Arthritis and running

Congratulations to our patients, some of whom could not walk last year who ran the Standard Chartered 10 k race in Dubai this year!

A cure for Rheumatoid Arthritis? Posted from Dubai. UAE

A researcher from Northwestern University Feinberg School of Medicine has invented a novel way to halt and even reverse rheumatoid arthritis. He developed an imitation of a suicide molecule that floats undetected into overactive immune cells responsible for the disease.


Whimsically referred to as Casper the Ghost, the stealthy molecule causes the immune cells to self-destruct.

The approach, tested on mice, doesn't carry the health risks of current treatments.

"This new therapy stopped the disease cold in 75 percent of the mice," reported Harris Perlman, the lead author and an associate professor of medicine at Feinberg. "The best part was we didn't see any toxicity. This has a lot of potential for creating an entirely new treatment for rheumatoid arthritis."

The study will be published in the February issue of Arthritis & Rheumatism.

Healthy immune cells are supposed to die after they attack an invading virus or bacteria. But in rheumatoid arthritis, the immune cells called macrophages live and go rogue. They proliferate in the blood, build up in the joints and invade cartilage and bone. Currently, there is no effective, nontoxic way to stop them.

Perlman discovered that immune cells in rheumatoid arthritis are low in a critical molecule called Bim, whose job is to order the cells to self-destruct. To correct that shortage, Perlman developed an imitation of the molecule, called BH3 mimetic. When Harris injected his drug into mice with rheumatoid arthritis, it floated ghostlike into their macrophages and bam!, the misbehaving immune cells self destructed.

In his research, Harris showed the molecule could prevent the development of rheumatoid arthritis as well as trigger a remission of existing disease. After the drug was injected in animals with the disease, joint swelling was reduced and bone destruction decreased.

Current treatments for rheumatoid arthritis include low-level chemotherapy and steroids. These are not always effective, however, and they are frequently accompanied by side effects. A newer class of therapy, which is sometimes used in combination with chemotherapy and steroids, is biologic response modifiers. These are antibodies or other proteins that reduce the inflammation produced by the hyperactive immune cells. These biologics don't work for everyone, though, and can be associated with side effects including the risk of infection.

Perlman said the next step is to develop nanotechnology for a more precise method of delivering the drug. His research was supported by the National Institute of Arthritis, Musculoskeletal and Skin Diseases and the National Institute of Allergy and Infectious Disease.

Rheumatology conference 2010

The Emirates Society of Rheumatology (ESR) in conjunction with the producers of Arab Health are pleased to announce the third Emirates Rheumatology conference in Dubai on 10.10.10. This now independent event aims to bring cutting edge information about rheumatic diseases once more to the region. Rheumatoid arthritis and other connective tissue diseases are a leading cause of disability around the world. Through better management of these conditions by Rheumatologists, Orthopedic Doctors, Family doctors and Internists the burden of these diseases will be reduced for patients and their families.

Awards for presentations Best Investigator and Best Young Investigator in the field of Rheumatology will be given again at this year’s conference. Abstracts will be considered from doctors and researchers in the region.

Keeping with tradition, this unique conference will focus on small group sessions, workshops, hands-on training and bring a special emphasis on the most pressing problems facing the region.
Dr. Humeira Badsha,
Consultant Rheumatologist,
Secretary, ESR

Osteoporosis UAE

Osteoporosis risk to one in three woman in UAE
Alison McMeans

Last Updated: October 19. 2009 10:55PM UAE / October 19. 2009 6:55PM GMT ABU DHABI // One in three women in the Emirates is at risk of developing osteoporosis, a disease that causes fragile bones and can sometimes be fatal, according to a study to be released today.

The research, released in conjunction with World Osteoporosis Day, was conducted on 50,000 women in the UAE, Saudi Arabia and Kuwait since the beginning of last year. The women were approached in public venues, such as malls, and offered free bone screening. Half of those in Saudi Arabia were at risk, while the average across the region was two out of five.



When low bone density develops into osteoporosis, bones become brittle and more likely to break. The most serious are hip and spine fractures; overall they take longer to heal in osteoporosis patients, with 20 per cent of people dying and 50 per cent left with a permanent disability. Spinal fractures can also cause compression and lead to “dowager’s hump”, a mostly untreatable and painful ailment.



