PSORIATIC ARTHRITIS NEWSLETTER NO. 105

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PSORIATIC ARTHRITIS NEWS AND VIEWS

VOLUME- 6 ISSUE- 06

July 31, 2006

PSORIATIC ARTHRITIS MEDICAL NEWS

HOSPITALS RANKED BEST IN UNITED STATES

s Hopkins Tops U.S. News and World Report's Annual Honor Roll

By Miranda Hitti - WebMD Medical News, Reviewed By Louise Chang, MD

U.S. News and World Report has published its 2006 list of America's best

hospitals.

Fourteen hospitals made the magazine's honor roll, with s Hopkins in

Baltimore, Md., in the top spot.

Here's the list:

s Hopkins Hospital (Baltimore, Md.)

Mayo Clinic (Rochester, Minn.)

The Cleveland Clinic

Massachusetts General Hospital (Boston)

UCLA Medical Center (Los Angeles)

New York-Presbyterian Hospital, The University Hospital of Columbia and

Cornell (New York City)

Duke University Medical Center (Durham, N.C.)

-Jewish Hospital/Washington University (St. Louis)

University of California, San Francisco Medical Center

University of Washington Medical Center (Seattle)

Brigham and Women's Hospital (Boston)

University of Michigan Hospitals and Health System (Ann Arbor)

Stanford Hospital & Clinics (Stanford, Calif.)

University of Pittsburgh Medical Center

The list is based on various factors, including: the hospitals' reputation

among board-certified physicians; quality-of-care measures such as ratio of

nurses to patients; and in-hospital death rates for Medicare patients after

taking into consideration the severity of the patients' illness.

Specialty Rankings

The magazine also ranked hospitals for 16 specialties. Here are the top

three hospitals listed for cancer, heart and heart surgery, and pediatrics.

Cancer:

Memorial Sloan-Kettering Cancer Center (New York)

University of Texas M.D. Cancer Center (Houston)

s Hopkins Hospital (Baltimore, Md.)

Heart and Heart Surgery:

The Cleveland Clinic

Mayo Clinic (Rochester, Minn.)

s Hopkins Hospital (Baltimore, Md.)

Pediatrics:

The Children's Hospital of Philadelphia

Children's Hospital Boston

s Hopkins Hospital (Baltimore, Md.)

SOURCE: U.S. News & World Report, " Best Hospitals 2006, " July 9, 2006,

online edition.

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HANG UP YOUR CELL OR GET HIT BY LIGHTING

Don't use your mobile phone outdoors in a storm, doctors warn

Reuters Service - LONDON

People should not use mobile phones outdoors during thunderstorms because of

the risk of being struck by lightning, doctors said on Friday.

They reported the case of a 15-year-old girl who was using her phone in a

park when she was hit during a storm. Although she was revived, she suffered

persistent health problems and was using a wheelchair a year after the

accident.

" This rare phenomenon is a public health issue, and education is necessary

to highlight the risk of using mobile phones outdoors during stormy weather to

prevent future fatal consequences from lighting strike injuries, " said Swinda

Esprit, a doctor at Northwick Park Hospital in England.

Esprit and other doctors at the hospital added in a letter to the British

Medical Journal that usually when someone is struck by lightning, the high

resistance of the skin conducts the flash over the body in what is known as a

flashover.

But if a metal object, such as a phone, is in contact with the skin it

disrupts the flashover and increases the odds of internal injuries and death.

The doctors added that three fatal cases of lightning striking people while

using mobile phones have been reported in newspapers in China, South Korea and

Malaysia.

" The Australian Lightning Protection Standard recommends that metallic

objects, including cordless or mobile phones, should not be used (or carried)

outdoors during a thunderstorm, " Esprit added. © Reuters 2006. All rights

reserved.

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INFORMED PATIENTS MAKE BETTER DECISIONS

( News Service)

More and more, drugs and treatments are being developed to deal with illness

and disability.

Wellness and prevention are actually becoming standards for health care.

And the number of wage and salary jobs in pharmaceutical and medicine

manufacturing is expected to increase by about 26 percent over the 2004-14

period,

according to the U.S. Bureau of Labor Statistics.

