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.

Stem Cells for arthritis. Posted by Rheumatologist in Dubai.

Stems cells taken from just a few grams of body fat are a promising weapon against the crippling effects of osteoarthritis.  This interview is from the Chicago Tribune.

For the past two decades, knee, hip or other joint replacements have been the standard treatment for the deterioration of joint cartilage and the underlying bone. But artificial joints only last about 15 years and are difficult to repair once they fail.

Stem cell injections may offer a new type of therapy by either stopping the degenerative process or by regenerating the damaged cartilage, said pioneering researcher Dr. Farshid Guilak, a professor of orthopedic surgery and director of orthopedic research at Duke University.

Guilak, one of the first researchers to grow cartilage from fat, explains why stem cells are a bright light in osteoarthritis research and why widespread clinical use is still years away. Below is an edited transcript of the interview.

Q: How are stem cell injections purported to help?

A: Several studies in animals show that stem cell injections may help by reducing the inflammation in the joint. Stem cells appear to have a natural capacity to produce anti-inflammatory molecules, and once injected in the joint, can slow down the degenerative process in osteoarthritis.

(Since this interview, research published in Stem Cells Translational Medicine has found that stem cells may also be an effective way to deliver therapeutic proteins for pain relief related to rheumatoid arthritis.)

Q: Does the bulk of research look at how stem cells heal traumatic injuries, or does it look at degenerative conditions such as arthritis?

A: Nearly all previous studies on stem cell therapies in joints have focused on trying to repair small "focal" damage to the cartilage. Only a few recent studies have begun to examine the possibility for treating the whole joint, either to grow enough cartilage to resurface the entire joint or to use stem cells to prevent further degeneration.

Q: Meaning one day, entire joint surfaces such as hips and knees could be grown in a lab?

A: That has been one of our primary research goals, so that people with arthritis can simply resurface the cartilage in their joints without having a total joint replacement. To do this, we have developed a fabric "scaffold" that can be created in the exact shape of the joint, while allowing stem cells to form new cartilage. One of our most exciting findings was the discovery that fat tissue contained large numbers of stem cells that could form cartilage and bone. In this way, we could easily get enough cells from a small liposuction procedure to completely resurface a person's worn-out hip or knee.

Q: Is it legal to get stem cell treatment for osteoarthritis in the U.S.?

A: While there is great promise for stem cell therapies, there's little clinical evidence supporting it for arthritis; we don't yet know if this type of treatment is safe in humans, or for that matter, that it even works. Some physicians are offering these treatments without FDA approval, but I feel it is irresponsible and potentially dangerous to perform such a procedure without having a clear understanding of the possible risks and benefits. Several clinical trials are planned and ongoing, mostly outside the U.S.

New test for Rheumatoid arthritis not available in UAE

The only tests available for Rheumatoid arthritis in UAE are rheumatoid factor and anti-CCP>
The 14-3-3eta lab-developed test is based on the 14-3-3eta protein biomarker through an exclusive license agreement in the United States with Augurex Life Sciences. One test provides results of 14-3-3eta blood levels, while a comprehensive panel provides results of blood levels of the novel marker as well as the conventional RA markers CCP antibodies and RF.

Physicians may consider results of RF, CCP antibody and 14-3-3eta tests, along with a medical evaluation and X-rays, to diagnose RA.

Quest Diagnostics already provides the RF and CCP antibody tests, and a panel that incorporates these assays as well as 14-3-3eta has certain advantages, including potentially higher sensitivity for detecting RA, than any of the three markers can provide alone. A panel also allows a physician to test a patient only once and receive a single report.

This “one blood draw, one report” approach is significantly more convenient for the patient and clinician in those cases where a physician may believe consideration of results of all three tests would aid diagnosis.

On the other hand, a physician may not believe results of all three tests are required for a reliable diagnosis or perhaps a patient received certain tests already, perhaps under care of a different doctor, and additional testing would be redundant and unnecessary. In these cases, single tests may be more appropriate.

How do these novel tests allow for early diagnosis of RA?
Research shows that elevated blood levels of the 14-3-3eta biomarker outperform conventional RF or CCP antibody testing for RA. When physicians consider results of all three markers, the sensitivity improves even further.

In addition, co-morbid conditions, such as type 1 diabetes, osteoporosis and gout, do not abnormally raise blood levels of 14-3-3eta.

What to ask your doctor regarding your Lupus?

1. Do I have kidney or other organ involvement?

2. How active is my SLE presently?  Are my C3 C4 low and dsDNA high as these can be signs of active lupus?

3. Should I take calcium and Vitamin D supplements?

4.  I have heard lupus patients are at high risk for heart disease.  Do I need to have my cholesterol checked?

5.  I have heard a medication called Hydroxycholoroquine can reduce lupus flare.  Should I take this?

6.  Should I have a bone density test?