Biological Agents for Relief of RA

Several people in my life (including my mother) have struggled with RA and have now found relief with so-called "biological agents." I was interested in finding out exactly what these "agents" are and how they work (immunologically speaking . . . . )

These treatments are currently marketed as Enbrel, Remicade, and Humira. They are each a slightly different type of TNF (tumor necrosis factor) blocker. As we all know, TNF is a pro-inflammatory cytokine. These medications (which must be given as an injection or as an intravenous infusion) work by completely blocking the action of TNF. This provides great relief to many RA sufferers. For some, it even stops the progression of rheumatoid arthritis.

This may seem to be a perfect treatment! But . . . A major downside to this type of treatment (an issue that we discussed on Monday) is that our immune systems manufacture TNF for a reason. By blocking TNF completely, the immune systems of the RA patients are compromised and the patients are therefore highly susceptible to infectious diseases. I suspect that research in this area will continue until a treatment is found that inhibits progression of RA without compromising the immune system in the process.

Vitamin D and Rheumatoid Arthritis

So I was looking around at studies done on treatments for arthritis and ran across this article on Vitamin D. The article is called "Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women's Health Study". The point of their study was to evaluate the association between vitamin D intake and incidences of rheumatoid arthritis. They picked women between 55 and 69 who previously had no history of rheumatoid arthritis. Their diet and vitamin D intake were evaluated using a questionnaire. The women were then followed up for 11 years to check possible cases of the disease. Their results showed that a greater intake of Vitamin D lead to a decreased risk of RA.

An issue with this study is that it was only done on women. We really have no data then on how Vitamin D intake affects men. It might also be interesting to see what affect Vitamin D has on people who already have rheumatoid arthritis.

http://www.ncbi.nlm.nih.gov/pubmed/14730601

Psoriatic Arthritis

Many articles about arthritis mention that there are hundreds of types of arthritis. The most common types that we have been discussing in class are rheumatoid arthritis and osteoarthritis, which are also the only 2 out of hundreds that I have heard of before. So I decided to learn about another type of arthritis.

I found an article containing information about a type of arthritis that occurs in people with psoriasis, called psoriatic arthritis. It is defined as "an inflammation of the joints that occurs in 10 to 30 percent of patients with psoriasis. It is not a type of psoriasis, but a symptom of psoriasis which is classified as a type of arthritis." The article I found stated that "Approximately 1 million people in the United States suffer from psoriatic arthritis. Most of them are adults between the ages of 30 to 50. However, psoriatic arthritis can affect juveniles and young people." I thought that it was very interesting that this type of arthritis is known to occur in children, because arthritis is usually said to occur in older people.

Psoriatic arthritis is suspected to be caused by genetics, but the cause is unknown. Therapy for this condition includes psoriasis treatment and progress that is being made in a type of medication made from human and animal proteins, called biologics.

http://www.omnimedicalsearch.com/conditions-diseases/psoriatic-arthritis.html

Arthritis and Heredity?

One of you asked whether arthritis is hereditary so I decided to try to find some information on it. Discovery Health posted an article titled “Arthritis and Heredity” in which it talked about the many forms of arthritis and which ones tend to run in families. The most common varities of arthritis are osteoarthritis and rheumatoid arthritis with arthritis affecting one in seven Americans. While the article did not talk very much about the heredity of arthritis too much it did provide a lot of information on how arthritis can develop and what types of people are most affected. In osteoarthritis may be due to inactivity caused by muscle weakness and obesity. This form of arthritis is more common in women and in older people. Rheumatoid arthritis involves the body’s immune system attacking its own tissues. Women are much more likely than men (2 times more) to have this form of arthritis. Unlike osteoarthritis, rheumatoid arthritis tends to affect people of all ages and can travel throughout the body.