There will just about always be a market for over-the-counter and

prescription drugs.

There is also an increasing viability for complementary and alternative

methods of dealing with stress and disease.

Transcendental meditation, a relaxation technique centuries old, could

decrease blood pressure and reduce insulin resistance, according to a small

trial

whose results were printed recently in the Archives of Internal Medicine, a

publication of the American Medical Association.

The downside is that the more the public is flooded with information, the

more confused we can become.

We can begin to doubt our medical professionals and our government

regulators.

-Vioxx, a popular arthritis drug, was pulled off the market two years ago

when it was found to increase the risk of heart attacks and strokes in some

long-term users.

That controversy led to a study by the Government Accountability Office,

which found that the Food and Drug Administration, our overseer when it comes to

drug safety, doesn't have sufficient policies concerning the very heart of

what we depend upon it for: drug safety issues.

-Ortho Evra, the birth control patch, was the subject of a recent warning

when it was discovered that users were at a higher risk of blood clots than

previously thought.

-Bisphosphonates, which are used to treat cancer and debilitating bone

diseases such as osteoporosis -- Actonel and Fosamax among the most popular --

were found to put patients at risk of developing a painful condition that breaks

down the jaw bone.

-Zocor, the popular cholesterol-lowering drug, will be available in generic

form Friday. That move is stimulating debate fueled by its competitors that

patent-protected drugs such as Lipitor are " a better clinical choice than

generic competitors. "

-A drug -- tolbutamide -- which is part of a class of diabetes medications

known as a sulfonylurea, was found to increase the chance of dying of a heart

attack. There is controversy over the study and some doctors refuse to address

the results at all.

Where does this leave the average patient?

In a quandary, most likely, and dependent on more than one opinion when

weighing the pros and cons of any treatment or medication.

Sometimes, a second opinion or even a third is necessary before decisions

are made. Take the patient I know whose doctor couldn't pronounce one of the

strong drugs in a cocktail mix he had prescribed. It doesn't infuse confidence.

We are lucky and should be grateful to have a plethora of options when it

comes to dealing with illness and disease. But choices increase our

responsibility to think clearly when making decisions.

Copyright 2006 The News Service. All rights reserved.

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YOU ARE NEVER TOO OLD OR TOO FRAIL TO EXERCISE

By LeWine, M.D. - Brigham and Women's Hospital

Not only are people living longer, but a greater number of people are living

healthier well into their 80's and 90's. No matter how healthy we've become,

however, at some point we all have to adapt our exercise goals to our

changing bodies.

Most of my columns are written for people who are able to do moderate to

high intensity exercise. This month I'm directing my comments to people who need

a gentler approach because they're physically weak due to advanced age or a

chronic disability, such as severe arthritis.

No matter how old you are or how weak you feel, strive to keep active in

some way. It's an important key to your independence.

Activities of Daily Living

To maintain even a basic level of independence, you need to be able to

perform your Activities of Daily Living, or ADLs. The ability to do so without

help means that you can be alone at home for at least part of the day. ADLs

include:

Eating

Dressing

Bathing

Transfering from bed to chair and back

Getting to a toilet or bedside commode

Controlling bladder and bowel function

Calling for help immediately when needed

There's another level of ADLs called the Instrumental Activities of Daily

Living or IADLs. These are the essential activities that allow one to live

alone and independently:

Getting food and supplies into the home

Preparing food

Keeping the home clean

Arranging to have finances managed

Taking medications correctly and complying with other therapies

Using a telephone

Exercise has the potential to improve many of the physical changes

associated with frailty and disability and help a person stay independent.

That's

because muscle strength, general stamina, flexibility and balance can all be

improved with exercise. Multiple studies show that these improvements can occur

in just weeks of starting to exercise. And the people who benefit the most are

those who are the most frail.

Helping Your Joints and Bones

Regular physical activity helps preserve joint structure and function.

People with either osteoarthritis or rheumatoid arthritis (the two major types

of

arthritis) (Editors addition: and PSORIATIC ARTHRITIS), can decrease their

pain and increase their mobility with an exercise program as long as they use

proper technique and pay attention to safety.