Yet the disease is “entirely preventable”, said Joanne Todd, a nutritionist and a researcher at Anlene, a line of dairy products fortified with vitamin D that backed the study.

Vitamin D, which is produced by exposure to sunlight and through diet and helps the body absorb calcium, is essential for strong bones. Low levels – common to the region – can lead to a host of health problems including osteoporosis.

Fibromyalgia Treatment - Posted by Humeira badsha Rheumatology Doctor in Dubai UAE

PHILADELPHIA -- Milnacipran (Savella) improved pain and mental functioning in patients suffering from fibromyalgia, researchers said here.
"Significant improvements in pain were seen by the second week of the dose escalation period and were sustained throughout the three-month treatment period," said Lesley M. Arnold, MD, a psychiatrist at the University of Cincinnati College of Medicine.

"An important benefit of milnacipran therapy may be the demonstrated ability to improve mental functioning in addition to pain," she told attendees at the American College of Rheumatology meeting.

Arnold said patients with fibromyalgia suffer a "constellation of symptoms that affect all parts of the body." The symptoms often interfere with sleep, and in turn cause difficulty concentrating.

Milnacipran is a selective, dual serotonin-norepinephrine reuptake inhibitor that was approved by the FDA earlier this year for the management of fibromyalgia.

Arnold reported that 27.7% of patients on milnacipran experienced at least a 50% decrease in 24-hour recall pain scores from baseline to endpoint compared with 18.1% of patients taking placebo (P<0.001).

In addition, after three months of therapy, a greater proportion of patients treated with milnacipran experienced at least a 30% reduction in pain from baseline and also rated themselves as "very much improved" or "much improved" based on the patient global assessment.

"Some patients who rated themselves as globally "much" or "very much" improved experienced a decrease in pain as early as week one of treatment with a stable dose of milnacipran that persisted throughout the study," Arnold told MedPageToday.

Patients also showed significant improvements with the drug relative to placebo on the Mental Component Summary of the Short Form-36 (SF-36) assessment and the Fibromyalgia Impact Questionnaire (FIQ), which evaluates patients' overall ability to function.

Whereas placebo patients had a 0.5-point decrease in SF-36 mental scores from baseline, those on milnacipran had an increase of 1.54 points (P<0.001).

There was also a 5-point improvement in FIQ scores with milnacipran relative to placebo (P<0.001), Arnold reported.

She said the results are consistent with previous trials that have demonstrated the safety and efficacy of milnacipran at doses of 100 mg/day and 200 mg/day.

This phase III, double-blind, placebo-controlled trial of 1,025 fibromyalgia patients was designed to further evaluate the efficacy and tolerability of milnacipran 100 mg/day.

Arnold and her colleagues randomly assigned 516 patients to milnacipran 100 mg/day. Another 509 patients were assigned placebo. The patients underwent four to six weeks of flexible dose escalation, followed by 12 weeks of stable-dose treatment followed by a two-week randomized, double-blind discontinuation phase.

"Fibromyalgia is a huge problem for a great many people," said Daniel Lewis, MD, of the Deakin University Integrative Health Research Unit in Melbourne, Australia. "This study shows that milnacipran appears to be helpful in reducing pain, but its impact in other areas is worth noting."

Lewis said the sleep disturbances and mental confusion are major problems for patients with fibromyalgia.

Arnold reported that the most common adverse event in both treatment groups was nausea, which, like other adverse events, tended to be mild to moderate in severity, with approximately 70% of the incidences in both groups resolved within three weeks after onset.

Discontinuations due to adverse events were 13.9% in the placebo group and 17.8% in the milnacipran group. About eight serious adverse events were experienced by milnacipran patients, six occurred among placebo patients.

"For most patients, milnacipran was well tolerated during the three-month treatment period," Arnold said.

New treatment for Osteoarthritis. Reported By Dr. Humeira Badsha Rheumatologist Dubai, United Arab Emirates

PHILADELPHIA -- Patients who were treated with tanezumab, an investigational monoclonal antibody against nerve growth factor, had relief of osteoarthritis knee pain over the course of a year, researchers said here.
At a dosage of 50 mcg/kg, mean pain scores declined 26 points (SD 30) from a baseline mean of 67 after 16 weeks in the initial randomized, placebo-controlled study, according to Thomas Schnitzer, MD, PhD, of Northwestern University, who presented the findings at a poster session at the American College of Rheumatology's annual meeting.

