New Treatment for Osteoarthritis.

The osteoporosis drug teriparatide (Forteo) stopped and even reversed cartilage loss in a mouse model of osteoarthritis," according to University of Rochester researchers. During the study, they severed the "medial collateral ligament in the legs of mice, which quickly leads to degeneration of cartilage in the affected joints -- much as similar injuries in human knees eventually induce osteoarthritis." After some eight weeks, "cartilage area was reduced about 20 percent, compared with mice given a sham surgery." Then, the injured mice received either "teriparatide or placebo immediately, continuing treatment for 12 weeks." By trial end, "teriparatide was associated with 20 to 27 percent more joint cartilage than in placebo-treated mice." The team was even more intrigued by the "mice who did not start drug treatment until eight weeks after the injury." Those mice "had 31 to 35 percent more cartilage at study week 12 (four weeks after starting treatment) than placebo-treated mice."

Fasting and your arthritis.

During the holy month of Ramadan, Muslims including those with arthritis will fast from sunrise to sunset. There has been some evidence of the benefits of fasting and detoxification diets helping arthritis. However, some general precautions should be adhered to. For patients with arthritis, it is always wise to check with your Rheumatologist as to whether you can continue to fast and take medications which may be immune suppressants, or irritant to the stomach. Also the timing of your medications may vary during Ramadan and hence check with your doctor. If you have gout avoid red meats and shellfish. With all forms of arthritis a healthy, balanced diet is helpful. It is important during Ramadan to make sure one does not get dehydrated so take at least 8 -10 glasses of water between iftar and suhoor. Dehydration can be especially bad for those with gout or high uric acid levels, those with multiple medicines for rheumatoid arthritis, or anyone with kidney problems due to lupus. Fruit juices can be consumed in moderation. In fact pineapples contain an enzyme bromelain, which is useful for arthritis. Cherry juice may be helpful for gout. Oily fish or omega or fish oil supplements, ginger, garlic, turmeric, soya bean, avocadoes are some foods which are helpful. Remember to get 1000 mg of calcium from dairy products (1 glass of low fat milk has 290 mg of calcium, 1 cup of yogurt has 250 mg) and enough vitamin D through sun exposure, or else take a calcium supplement with vitamin D. Exercise in moderation. If exercising during fasting it may be wise to reduce your usual exercise duration and intensity by 30%, and be sure to warm up and cool down. Fasting during Ramadan can have many health and spiritual benefits. The Emirates Arthritis Foundation and doctors at Dubai Bone and Joint Center wish you a happy and peaceful holy month.

Study of arthritis in the Emirates

The Emirates Foundation, Abu Dhabi, has awarded the

Emirates Arthritis Foundation a grant of AED 250,000.00 towards research



The welcome funding received from The Emirates Foundation has been allocated to assist with the study of Rheumatoid Arthritis in patients of Arab ancestry. This important research will result in a nationwide database of Rheumatoid Arthritis patients and will help to ascertain the need for financial support, disability and workplace assistance. From this information, EAF will be able to provide relevant assistance to people who most need it.

Rheumatoid Arthritis is a painful disease causing inflammation in the joints. It occurs in patients of all ages, but most prominently in women after the age of 25.

Emirates Arthritis Foundation formed under the patronage of Her Royal Highness Princess Haya Bint Al Hussein

Early Treatment for Rheumatoid Arthritis. Posted Aug 10, Dubai, United Arab Emirates

