Knee pain, arthritis and noisy knees

Many people are worried about their noisy knees.  Read my comments about this in this blog

https://www.drbadshamedical.com/why-is-my-knee-so-noisy/

The science of yoga. Adventures with yoga in Dubai

I am a believer and convert to yoga.  No other form of physical exercise brings such peace and equanimity to the practitioner.

There have been 1000s of studies regarding yoga and its health benefits.  In 2008 we published a landmark study detailing the health benefits of yoga for arthritis.  https://www.ncbi.nlm.nih.gov/pubmed/19184028.

https://www.drbadshamedical.com/conditions-treatments/new-treatments/alternative-therapies/yoga-for-arthritis/

Aplar 2017 in Dubai ( Asia Pacific Rheumatology Conference Dubai ) October 16- 20

We are so pleased and excited to be hosting doctors from around the world to teh rheumatology conference in dubai.

Please follow this link : http://www.aplar2017.com

New medicine for Psoriasis arthritis soon available in Dubai UAE

Psoriatic arthritis is a type of arthritic inflammation that occurs in about 15% of patients who have a skin rash called psoriasis, and it can affect any joint in the body.

Results of a recent clinical trial has revealed that Ixekizumab not only shows considerable promise for the treatment of moderate to severe psoriasis, it looks like it may be a winner for comorbid psoriatic arthritis, too.

According to Dr. Alice B Gottlieb of the Tufts University School of Medicine, the investigational IgG4 humanized monoclonal antibody directed against interleukin-17A brought marked improvements in joint pain, systemic inflammatory burden, and quality of life as well as skin disease in patients with both psoriasis and self-reported psoriatic arthritis. This result of a combined analysis of three phase III clinical trials was reported by Dr. Alice B. Gottlieb at the annual congress of the European Academy of Dermatology and Venereology in Copenhagen recently.

Details of the Study

Of the 3,126 patients with moderate to severe psoriasis who participated in the 12-week trials, 751 (24%) also had self-reported psoriatic arthritis. Dr. Gottlieb’s analysis focused on them.

She was quick to note that the UNCOVER trials were primarily psoriasis studies that relied upon patient self-report of psoriatic arthritis. Nevertheless, it seems likely that the great majority of self-reported psoriatic arthritis patients really did have the rheumatologic disease, since the mean baseline C-reactive protein (CRP) level in that group was 8.43 mg/L, a level far higher than expected in patients with psoriasis only.

In any case, more-rigorous phase III studies of ixekizumab conducted specifically in patients with formally rheumatologist-diagnosed psoriatic arthritis and treated in rheumatology practices are due to be presented at the annual meeting of the American College of Rheumatology in November 2015. And while Dr. Gottlieb wasn’t at liberty to discuss those results, she did hint that the data will be strongly positive.

“If you’re happy about these UNCOVER findings, you’ll be ecstatic about those,” predicted Dr. Gottlieb, professor of dermatology and dermatologist in chief at Tufts Medical Center, Boston.

Also coming up at the American College of Rheumatology meeting will be the results of the first-ever head-to-head comparison of an IL-17 inhibitor versus a tumor necrosis factor–alpha blocker in psoriatic arthritis patients. While at present most physicians consider a TNF inhibitor to be the treatment of choice in patients with psoriatic arthritis,  that view may change as a result of the forthcoming comparative study, according to the dermatologist.

In each of the three phase III UNCOVER studies, patients were randomized to 12 weeks of subcutaneous ixekizumab at 80 mg every 2 or 4 weeks following a 160-mg loading dose, or to placebo. At baseline, the subgroup with self-reported psoriatic arthritis had a mean Psoriasis Area and Severity Index ( PASI) 0f about 21, a self-rated joint pain severity of 50 on a 0-100 scale, a CRP of 8.43 mg/L, and a Dermatology Life Quality Index (DLQI) score of 14.

The Results

Joint pain decreased dramatically in the two ixekizumab groups as early at 2 weeks into the trial, at which point, patients on treatment every 2 weeks averaged a 13.1-point reduction from baseline, with a similar 14.1-point drop noted in those on an every 4 weeks schedule. At week 12, the mean reductions from baseline were 25.2 and 26.8 points, compared with a 1.1-point increase in joint pain among placebo-treated controls.

Inflammatory burden plunged quickly, as evidenced by mean reductions in CRP of 4.63 mg/L and 4.33 mg/L at week 1 with biweekly and monthly dosing, respectively. These reductions were then maintained through week 12.

In terms of improvement in skin symptoms, with ixekizumab dosed every 2 weeks, the PASI 75 response was 89.8% at 12 weeks, the PASI 90 response was 69.3%, and the PASI 100 response (clear skin) was 37.1%. In patients treated every 4 weeks, the rates were 81.1%, 60.8%, and 34.7%.

“There’s good news in both groups, but I think the news is even better in the every-2-weeks group,” Dr. Gottlieb commented.

The ixekizumab-treated groups also showed what Dr. Gottlieb described as “dramatic” improvements – in the 4+ to 5+ point range – in both the mental and physical component scores on the SF-36, another widely used quality of life measure.

Improvements in skin and self-reported joint symptoms appeared to correlate. “Obviously, one needs to look at this more carefully in a phase III psoriatic arthritis study. That’ll provide a more robust answer. But this gives a hint,” she said.