Here is the link to the site:

http://health.discovery.com/centers/arthritis/arthritis_qa/arthritis_hered.html

Hydrotherapy and Tai Chi effects on Osteoarthritis

As I was looking around for arthritis related topics to blog on, I came upon an interesting study that looked at two different activities and their effect on symptoms of OA.

The study done in 2007 ran a 12 week test, with a 12 week follow up, on 152 elderly sufferers of osteoarthritis of the hip or knee. Subjects needed to be about 70 years of age and classified as inactive. 55 subjects were placed in a 12 week hydrotherapy class, 56 subjects were placed in a 12 week Tai Chi course and, 41 were placed in a control (wait list). Each session was 1 hour long and held twice a week, making a total of 24 classes.
Results showed a decrease in joint pain for patients in both hydrotherapy and Tai Chi groups based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Physical function also improved in these two groups and was tested using the "Up and Go" test, 50-foot walk time, and timed stair climb. The "Up and Go test" is a measure of a patient's ability to get up out of a chair without arm support, walk several paces out and back, and sit back down without arm support. These improvements were sustained by most subjects for an additional 12 weeks after the classes.


http://www.arthritiswa.org.au/documents/PAFORMmainresultsACR.pdf

The article "What A Pain," from The Boston Globe, referenced the Arthritis Foundation a few times, so I decided to learn more about it. I went to the website and found that it was actually very helpful and informative about arthritis. The website has information about many types of arthritis, events to raise awareness, and current research.

One of the topics that is currently being researched that I found interesting was in an article called, "Clarifying the Role of Fat in Osteoarthritis." It mentions how obesity is thought to increase the risk of arthritis due to increased weight and force on joints. The article goes on to say, "excess fat may take a toll in another way, too. Fat is a metabolically active tissue that secretes cytokines, or signaling molecules, that can trigger inflammation. An increase in cytokines may help to explain why, for example, obesity increases the risk not only for osteoarthritis in the knees, which would be directly impacted by the increased load, but also in the wrist, which is not a weight-bearing joint."

Research is currently being done on this topic. Here is the website to the Arthritis Foundation webpage
http://www.arthritis.org/

Different Categories of Crohn's Disease

Interestingly I stumbled on a website that contained alot of really interesting information about Crohn's Disease. A lot of the material was, more or less, a review of things that we have seen in the various papers we have read; however, I did find a couple of interesting things that we have not really talked about. The first is different categories of Crohn's. The following table was taken from the website Crohns.net and lays out various forms of the disease mostly based on the origin of the symptoms.

Subcategory	Area Affected
Ileocolitis	The most common form of Crohn's Disease, affecting the ileum and colon
Ileitis	Affects only the ileum; fistulas or inflammatory abscesses possible
Gastroduodenal Crohn's Disease	Affects the stomach and duodenum; bowel obstruction possible
Jejunoileitis	Patchy areas of inflammation in the jejunum; fistulas possible
Crohn's (Granulomatous) Colitis	Affects only the colon and anus; anal fistulas, abscesses, and ulcers possible

Adapted from Crohn's and Colitis Foundation of America, Inc. 2004
http://www.ccfa.org/research/info/aboutch

There is also some interesting information about diseases that can arise from Crohn's. Of these one of the most common is osteoporosis. This comes about for two reasons; the first is a lack of nutritional absorption of vitamins d and k and the second is the treatment of the disease with corticosteroids. Both of these lead to decreased bone density and thus the condition of osteoporosis. Some other major medical problems that could occur either as a result of the different therapies or the disease state itself are colorectal cancer, infertility, bacterial infections, even a higher possibility of ischemic stroke. The increase in risk for stroke is thought to be because of a vitamin B deficiency and a hypercoaguable state brought on as an effect of the disease.

If you would like to to read more about this or see more about Crohn's in general visit crohns.net.

Information taken from
http://www.crohns.net/Miva/education/articles/Potential_Sequelae_of_Crohns_Disease.shtml\
http://www.crohns.net/Miva/education/articles/Crohns_Disease_Table_1.shtml