Disability Law Blog

Genetic Factors Influence Development of Knee Arthritis

Via Reuters:

Genetic factors appear to play a role in the development of arthritis of the knee, according to a report in the Annals of the Rheumatic Diseases.

Previous studies investigating possible genetic contributions to knee arthritis have been inconclusive, the authors explain, but recent studies suggest that the amount of cartilage in the knee, which is influenced by genetic factors, may determine the risk of arthritis.

The study was conducted at the Menzies Centre for Population Health Research in Tasmania, Australia.

Stem Cell Transplant from Patient's Sister Apparently Cures Rheumatoid Arthritis

Via Reuters:  

Transplanting stem cells from a healthy woman to her sister with severe rheumatoid arthritis apparently cured the disease, researchers report in the journal Arthritis & Rheumatism.

At the Northwestern University in Chicago, researchers led by Dr. Richard K. Burt used stem cells from the sibling to treat a 52-year-old woman with rheumatoid arthritis in 38 joints. Prior to transplantation, the woman was given various drugs to increase the odds that her body wouldn't reject the cells.

Her morning stiffness disappeared before she was discharged from the hospital and did not recur. Her rheumatoid nodules were completely gone 9 months after transplantation and now one year later the patient is disease-free and is not taking any drugs to suppress her immune system.

Amazing stuff!

Glucosamine and Methylsulfonylmethane, When Taken Together, are More Effective in Treatment of Osteoarthritis

From Reuters:

"Combined glucosamine and methylsulfonylmethane -- better known as just MSM -- is more effective against osteoarthritis than either agent alone, according to Indian researchers.

In the journal Clinical Drug Investigations, Drs. P. R. Usha and M. U. R. Naidu report that although the individual agents did improve pain and swelling in patients' affected joints, the combined therapy was more effective than the single agents in reducing these symptoms and improving the function of joints.

. . . After 12 weeks of treatment, the average pain score had fallen from 1.74 to 0.65 in the glucosamine-only group. In MSM-only participants, it fell from 1.53 to 0.74. However, in the combination group, it fell from 1.7 to 0.36."

Miscarriage Linked to Risk of Progressive Joint Disease in Rheumatoid Arthritis

Via Reuters :  Researchers at the Leiden University Medical Center report in the Annals of the Rheumatic Diseases that women with a history of miscarriage before they developed rheumatoid arthritis seem to be at increased risk for progressive joint disease.

Synthetic Antibody Helps in Treatment of Rheumatoid Arthritis

Via Reuters:  Blocking the activity of a natural protein involved in inflammation may be a new approach to treating rheumatoid arthritis. Dr. Nishimoto Norihiro from Osaka University and his colleagues have shown that a synthetic antibody targeting the receptor for a hormone-like protein called interleukin 6 (IL-6) significantly reduces disease activity in patients with difficult-to-treat rheumatoid arthritis.

IL-6 regulates the immune response, inflammation, and bone metabolism, Dr. Norihiro's team explains in the medical journal Arthritis & Rheumatism. Overproduction of IL-6 is thought to play a role in rheumatoid arthritis. In a 3 month study using an anti-IL-6 antibody, dubbed MRA, all measures of arthritis activity improved with MRA treatment with benefit seen as early as 4 weeks into treatment.

Joint Dilemma: Glucosamine, Chondroitin and Bum Knees

Dr. Susan Whiteman describes her journey into the nether world of bad knees and the treatments that may not help in this Washington Post article:

As any of the millions of Americans tottering around on ramshackle cartilage and ruptured ligaments can attest, the knee rates as the most unsound joint in the body. Each year, surgeons condemn more than 260,000 dilapidated knee joints and rebuild them, cementing titanium and polyethylene plastic to their skeletal ruins. Despite meaty muscles to brace it, despite a scaffold of ropy ligaments and tendons to buttress it, despite the bony shingle of a kneecap to shelter it, this load-bearing hinge between the two longest columns of bone in the body is prone to injury. Once damaged, the timbers of a leg shiver with the ravages of osteoarthritis.

. . . As is common in early osteoarthritis, my knees don't hurt. Not yet. But I know what lies ahead. As osteoarthritis progresses, cartilage, which acts as a cushion between the bones of a joint, grinds down. Bone scrapes against bone. That hurts -- a lot. The time for me to act to avoid the pain, debilitation and joint replacement surgery associated with the condition, I figure, is now.