The UNCOVER program was sponsored by Eli Lilly. Dr. Gottlieb serves as an adviser to Lilly and numerous other pharmaceutical companies.

#PsoriaticArthritis #JoinPain #Inflammation #Arthritis

Arthritis medicine can cure baldness! Posted by Rheumatologist in Dubai

A new kind of medicine called JAK (janus kinase ) inhibitor is making waves for being able to cure alopecia areata (a type of baldness), read the full story with the link below

http://news.sciencemag.org/health/2015/10/arthritis-drug-doubles-hair-fertilizer

New oral medication for Rheumatoid arthritis not available yet in Dubai or UAE

Researchers studied the effectiveness and safety of tofacitinib (brand name Xeljanz) in combination with non-biologic DMARDs. Tofacitinib is a JAK (Janus kinase) inhibitor. There were 792 patients with active rheumatoid arthritis involved in the study which was conducted in 114 centers in 19 countries. The study participants were randomly assigned oral tofacitinib (5 mg or 10 mg twice daily) or placebo. At 3 months, patients in the placebo group who did not respond were blindly switched to 5 or 10 mg. tofacitinib twice daily.

Results, published August 20, 2013 in the Annals of Internal Medicine, revealed that response at 6 months was 21% greater for patients taking 5 mg. tofacitinib and 26% greater for patients taking 10 mg. tofacitinib compared to patients who were on placebo for 3 months and then switched to tofacitinib. Optimistic results, yes -- but the study had limitations. Placebo groups were smaller than the tofacitinib groups. Placebo was given for a shorter duration. Patients primarily received methotrexate, not other non-biologic DMARDs. Plus, the assessment of drug combinations other than tofacitinib plus methotrexate was limited. For example, patients were allowed to continue taking corticosteroids during the study.

Do you have steroids for arthritis?

You may have heard people with arthritis talk about what it was like to wean or taper off of prednisone. They describe varying degrees of withdrawal symptoms. For some, it was a nightmare.

It can be worse for people who took the drug for a long time or at a high dose. Prednisone is not a drug that can be stopped abruptly. It must be tapered gradually on a schedule determined by your doctor. Still, there may be withdrawal symptoms.

What has been your experience with discontinuing prednisone?

Doctors treating back pain incorrectly

According to a study published Monday in JAMA Internal Medicine, more physicians are ignoring national guidelines from the American College of Physicians when treating patients with back pain. The group recommends the use of “use of nonsteroidal anti-inflammatory drugs (NSAIDs),” such as ibuprofen and aspirin, combined with physical therapy. However, the study says physicians are instead, “increasingly” prescribing patients with back pain “narcotic drugs, ordering expensive imaging tests or referring them to other physicians.” Furthermore, the study’s lead author, John Mafi, a chief medical resident at Boston’s Beth Israel Deaconess Medical Center, claims that the guidelines “caution against early imaging or other aggressive treatments, except in rare cases.”

Fibromyalgia treatment

According to a Chicago Tribune report, there have been studies that suggested fibromyalgia patients have decreased levels of creatine in their brain and muscle tissues. One previous study suggested that creatine supplements improved fibromyalgia symptoms, but the quality of the study was questioned.

A research team conducted a 16-week double-blind, randomized, controlled trial to evaluate the effect of taking creatine supplements versus placebo. In the study, published online April 1, 2013 in Arthritis Care & Research, creatine supplementation was found to improve muscle strength modestly. But, it had no impact on pain, cognitive function, quality of sleep, or overall quality of life. While the study concluded that creatine supplementation is a "useful dietary intervention" to improve muscle function in fibromyalgia patients, it is important that fibromyalgia patients realize creatine is no panacea.

Lupus test

The ANA test or anti-nuclear antibody is used to test for SLE or lupus.  Normal or healthy people can also test positive for ANA but in low titers.  ANA test greater than 1/160 are significant and need follow up tests.  Tests such as dsDNA or Smith can confirm lupus.  An antiRO and anti La test is suggestive of Sjogren's.  This test should only be done if there is a suspicion of connective tissue disease.

Rheumatoid arthritis treatment in Dubai

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Previous studies have shown that early, intensive intervention can help RA patients achieve remission, and reduce joint damage and disability. Treat-to-target (T2T) is a medical strategy that sets remission – or at the very least, low disease activity – as a goal; specific drugs and doses are stepped up systematically if remission is not reached within certain time periods.

Earlier findings of this Dutch study – called the DREAM trial – showed that remission can be achieved using the T2T strategy among patients with early RA (with symptom duration of one year or less) in the everyday world of daily clinical practice. But could the remission be sustained over the long-term?

A total of 342 patients from the DREAM trial had three-year follow up data for this phase of the analysis. Among them, nearly 62 percent were in remission at the three-year mark. Remission was defined as having a DAS28 score of less than 2.6. DAS28 measures disease activity in 28 key joints and certain blood markers.

Sustained DAS28 remission – defined as a DAS28 of less than 2.6 for six months or more – was achieved by more than 70 percent of patients at least once during the three years, with nearly 75 percent of those patients achieving a sustained remission for greater than a year. At the end of the three-year period, about 43 percent of the study subjects were in a period of sustained remission. The protocol called for a gradual decrease in medication for those experiencing sustained remission – and eventual discontinuation of drug therapy. At the three-year mark, a quarter of the subjects in the remission group were taking no medications.

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.

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. 

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.

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.