In the FAST study (Fitness And Seniors Trial), older adults with

osteoarthritis were in one of three exercise groups:

General aerobics

Resistance training to increase muscle strength

Range of motion exercises for the joints most involved

A group of similar patients did not receive any exercise " treatment " and

remained sedentary.

The researchers looked for improvements in sense of well-being and level of

disability over a period of 18 months. The seniors in each of the three

exercise groups scored better than the sedentary subjects. Interestingly, the

folks

in all three of the exercise groups showed similar improvements on average.

When it comes to keeping bones strong and preventing bone loss

(osteoporosis), the type of exercise you do matters. It must be " weight bearing "

such as

walking, jogging, dancing and stair climbing. Resistance exercises—using free

weights (barbells and dumbbells) or machines with adjustable tensions—using

even very modest weights or resistance may also help. To stimulate bone

activity, weight bearing exercise must be combined with adequate intake of

vitamin

D and calcium.

Preventing Falls

Falls in the elderly are a major cause of hospitalization and loss of

independence. Maintaining muscle strength, stamina, balance and flexibility

decrease the risk of falling and also decrease the risk of severe injury when a

fall

does occur. By far, balance training has shown the most consistent benefit

for preventing falls.

Recently tai chi, an Asian practice where a series of slow movements are

coordinated with deep breathing and mental focus, has become popular in Western

countries. Studies suggest that tai chi may help prevent falls by improving

balance, enhancing strength in the lower leg muscles, and increasing stamina.

If tai chi is not an option, there are simple home exercises you can do to

decrease the risk of falls. The best approach is to combine some light

resistance training, especially for the quadriceps (the muscles in the front

part of

the thigh), and balance exercises.

Balance Routines to Practice at Home

Anyone who is able to stand can improve his or her balance. Try this routine

if you are very weak and unsteady, preferably with another person close by

as a precaution. Get behind a heavy stable chair, preferably one that is

cushioned. You will be using this for support.

Step 1: Grab the back of the chair with both hands. Slowly lift the heels of

both feet, moving on to your toes. Try to raise your heels as high as you can

and hold them for 1 to 2 seconds. Rest for 10 to 15 seconds. Repeat this

routine 8 to 12 times, or stop sooner if you are fatigued. Once you have

mastered this, move to Step 2.

Step 2: Hold on to the back of the chair with only one hand and lift

yourself onto your toes as in Step 1. Once you feel very secure balancing

yourself

with one hand only, try lifting the other hand an inch off the chair and see

if you can still raise yourself onto your toes. Stop immediately if you feel

unsteady. You can try again tomorrow.

Step 3: Grab the back of the chair with both hands like you did in Step 1.

Shift your weight to your stronger leg, then bend the knee of your weaker leg

and lift your foot behind you. As long as you're able to keep your balance,

try to get your foot higher than your knee. Hold for a couple of seconds and

repeat 8 to 12 times. Tomorrow practice with the other leg. Once you have

mastered both legs, you are ready to move to Step 4.

Step 4: Grab the back of the chair in the middle with one hand. Raise your

weaker leg as described in Step 3. Aim for the same number of repetitions.

Remember to go slow and stay in control. Your muscles work harder with slower,

more purposeful movements. Tomorrow switch hands and legs.

Step 5: Hold on to the back of the chair with one or both hands. Bend the

knee of your weaker leg and lift it in front of you to just below your hip. Hold

it for a couple of seconds. The goal here is to keep your body and hips

still as you lift the knee. As you get comfortable with this exercise, try

lifting one hand off the chair and then both hands. But keep your hands close

to

the chair in case you feel unsteady. Repeat 8 to 12 times.

Step 6: The last and most advanced step is marching in place behind the

chair. Instead of bending and lifting the same knee multiple times, you will now

alternate lifting your legs. The eventual goal is to do this without having to

use your hands to support you. But always stay in back of the soft chair.