Find out what she discovers from her evaluation of the available treatments.

Artificial Discs Hold Promise for People with DDD

Via Reuters:  This article discusses a "new" technology that's been used in Europe for 10 years--implantation of manmade discs in people with back pain caused by degenerative disc disease:

After decades of research into alternatives to spinal fusion as a treatment for chronic back pain, U.S. surgeons are testing manmade discs that relieve the aches without sacrificing mobility.

In what business analysts call the "next big thing" in the $3 billion spinal market, companies such as Johnson & Johnson, Medtronic Inc., Swiss implant maker Synthes-Stratec and privately held SpineCore are racing to develop artificial discs for the neck and lower back.

Experts say that the procedure only works for people with degenerative disc disease. The best candidates for implantation are otherwise healthy people in their 30s and 40s.

Joint Replacement Surgery Increasingly Popular

Via ABCNEWS:  Good article on joint replacement surgery. Dr. Joseph D. Zuckerman, professor and chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases, discusses how these surgeries are performed and what factors contribute to their success:

Hip and knee replacements are the most common surgeries. About 300,000 total knee replacement surgeries and approximately 200,000 total hip replacements are performed annually in the United States. Surgeons can also replace other joints, such as the ankle, foot, shoulder, elbow and fingers.

. . . The best candidate for [joint replacement surgery] is somebody with arthritis that has not responded to other treatment measures who is a motivated patient and in reasonably good health. The best candidates are those who can participate in the recovery plan after surgery because these operations are only successful if you participate in the exercise regimen.

Celebrex May Protect Osteoarthritic Cartilage

Via Reuters:  Results of lab studies are a balm to my aching knees. The studies suggest that not ony does celecoxib (sold as Celebrex) relieve osteoarthritic pain, it may also have a beneficial effect on cartilage in patients with this condition:

[C]certain moderately selective COX-2 inhibitors may inhibit the synthesis of cartilage proteoglycans. Proteoglycans, along with hyaluronan, are required to provide cartilage with its elasticity and stiffness on compression. These entities are depleted in osteoarthritis and other conditions. To assess the possible effects of celecoxib, the researchers exposed prepared osteoarthritic cartilage specimens to both diclofenac, a non-selective COX inhibitor, and to celecoxib.

Diclofenac did not affect the metabolic balance of hyaluronan and proteoglycans. However, in a "relatively dose-dependent" manner celecoxib increased their synthesis. Celecoxib also reduced the loss of these components from cartilage tissue. Thus, "in contrast to several other nonsteroidal anti- inflammatory drugs . . . celecoxib might be beneficial to osteoarthritic joints by enhancing the cartilage content of both hyaluronan and proteoglycans."

Read more about it in the November issue of the Journal of Rheumatology (subscription required).

NIH Panel Says Total Knee Replacement Very Effective

Via the New York Times:   An 11-member panel convened by the National Institutes of Health (NIH) reports that Total Knee Replacement surgery is underutilized and that replacing a joint quickly relieved pain and improved mobility and quality of life in 90 percent of the patients:

The surgery is so effective, the panel said, that many more people from all classifications should consider it. Just 1 percent of the artificial joints fail each year. By 20 years out, studies show, 20 percent will require replacement. "Many studies show that total knee replacement may be an underutilized procedure," Dr. Marc Hochberg, a panelist from the University of Maryland School of Medicine, said. "There are no data suggesting it is being overutilized."

About 300,000 Americans have replacements each year. The number has been increasing, and doctors expect it to increase further as the population ages.

The report is available at the NIH website.

Multiple Cups of Java Don't Raise Rheumatoid Arthritis Risk

From Reuters:   A new study in the November issue of Arthritis & Rheumatism reviewed information from more than 80,000 women over an almost 20 year period, and concluded that the risk of rheumatoid arthritis (RA) appeared unrelated to the amount of decaffeinated coffee, coffee, tea and total caffeine women consumed.

Although women's choice of beverage appeared to have no influence on their risk of RA, their smoking habits did. Specifically, the researchers found that heavy smokers were more likely to develop RA than non-smokers, a finding that other researchers have discovered, as well.

[Dr. Elizabeth W.] Karlson, who is based at Brigham and Women's Hospital in Boston, said that coffee drinkers may be more likely to be long-term smokers than non-coffee drinkers, and this tendency may help explain why previous reports linked drinking coffee with RA.