Investigators say TNF blockers may benefit certain patients with early RA.
HealthDay (8/6, Preidt) reported, "Patients with early rheumatoid arthritis (RA) who respond poorly to standard treatment with methotrexate may benefit from additional treatment with tumor necrosis factor (TNF) blockers," according to a Swedish study published in The Lancet. "Previous research has shown that 20 to 40 percent of patients have a good response to methotrexate therapy and don't need more intensive combination treatment." Aiming to find a way to help the remaining percentage, researchers looked to "487 patients with early RA (less than one year's duration) who were initially treated with methotrexate." Some three to four months after treatment started, "the 258 patients with an inadequate response to methotrexate were randomly assigned to receive either the TNF blocker infliximib (Remicade) or the conventional disease-modifying antirheumatic drugs [DMARDs], sulfasalazine and hydroxychloroquine."
According to WebMD (8/6, Hitti), "one year later, 39 percent of the patients taking methotrexate plus Remicade had only low levels of RA symptoms, compared to 25 percent of patients taking methotrexate plus sulfasalazine and hydroxychloroquine." Lead investigator R.F. van Vollenhoven, MD, was quick to point out that the "difference between the two groups didn't happen right away; the Remicade-plus-methotrexate group took the lead after six months of treatment." Nevertheless, "the researchers aren't recommending anti-TNF drugs for everyone with RA, because anti-TNF drugs are more expensive than conventional drugs and aren't always needed or appropriate."
MedPage Today (8/6, Gever) quoted the authors, "In patients with early rheumatoid arthritis in whom methotrexate treatment failed, addition of a tumor necrosis factor antagonist to methotrexate monotherapy is clinically superior to addition of conventional disease-modifying antirheumatic drugs." The authors of an accompanying editorial, however, "argued that the study should not be interpreted as showing that infliximab is superior to oral DMARDs as the proper partner with methotrexate." In fact, "they noted that a statistical advantage can be found for biologic agents, even though only 20 percent of patients with suboptimal response to methotrexate do better on them." In other words, "the most important information to be gathered from clinical trials in rheumatoid arthritis is not necessarily comparisons of agents, but rather the strategy of tight control, aiming for remission."

New medicine for Osteoporosis in breast cancer patients.Dr. Humeira Badsha, Consultant Rheumatologist Dubai, United Arab Emirates

Amgen says denosumab met goals in late-stage study.
The AP (8/4) reports, "Biotechnology company Amgen Inc. said Monday its drug denosumab met the goals of a late-stage study in treating patients with cancer that has spread to their bones." For the trial, researchers "compared denosumab and" Novartis AG's "Zometa [zoledronic acid] in the treatment of bone metastases in 1,776 advanced cancer patients." Amgen reported that "the two drugs had similar effects in delaying the length of time until a patient's first bone injury and subsequent bone injuries."

The trial also showed that "the time to a subsequent event, the secondary endpoint, was also better than Zometa's, though not by a statistically significant amount," Dow Jones Newswires (8/4, Gryta) reports. Currently, "the US Food and Drug Administration is also reviewing denosumab as a treatment for osteoporosis and bone loss caused by hormone treatment in patients with breast and prostate cancer."

Reuters (8/4, Berkrot) reports that the trial is the second of three planned studies testing the drug in patients with cancer that has spread to their bones. According to Amgen, full details of the trial are expected to be presented at a future medical meeting.

Rheumatoid Arthritis treatment in Dubai UAE, Emirates

In a recent study published in the Annals of Rheumatic Diseases it was found that care of Rheumatoid Arthritis in the uAE has improved and is now comparable to other High GDP countries. The only disparity is low access and use of the newer Biological agents due to their expense and lack of coverage.

