Gout Risk From Purine Rich Foods

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Main Category: Gout
Also Included In: Arthritis / Rheumatology
Article Date: 31 May 2012 – 12:00 PDT

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Foods rich in purines, particularly those found in meat and seafood, quintuple the immediate risk of a gout flare-up, according to research published online in the Annals of the Rheumatic Diseases.


While the anecdotal evidence has suggested that purine rich foods can trigger gout attacks, it hasn’t been clear whether they prompt flare-ups in the short term, say the authors.
 


They base their findings on 633 people with confirmed gout, whose health was tracked over a year, online. The average age of the participants was 54, and most of them (78%) were men.
 


They were asked to provide details of history of gout attacks, including the timing and symptoms of the attack; what drugs they were taking to manage their condition; and to list any potential triggers in the two days running up to an attack.
 


This included dietary sources of purines. Foods rich in purines include meat, offal, seafood, beans, peas, lentils, oatmeal, spinach, asparagus, mushrooms, yeast, and alcohol.
 


They were also asked to provide the same information over two-day periods every quarter when they were not experiencing a flare-up, by way of a comparison.
 
Over half drank alcohol (61%), a known risk factor for the condition, while 29% used water pills (diuretics) and almost half took allopurinol – a drug used to prevent gout attacks.
 
Over half used non-steroidal anti-inflammatory drugs, while one in four (25%) took colchicines, another class of anti-gout drug.
 


During the 12 month monitoring period, 1,247 gout attacks were recorded, most of which occurred in the toe joints, causing intense pain and redness. 

The average amount of dietary purine during a two-day period without gout attacks was 1.66 g, while that consumed in the two days before an attack was 2.03 g.
 
Compared with those in the bottom 20% of purine consumption, those in the top 20% were almost five times as likely to have a gout flare-up.



Animal sources of purines carried a significantly higher risk than plant sources of triggering an attack.

These findings held true, irrespective of age, gender, alcohol intake and use of medications to control symptoms/pain.



The fact that plant sources of purines had significantly less impact than animal sources can be explained by lower purine content in those foods, say the authors, who emphasise that plant sources contain other important nutrients and contribute to lowering insulin resistance – long advocated as a measure to control gout.


The researchers conclude:
 “Avoiding or reducing purine-rich food intake, especially of animal origin, may help reduce the risk of recurrent gout attacks.” 


Written By Petra Rattue

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In Juvenile Arthritis Treatment, Injection Of Methotrexate No Better Than Oral Therapy

Main Category: Arthritis / Rheumatology
Also Included In: Pediatrics / Children’s Health
Article Date: 31 May 2012 – 1:00 PDT

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A retrospective analysis of methotrexate (MTX) safety data found that injection of this disease-modifying anti-rheumatic drug (DMARD) was not superior to oral therapy in long-term treatment of patients with juvenile idiopathic arthritis (JIA). Findings published in Arthritis Care Research, a peer-reviewed journal of the American College of Rheumatology (ACR), suggest that with similar efficacy and tolerability the more comfortable oral approach may be more suitable to treat pediatric arthritis patients.

There are a number of chronic arthritis conditions, collectively referred to as JIA, that affect children and teens. Medical evidence reports JIA incidence ranges from 10 to 100 per 100,000 children under 16 years of age, making it the most common chronic pediatric inflammatory disease. In the U.S. the ACR estimates that 294,000 children are diagnosed with JIA, which can lead to severe disability.

Previous studies have confirmed the safety and efficacy of MTX, which is one of most common first line DMARD treatments for arthritis. While side effects such as nausea and vomiting may limit MTX use in children, the type of delivery method may also pose a significant burden to the patients,” explains Dr. Ariane Klein from Asklepios Klinik in Sankt Augustin, Germany. “Our study compares the efficacy of oral MTX to injection of the drug and to assess side effects in children with JIA.”

Using data collected by the German Methotrexate Registry since 2005, researchers identified JIA patients who were treated with MTX for at least 6 months and who did not receive additional biologic therapies. Participants who changed their MTX approach during the observation period were excluded. The study groups consisted of 259 (63%) patients who received oral MTX and 152 (32%) patients receiving MTX injections. In both groups, patients had a median age of ten years, two-thirds were female, and all received a comparable dose of MTX.

A clinical response (efficacy) based on the PedACR 30 score after six months of MTX therapy was found in 72% receiving oral therapy and 73% of patients using injections. At least one adverse event was reported in 22% of patients in the oral cohort compared to 27% in the injection therapy group. Researchers found that significantly more patients receiving MTX injections discontinued treatment due to adverse events compared to those on oral treatment at 11% versus 5%, respectively.

Dr. Klein concludes, “Our analysis found that efficacy and tolerability of MTX was similar in both delivery methods. The often unpopular MTX injection did not appear to be superior to oral administration and may likely be spared without clinical consequences.” The authors advised further controlled studies to determine the best application route of MTX treatment in patients with juvenile arthritis.”

