PSORIATIC ARTHRITIS NEWSLETTER NO. 6

[Guest guest]

PSORIATIC ARTHRITIS NEWS AND VIEWS

VOL. 1 ISSUE 6 December 8, 2001

PSORIATIC ARTHRITIS MEDICAL NEWS

Before we begin with the latest news, I would like to take this opportunity

to publicly say how glad I am that Atwood Stack is home again and on

the mend. We are privileged to have as our founder and once again

she has proven how tough she can be in facing the daily challenges of her

life.

FDA APPROVES NEW COX-2 INHIBITOR -WASHINGTON (Reuters Health) Pharmaceutical

makers Pharmacia Corp. and Pfizer Inc. jointly announced on Monday that

Pharmacia has received approval from the US Food and Drug Administration

(FDA) to market a new COX-2 inhibitor, offering a once-a-day treatment

regimen for osteoarthritis. The companies said that Pharmacia received

approval for Bextra (valdecoxib tablets), a COX-2 inhibitor that would also

be indicated for the treatment of adult rheumatoid arthritis and for

menstrual pain. Pfizer is Pharmacia's co-promotion partner.

The companies said that the approval of Bextra was based upon global clinical

trials, involving more than 5,000 patients. In those clinical trials, the

companies said that the 10 mg tablet of Bextra taken once daily was shown to

be as effective as the commonly prescribed doses of other NSAIDs, including

ibuprofen, diclofenac and naproxen for the treatment of osteoarthritis.

Pharmacia spokesman Craig Buchholtz told Reuters Health that the exact launch

date and price per dose had yet to be determined.

Merrill Lynch securities analyst Tighe said that he expects 2002 sales

of Bextra to generate about $450 million in revenues. Tighe said that these

estimates were in part based upon the fact that the FDA approval was received

ahead of schedule, giving the companies a jump on Merck's second generation

COX-2 inhibitor Arcoxia (etoricoxib).

Merck just filed for the approval of Arcoxia in the last couple of months.

Copyright © 2001 Reuters Ltd.

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Editors note: This is the second in our series about less common forms of

arthritis. Our last issue covered Anklosing Spondylitis.

INFECTIOUS ARTHRITIS Joint pain, soreness, stiffness and swelling may follow

an infection involving several types of agents, including bacteria, viruses

and even fungi. These infections may affect one part of the body (for

example, through the lungs during pneumonia) and infect the joint after

spreading through the bloodstream. They may enter the joint through a nearby

wound. Sometimes, tissue around the joint can become infected after surgery,

an injection or trauma. Once the infectious agent reaches the joint, it can

cause symptoms of joint inflammation and, at times, fever and chills.

Depending on the type of infection, one or more joints may be affected. For

example, bacteria tend to cause infection of only one joint, often the knee.

Small joints -- the fingers and toes -- are more likely to become infected

after an inoculation or bite. Among intravenous drug users, less commonly

infected joints, such as those in the spine or sternum (breastbone), may be

involved. People who already suffer from rheumatoid arthritis or other joint

disease are at increased risk of infectious arthritis.

Certain infectious agents may cause reactive " arthritis, in which the

infectious agent is no longer present; but weeks, months or even years later,

arthritis develops as a reaction to the prior infection. This is thought to

occur because, in genetically susceptible people, part of the bacteria looks

similar to proteins present in the joint, setting off an autoimmune

inflammatory reaction. In this way, the infection may cause an ongoing

arthritis long after it has come and gone. Infections of the genital and

gastrointestinal tract are the most common triggers of reactive arthritis.

SYMPTOMS

Joint pain and stiffness, typically in the knee, shoulder, ankle, finger,

wrist or hip. Warmth and redness in surrounding tissue.

Chills, fever, weakness.

Skin rash.