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST–RA database

T Sokka,1 H Kautiainen,2 T Pincus,3 S Toloza,4 G da Rocha Castelar Pinheiro,5
J Lazovskis,6 M L Hetland,7 T Peets,8 K Immonen,9 J F Maillefert,10 A A Drosos,11
R Alten,12 C Pohl,12 B Rojkovich,13 B Bresnihan,14 P Minnock,15 M Cazzato,16
S Bombardieri,16 S Rexhepi,17 M Rexhepi,17 D Andersone,18 S Stropuviene,19
M Huisman,20 S Sierakowski,21 D Karateev,22 V Skakic,23 A Naranjo,24 E Baecklund,25
D Henrohn,25 F Gogus,26 H Badsha,27 A Mofti,28 P Taylor,29 C McClinton,29 Y Yazici3
For numbered affiliations see
end of article
Correspondence to:
Dr T Sokka, Arkisto/Tutkijat,
Jyva¨skyla¨ Central Hospital,
40620 Jyva¨skyla¨, Finland;
tuulikki.sokka@ksshp.fi
Accepted 19 May 2009
Published Online First
This paper is freely available
online under the BMJ Journals
unlocked scheme, see http://
ard.bmj.com/info/unlocked.dtl
ABSTRACT
Objective: To analyse associations between the clinical
status of patients with rheumatoid arthritis (RA) and the
gross domestic product (GDP) of their resident country.
Methods: The Quantitative Standard Monitoring of
Patients with Rheumatoid Arthritis (QUEST–RA) cohort
includes clinical and questionnaire data from 6004
patients who were seen in usual care at 70 rheumatology
clinics in 25 countries as of April 2008, including 18
European countries. Demographic variables, clinical
characteristics, RA disease activity measures, including
the disease activity score in 28 joints (DAS28), and
treatment-related variables were analysed according to
GDP per capita, including 14 ‘‘high GDP’’ countries with
GDP per capita greater than US$24 000 and 11 ‘‘low
GDP’’ countries with GDP per capita less than US$11 000.
Results: Disease activity DAS28 ranged between 3.1 and
6.0 among the 25 countries and was significantly
associated with GDP (r = 20.78, 95% CI 20.56 to
20.90, r2 = 61%). Disease activity levels differed
substantially between ‘‘high GDP’’ and ‘‘low GDP’’
countries at much greater levels than according to
whether patients were currently taking or not taking
methotrexate, prednisone and/or biological agents.
Conclusions: The clinical status of patients with RA was
correlated significantly with GDP among 25 mostly
European countries according to all disease measures,
associated only modestly with the current use of
antirheumatic medications. The burden of arthritis
appears substantially greater in ‘‘low GDP’’ than in ‘‘high
GDP’’ countries. These findings may alert healthcare
professionals and designers of health policy towards
improving the clinical status of patients with RA in all
countries.
Health disparities, including high mortality rates,
are associated with low socioeconomic status in
many specific diseases in many countries.1–6
Furthermore, differences in gross domestic product
(GDP) in different countries are associated significantly
with differences in mortality rates among
countries.7–9 Most reports of these observations are
based on surveys and national databases, with
relatively limited information from clinical settings
based on physical examination, laboratory tests,
medications and patient self-report information
concerning functional status, pain, psychosocial
distress, etc, to understand further the basis for
these disparities. Furthermore, little is known
concerning associations of GDP and clinical outcomes
of chronic disabling musculoskeletal conditions
such as rheumatoid arthritis (RA).
A multinational database Quantitative Standard
Monitoring of Patients with Rheumatoid Arthritis
(QUEST–RA)10 11 was established to assess 100
unselected consecutive patients with RA per clinic
and included 25 countries by April 2008.
Considerable variation was observed in clinical
status in different countries according to most
clinical measures, whether derived from the physician,
patient or laboratory, as well as the
composite RA disease activity score in 28 joints
(DAS28) index.12 In this report, we compare
demographic characteristics, RA disease activity
measures and treatment-related variables between
‘‘high GDP’’ and ‘‘low GDP’’ countries, and analyse
associations between DAS28 and GDP.

New treatment for Rheumatoid Arthritis soon in Dubai, United Arab Emirates

Starting September 2009, we will beable to offer a new treatment for Rheumatoid Arthritis,Actemra.

Patients with rheumatoid arthritis treated with ACTEMRA™ (tocilizumab) experienced a rapid and significant reduction in the signs and symptoms of their disease, according to a study published in this week's issue of The Lancet.

Results from the OPTION (TOcilizumab Pivotal Trial in Methotrexate Inadequate respONders) trial
a major Phase III international study - demonstrated that rheumatoid arthritis (RA) patients not only achieved greater improvement of symptoms but also a higher quality-of-life with ACTEMRA, an innovative interleukin-6 (IL-6) receptor inhibitor, compared with methotrexate, a commonly used RA treatment.