Getting Started

Getting started is probably the toughest hurdle to overcome. Too often

older, frail people have the wrong impression that they are past the point where

exercise can do any good. In fact, the more widely held notion is that exercise

will make them worse. This is clearly not the case as long as the exercise

program is designed to be safe, easy at first and to progress at a reasonable

pace.

Keep your exercise sessions short—7 to 10 minutes when first starting out—

and your routines simple to build your confidence that you can do it.

LeWine, M.D., is chief editor of Internet publishing, Harvard Health

Publications. He is a clinical instructor of medicine at Harvard Medical

School and Brigham and Women's Hospital. Dr. LeWine has been a primary care

internist and teacher of internal medicine since 1978

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WATCHDOG GROUP SEEKS CRACKDOWN ON LASERS

WASHINGTON (AP)

Smokers who pay hundreds of dollars to be zapped by lasers purported to help

them quit are victims of fraud, a watchdog group alleged Thursday in seeking

a federal crackdown.

Public Citizen petitioned the Food and Drug Administration to halt five

companies from promoting low-power laser therapy for smoking cessation. The

companies do not have FDA clearance to market the lasers for that purpose, nor

is

there any scientific evidence they are safe or effective, said Dr. Sidney

Wolfe, director of Public Citizen's Health Research Group.

" There is a prohibition on any kind of marketing or advertising for any

unapproved uses of an FDA-regulated product, " Wolfe said. " It's just a massive

fraud. "

The FDA will evaluate the petition, spokeswoman Cruzan said. The FDA

has cleared the so-called biostimulation lasers or laser acupuncture devices to

be marketed only to help provide temporary pain relief, according to its Web

site.

Freedom Laser Therapy Inc., singled out in the petition as the most

prominent of the five companies, charges smokers as much as $349 for a 30-minute

laser " acupuncture " session and kit with vitamins, booklet and video.

FDA regulations do allow the therapy to be used in investigational clinical

trials or studies -- exactly what Freedom Laser Therapy said it is carrying

out at its two locations, in Santa , Calif. and Royal Oak, Mich.,

president Craig Nabat said.

The company charged thousands of smokers to participate in the trials so far

but has not collected data on whether the program successfully helped them

quit, said Nabat, who wants to open franchises nationwide.

" We are not documenting exactly how many people are coming through -- how

successful they are, " said Nabat, adding that client referrals vouch for the

program's effectiveness.

Dr. Norman Edelman, chief medical officer of the American Lung Association,

said any institutional review board likely would find such trials unethical.

Early attempts at following up with all clients proved laborious, expensive

and ultimately fruitless, Nabat said.

" When we do follow-up phone calls, people don't call us back, " added the

self-described entrepreneur and inventor of an infomercial product called The

Findit Keyfinder.

There is no evidence laser therapy works in helping smokers quit, Edelman

said. And not collecting data means there never will be any evidence.

" How can you run a clinical trial without collecting data? I don't

understand that, " Edelman said. " The very answer is coming up pointing to the

fact it

is snake oil. "

The companies claim laser therapy triggers the release of endorphins, or the

body's natural painkillers, that can help smokers cope with withdrawal.

But reviews of medical literature turn up few reports of well-run clinical

trials that examined laser stop-smoking therapy, according to both the American

Lung Association and Public Citizen. And the few studies that have been done

show no difference in success rates between patients zapped with a laser and

those receiving a placebo or sham treatment, Wolfe said.

Laser Therapeutics Inc., a Centerville, Mass. laser importer and

distributor, has completed laser therapy trials and is preparing to seek FDA

approval

for their use in smoking cessation, said Neil Camera, a company officer. Camera

said the results of the trials were confidential, but that the company

planned to submit its application within the next 90 days. It supplies Freedom

Laser Therapy and several other of the companies listed in the petition.

The FDA warned Laser Therapeutics in October 2004 over its failure to

properly monitor clinical laser trials.

Copyright 2006 The Associated Press. All rights reserved.

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STEM CELL RECEPTORS MAY FIGHT AUTOIMMUNE DISEASES

(HealthDay News)

New information about the role of bone marrow stem cells could lead to

important advances in treating diseases like leukemia, lupus and rheumatoid

arthritis, scientists say.