It is unusual for joint deformity to result from infectious arthritis if it

is promptly detected and appropriately treated. Some of the more common types

of infectious arthritis include:

LYME DISEASE

Lyme disease is caused by bacteria that live in the deer tick and are

transmitted through a tick bite into a person's bloodstream. Also called Lyme

arthritis, this form of infectious arthritis is named for the Connecticut

town where it was first observed. Lyme disease is only found in parts of the

world where the appropriate ticks are found; in the United States, most cases

are described in coastal New England (Massachusetts, Rhode Island and

Connecticut), New York, New Jersey, Pennsylvania, Wisconsin and Minnesota.

After a person is bitten by a tick, a large, round, red rash (called erythema

migrans) usually develops around the bite; there is often a normal-appearing

area of skin in the center. Flu-like symptoms may develop, including fever,

headaches, chills, body aches, stiffness, nausea, fatigue and sore throat.

The symptoms of Lyme disease often mimic those of other diseases. In

addition, considerable time can pass between the first appearance of the rash

and the next wave of symptoms. Because the bite goes unnoticed and the rash

may be overlooked, Lyme disease is not always suspected initially. When the

infection is not treated, further symptoms develop, most seriously joint

inflammation (most commonly, the knee), neurological symptoms (confusion,

convulsions, muscle weakness), and an abnormally slow heart rate that may

lead to fainting. Antibiotic treatment (either orally or intravenously)

usually cures the illness. A pacemaker may be necessary for the abnormal

heart rhythm.

GONOCCAL OR GONORRHEAL ARTHRITIS

Gonorrhea is a sexually transmitted bacterial infection that produces, among

other symptoms, pain in one or more joints and/or tendons. There may also be

a rash and fever associated with this type of infectious arthritis. About a

third of all those who contact gonorrhea report joint pain, although actual

infection is probably much less frequent. STAPHYLOCCAL ARTHRITIS

The staphylococcal bacteria can be released in the bloodstream and spread to

the knee or other joints, causing intense and sudden pain, swelling and

immobility of the joint. This is a serious condition because joint damage may

develop in a matter of days if the infection is not promptly detected and

treated.

TUBERCULOSIS

Tuberculosis, an infectious disease caused by the tubercle Bacillus, is

characterized by inflammation, abscesses (pus-filled pockets), necrosis

(death of tissue), calcification (accumulation of calcium deposits) and

fibrosis (abnormal formation of fibrous, or scar, tissue). Although

tuberculosis is most commonly associated with the lungs, it can affect other

parts of the body, including the gastrointestinal tract, the nerves, lymph

system and skin, as well as bones and joints. The inflammation in joints

caused by tuberculosis tends to be less dramatic than some other bacterial

infections, so a more chronic arthritis may develop unless antibiotic therapy

is administered.

VIRAL ARTHRITIS

Viruses are minute organisms that depend on the nutrients found inside living

cells to thrive and reproduce. Among the more than 300 known viruses, many

cause important infectious diseases, including colds, upper respiratory

infections, HIV, hepatitis, rubella and mumps among others. Arthritis can

arise in connection with many of these viral infections. In general, the

arthritic symptoms will disappear in a few days, when the underlying disease

runs its course. Many joints may be simultaneously affected; in fact, viral

infections may mimic rheumatoid arthritis except that with most types of

viral arthritis complete resolution is observed within several days or weeks.

Some viruses, including hepatitis B and C and HIV, may cause a more chronic

infection along with joint pain or inflammation.

DIAGNOSIS

If your doctor suspects that your arthritic symptoms are related to a

bacterial infection, he or she will likely draw fluid from the affected joint

with a needle (after providing numbing medication to the area) in order to

have it analyzed in the lab. Blood and urine tests may also be helpful. When

a sexually transmitted disease is the suspected cause, a pelvic examination

(for women) and penile swab (for men) may be recommended to detect the

underlying infection. For most viral disease, no specific tests are helpful;

for the more chronic and serious agents, such as hepatitis B and C and HIV,

accurate antibody tests for diagnosis are available.

