guilt and anger. You and your family should understand that fibromyalgia causes chronic pain and fatigue. You must take an active role
in managing your fibromyalgia by exercising regularly, educating yourself about your condition, and learning how to implement relaxation techniques and stress
management strategies.