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Throughout the month of May, the American College of Rheumatology, ACR Research and Education Foundation, Arthritis Foundation, Mayo Clinic, and Nemours have been partnering to celebrate Arthritis Action Month (formerly Arthritis Awareness Month) in the U.S.

Full citation: “Efficacy and Safety of Oral and Parenteral Methotrexate Therapy in Children with Juvenile Idiopathic Arthritis.” Ariane Klein, Ingrid Kaul, Ivan Foeldvari, Gerd Ganser, Urban Andreas and Gerd Horneff. Arthritis Care and Research; Published Online: May 30, 2012 (DOI: 10.1002/acr.21697).
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Rheumatoid Arthritis Battle

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Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 25 May 2012 – 12:00 PDT

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Over one million adults in the U.S. suffer from rheumatoid arthritis, a systemic inflammatory autoimmune disease that can be incapacitating. Researchers have now discovered the mechanism by which a cell signaling pathway contributes to the development of rheumatoid arthritis (RA). The study, published ahead of the print version of Nature Immunology shows evidence that drugs that are being developed for diseases like cancer, could potentially be used to treat RA.

Study leader, Xiaoyu Hu, M.D., Ph.D., a research scientist at Hospital for Special Surgery in New York City declared: “We uncovered a novel mechanism by which the Notch pathway could contribute to RA.”

The team was aware of the fact that Notch, an intracellular molecular pathway plays a role in diseases like cancer before they embarked on their study due to the fact a study of another research team discovered in 2011 that a certain mutation in a gene involved in the Notch pathway places patients at risk for RA. However, the study was unable to reveal the mechanism.

Hu said: “We were intrigued. Nothing has been known about how the Notch pathway is important to RA.” Hu started to collaborate with other U.S. scientists and scientists from abroad and they discovered that Notch could potentially be involved in a misfiring of the immune system, which is frequently observed in RA.

They developed methods to evaluate a potential impact of the Notch pathway on macrophages, i.e. white blood cells within tissues that ingest pathogens and can cause inflammation. Macrophages that have become abnormal possess attributes of being destructive and causing widespread inflammations, which can strongly contribute to acute and chronic rheumatoid arthritis. Dr. Hu explains: “In the case of RA, inflammatory macrophages attack joints and they produce inflammatory mediators that basically sustain inflammation in joints.”

The researchers discovered during their experiments that knockout mice with a missing Notch pathway in their macrophages were unable to produce certain types of macrophages and have a lesser inflammatory phenotype.

Dr. Hu explains:

“Notch is essential for the development and function of a cell type called the inflammatory macrophages and if this pathway is missing in mice, then you don’t get good differentiation of the inflammatory macrophages.”

In simple terms, the Notch pathway is vital in order to differentiate and function of inflammatory macrophages, which in turn are vital for human RA pathogenesis.

The researchers cleaned out the specifics of how Notch influences the molecular cascade, which lead to generating inflammatory macrophages in a series of in vitro studies. Another experiment demonstrated that by using GSI-34, a Notch pathway inhibitor currently under development for the treatment of cancer and Alzheimer’s, that the drug was able to block the function of macrophages.

According to the researchers, the study offers an insight into how Notch contributes to rheumatoid arthritis pathogenesis, in addition to demonstrating for the first time that GSI-34 could potentially be used to treat RA.

Various companies are currently in the process of developing Notch inhibitors, some of which are already undergoing Phase III trials.

Dr. Hu concludes: “Before this study, the Notch pathway has been implicated mainly in cancer, but in this study we define how it is connected to RA.”

Written By Petra Rattue

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Underrated Danger In Rheumatoid Arthritis From Standard Heart Disease Risk Tools

Main Category: Heart Disease
Also Included In: Arthritis / Rheumatology;  Immune System / Vaccines
Article Date: 23 May 2012 – 1:00 PDT

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Heart disease risk assessment tools commonly used by physicians often underestimate the cardiovascular disease danger faced by rheumatoid arthritis patients, a Mayo Clinic study has found. Inflammation plays a key role in putting those with rheumatoid arthritis in greater jeopardy for heart disease, yet many cardiovascular disease risk assessment methods do not factor it in, the researchers note. More work is needed to figure out what drives heart disease in rheumatoid arthritis patients, and more accurate tools to assess that risk should be developed, the authors say. The study is published online in the American Journal of Cardiology.

In rheumatoid arthritis, the immune system attacks tissues, inflaming joints. It can also affect other parts of the body. Rheumatoid arthritis patients have a higher risk of early death than the general population, and previous research suggests cardiovascular disease is the main reason. The Mayo study gauged the accuracy of two commonly used tools for assessing heart disease danger – the Framingham and Reynolds risk scores – and found they substantially underrated cardiovascular disease danger in women and men with rheumatoid arthritis, particularly in older patients and people who test positive for rheumatoid factors, proteins produced by the immune system and often associated with rheumatoid arthritis.

