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The Arthritis
Foundation and TOA are proud to provide special E-Connect issues to
support the Austin Arthritis Walk. We have selected articles we hope
to be of interest to Orthopaedic Practices.
We want to thank
our sponsors, Balcones
Imaging and Carpe-eDatum
for bringing you this week’s issue.
As an active member
in the orthopaedic community we would like to ask you to join TOA in
supporting the Arthritis Foundation. The funds raised through the
Austin Arthritis Walk directly support arthritis research, health
education and government advocacy initiatives to improve the lives of
people with arthritis.
The Austin
Arthritis Walk will be held on Saturday, May 19, 2007,
Westlake High School. Registration for the event begins at 9:00 a.m.;
the walk begins at 10:00 a.m. You can also register on-line at
www.austinarthritiswalk.kintera.org.
Thank you,
Jeseka
Wallace
Texas Orthopaedic Association
2007 Austin Arthritis Walk Chair
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Common NSAIDs for Osteoarthritis Associated with High Blood Pressure
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February 2007
Forman JP, RimmEB, Curhan GC. Frequency of analgesic use and risk of
hypertension among men. Arch Intern Med 2007;167:394-399.
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Ibuprofen,
acetaminophen, and aspirin are among the most frequently used drugs in
the United States, and their use by people with arthritis is
substantially higher than among the general public. At low doses,
ibuprofen and other drugs in the same category called nonsteroidal
anti-inflammatory drugs (NSAIDs) help a wide range of problems, from
muscle aches and headaches to minor pain and fever. At higher doses,
NSAIDs help reduce joint inflammation. Acetaminophen, an analgesic
used to ease pain, is among the most-used drugs for many forms of
arthritis. Unlike NSAIDs, which target both pain and inflammation,
analgesics are designed purely for pain relief. Because of its low
cost, effectiveness and safety, rheumatologists recommend
acetaminophen as a first-line option against osteoarthritis (OA) pain.
The amount of aspirin needed to control inflammation is quite high and
can cause stomach side effects. Much lower doses of aspirin, that are
less likely to be associated with side effects, are used frequently
for heart health or on occasion for headache.
What Problem Was Studied?
Because these three pain relievers are so commonly taken and because
of the chemical effects they have on the body's circulatory system,
researchers at Brigham and Women's Hospital, Harvard Medical School,
and Harvard School of Public Health in Boston, sought to determine the
association between these medications and high blood pressure
(hypertension). Furthermore, in 2002, two large studies of women
reported an increased risk of developing hypertension with a high
frequency of analgesic use; the current study investigated the
relationship among men. Results of this study were published in the
February 26, 2007 issue of Archives of Internal Medicine.
What Was Done In the Study?
An ongoing study of more than 51,000 male health professionals
provided the data needed for the analysis. Starting in 2000, detailed
information about pain reliever use was gathered from these study
participants through a questionnaire. Only those who returned the
complete questionnaire and who did not already have hypertension were
included in the study. The final sample included 16,031 men. These men
filled out detailed health questionnaires again in 2002 and 2004.
What Were the Study Results?
John P. Forman, MSc, MD, and colleagues analyzed the questionnaires
and determined that 1,968 men developed hypertension during the 4-year
follow-up period. The research team then compared medication use among
and between those with and those without new cases of hypertension.
They found that all three analgesic classes "moderately increased" a
man's risk of developing high blood pressure. Compared with men who
did not take any of the analgesics, those who took NSAIDs six or seven
days per week had a 38 percent higher risk of developing hypertension;
those who took acetaminophen at the same frequency had a 34 percent
higher risk; and those who took aspirin at this frequency had a 26
percent higher risk. Likewise, compared with men who did not take any
pain relievers, those who took 15 or more NSAID pills per week had a
33 percent higher risk of developing high blood pressure; those who
took 15 or more acetaminophen pills per week had a 4 percent higher
risk; and those who took 15 or more aspirins per week had a 17 percent
greater risk.
What Does This Mean for People with Arthritis?
As Dr. Forman states in the article's conclusion, "These data add
further support to the hypothesis that nonnarcotic analgesics
independently elevate the risk of hypertension. Given their common
consumption and the high prevalence of hypertension, our results may
have substantial public health implications, and suggest that these
agents be used with greater caution."
"Given the number of studies being released over the past few years
regarding potential side effects of various pain relievers," says
Arthritis Foundation Chief Science Officer John Hardin, MD, "we urge
people considering taking acetaminophen or NSAIDs for arthritis pain
or inflammation to weigh the benefits of these medications with the
potential risks. This is especially true for people with known
cardiovascular or liver risk factors." The Arthritis Foundation
recommends that people considering or taking any pain reliever for
arthritis work with their doctor to determine a treatment plan that is
best for their individual situation.