TREATMENT

Because many bacterial infections can rapidly and permanently destroy the

cartilage around the joints, a joint infection needs to be treated

immediately. If bacterial infection is involved, antibiotics will be

prescribed. Viral infections do not respond to antibiotics, although

antiviral therapies are available for some (for example, HIV infections may

be treated with a number of antiviral medications, often in combination);

aspirin or ibuprofen may be taken to alleviate the pain and swelling during

the time it takes for the infection to run its course. Fortunately, viral

infections do not cause joint damage as a rule. In cases in which the

underlying condition is chronic, treatment will target pain and swelling

throughout the course of the disease.

Sometimes, hospitalization may be recommended in order to drain the infected

joint and to allow rest of the joint. In some cases, the joint may need to be

opened surgically so that damaged tissue can be removed. It may be difficult

to determine whether surgical intervention during a bacterial joint infection

is necessary, as studies comparing surgery to a more conservative approach

have not been performed. Surgery is rarely necessary for those bacteria

associated with sexually transmitted diseases. If serious damage has already

occurred, surgical reconstruction of the joint may be considered.

While the joint is recovering from the infection, it may be necessary to

immobilize the joint with a splint. After the joint recovers, physical

therapy may be necessary to restore strength and mobility.

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CURRENT RESEARCH IN RHEUMATOID ARTHRITIS FROM NIH

The National Institute of Arthritis and Musculoskeletal and Skin Diseases

A broad look at what the NIH is doing in research for rheumatoid arthritis.

Over the last several decades, research has greatly increased our

understanding of immunology, genetics, and cellular and molecular biology.

This foundation in basic science is now showing results in several areas

important to rheumatoid arthritis. Scientists are thinking about rheumatoid

arthritis in exciting ways that were not possible even 10 years ago. The

National Institutes of Health funds a wide variety of medical research at its

headquarters in Bethesda, land, and at universities and medical centers

across the United States. One of the NIH institutes, the National Institute

of Arthritis and Musculoskeletal and Skin Diseases, is a major supporter of

research and research training in rheumatoid arthritis through grants to

individual scientists, Specialized Centers of Research, and Multipurpose

Arthritis and Musculoskeletal Diseases Centers.

Following are examples of current research directions in rheumatoid arthritis

supported by the Federal Government through the NIAMS and other parts of the

NIH.

Scientists are looking at basic abnormalities in the immune systems of people

with rheumatoid arthritis and in some animal models of the disease to

understand why and how the disease develops. Findings from these studies may

lead to precise, targeted therapies that could stop the inflammatory process

in its earliest stages. They may even lead to a vaccine that could prevent

rheumatoid arthritis.

Researchers are studying genetic factors that predispose some people to

developing rheumatoid arthritis, as well as factors connected with disease

severity. Findings from these studies should increase our understanding of

the disease and will help develop new therapies as well as guide treatment

decisions. In a major effort aimed at identifying genes involved in

rheumatoid arthritis, the NIH and the Arthritis Foundation have joined

together to support the North American Rheumatoid Arthritis Consortium. This

group of 12 research centers around the United States is collecting medical

information and genetic material from 1,000 families in which two or more

siblings have rheumatoid arthritis. It will serve as a national resource for

genetic studies of this disease.

Scientists are also gaining insights into the genetic basis of rheumatoid

arthritis by studying rats with autoimmune inflammatory arthritis that

resembles human disease. NIAMS researchers have identified several genetic

regions that affect arthritis susceptibility and severity in these animal

models of the disease, and found some striking similarities between rats and

humans. Identifying disease genes in rats should provide important new

information that may yield clues to the causes of rheumatoid arthritis in

humans.

Scientists are studying the complex relationships among the hormonal,

nervous, and immune systems in rheumatoid arthritis. For example, they are

exploring whether and how the normal changes in the levels of steroid

hormones (such as estrogen and testosterone) during a person's lifetime may

be related to the development, improvement, or flares of the disease.