“This study emphasizes that patients with rheumatoid arthritis are at higher risk for heart disease, and that conventional predictors of risk are not adequate for estimating this risk. Physicians caring for patients with rheumatoid arthritis should be aware of this heightened risk even when conventional risk factors seem to indicate no increased risk, and consider measures to assess and lower CV risk in these patients,” says co-author Eric Matteson, M.D., chairman of Mayo Clinic’s rheumatology division.

Among those studied were 525 patients over 30 who were diagnosed with rheumatoid arthritis between 1988 and 2007 and had no previous history of cardiovascular disease. The study used medical records from the National Institutes of Health-funded Rochester Epidemiology Project, whose resources make Olmsted County, Minn., one of the few places in the world where researchers can examine medical data on virtually everyone in a defined geographic population to find the true frequency of certain conditions and the success of treatments.

The patients’ 10-year risk of developing cardiovascular disease was measured using the Framingham and Reynolds risk scores. The mean follow-up period was 8.4 years; 84 patients developed cardiovascular disease during that time. The observed heart disease risk turned out to be twice as high among women and 65 percent higher in men than the Framingham risk score predicted, and the Reynolds tool had similar shortcomings, researchers found. Patients 75 and older proved to be three times more at risk than the Framingham score indicated. Patients with positive rheumatoid factor also had more heart disease events than the risk scores predicted.

“Ongoing research is attempting to determine how inflammation leads to increased cardiovascular risk in rheumatoid arthritis, and what treatments for rheumatoid arthritis might reduce this risk,” Dr. Matteson says. “Further work must also evaluate just how patients with rheumatoid arthritis should be managed to detect and reduce their risk for cardiovascular disease.”

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Medical Supplies Galore!

If you were in charge of buying items for a hospital or clinic or even had your own practice, you should make the most of a government seized item auction. You can find an innumerable number of medical supplies out there that are brand new and ready to be bought at a discount! You can find anything from stretchers, medical machines, exam tables, sensors, gurneys, robes, IV stands, or anything medical you can think of. Usually these items sell for less than their original prices. Medical equipment can be very expensive and with these auction you really can score a deal. They also go on in every state. If you were a doctor looking to outfit your new office with some top of the line items then you should definitely check out a live or online government auction!


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New Target Identified In The Rheumatoid Arthritis Battle

Main Category: Arthritis / Rheumatology
Also Included In: Cancer / Oncology;  Genetics
Article Date: 22 May 2012 – 0:00 PDT

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A new study led by researchers at Hospital for Special Surgery identifies the mechanism by which a cell signaling pathway contributes to the development of rheumatoid arthritis (RA). In addition, the study provides evidence that drugs under development for diseases such as cancer could potentially be used to treat RA. Rheumatoid arthritis, a systemic inflammatory autoimmune disease that can be crippling, impacts over a million adults in the United States.

“We uncovered a novel mechanism by which the Notch pathway could contribute to RA, said Xiaoyu Hu, M.D., Ph.D., a research scientist at Hospital for Special Surgery in New York City and principal investigator of the study. The study appears online in advance of print in Nature Immunology.

Prior to this study, researchers knew that an intracellular molecular pathway called Notch is involved in diseases such as cancer. In the last year, other scientists conducted a genome wide association study to identify genes that were linked to the development of rheumatoid arthritis. They discovered that a certain mutation in a gene involved in the Notch pathway puts patients at risk for RA, but nobody knew just how it was involved.

“We were intrigued. Nothing has been known about how the Notch pathway is important to RA,” said Dr. Hu. Working with researchers at other institutions in the United States and abroad, HSS investigators started putting two and two together and noted that Notch might be involved in a misfiring of the immune system that is commonly seen in RA.

The researchers designed experiments to test whether the Notch pathway had an influence on macrophages, a type of white blood cell that is most commonly known for gobbling up pathogens but which can also cause inflammation. Macrophages that have gone awry possess widespread pro-inflammatory and destructive capabilities that can critically contribute to acute and chronic rheumatoid arthritis. “In the case of RA, inflammatory macrophages attack joints and they produce inflammatory mediators that basically sustain inflammation in joints,” said Dr. Hu.

In experiments, researchers found that knockout mice that lack the Notch pathway in macrophages were unable to produce certain type of macrophages and exhibited a lesser inflammatory phenotype.

“Notch is essential for the development and function of a cell type called the inflammatory macrophages and if this pathway is missing in mice, then you don’t get good differentiation of the inflammatory macrophages,” said Dr. Hu. In a nutshell, the Notch pathway is essential for the differentiation and function of inflammatory macrophages, and these macrophages are critical for human RA pathogenesis.

