Osteoarthritis Pain Alleviated By Antidepressant

Main Category: Pain / Anesthetics
Also Included In: Arthritis / Rheumatology;  Depression
Article Date: 26 Mar 2012 – 0:00 PDT

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Antidepressants can play a key role in alleviating painful conditions like osteoarthritis and may result in fewer side effects than traditionally prescribed drug regimes, such as anti-inflammatories and opioids, according to a perspective paper published online ahead of print publication by the International Journal of Clinical Practice.

American doctors Leslie Citrome and Amy Weiss-Citrome analysed the latest clinical evidence on duloxetine, a well-established antidepressant that received US Food and Drug Administration (FDA) approval in 2010 for use with chronic musculoskeletal pain, including osteoarthritis.

“It is not uncommon to treat osteoarthritis with a combination of drugs that work in different ways” explains Dr Leslie Citrome, Clinical Professor of Psychiatry and Behavioural Sciences at New York Medical College, Valhalla, New York, USA. “Our review supports this approach and confirms that antidepressants are not just for depression and can play a key role in relieving this painful condition.”

The authors looked at studies exploring the effects of duloxetine being used on its own or in combination with non-steroidal anti-inflammatory drugs (NSAIDs). These included the two randomised double-blind, placebo controlled clinical trials that formed the basis of FDA approval for duloxetine for the treatment of chronic pain associated with osteoarthritis.

Study results were analysed using number needed to treat (NNT) and number needed to harm (NNH). These quantify how many patients need to be treated with one intervention versus another before encountering one additional patient who experiences a desired outcome (NNT) or undesired disadvantage, such as a side-effect (NNH). A smaller number indicates greater advantages for NNT and greater disadvantages for NNH.

“Applying these simple methods to often complex research gives us a real indication of whether a drug will benefit or harm our patients, which is what we as clinicians are most interested in” explains Dr Citrome.

When duloxetine was compared with a placebo tablet containing no active ingredients, using data from the two FDA approval studies, the NNT was six. This means that six patients would need to be treated with duloxetine instead of receiving the placebo before encountering one additional patient experiencing an improvement in pain using a composite measure that brings together a number of indicators of efficacy. Such a low NNT makes a compelling case for this treatment approach.

The authors say that this finding, over 13 weeks, compared favourably with other studies of NSAIDs – the NNT was five for etodolac after four weeks and four for tenoxicam after eight weeks.

When the side effects of the various drugs were taken into account, this showed that when duloxetine was used on its own for 13 weeks it provided a number of advantages over NSAIDs, which can lead to gastrointestinal bleeding, and opiates such as morphine, which can cause constipation.

The most common side effects of duloxetine – nausea, fatigue and constipation – were small when compared to the placebo, resulting in NNHs of 16, 17 and 19 respectively. This means, for example, that 16 patients would need to be treated with duloxetine instead of receiving the placebo before encountering one additional patient experiencing nausea.

The studies used to gain FDA approval also showed that pain reduction using duloxetine on its own was not dependent on an improvement in depressive symptoms.

“Although the use of duloxetine as a monotherapy for pain has been approved by the regulatory agencies, it is quite common for patients to receive a combination of drugs and NSAIDs are the most frequently prescribed drugs for the pain associated with osteoarthritis” says co-author Dr Amy Weiss-Citrome, a specialist in Physical Medicine and Rehabilitation.

For that reason the authors also examined the findings of a recent study that showed the potential synergy of duloxetine and NSAIDs.

The study, a ten-week double-blind trial of 524 patients with osteoarthritis of the knee, found that those who took a combination of duloxetine and NSAIDs reported greater pain reductions than the control group who took a NSAID with a placebo.

The NNT for the outcome of substantial improvement in pain with combination treatment versus NSAIDs alone was six, underlining the benefits of this approach.

“We believe that our analysis of these studies demonstrate that clinicians managing patients suffering from osteoarthritis should also consider prescribing adjunctive antidepressants that can effectively impact on central pain pathways” concludes Dr Leslie Citrome.

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Tomosynthesis Effective In Diagnosing Knee Osteoarthritis

Main Category: Arthritis / Rheumatology
Also Included In: Radiology / Nuclear Medicine
Article Date: 25 Mar 2012 – 0:00 PDT

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A recent study done by researchers at Boston University School of Medicine (BUSM) shows that tomosynthesis may be more beneficial in diagnosing knee osteoarthritis than X-ray imaging. In the study, which is published online in the journal Radiology, tomosynthesis detected more osteophytes (abnormal bony spurs) and subchondral cysts (small collection of fluid within the bone) in the knee joint than conventional X-ray imaging.