Researchers at the Oklahoma Medical Research Foundation in Oklahoma City, in

collaboration with the University of Tokyo, Osaka University and Saga

University of Japan, studied the purified bone marrow stem cells of laboratory

mice. They discovered that these cells -- once thought to be essentially dormant

-- can identify the presence of bacteria and viruses in the blood.

" We have long known that so-called hematopoietic (blood) stem cells create

the blood cells that are the front-line soldiers in the body's immune system, "

study author and foundation researcher Kincade said in a prepared

statement. " But we did not believe that infectious agents played an active role

in

the process, " he added.

Once the infectious agents have been identified, the stem cells begin

defending the body against these foreign pathogens -- a fact that surprised the

scientists.

" What we have now discovered is that these stem cells have a sort of

antennae that detect bacteria and viruses, " said Kincade. " And when stem cells

receive these distress signals, they spring to action, creating cells the body

most needs early in life-threatening situations, " he said.

That could mean very good news for patients with autoimmune diseases.

Understanding the role of these stem cells means that scientists one day may be

able to figure out how to manipulate these stem cells to benefit such patients.

" It may be possible to boost immunity when necessary and also shut down

inappropriate responses. That could provide a powerful tool to fight cancer,

lupus and many other diseases, " Kincade said.

The findings appear in the June issue of the journal Immunity. Kohnle

- SOURCE: Oklahoma Medical Research Foundation, Copyright © 2006 ScoutNews

LLC.

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STUDY SAYS MILLIONS HAVE RAGE DISORDER

CHICAGO (AP)

To you, that angry, horn-blasting tailgater is suffering from road rage. But

doctors have another name for it -- intermittent explosive disorder -- and a

new study suggests it is far more common than they realized, affecting up to

16 million Americans.

" People think it's bad behavior and that you just need an attitude

adjustment, but what they don't know ... is that there's a biology and cognitive

science to this, " said Dr. Emil Coccaro, chairman of psychiatry at the

University

of Chicago's medical school.

Road rage, temper outbursts that involve throwing or breaking objects and

even spousal abuse can sometimes be attributed to the disorder, though not

everyone who does those things is afflicted.

By definition, intermittent explosive disorder involves multiple outbursts

that are way out of proportion to the situation. These angry outbursts often

include threats or aggressive actions and property damage. The disorder

typically first appears in adolescence; in the study, the average age of onset

was

14.

The study was based on a national face-to-face survey of 9,282 U.S. adults

who answered diagnostic questionnaires in 2001-03. It was funded by the

National Institute of Mental Health.

About 5 percent to 7 percent of the nationally representative sample had had

the disorder, which would equal up to 16 million Americans. That is higher

than better-known mental illnesses such as schizophrenia and bipolar disorder,

Coccaro said.

The average number of lifetime attacks per person was 43, resulting in

$1,359 in property damage per person. About 4 percent had suffered recent

attacks.

The findings were released in the June issue of the Archives of General

Psychiatry.

The findings show the little-studied disorder is much more common than

previously thought, said lead author Kessler, a health care policy

professor at Harvard Medical School.

" It is news to a lot of people even who are specialists in mental health

services that such a large proportion of the population has these clinically

significant anger attacks, " Kessler said.

Four a couple of decades, intermittent explosive disorder, or IED, has been

included in the manual psychiatrists use to diagnose mental illness, though

with slightly different names and criteria. That has contributed to

misunderstanding and underappreciation of the disorder, said Coccaro, a study

co-author.

Coccaro said the disorder involves inadequate production or functioning of

serotonin, a mood-regulating and behavior-inhibiting brain chemical. Treatment

with antidepressants, including those that target serotonin receptors in the

brain, is often helpful, along with behavior therapy akin to anger

management, Coccaro said.

Most sufferers in the study had other emotional disorders or drug or alcohol

problems and had gotten treatment for them, but only 28 percent had ever

received treatment for anger.

