Arthritis Blog

Arthritis patients, and the doctors who treat them, are being warned about a link between TNF-alpha blockers and fungal infection. The FDA has announced that the makers of four TNF-alpha drugs (Enbrel, Remicade, Humira, and Cimzia) must strengthen warnings about fungal infection. Warnings already exist on TNF-alpha drugs regarding serious infection, including fungal infection, but the FDA fears fungal infection is going unnoticed in too many patients.

Based on reports that were reviewed by the FDA, health care professionals are not recognizing cases of histoplasmosis and other fungal infections consistently -- leading to delayed treatment. The FDA reviewed 240 reports of histoplasmosis, an infection caused by the fungus Histoplasma capsulatum, in patients treated with Enbrel, Remicade, or Humira. The majority of those reports came from an area where H. capsulatum is commonly found (the Ohio River and Mississippi River valleys). In at least 21 of those cases, histoplasmosis was not diagnosed initially, leading to delayed treatment -- and ultimately 12 of those patients died. There were also reports of patients who took TNF blockers and developed coccidioidomycosis and blastomycosis -- some resulting in death.

One forum member wrote, "Has everyone heard on the news the new warnings for Remicade, Humira, etc. Sounds pretty awful. I'm on Humira and now worried about one more potential life threatening side effect." While the news is alarming to those on the drugs, be sure you discuss the warning with your doctor. Discuss your concerns and how this may affect you. Read the facts in Fungal Infection - A Risk With TNF-alpha Blockers.

Related Resources:

• TNF-alpha Blockers - What You Need to Know
• Is Infection a Serious Side Effect of Biologics?
• Are Some Patients Unsuitable Candidates for Biologics?
• Test Your Knowledge - TNF Blockers

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• Join Us in Our Arthritis Forum / Message Board

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Joint replacement is considered a last resort treatment option to relieve arthritis pain and restore function to the affected joint. More conservative treatment options are usually tried before surgery is recommended. When pain is no longer well-controlled and joint damage significantly affects quality of life, joint replacement is a good choice for many patients.

According to the Centers for Disease Control and Prevention, knee and hip replacement procedures account for 35% of total arthritis-related procedures during hospitalization. Every year in the United States alone, more than 285,000 hip replacements are performed, and the number is expected to double to about 573,000 by the year 2030. More than 300,000 knee replacements are performed, and the number is expected to increase 525% by the year 2030. In 2006, 160,000 hip and knee replacements were performed in England and Wales.

The need for revision (a repeat surgery to repair a failed prosthesis) is a concern for patients facing joint replacement surgery. Researchers in England, by merging two databases, analyzed revision rates from April 2003 to September 2006. They found that in the 3-year period, 1 in 75 patients required revision of their joint replacement. That was considered to be low -- but researchers also found that the type of joint replacement made a difference. Highest revision rates were experienced by women who had a hip resurfacing procedure (head of femur is not replaced) rather than total hip replacement surgery. For those who had undergone knee surgery, the highest revision rates were among those who had a specific type of knee replacement -- a unicondylar knee replacement (only the damaged part of the knee is replaced). There also was no link between a patient's age and revision rates for hip replacements. But, for knee replacement, revision rates decreased strongly with age. Hip resurfacing and unicondylar knee replacements are newer procedures. More research will indicate whether or not they require more frequent revision than total joint replacement procedures.

Related Resources

• Birmingham Hip Resurfacing System
• Total Knee Replacement - What You Need to Know
• Total Hip Replacement - What You Need to Know
• Joint Replacement Screening Quiz - When Is the Right Time?

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About 75-90% of patients with rheumatoid arthritis improve during pregnancy, according to previous reports. But how have the new rheumatoid arthritis treatments made available during the last decade affected this statistic? According to a report in the September 15, 2008 issue of Arthritis Care & Research, 84 rheumatoid arthritis patients were assessed for disease activity in 28 joints and their medication use was noted -- before conception, at each trimester, and at 6, 12, and 26 weeks postpartum

Results of the study showed that disease activity decreased during pregnancy and increased postpartum. In patients with at least moderate disease activity in the first trimester, about 48% showed moderate improvement during pregnancy. In patients with low disease activity in the first trimester, disease activity was found to be stable during pregnancy. Less medication was used during pregnancy compared with before conception and postpartum. Also, about 39% of patients had at least a moderate flare postpartum. Researchers concluded that "patients achieve remission during pregnancy and deteriorate postpartum, although less frequently than previously described."