Daichi Hayashi, MD, PhD, research instructor at the Quantitative Imaging Center in the department of radiology at BUSM, is the lead author of the study. The research was led by Ali Guermazi, MD, PhD, professor of radiology at BUSM and chief of musculoskeletal radiology at Boston Medical Center.

Osteoarthritis, the most common form of arthritis, is characterized by a degeneration of cartilage and the underlying bone and other soft tissues in the joints, leading to pain and stiffness. According to the Centers for Disease Control and Prevention, osteoarthritis is the leading cause of disability in the United States, affecting approximately 26.9 million Americans.

Osteoarthritis can be diagnosed clinically, from symptoms and physical examinations, or by taking and evaluating images. While X-ray imaging has commonly been used to diagnose the disease, recent research has shown that it is less accurate than Magnetic Resonance Imaging (MRI). However, while MRI provides higher-quality images, it is much more expensive than X-rays and cannot be routinely used in daily clinical practice. CT scan is another imaging technique that can provide detailed images of the joint, but it exposes patients to higher doses of radiation than X-rays.

“Despite the known limitation of X-ray imaging, it is widely used to diagnosis knee osteoarthritis, both in terms of daily clinical practice and also for clinical research studies,” said Hayashi.

Given the limitations, Hayashi and the team lead by Guermazi explored tomosynthesis to image the knee joint and determine its accuracy in detecting signs of osteoarthritis in the knee. Tomosynthesis uses an X-ray beam to take tomographic images (that is, images in slices similar to those from CT scans), which allows for better visualization than from a single X-ray image. The radiation exposure from tomosynthesis is similar to the traditional X-ray and much lower than CT. Also, it takes seconds to obtain images using tomosynthesis and can be done while a person is standing up.

The team examined 40 participants (80 knees), all over the age of 40, who were recruited irrespective of knee pain or an X-ray diagnosis of osteoarthritis. The knees were imaged using X-ray, tomosynthesis and MRI. The presence of osteophytes and subchondral cysts were recorded, and knee pain was assessed for each participant based on a questionnaire.

The results demonstrated that tomosynthesis, compared to X-ray, improves the detection of osteophytes in the knee joint in patients with or without osteoarthritis. The sensitivity for detecting osteophytes increased by five to 29 percent with tomosynthesis compared to X-ray. The sensitivity for detection of subchondral cysts in the knee joint increased by 11 to 50 percent with tomosynthesis compared to X-ray. The study also concludes that subjects with tomosynthesis-detected osteophytes and cysts were more likely to feel pain than those without the lesions.

“This study shows that the images obtained through tomosynthesis are significantly better than those from X-rays and could potentially be a better diagnostic tool for knee osteoarthritis in patients with knee pain,” said Hayashi. “While tomosynthesis has not been widely used in imaging of bones and joints to date, the results of our study show that using tomosynthesis to detect knee osteoarthritis can be effective.”

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Head of Bed

There are reasons to have the head of the medical bed elevated:

#1  This helps when eating in bed.  People need to be in the most natural position for swallowing safely.  Food and drink can cause coughing or choking if a person in not in the most upright position.

#2  During the declining in health state or the dying process respiratory difficulty is common.  The body may be too weak to cough or clear phlegm from the upper airway.  Laying flat may also contribute to feeling like they just don’t “get enough air.”

#3  Preventing or postponing “aspiration pneumonia” is the third reason.  I will talk about what “aspiration pneumonia” is in another entry.

Specifications of Citizen CH 432 Bp Monitor (Medium Cuff (22-32cm), White and Blue)

Rs. 1249

Summary of Citizen CH 432 Bp Monitor (Medium Cuff (22-32cm), White and Blue)

Key Features

Memory Recall

Auto Shut off Function

Auto-Measuring System

LCD Display

4 AA Battery Operated

Oscillometric Method

Citizen CH 432, an automatic BP monitor that combines attributes like ease of use, comfort and precision could keep your blood pressure in track on a daily basis. Clinically validated, this BP monitor displays genuine and precise measurement readings. The CH 432 digital BP monitor also incorporates automatic measuring feature that helps in obtaining quick and accurate BP measurement readings. Your blood pressure is measured automatically, saving your time as well as making the process of deriving measurement readings simple and easy.

Build

Designed for simplicity, this Citizen blood pressure monitor provides a standard size cuff which mechanically inflates with the help of its inbuilt pump. With its one button operation, the BP monitor is very user friendly. The operation of the BP monitor is just a push of a button away. You can view the accurate measurements on the easy to read LCD display.