" This is a well-designed, large-scale, face-to-face study with interesting

and useful results, " said Dr. Fassler, a psychiatry professor at the

University of Vermont. " The findings also confirm that for most people, the

difficulties associated with the disorder begin during childhood or adolescence,

and they often have a profound and ongoing impact on the person's life. "

Hartstein, a psychologist at Montefiore Medical Center in New York,

said she had just diagnosed the disorder in a 16-year-old boy.

" In most situations, he is relatively affable, calm and very responsible, "

she said. But in stressful situations at home, he " explodes and tears apart his

room, throws things at other people " to the point that his parents have

called the police.

Hartstein said the study is important because many people are not aware of

the disorder. Copyright 2006 The Associated Press. All rights reserved.

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AMA WANTS HALT ON DRUG ADS AIMED AT CONSUMERS

By Reinberg - HealthDay Reporter - (HealthDay News)

In an effort to make prescription-drug ads aimed at consumers more

understandable and informative, the American Medical Association is calling for

a

temporary halt on advertising for newly approved drugs.

The AMA is also calling for guidelines for future ads, which would be

subject to approval by the U.S. Food and Drug Administration before they

appeared.

At its just-concluded annual House of Delegates meeting in Chicago, the AMA

endorsed a policy asking for a temporary moratorium on so-called

direct-to-consumer (DTC) advertising of new prescription drugs and implantable

medical

devices.

" A temporary moratorium on DTC advertising of prescribed drugs and medical

devices will benefit both the patient and physician, " AMA President-elect Dr.

M. said in a prepared statement. " Physicians will have the

opportunity to become better educated on the pros and cons of prescription drug

uses before prescribing them, and will be better able to determine when they are

best suited for their patients' medical needs. "

Medical devices were added to the proposal because many doctors who spoke at

the AMA meeting said direct-to-consumer ads for medical devices were already

appearing, told HealthDay. " This is happening in such fields as

orthopedics, " he said.

The association plans to ask the FDA to enact the policy, so the length of

any moratorium would be determined by the drug agency. " If you have a drug

which is critical to the treatment of a particular disease for which alternate

treatments are not available, that would push to limiting the length of the

moratorium, " said.

The AMA also endorsed new guidelines for advertising prescription drugs to

consumers. The guidelines call for providing objective information about the

benefits and risks of a drug as determined in clinical trials. They also urge

more research into the effects of direct-to-consumer advertising on " the

patient-physician relationship, overall health outcomes and health-care costs. "

The doctors' group also wants the FDA to approve all direct-to-consumer ads

before they appear. " We crafted our proposal to provide for very tight FDA

authority over DTC ads, " said.

In addition, ads should allow enough time or space for consumers to

understand all the warnings, precautions and potential side effects, without

being

distracted by other content in the advertisement, the doctors' group said.

The ads should also refer patients to their doctors for a full explanation

of a drug and its use, and be targeted to age-appropriate audiences, the

guidelines state.

The Pharmaceutical Research and Manufacturers of America said it generally

supports the AMA's position. But the drug industry group believes its own

voluntary monitoring program is sufficient to deal with the content of

direct-to-consumer ads.

" PhRMA appreciates and supports the American Medical Association's

continuing efforts to improve patient education and to provide quality

information on

health conditions and the treatment options available to conquer disease, "

Dr. Antony, chief medical officer for the group, said in a prepared

statement. " Informed patients are better patients and DTC advertising provides

doctors and patients with accurate, educational information about disease and

treatment options. "

" PhRMA and its member companies announced last year its voluntary Guiding

Principles on Direct-to-Consumer Advertisements About Prescription Medicines in

an effort to further enhance the educational value of prescription drug

advertising, " Antony added. " While there are subtle differences between the

Guiding Principles and the AMA's report, both emphasize the critical need to

educate physicians and other health-care providers about a new medicine before

it

is advertised to the public. "

Dr. Lurie, deputy director of consumer advocacy group Public Citizen's

Health Research Group, thinks the AMA proposal doesn't go far enough to

guarantee complete information on prescription drugs to the public.

" The AMA suggestion is fine but it is nonspecific, " said Lurie, adding

there's no mention of how many years the moratorium would be in effect. " All

that

is up in the air, and there is no reason why that can't be made more

specific, " he said.