"Results of this pivotal study convincingly demonstrate that tocilizumab can effectively and rapidly diminish the painful and debilitating effects of rheumatoid arthritis," said Josef Smolen, M.D., lead investigator of the OPTION trial and Professor of Medicine at the Department of Internal Medicine at the Medical University of Vienna, Austria. "These trial findings are significant because we know that many rheumatoid arthritis patients continue to experience symptoms of joint pain and stiffness, physical disability and fatigue despite treatment with existing therapies."

Rheumatoid arthritis is a progressive autoimmune disease characterized by inflammation of the membrane lining in the joints throughout the body. This inflammation causes distortion of the joint and impaired function accompanied by pain, stiffness and swelling and ultimately leading to irreversible joint destruction and disability. In addition, the systemic symptoms of RA include fatigue, anaemia, osteoporosis and may contribute to shortening life expectancy by affecting major organ systems. Sadly after 10 years, less than 50% of patients can continue to work or function normally on a daily basis.

ACTEMRA is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody and it represents a novel mechanism of action to treat RA. Research has shown that reducing the activity of IL-6, one of several key cytokines involved in the inflammatory process, reduces inflammation of the joints and relieves certain systemic effects of RA.

About the OPTION Study

In the OPTION trial, a three-arm, double-blind, controlled Phase III study, 623 patients were randomized to receive ACTEMRA intravenously (either 4mg/kg or 8mg/kg) every four weeks plus methotrexate weekly or placebo infusions plus methotrexate weekly. The study was conducted in 73 trial sites in 17 countries outside the United States.

At 24 weeks, 58.5% of ACTEMRA patients (8mg/kg) achieved a 20% reduction in RA symptoms (ACR20)1, compared with 26.5% of patients in placebo plus metrotrexate patients. In the study, 43.9% of patients treated with ACTEMRA (8 mg/kg) plus methotrexate achieved at least a 50% (ACR50) reduction in symptoms compared to 10.8% of patients receiving placebo and methotrexate; ACR70 was achieved in 22% of the treatment group versus 2% in the control group. A rapid decrease in disease activity (DAS28)2 was seen as early as two weeks in a greater proportion of patients treated with ACTEMRA plus methotrexate, with 27.5% achieving clinical remission (DAS28≤ 2.6) by 24 weeks.

Additionally, results showed that 80% of patients in the ACTEMRA (8mg/kg) plus methotrexate group responded with moderate to good improvements in RA symptoms, according to the EULAR response criteria3, compared with 35% for those treated with placebo and methotrexate at 24 weeks.

The OPTION trial also assessed physical function and quality-of-life at baseline and every four weeks thereafter. Patients receiving ACTEMRA achieved significantly greater improvement in areas of fatigue and mental function at 24 weeks, and achieved normal levels of hemoglobin and C-reactive protein (CRP), a marker of inflammation due to RA, compared with patients receiving placebo plus methotrexate.

About ACTEMRA

ACTEMRA is the result of research collaboration by Chugai and is being co-developed globally with Chugai. ACTEMRA is the first humanized interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody. An extensive clinical development program of five Phase III trials was designed to evaluate clinical findings of ACTEMRA. Three other studies are completed and have reported meeting their primary endpoints. A fifth trial, a two-year study called LITHE (TociLIzumab safety and THE prevention of structural joint damage), is currently underway and is expected to report preliminary first-year data in 2008. ACTEMRA is awaiting approval in the United States and Europe. In Japan, ACTEMRA was launched by Chugai in June 2005 as a therapy for Castleman's disease; in April 2006, additional indications for rheumatoid arthritis and systemic-onset juvenile idiopathic arthritis were also filed in Japan.

ACTEMRA is generally well tolerated. The overall safety profile of ACTEMRA is consistent across all global clinical studies. The most common, non-serious, adverse events reported are upper respiratory tract infection, nasopharyngitis, headache and hypertension. As with other biological disease modifying anti-rheumatic drugs (DMARDs), serious infections and hypersensitivity reactions including a few cases of anaphylaxis, have been reported in some patients treated with ACTEMRA. Increases in liver transaminases (ALT and AST) were seen in some patients; these increases were generally mild and reversible, with no hepatic injuries or any observed impact on liver function.