In a series of test tube studies, the researchers flushed out the specifics of how Notch influences the molecular cascade that leads to generation of inflammatory macrophage. In another experiment, the investigators used an inhibitor of the Notch pathway called GSI-34 that is under development and showed that this drug could inhibit the function of macrophages.

The researchers say the study provides the first explanation of how Notch contributes to rheumatoid arthritis pathogenesis. It also shows, for the first time, that investigational Notch inhibitors under development for cancer and Alzheimer’s could potentially be used to treat RA. Several Notch inhibitors are under development by various companies and a few are currently in Phase III trials.

“Before this study, the Notch pathway has been implicated mainly in cancer, but in this study we define how it is connected to RA,” said Dr. Hu.

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The study was supported by funding from the National Institutes of Health and the American College of Rheumatology. Other authors involved in the study include Hospital for Special Surgery researchers Baohong Zao, Ph.D., Lionel Ivashkiv, M.D., Carl Blobel, M.D., Ph.D., Jimmy Zhu, Sinead Smith, and Allen Chung; Julia Foldi, Ph.D., and Chao Shi, Ph.D., from Weill Cornell Graduate School of Medical Sciences; Hasina Outtz and Jan Kitajewski, Ph.D., from Columbia University; Silvio Weber and Paul Saftig, Ph.D., from the Christian Albrechts Universitat Kiel, Kiel, Germany; Yueming Li, Ph.D., from Memorial Sloan-Kettering Cancer Center; and Keiko Ozato, Ph.D., from the National Institute of Child Health and Human Development.
Hospital for Special Surgery

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Strength in weakness

Depressed patients, overworked nurses and isolation rooms fill the corridors of this immensely dreary, sterile building. There is commotion and movement in every corner with deceiving optimism, but the uneasy spirit of lifelessness and apprehension screams even louder. All that was once healthy and vibrant seem sunk in a deep degeneracy and degradation of mind and body.

Taking all precautions, I place a clean mask over my face and quickly walk past the isolation rooms to make my way over to my friend’s room. He greets me with a plastered smile, and it doesn’t take me long to figure out he is in critical condition. His room appears clean, but is cluttered with medical equipment and other miscellaneous items that do nothing to create a much needed ambiance of healing and relaxation. Despite the mix of medicine and body odor lingering in the thick, stuffy air, the windows remain tightly shut under a dark green curtain that looks more like a carpet. An atmosphere of anxiety and gloom is dense in here.

Sharing this tiny space with us is an old, Nicaraguan man named Daniel. He appears way too jolly for a sick patient and I wonder if he’s senile. We exchange simple words of courtesy between his long, painful coughs and I begin to sense his loneliness and longing for companionship. Even so, I stay as far removed from him as possible to avoid contracting the virus responsible for his dwindling health. Each time he coughs, I not only hear, but am jarred by the idea of being infected by the phlegm and/or other unknown fluids spewing out from his wet, uncovered mouth.

Hours pass before I realize he has, without my permission, worked his way into my heart. He calls me by my Spanish name every 30 minutes or so and refers to me as his daughter. He uses what little energy he has with his feeble arms to bring me his chair so I can prop my feet up during the night. He encourages me to learn Spanish and asks me to practice speaking with him. Every now and then, he looks completely distracted and resumes talking again by telling me how “bonita” I am. His compliments don’t flatter me, but they mean more to me than the various contrived generalities with which some men try to win my affection. Amidst this gloomy, depressing environment, a 90-year old man fading away with pneumonia is somehow putting a smile on my face and placing courage back into my heart. In return, I give him my affection, the only thing I have to offer to this strangely familiar old man.

I wish for his health to return so he can tell me more stories of his youth, his family and his struggles. Alas, this sweet, gentle old man, who is also incredibly sharp, is a diabetic with pneumonia, withering away by the hour and drowning internally in his own bodily fluids. Before long, he will leave this place along with other patients on this floor, and it makes me consider how my last moments will be perceived and the ways in which I will impact the people in my life. What colors will I show when my body is deteriorating and death becomes the most tangible, inescapable reality?

I have long ways to go before I can match Daniel’s strength and grace.

Killer Infections

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What is this deadly infection that’s killed 6 babies at the Royal Jubilee Hospital in Belfast, Ireland?

Pseudomonas aeruginosa is a common bacterium that can cause disease in animals, including humans. It is found in soil, water and on most surfaces. The symptoms of such infections are generalized inflammation and sepsis. If such colonizations occur in critical body organs, such as the lungs, the urinary tract, and kidneys, the results can be fatal especially in new born babies. Because this bacteria thrives on most surfaces, sometimes it can be found on medical equipment, causing cross-infections in hospitals and clinics.

New born babies are vulnerable due to their undeveloped immune system.

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