Scientists are also looking at how these systems interact with environmental

and genetic factors. Results from these studies may suggest new treatment

strategies.

Researchers are exploring why so many more women than men develop rheumatoid

arthritis. In hopes of finding clues, they are studying female and male

hormones and other elements that differ between women and men, such as

possible differences in their immune responses.

To find clues to new treatments, researchers are examining why rheumatoid

arthritis often improves during pregnancy. Results of one study suggest that

the explanation may be related to differences in certain special proteins

between a mother and her unborn child. These proteins help the immune system

distinguish between the body's own cells and foreign cells. Such differences,

the scientists speculate, may change the activity of the mother's immune

system during pregnancy.

A growing body of evidence indicates that infectious agents, such as viruses

and bacteria, may trigger rheumatoid arthritis in people who have an

inherited predisposition to the disease. Investigators are trying to discover

which infectious agents may be responsible. More broadly, they are also

working to understand the basic mechanisms by which these agents might

trigger the development of rheumatoid arthritis. Identifying the agents and

understanding how they work could lead to new therapies.

Scientists are searching for new drugs or combinations of drugs that can

reduce inflammation, can slow or stop the progression of rheumatoid

arthritis, and also have few side effects. Studies in humans have shown that

a number of compounds have such potential. For example, some studies are

breaking new ground in the area of " biopharmaceuticals, " or " biologics. "

These new drugs are based on compounds occurring naturally in the body, and

are designed to target specific aspects of the inflammatory process.

Investigators have also shown that treatment of rheumatoid arthritis with

minocycline, a drug in the tetracycline family, has a modest benefit. The

effects of a related tetracycline called doxycycline are under investigation.

Other studies have shown that the omega-3 fatty acids in certain fish or

plant seed oils also may reduce rheumatoid arthritis inflammation. However,

many people are not able to tolerate the large amounts of oil necessary for

any benefit.

Investigators are examining many issues related to quality of life for

rheumatoid arthritis patients and quality, cost, and effectiveness of health

care services for these patients. Scientists have found that even a small

improvement in a patient's sense of physical and mental well-being can have

an impact on his or her quality of life and use of health care services.

Results from studies like these will help health care providers design

integrated treatment strategies that cover all of a patient's needs-emotional

as well as physical.

Source: The National Institute of Arthritis and Musculoskeletal and Skin

Diseases of the National Institutes of Health

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AMERICANS STRESSED BY ATTACKS By JEFF DONN - The Associated Press BOSTON (AP)

- Nearly half of American adults had pronounced symptoms of stress from the

Sept. 11 attacks in a nationwide survey documenting the catastrophe's broad

effect on public health. ``It's important for people to understand if they

had these types of reactions, they're not alone, and they're not unusual,''

said Dr. Mark Schuster, a pediatrician who led the study at the Rand think

tank in Santa , Calif. ``It helps people to get over the symptoms if

they realize these are normal reactions.''

The findings, published in Thursday's New England Journal of Medicine,

confirm what other surveys have found: that the psychological impact of the

terrorist attacks reverberated near and far.

The researchers conducted telephone interviews with a representative sample

of 560 adults on the weekend after the Sept. 11 attacks.

The adults were asked if they felt upset when reminded of the attacks, were

disturbed by repeated memories or dreams, had trouble concentrating or

sleeping, or suffered from irritability or angry outbursts.

Ninety percent reported one symptom at least ``a little bit.'' Forty-four

percent had at least one symptom ``quite a bit'' or ``extremely.'' The most

common substantial symptom, shared by 30 percent, was feeling upset by

reminders.

Women, minorities, people with prior mental health problems, heavy television

watchers and those closer to the World Trade Center were most likely to

report stress.

Asked how they coped, 98 percent of those surveyed said they talked to

others, 90 percent turned to religion, 60 percent joined in group activities,

and 36 percent made donations or did volunteer work. Only 18 percent bought

extra food, gasoline or other supplies. Thirty-nine percent occasionally

avoided television or other reminders of the attacks.