Performance and Features

The automatic Citizen BP monitor displays a measurement range from 0 to 280 mmHg for pressure and 40 to 80 beats/ minute for pulse. The monitor simultaneously displays both the systolic and diastolic pressure. With the ability to hold up to 90 readings, the digital blood pressure’s memory feature functions competently. The accuracy rate of this Citizen BP monitor stands at +/- 3mmHg for pressure and +/- 5% of reading for pulse rates. Powered by an integrated replaceable battery, this automatic blood pressure monitor uses alkaline batteries. The Auto shut- off feature in the BP monitor enhances battery life as the device automatically switches off when not in use.

top

IN THE BOX

Sales Package:    Main Unit, Cuff, 4 batteries, Instruction manual, Warranty card

PRODUCT DETAILS

Type: Upper Arm

Variant:      Medium Cuff (22-32cm)

Color:        White and Blue

Model ID:  CH 432

Brand:        Citizen

DEVICE CHARACTERISTICS

Memory Function:       Yes

Display:     LCD

MEASUREMENT

Measurement Method: Oscillometric Method

Measurement Accuracy Pressure(mmHg):       ±3 mmHg

Measurement Range Pressure(mmHg) (Min):  0 mmHg

Measurement Range Pressure(mmHg) (Max): 280 mmHg

Measurement Range Pulse(beats/min) (Max):  180 beats/min

Measurement Range Pulse(beats/min) (Min):  40 beats/min

Measurement Accuracy Pulse(% of reading):  ±5 % of reading

POWER REQUIREMENTS

No. of Battery:    4

Power Source:    Battery

Battery Type:       AA

WARRANTY

1 Year Citizen India Warranty and Free Transit Insurance. See Details

Welcome to DME Reality

At some point in our lives, pretty much everybody in Michigan will have problems with mobility challenges, whether it be due to stroke, MS, weakness, ALS, recovery from a sports or auto injury, or simply aging.   Some mobility issues are more difficult to overcome than others but all have one thing in common: sooner or later, each of us is probably going to encounter limits to what our insurance will pay, even though we may genuinely need certain equipment to continue to live a simple quality of life.  When it comes to getting the Durable Medical Equipment (DME) we need when insurance or hospitals can no longer help, patients, families and care-givers frequently face a real challenge.

But how do you tell what will really need to be paid for out of our own pocket, and what are your options if that time comes?

In this blog, we hope to provide some insights from professionals who really care, some advice, some real alternatives that have worked for real people for you to consider.  We do not profess to know everything, and we recommend that you do not rely on our advice alone since everybody’s situation will be different.  However, we do have many years experience caring for and providing DME services and products to people who need them.  We have seen the difficulties people sometimes face when the equipment they need is not covered by insurance, in researching and finding reputable suppliers, and in understanding the barrage of technical terms that can make choices so difficult.

This blog is made possible by the support of Traxx Mobility Systems and by Greater Detroit Ramp. Both these Michigan companies offer equipment and services that fit under the heading of Durable Medical Equipment, and see first hand the challenges families can face when trying to adapt their homes to suit a family member with limited mobility.

We of course hope that if you have a requirement for either a power lift system or residential access installation that you will consider contacting one of our companies. However, we do not ask that you register to use or read this blog, and we do not collect personally identifiable contact information, except where you choose to provide it, and even in these circumstances we do not use it for marketing purposes.  The information we provide, either ourselves or from our guest contributors, is made available as a public service and as a means of giving consumers what the often feel they lack – a way to move forward.

We hope it answers at least some of the questions you may have, and we wish you the very best of luck and health for the future.

Therapy Dogs International Testing Part 10

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TEST 10: REACTION TO MEDICAL EQUIPMENT (this is NOT part of the Canine Good Citizen test)

The dog must be tested around medical equipment (such as wheelchairs, crutches, canes, walkers, or other devices which would ordinarily be found in a facility) to judge the dog’s reactions to common health care equipment.

For some dogs seeing medical equipment and/or people moving in a manner they are not accustomed to is no big deal. For others they may be afraid. So it’s definitely a good idea to expose your dog to as many things as possible before testing. Ideally look for a dog training facility around you that has access to a variety of medical equipment. If there isn’t such a place, you’ll have to be more ingenious, perhaps checking with a local retirement facility to see if they would let you and your dog come observe people’s comings and goings. Some institutions are very strict about TDI compliance, while others are not so much so. You will want to make sure your dog is very solid in all other aspects of the testing before you even make this kind of request.