The recent concern over safety of arthritis pain relievers underscores
the tremendous impact of arthritis on the nation, and the need for
ongoing research for development of new medications, treatment and
understanding of the disease.
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AF
Statement On Hyaluronic Acid Treatment For Osteoarthritis Of The
Knee
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Summary
Hyaluronic acid (currently marketed under the brand names
Hyalgan, Synvisc and Supartz) is an FDA-approved treatment
for the relief of pain in osteoarthritis (OA) of the knee.
Treatment involves a series of
injections given directly into the
knee joint. |
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The Arthritis Foundation believes that
hyaluronic acid provides doctors and patients another option for
treating OA, a disease that can be painful and difficult to manage. It
should be considered for people with OA of the knee who have not
responded well to exercise, physical therapy and simple,
over-the-counter (OTC) analgesics, such as acetaminophen and
ibuprofen. Hyaluronic acid also may be considered for individuals who
may be at risk for upper gastrointestinal (GI) or kidney
complications.
Full Statement
Cartilage in the knee provides a cushion between the bones to allow
the joint to move smoothly and without pain. Hyaluronic acid is
naturally produced by the body, and helps to dissipate the shock of
high impact movements, to lubricate cartilage and to facilitate
movement within the joint. With OA, the cartilage and other structures
of the joint are damaged and over time begin to break down. During
this process the concentration of hyaluronic acid in the joint
decreases and may be broken down. Consequently, lubrication and shock
absorption to the cartilage and joint surfaces are thought to be
reduced. This may contribute to the joint stiffness, pain and loss of
movement commonly seen in OA of the knees. Hyaluronic acid injections
are intended to replace or supplement the body’s natural hyaluronic
acid that has been broken down by OA. There is no evidence that the
treatment alters the progression of knee OA in humans. There is little
information on the long-term effects of repeated cycles of hyaluronic
acid injections.
Supplemental hyaluronic acid is a purified extract made from the combs
of roosters. It is a thick substance that is injected into the joint
once a week for three or five weeks, depending on the specific brand
of product. This type of treatment is often referred to as joint fluid
therapy or “viscosupplementation.” Mild side effects noted in clinical
studies have included local symptoms such as pain, knee swelling, rash
and itching at the injection site. Allergic reactions have been rare.
Clinical studies have shown that hyaluronic acid injections relieve
pain better than placebo and are as effective in providing pain relief
as non-steroidal anti-inflammatory drugs (NSAIDs).
The Arthritis Foundation believes that while more studies are needed
to determine the long-term results of such treatments, hyaluronic acid
provides an option for people with OA of the knee who have not
responded well to OTC drug treatments or exercise and physical
therapy. It also may be appropriate for those who may be at increased
risk for upper GI complications, such as patients who: are over 65
years old; are taking oral corticosteroids and/or anticoagulants; have
a history of peptic ulcer disease or upper GI bleeding; are smokers;
and consume high volumes of alcohol. Hyaluronic acid also may be
considered in patients with kidney failure. As with all arthritis
treatments, the Arthritis Foundation recommends that you talk with
your doctor about the appropriate option(s) for your individual
situation.
For More Information
Contact your local Arthritis Foundation chapter at 1-800-283-7800 for
free brochures about managing arthritis.
Find the local chapter that serves your area.
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National
Arthritis Walk® Sponsors
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The Arthritis Foundation would like to thank our national
sponsors that not only contribute financially to help make the
Arthritis Walk® possible, but also provide extensive awareness
and corporate employee support for the event. |
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National Presenting
Sponsor
 Aleve,
marketed by Bayer Consumer Care, is proud to continue as the National
Presenting Sponsor of the Arthritis Walk®. Aleve stands behind the
mission of the Arthritis Foundation, which is to improve the lives of
people with arthritis. Aleve will encourage consumers across the nation
to "team up for a cure" in the fight against arthritis by participating
in the Arthritis Walk® 2007. Bayer Consumer Care employees will also do
their part by participating in local events through teams and
volunteerism. Go TEAM ALEVE! Aleve will also help the Arthritis
Foundation raise close to $1 million dollars through the sale of
Arthritis Walk® Aleve stars at various retail locations. Thanks Aleve!
National
Sponsor
 Nature
Made® TripleFlex™ shares the Arthritis Foundation’s commitment to
finding a cure for America’s #1 disability, and is proud to be a
national sponsor of the Arthritis Walk®. As the leading high-quality,
consumer-focused joint health supplement brand, TripleFlex is
dedicated to helping people with arthritis lead active, mobile lives.
Team TripleFlex will encourage people to sign up and get involved with
the Arthritis Walk® via a national advertising campaign and in-store
displays at their grocery, drug, mass and club retail partners
nationwide.