Related Resources:

• Guide to Pregnancy and Arthritis
• Pregnancy Advice for Women With Arthritis
• Does Stress Trigger Rheumatoid Arthritis?
• Women With Lupus and RA Have Greater Pregnancy Complications

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Fibromyalgia symptoms can mimic or overlap symptoms associated with other rheumatic diseases. Muscular pain, fatigue, headaches, sleep problems, memory problems, noise sensitivity, and depression are just some of the symptoms associated with fibromyalgia. According to a study published in the July 2008 issue of the Journal of Rheumatology researchers have suggested that hippocampus dysfunction may explain some fibromyalgia symptoms.

The study assessed 15 female patients, who met criteria for classification of fibromyalgia, and compared them to 10 healthy females for N-acetylaspartate (NAA), choline, creatine, and their ratios from both hippocampi. Results showed that the hippocampus was dysfunctional in fibromyalgia patients -- primarily demonstrated by lower NAA levels compared to the healthy women. The hippocampus is a part of the brain and functions in the maintenance of cognitive functions, sleep regulation, and pain perception. The findings are considered another piece to what's considered a puzzling medical condition.

Related Resources:

• Fibromyalgia Screening Quiz
• Test Your Knowledge - Fibromyalgia
• Recognize Signs and Symptoms of Fibromyalgia
• 10 Things You Should Know About Fibromyalgia

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• Join Us in Our Arthritis Forum / Message Board

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Arthritis patients who take NSAIDs (nonsteroidal anti-inflammatory drugs) have an increased risk of developing bleeding ulcers -- one of the most serious problems associated with NSAID use. While there are many potential side effects that can occur from longterm use of NSAIDs, bleeding ulcers can be life-threatening and must be taken seriously. Bleeding typically occurs from the duodenum or stomach, but may also develop from the large intestine.

While warning signs often occur, such as stomach discomfort or bloody/black stools, some patients -- especially the elderly -- may have no warning before they develop serious bleeding. Fortunately, for those patients who need to take NSAIDs to treat their arthritis, there are ways to decrease the risk of ulcers and complications from ulcers such as gastrointestinal bleeding. We asked Scott J. Zashin, MD (a rheumatologist) and he suggested 9 Ways to Reduce Your Risk of Bleeding Ulcers from NSAID Use.

Related Resources:

• 10 Things You Need to Know About NSAIDs
• Nexium Reduces Risk of Ulcers for NSAID Users
• Voltaren Gel - What You Need to Know
• Gastrointestinal Bleeding - Don't Ignore Your Symptoms

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• Join Us in Our Arthritis Forum / Message Board

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Unless you or a loved one have one of the over 100 types of arthritis, I doubt the word "rheumatology" is in your vocabulary. But, when arthritis enters your life, you learn quickly about rheumatology -- a subspecialty of internal medicine. Rheumatology is the medical specialty that focuses on arthritis and related rheumatic diseases. Doctors who specialize in rheumatology are referred to as rheumatologists.

Arthritis patients, especially early in the course of their disease, may question if it is necessary to go to a specialist in rheumatology. If you're already an established patient and have a good rapport with an internal medicine doctor -- can't the internist diagnose and treat arthritis? Learn when you should see a rheumatologist and why in What Is Rheumatology?

Related Resources:

• Arthritis Screening Quiz
• First Visit to the Rheumatologist
• I Think I Have Arthritis. Now What?
• Test Your Knowledge - Types of Arthritis and Rheumatic Diseases

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Rheumatoid arthritis causes bone loss but exactly how that happens has not been fully understood. It is known that TNF-alpha plays an important role in autoimmune diseases like rheumatoid arthritis. When it is overproduced, TNF-alpha signals the destruction of bone and cartilage. Human bone is continually regenerated in what could be called a biological balancing act. Osteoclasts break down bone to pave the way for new bone. Osteoblasts build new bone where osteoclasts removed it.