If your dog shows any concern about the equipment make sure you have lots of tasty treats and start feeding your dog as soon as he sees the equipment. You’ll approach this the same way as I suggested introducing the vacuum cleaner in Test 9 — desensitization and counter conditioning. As you proceed, if you can actually get the person using the equipment to toss your dog a treat all the better!

One thing to watch out for — many a dog has fallen in love with the tennis balls that may be attached to the bottom of a walker! If you have a tennis ball crazy dog you will need to train an excellent “leave it”. That training will be covered in our next session.

Good luck


Potential Therapy For Autoimmune Diseases

Main Category: Diabetes
Also Included In: Arthritis / Rheumatology;  Immune System / Vaccines
Article Date: 19 Mar 2012 – 2:00 PDT

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Autoimmune diseases, such as Type I diabetes and rheumatoid arthritis, are caused by an immune system gone haywire, where the body’s defense system assaults and destroys healthy tissues. A mutant form of a protein called LYP has been implicated in multiple autoimmune diseases, but the precise molecular pathway involved has been unknown. Now, in a paper published March 18 in Nature Chemical Biology, researchers at Sanford-Burnham Medical Research Institute (Sanford-Burnham) show how the errant form of LYP can disrupt the immune system. In doing so, they also found a potential new therapy for autoimmune diseases – a chemical compound that appears to inhibit this mutant protein.


T cells and autoimmune disease

In Caucasian populations, a mutated form of LYP (short for lymphoid tyrosine phosphatase) is the third most common single-gene cause of Type 1 diabetes. It ranks second for rheumatoid arthritis.

Researchers have known that LYP and another protein called CSK (C-terminal Src kinase) work cooperatively to keep the immune system’s destructive T cells from being activated. Because the uncontrolled activation of T cells is a hallmark of many autoimmune diseases, the proper functioning of LYP with CSK is thought to keep T cells in check.

While the normal form of LYP can bind CSK, the disease-associated mutant LYP cannot. In the new study, Sanford-Burnham researcher Lutz Tautz, Ph.D. led an international group of scientists in showing that normal LYP can disassociate itself from CSK, which paradoxically makes LYP better at dampening the signals that activate T cells. These findings explain why the mutant form of LYP is better at limiting T cell activation than normal LYP.

“It’s still a mystery how a protein that impairs T cell signaling causes autoimmunity,” said Tautz. “In a simple model of autoimmunity, you would think the opposite.”

One possible explanation, Tautz said, is that the mutant LYP weakens the action of regulatory T cells, which control the other type of T cells, the kind that causes autoimmunity.

“If you have regulatory T cells that are not as active because they have inhibited signaling, then they might not be able to do their job properly,” Tautz said.


Towards new therapeutics

In their study, the researchers also screened 50,000 drug-like chemical compounds and found 33 that have a specific effect on LYP activity. One compound, called LTV-1, blocked the action of the mutant LYP protein in human T cells. In fact, under physiological conditions, LTV-1 is the most potent LYP inhibitor reported to date.

Tautz said he plans to next develop the LTV-1 compound further, in part by modifying it chemically to make it more effective as a drug. Tests in mice, however, could be problematic because a separate study recently showed that mice with a corresponding LYP mutation don’t get sick at all.

Developing new treatments for autoimmune diseases would help millions of people. Overall, autoimmune diseases affect more than 25 million individuals in the United States alone. According to the U.S. Department of Health and Human Services, autoimmune diseases are a leading cause of death and disability.

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This research was funded by the National Cancer Institute, the Norwegian Cancer Society, the American Cancer Society, the Oxnard Foundation, the Belgian Research National Scientific Fund, and Liege University.

The study was co-authored by Torkel Vang, Sanford-Burnham and University of Oslo; Wallace H. Liu, Sanford-Burnham; Laurence Delacroix, Liege University; Shuangding Wu, Sanford-Burnham; Stefan Vasile, Sanford-Burnham; Russell Dahl, Sanford-Burnham; Li Yang, Sanford-Burnham; Lucia Musumeci, Liege University; Dana Francis, Brown University; Johannes Landskron, University of Oslo; Kjetil Tasken, University of Oslo; Michel L. Tremblay, McGill University; Benedicte A. Lie, University of Oslo; Rebecca Page, Brown University; Tomas Mustelin, Sanford-Burnham; Souad Rahmouni, Liege University; Robert C. Rickert, Sanford-Burnham; and Lutz Tautz, Sanford-Burnham.
Sanford-Burnham Medical Research Institute

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