National Sponsor
 Pfizer
Animal Health is proud to join the Arthritis Foundation as a national
sponsor for the 3rd year in 2007. Canine arthritis affects dogs of any
age, sex, breed, or size. While there is no cure, the sooner your dog
is properly diagnosed and treated, the sooner he or she can overcome
the pain and become an active member of the family again. Rimadyl® has
helped more than 10 million dogs receive safe and effective relief of
pain and inflammation due to canine arthritis, orthopedic and soft
tissue surgery. Rimadyl® is made by Pfizer Animal Health, which
provides pet owners and veterinarians with medications to keep pets
healthy, happy and living life to the fullest.
National Sponsor
 Biomet,
Inc has recently joined the Arthritis Foundation as a national sponsor
for the Arthritis Walk. Biomet, Inc. is a worldwide leader in the
design and manufacture of products for hip replacement, knee
replacement, shoulder replacement, elbow replacement, and other small
joint replacement. Engineering excellence is their heritage and
passion. For over 25 years, they have applied the most advanced
engineering and manufacturing technology to the development of highly
durable joint replacement systems and minimally invasive surgical
procedures. Biomet has had several local Arthritis Foundations chapter
sponsorships such as galas and golf tournaments but this is their
first national sponsorship.
National Media Sponsor
 We
are proud to have Arthritis Today magazine as a National Media Sponsor
of the Arthritis Walk®. Arthritis Today is devoted to education about
arthritis and active living. Arthritis Today is encouraging readers to
participate in Arthritis Walk® events in their local communities.
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Role Of DAP12 In Regulating Inflammation
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Read the abstract via PatientInform
As was explained in the
introduction to this issue, Toll-like receptors (TLRs) on and
within macrophages are intimately involved in the
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inflammatory response. When the
receptors recognize and lock onto a “pathogen
associated molecular pattern," a series of chemical
events begins that results in the
release of
proinflammatory cytokines. It is this signaling pathway and
inflammatory response that arthritis researchers are trying to better
understand and control. Jessica A. Hamerman, PhD, previously of
University of California, San Francisco and now of Benaroya Research
Institute of Seattle, Washington, is using her Arthritis Foundation
research grant to study macrophages, TLRs and the chemical signals
involved in turning on and turning off the production of
proinflammatory cytokines.
What Problem Was Studied?
DAP12 is a signaling molecule found within macrophages. Although not a
direct member of the TLR–inflammatory cytokine cascade, the DAP12
signaling pathway intersects with the TLR pathway in such a way that
DAP12 can alter the TLR signal and influence the release of the
cytokines tumor necrosis factor, interleukin-6 and interleukin-12.
Hamerman’s team developed experiments to characterize the role of
DAP12 in inflammatory reactions.
What Was Done In the Study?
Hamerman and colleagues performed a series of experiments on
macrophages from specially bred mice that were incapable of producing
DAP12 and macrophages from mice that could produce DAP12. They ran
experiments on macrophages that had been removed from body (in vitro
experiments) as well as experiments on the different types of mice (in
vivo experiments). They expected that macrophages incapable of
producing DAP12 would have no reaction, or a smaller reaction, to
bacteria than would the normal macrophages because the signaling
cascades within the cell would be interrupted.
What Were the Study Results?
Unexpectedly, the mice that could not produce DAP12 had a stronger
reaction to the antigen than did the normal mice. The DAP12-deficient
macrophages produced or released higher concentrations of tumor
necrosis factor, interleukin-6 and interleukin-12 than did the normal
macrophages. This result indicates that DAP12 may give inhibitory
signals to the TLR chemical cascade rather than the stimulatory
signals that the research team hypothesized. The team got the same
results in both the in vitro and in vivo experiments.
What Does This Mean for People With Inflammatory Disorders?
Finding a molecule that may inhibit or turn off the inflammatory
response in macrophages is an important step for scientists.
Inflammatory disorders, such as rheumatoid arthritis, juvenile
arthritis, diabetes, etc., may occur because these negative signals
that tell the body to “turn off” inflammation may never get produced,
or may not reach their targets. Identifying one of these inhibitory
signals opens another path through which inflammation can be regulated
with medication.
Because some of Hamerman’s results were contrary to results obtained
by other research teams, and because she learned that DAP12-deficient
macrophages produced not only greater concentrations of
proinflammatory cytokines, but also greater concentrations of
anti-inflammatory cytokines, her work with DAP12 will continue. Her
lab has recently identified a receptor expressed in macrophages that
works with DAP12 to inhibit inflammatory cytokine production.
Eventually she hopes her diligence will lead to the discovery of a
therapy that will tell the body to turn off the inflammatory signals
when they are not needed.
Hamerman JA, Tchao NK, Lowell CA,
Lanier LL. Enhanced Toll-like receptor responses in the absence of
signaling adaptor DAP12. Nature Immunology 2005;6:579-586.
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Thank You To Our Sponsors!
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