After another 32 weeks of treatment at that dosage, mean scores declined an additional 9 points, settling at 35 (SD 27) at the end of the extension phase.

Pain scores in patients on higher and lower doses of the drug during the randomized portion appeared to converge toward the mid-30s when they were switched to the 50-mcg/kg dose during the extension.

"Repeated dosing with this compound gives sustained pain relief," Schnitzer said.

Tanezumab's target, nerve growth factor, plays an important role in the development of chronic pain states, such that the pain often takes on a life of its own, Schnitzer said.

Injured and inflamed tissues often show elevated levels of nerve growth factor, which in turns seems to mediate heightened perceptions of pain.

In addition to being studied for osteoarthritis knee pain, tanezumab has also been investigated as a treatment for pain associated with endometriosis, prostatitis, and bone metastases in cancer.

The current osteoarthritis study was an extension of a dose-ranging, placebo-controlled trial that found tanezumab significantly better than placebo in improving patients' walking pain and overall global assessment of response to treatment. That study tested five doses of tanezumab.

In the extension trial, patients on placebo, 10 mcg/kg of tanezumab or 25 mcg/kg of tanezumab said they achieved greater pain relief when switched to the 50 mcg/kg dose of tanezumab.

Schnitzer said patients who had been taking 100 mcg/kg and 200 mcg/kg said they experienced slightly decreased efficacy.

However, the mean pain scores by the end of the study were similar across all the treatment groups, he reported.

"Administration of repeat doses of tanezumab 50 mcg/kg in patients with moderate to severe osteoarthritis knee pain was safe and well tolerated for up to one year," Schnitzer said.

He said 281 patients entered the extension phase of the study. About 40% of the patients were men. The mean age of the group was 59, and 90% were white.

Most adverse events were rated as mild and transient, and none of the serious adverse events experienced in the study were considered drug-related. None of the participants died.

About 11% of the patients discontinued the study for lack of efficacy.

Asked whether a biologic drug could ever be cost-effective as a pain reliever in osteoarthritis -- having no impact on the underlying joint erosion -- Schnitzer said it was not out of the question.

He said it was conceivable that a year's treatment cost with the drug could be in the vicinity of $1,000, which would be competitive with more conventional brand-name drugs.

For example, the COX-2 inhibitor celecoxib (Celebrex) retails for about $1,500 per year at the most common dosage.

Joanne Jordan, MD, MPH, director of the arthritis center at the University of North Carolina in Chapel Hill, N.C., said that an alternative to opioid drugs would be welcome for patients whose pain is not controlled with nonsteroidal anti-inflammatory drugs.

"Patients don't like [opioids]," she said. "They're afraid of them, they worry about dependence."

Jordan agreed that pain in osteoarthritis cases "often doesn't match up with their structural abnormalities," suggesting a neurogenic component that may need to be targeted specifically in therapy.

Poster session discussant Timothy McAlindon, MD, of Tufts Medical Center in Boston, said there was increasing recognition that chronic pain from osteoarthritis may require treatments that go beyond the affected joints.

"We're beginning to recognize that chronic pain [from somatic conditions] has a neurological component," he said.

Treatments targeting pain regulators in the central nervous system are likely to attract more attention from rheumatologists in the future, McAlindon predicted

Vitamin D deficiency in kids

The AP (10/26, Tanner) reports that, according to a study published in Pediatrics, "at least one in five US children aged one to 11 don't get enough vitamin D and could be at risk for a variety of health problems, including weak bones." Harvard University researchers analyzed "data from a 2001-06 government health survey of nearly 3,000 children" who had undergone "blood tests measuring vitamin D levels." The investigators found that "about 20 percent of kids" under 12 had "blood levels that are too low." In addition, "applying a less strict, higher cutoff," the study authors found that "two-thirds of children that age, including 90 percent of black kids and 80 percent of Hispanics, are deficient in vitamin D."