Researchers have known that TNF-alpha decreases the number of bone-building osteoblasts but now they know how as well. A study published in the August 22 edition of the Journal of Biological Chemistry revealed that TNF-alpha affects osteoblasts through an enzyme referred to as Smurf1 (Smad Ubiquitin Regulatory Factor 1). Smurf1 turns off two proteins that are involved in bone-building. While there are drugs that have been developed that block TNF-alpha (Enbrel, Remicade, and Humira), researchers are now focused on designing drugs that would shut down Smurf1. Interestingly, mice that are engineered to have less Smurf1 expression have been found to develop thicker bones. This suggests that focusing on Smurf1 may also lead to new ways of treating osteoporosis. The significance of these findings will be determined in future studies.

Related Resources:

• Fast Facts About Rheumatoid Arthritis
• Test Your Knowledge - Rheumatoid Arthritis
• Rheumatoid Arthritis 101 - Free E-Course Newsletter
• Rheumatoid Arthritis Prognosis - How Soon Will Symptoms Worsen

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Fruit juice may not be the best choice when taking your arthritis medications. A Canadian researcher has concluded that fruit juice can decrease or increase the effect of certain medications by affecting their absorption. Emphasizing that patients shouldn't panic and stop drinking fruit juice, researchers will continue to study which drugs are affected and by how much.

It's well-known that grapefruit juice should be avoided with certain medications. In 1991, grapefruit juice was found to boost the amount of certain drugs absorbed into the bloodstream, increasing the drug's toxicity. Now, there are nearly 50 drugs that carry warnings about grapefruit juice. But it may also be that apple juice and orange juice affect the absorption of certain medications. The researcher said in The Gazette, "Chemicals in the fruit juices appear to turn off a pump that normally helps get drugs out of the gut and into the body. The concern is that drugs essential for treating serious medical conditions might lose their benefit." Methotrexate is named in the article as one of the drugs that may be affected by fruit juice.

The best advice regarding fruit juice and medication -- ask your doctor and pharmacist how you should take your pills for optimal effectiveness. It may be best to avoid fruit juices for at least two hours so that drugs can be fully absorbed.

Related Resources:

• Arthritis Drugs - What Are My Options?
• 10 Most Popular Arthritis Drugs Prescribed by Rheumatologists
• 10 Ways to Ensure Drug Safety
• More About Drug Side Effects / Adverse Reactions

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• Join Us in Our Arthritis Forum / Message Board

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Has your doctor discussed arthrography with you as part of determining why you may be having joint pain or joint stiffness, among other arthritis symptoms? Arthrography is an imaging technique that involves injecting a contrast agent into a joint prior to taking x-rays. The iodine-based contrast is injected into the joint cavity alone or combined with air so that structures within the joint can be assessed. When iodine is injected in to the soft tissues around a joint, it appears bright white on the arthrogram (the images produced by arthrography), allowing the doctor who reads the arthrogram to view the anatomy of the joint and assess joint function.

Conventional arthrography is helpful for detecting, with accuracy, certain arthritic or orthopedic conditions. Besides conventional arthrography, there is magnetic resonance arthrography, where the joint is distended with contrast agent that contains gadolinium. Learn more about this diagnostic technique in Arthrography - What You Need to Know.

Related Resources:

• What Are Osteophytes?
• What Is Joint Effusion?
• Is MRI Needed to Diagnose Osteoarthritis?
• Thermal Imaging Camera Used to Detect Arthritis

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Any time there's breaking news having to do with rheumatoid arthritis, and the words "cure" or "vaccine" are involved, you've grasped my attention and the attention of countless other rheumatoid arthritis patients. Before we dig into the details of the latest revolutionary development -- remember to view it with cautious optimism. BBC News has reported that according to Newcastle University researchers in the U.K., a single injection of modified cells could possibly halt the progression of rheumatoid arthritis.

A sample of a rheumatoid arthritis patient's white blood cells is taken, treated with a mix of steroids and vitamins, and re-injected back into the joint of the patient. A certain type of immune cell, known as a dendritic cell, is transformed from an autoimmune state to a tolerant state, or you could say reset to "pre-disease" mode. It is thought that the cells would remain in the pre-disease state unless whatever triggered the autoimmune response was encountered again. Not yet tested on animals or humans -- researchers are ready to do a safety trial on 8 patients. If successful, larger trials would be expected to follow. Even before the safety trial has begun, reports suggest the "arthritis vaccine" could be fully tested and made available to patients within 5 years.

Related Resources:

• Rheumatoid Arthritis Screening Quiz
• Symptoms of Rheumatoid Arthritis
• 2008 ACR Recommendations for Treating RA
• 10 Things You Should Know About Rheumatoid Arthritis

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