PSORIATIC ARTHRITIS MEDICAL NEWS

Before we begin with the latest news, I would like to take this
opportunity
to publicly say how glad I am that Michelle Atwood Stack is home
again and on
the mend. We are privileged to have Michelle as our founder and once
again
she has proven how tough she can be in facing the daily challenges of
her
life.

FDA APPROVES NEW COX-2 INHIBITOR -WASHINGTON (Reuters Health)
Pharmaceutical
makers Pharmacia Corp. and Pfizer Inc. jointly announced on Monday
that
Pharmacia has received approval from the US Food and Drug
Administration
(FDA) to market a new COX-2 inhibitor, offering a once-a-day
treatment
regimen for osteoarthritis. The companies said that Pharmacia
received
approval for Bextra (valdecoxib tablets), a COX-2 inhibitor that
would also
be indicated for the treatment of adult rheumatoid arthritis and for
menstrual pain. Pfizer is Pharmacia's co-promotion partner.
The companies said that the approval of Bextra was based upon global
clinical
trials, involving more than 5,000 patients. In those clinical trials,
the
companies said that the 10 mg tablet of Bextra taken once daily was
shown to
be as effective as the commonly prescribed doses of other NSAIDs,
including
ibuprofen, diclofenac and naproxen for the treatment of
osteoarthritis.
Pharmacia spokesman Craig Buchholtz told Reuters Health that the
exact launch
date and price per dose had yet to be determined.
Merrill Lynch securities analyst Steven Tighe said that he expects
2002 sales
of Bextra to generate about $450 million in revenues. Tighe said that
these
estimates were in part based upon the fact that the FDA approval was
received
ahead of schedule, giving the companies a jump on Merck's second
generation
COX-2 inhibitor Arcoxia (etoricoxib).
Merck just filed for the approval of Arcoxia in the last couple of
months.
Copyright © 2001 Reuters Ltd.


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Editors note: This is the second in our series about less common
forms of
arthritis. Our last issue covered Anklosing Spondylitis.

INFECTIOUS ARTHRITIS Joint pain, soreness, stiffness and swelling
may follow
an infection involving several types of agents, including bacteria,
viruses
and even fungi. These infections may affect one part of the body (for
example, through the lungs during pneumonia) and infect the joint
after
spreading through the bloodstream. They may enter the joint through a
nearby
wound. Sometimes, tissue around the joint can become infected after
surgery,
an injection or trauma. Once the infectious agent reaches the joint,
it can
cause symptoms of joint inflammation and, at times, fever and chills.
Depending on the type of infection, one or more joints may be
affected. For
example, bacteria tend to cause infection of only one joint, often
the knee.
Small joints -- the fingers and toes -- are more likely to become
infected
after an inoculation or bite. Among intravenous drug users, less
commonly
infected joints, such as those in the spine or sternum (breastbone),
may be
involved. People who already suffer from rheumatoid arthritis or
other joint
disease are at increased risk of infectious arthritis.
Certain infectious agents may cause reactive" arthritis, in which the
infectious agent is no longer present; but weeks, months or even
years later,
arthritis develops as a reaction to the prior infection. This is
thought to
occur because, in genetically susceptible people, part of the
bacteria looks
similar to proteins present in the joint, setting off an autoimmune
inflammatory reaction. In this way, the infection may cause an
ongoing
arthritis long after it has come and gone. Infections of the genital
and
gastrointestinal tract are the most common triggers of reactive
arthritis.
SYMPTOMS


Joint pain and stiffness, typically in the knee, shoulder, ankle,
finger,
wrist or hip. Warmth and redness in surrounding
tissue.

Chills, fever,
weakness.

Skin rash.
It is unusual for joint deformity to result from infectious arthritis
if it
is promptly detected and appropriately treated. Some of the more
common types
of infectious arthritis include:
LYME
DISEASE


Lyme disease is caused by bacteria that live in the deer tick and are
transmitted through a tick bite into a person's bloodstream. Also
called Lyme
arthritis, this form of infectious arthritis is named for the
Connecticut
town where it was first observed. Lyme disease is only found in parts
of the
world where the appropriate ticks are found; in the United States,
most cases
are described in coastal New England (Massachusetts, Rhode Island and
Connecticut), New York, New Jersey, Pennsylvania, Wisconsin and
Minnesota.
After a person is bitten by a tick, a large, round, red rash (called
erythema
migrans) usually develops around the bite; there is often a normal-
appearing
area of skin in the center. Flu-like symptoms may develop, including
fever,
headaches, chills, body aches, stiffness, nausea, fatigue and sore
throat.
The symptoms of Lyme disease often mimic those of other diseases. In
addition, considerable time can pass between the first appearance of
the rash
and the next wave of symptoms. Because the bite goes unnoticed and
the rash
may be overlooked, Lyme disease is not always suspected initially.
When the
infection is not treated, further symptoms develop, most seriously
joint
inflammation (most commonly, the knee), neurological symptoms
(confusion,
convulsions, muscle weakness), and an abnormally slow heart rate that
may
lead to fainting. Antibiotic treatment (either orally or
intravenously)
usually cures the illness. A pacemaker may be necessary for the
abnormal
heart
rhythm.