The most important part of the proposal calls for the FDA to prescreening

ads, Lurie said. " If prescreening really happened that would be a big help, " he

said.

" The real solution to the problem of lack of patient information is not to

leave it to the market, where self-interested people advertise only those

products on which they can make a buck, " Lurie said. " The real solution is to

provide patients with government-sanctioned information on each and every

drug. "

Another consumer advocate doesn't think the AMA proposal would do anything

to protect the public.

" Direct-to-consumer drug ads are dangerous and should be illegal, " said

Ruskin, executive director of the consumer watchdog group Commercial Alert.

" The AMA's policy is so weak that it will do little, if anything, to protect

public health. It won't make much of a difference at all. "

The AMA's said his group considered a ban on direct-to-consumer ads

but opted for FDA oversight instead. " There are some potential benefits from DTC

advertising, " he said. " In particular, educating the public about the

availably of new medications and prompting discussions between patients and

physicians about new medications. "

But there are some risks, added. " Such as building up false

expectations among patients about what these drugs may or may not do, or whether

they

are appropriate for the disease or condition that a patient has, " he said.

" Laying out the advantages and disadvantages of DTC ads and the benefits and

harms, we came down on the side of tight FDA oversight over DTC ads as opposed

to a total ban, " he said.

SOURCES: M. , M.D., president-elect, American Medical

Association, Chicago; Lurie, M.D., M.P.H., deputy director, Public

Citizen's

Health Research Group, Washington, D.C; Pharmaceutical Research and

Manufacturers

of America, Washington, D.C.; Ruskin, executive director, Commercial

Alert, Portland, Ore; June 14, 2006, American Medical Association's annual

House of Delegates Meeting, Chicago Copyright © 2006 ScoutNews LLC. All rights

reserved.

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STUDY COMPARES PSORIASIS TREATMENTS

(HealthDay News)

In a head-to-head trial of two treatments for chronic plaque psoriasis ,

Psoralen-UV-A (PUVA) therapy proved more effective than narrowband UV-B (NB-UVB)

in treating the illness, U.K. researchers report.

PUVA is a combination of 8-methoxypsoralen medication (taken orally) plus

exposure to UV-A (long-wave) radiation. NB-UVB involves exposure to UV-B

(short-wave radiation).

This study included 93 people with moderate-to-severe chronic plaque

psoriasis. They were divided into two groups that received either PUVA or

NB-UVB.

Both groups were treated twice a week, either until their skin cleared or up to

a maximum of 30 sessions.

Patients whose skin cleared during the study were followed up until relapse,

or for 12 months, whichever came first.

In patients with skin types I through IV (skin that's more likely to burn),

PUVA was 84 percent effective at clearing skin, compared to 65 percent for

NB-UVB. Patients receiving PUVA required a median of 17 treatments before their

skin cleared, compared with 28.5 treatments for those receiving NB-UVB.

Six months after skin clearance, 68 percent of patients in the PUVA group

were still clear, compared to 35 percent of those in the NB-UVB group.

Overall, people with skin types V and VI had a 24 percent rate of clearance,

compared to 75 percent for those with skin types I through IV.

However, the study also found that nearly half the patients receiving PUVA

suffered redness of the skin (erythema) during their treatment, compared to

less than 25 percent of those in the NB-UVB group.

Even though PUVA appears more effective, it does has a number of

disadvantages, the researchers said. It may cause nausea, it cannot be used

during

pregnancy, and it has the potential to cause skin cancer.

Despite those concerns, the study authors noted that PUVA, " tends to clear

psoriasis more reliably, with fewer treatments and for longer, and should,

therefore, still be used in appropriate patients. "

The findings were reported in the July Archives of Dermatology. SOURCE:

JAMA/Archives journals, news release, July 17, 2006 - Copyright © 2006

ScoutNews

LLC. All rights reserved.

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Good Health to All,

Jack

Newsletter Editor

_Cornishpro@..._ (mailto:Cornishpro@...)

Issue 2006- 06

07/31/06