People clearly watched lots of television to learn details of the attacks -

an average of eight hours on Sept. 11, according to the study. The study was

not designed to say if television ultimately eased or aggravated stress.

Schuster said he suspects it can work either way.

Such stress reactions typically diminish over time, researchers say. The

survey did not go beyond Sept. 16, but other surveys have indicated an easing

of stress since then.

Those surveyed by Rand were also asked about children in their homes. They

said 35 percent showed one or more stress symptoms. Forty-seven percent were

said to be worried about their own safety or that of someone they love. A

third of the adults limited television for their children, and 99 percent

talked to them about the attacks.

Dr. Carol S. North, a psychiatrist at Washington University in St. Louis who

studied survivors of the 1995 bombing in Oklahoma City, said the Sept. 11

attacks appeared to shake society even more broadly. ``What's really

interesting is its ability to reach out and touch someone quite a distance

away,'' she said.

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VIOXX, PRILOSEC -MOST ADVERTISED DRUGS WASHINGTON (Reuters) - Drug companies

spent nearly $2.5 billion last year in advertising brand-name drugs directly

to the public, the Kaiser Family Foundation reported Thursday. The nonprofit

foundation, which conducts research on health and family issues, said

consumers may remember the names of the drugs and the diseases they treat,

but may get mixed up about potential side-effects. It said the most heavily

advertised drugs are also often the most heavily prescribed.

The foundation's top 10 most-advertised prescription drugs were:

1. Vioxx, Merck and Co.'s anti-inflammatory ($160.8 million)

2. Prilosec, AstraZeneca's anti-ulcer drug ($107.9 million)

3. Claritin, Schering-Plough's antihistamine ($100.3 million)

4. Paxil, GlaxoKline's antidepressant ($92.1 million)

5. Zocor, Merck's anti-cholesterol drug ($91.2 million)

6. Viagra, Pfizer's erectile dysfunction drug ($89.8 million)

7. Celebrex, Pharmacia's competitor to Vioxx ($78.8 million)

8. Flonase, GlaxoKline's asthma drug ($78.1 million)

9. Allegra, an antihistamine made by Aventis ($67 million)

10. Meridia, made by Abbott (ABT.N) to treat obesity ($65 million)

The top 10 drugs by sales in 2000 were:

1. Prilosec ($4.6 billion)

2. Lipitor, Pfizer's cholesterol drug ($4.15 billlion)

3. Prevacid, Abbott's ulcer drug, ($3.15 billion)

4. Zocor ($2.8 billion)

5. Prozac, Eli Lilly's antidepressant ($2.66 billion)

6. Celebrex ($2.15 billion)

7. Epogen, Amgen's anemia drug ($2.06 billion)

8. Zoloft, an antidepressant by Pfizer ($1.98 billion)

9. Zyprexa, Eli Lilly's anti-psychotic ($1.9 billion)

10. Procrit, An anemia drug licensed to & ($1.8 billion)

Copyright 2001 Reuters Limited.

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COMMON LATIN Rx TERMS

LATIN ABBREVIATION MEANING

ante cibum ac before meals

bis in die bid twice a day

gutta gt drop

hora somni hs at bedtime

oculus dexter od right eye

oculus sinister os left eye

per os po by mouth

post cibum pc after meals

pro re nata prn as needed

quaque 3 hora q 3 h every 3 hours

quaque die qd every day

quater in die qid 4 times a day

ter in die tid 3 times a day

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Please be reminded that we are providing this newsletter for educational

purposes only and it is not ever intended as medical advice. Articles

relating to general health issues can be equally important too. Occasionally

there may be topics of sufficient value that warrant a good discussion with

your medical caregivers.

For new members who have an interest in past newsletters, please feel free to

e-mail me and I can provide you with exact message numbers that can be found

on our website: . Your comments are always

welcome

See you next issue and good health to all.

Jack

Cornishpro@...

Issue 2001 - 12/08/01-6