GONOCCAL OR GONORRHEAL
ARTHRITIS
Gonorrhea is a sexually transmitted bacterial infection that
produces, among
other symptoms, pain in one or more joints and/or tendons. There may
also be
a rash and fever associated with this type of infectious arthritis.
About a
third of all those who contact gonorrhea report joint pain, although
actual
infection is probably much less frequent. STAPHYLOCCAL
ARTHRITIS

The staphylococcal bacteria can be released in the bloodstream and
spread to
the knee or other joints, causing intense and sudden pain, swelling
and
immobility of the joint. This is a serious condition because joint
damage may
develop in a matter of days if the infection is not promptly detected
and
treated.
TUBERCULOSIS


Tuberculosis, an infectious disease caused by the tubercle Bacillus,
is
characterized by inflammation, abscesses (pus-filled pockets),
necrosis
(death of tissue), calcification (accumulation of calcium deposits)
and
fibrosis (abnormal formation of fibrous, or scar, tissue). Although
tuberculosis is most commonly associated with the lungs, it can
affect other
parts of the body, including the gastrointestinal tract, the nerves,
lymph
system and skin, as well as bones and joints. The inflammation in
joints
caused by tuberculosis tends to be less dramatic than some other
bacterial
infections, so a more chronic arthritis may develop unless antibiotic
therapy
is administered.
VIRAL
ARTHRITIS


Viruses are minute organisms that depend on the nutrients found
inside living
cells to thrive and reproduce. Among the more than 300 known viruses,
many
cause important infectious diseases, including colds, upper
respiratory
infections, HIV, hepatitis, rubella and mumps among others. Arthritis
can
arise in connection with many of these viral infections. In general,
the
arthritic symptoms will disappear in a few days, when the underlying
disease
runs its course. Many joints may be simultaneously affected; in fact,
viral
infections may mimic rheumatoid arthritis except that with most types
of
viral arthritis complete resolution is observed within several days
or weeks.
Some viruses, including hepatitis B and C and HIV, may cause a more
chronic
infection along with joint pain or
inflammation.

DIAGNOSIS



If your doctor suspects that your arthritic symptoms are related to a
bacterial infection, he or she will likely draw fluid from the
affected joint
with a needle (after providing numbing medication to the area) in
order to
have it analyzed in the lab. Blood and urine tests may also be
helpful. When
a sexually transmitted disease is the suspected cause, a pelvic
examination
(for women) and penile swab (for men) may be recommended to detect
the
underlying infection. For most viral disease, no specific tests are
helpful;
for the more chronic and serious agents, such as hepatitis B and C
and HIV,
accurate antibody tests for diagnosis are available.
TREATMENT


Because many bacterial infections can rapidly and permanently destroy
the
cartilage around the joints, a joint infection needs to be treated
immediately. If bacterial infection is involved, antibiotics will be
prescribed. Viral infections do not respond to antibiotics, although
antiviral therapies are available for some (for example, HIV
infections may
be treated with a number of antiviral medications, often in
combination);
aspirin or ibuprofen may be taken to alleviate the pain and swelling
during
the time it takes for the infection to run its course. Fortunately,
viral
infections do not cause joint damage as a rule. In cases in which the
underlying condition is chronic, treatment will target pain and
swelling
throughout the course of the
disease.

Sometimes, hospitalization may be recommended in order to drain the
infected
joint and to allow rest of the joint. In some cases, the joint may
need to be
opened surgically so that damaged tissue can be removed. It may be
difficult
to determine whether surgical intervention during a bacterial joint
infection
is necessary, as studies comparing surgery to a more conservative
approach
have not been performed. Surgery is rarely necessary for those
bacteria
associated with sexually transmitted diseases. If serious damage has
already
occurred, surgical reconstruction of the joint may be
considered.

While the joint is recovering from the infection, it may be necessary
to
immobilize the joint with a splint. After the joint recovers,
physical
therapy may be necessary to restore strength and mobility.


********************************
CURRENT RESEARCH IN RHEUMATOID ARTHRITIS FROM NIH
The National Institute of Arthritis and Musculoskeletal and Skin
Diseases
A broad look at what the NIH is doing in research for rheumatoid
arthritis.

Over the last several decades, research has greatly increased our
understanding of immunology, genetics, and cellular and molecular
biology.
This foundation in basic science is now showing results in several
areas
important to rheumatoid arthritis. Scientists are thinking about
rheumatoid
arthritis in exciting ways that were not possible even 10 years ago.
The
National Institutes of Health funds a wide variety of medical
research at its
headquarters in Bethesda, Maryland, and at universities and medical
centers
across the United States. One of the NIH institutes, the National
Institute
of Arthritis and Musculoskeletal and Skin Diseases, is a major
supporter of
research and research training in rheumatoid arthritis through grants
to
individual scientists, Specialized Centers of Research, and
Multipurpose
Arthritis and Musculoskeletal Diseases Centers.
Following are examples of current research directions in rheumatoid
arthritis
supported by the Federal Government through the NIAMS and other parts
of the
NIH.
Scientists are looking at basic abnormalities in the immune systems
of people
with rheumatoid arthritis and in some animal models of the disease to
understand why and how the disease develops. Findings from these
studies may
lead to precise, targeted therapies that could stop the inflammatory
process
in its earliest stages. They may even lead to a vaccine that could
prevent
rheumatoid arthritis.
Researchers are studying genetic factors that predispose some people
to
developing rheumatoid arthritis, as well as factors connected with
disease
severity. Findings from these studies should increase our
understanding of
the disease and will help develop new therapies as well as guide
treatment
decisions. In a major effort aimed at identifying genes involved in
rheumatoid arthritis, the NIH and the Arthritis Foundation have
joined
together to support the North American Rheumatoid Arthritis
Consortium. This
group of 12 research centers around the United States is collecting
medical
information and genetic material from 1,000 families in which two or
more
siblings have rheumatoid arthritis. It will serve as a national
resource for
genetic studies of this disease.
Scientists are also gaining insights into the genetic basis of
rheumatoid
arthritis by studying rats with autoimmune inflammatory arthritis
that
resembles human disease. NIAMS researchers have identified several
genetic
regions that affect arthritis susceptibility and severity in these
animal
models of the disease, and found some striking similarities between
rats and
humans. Identifying disease genes in rats should provide important
new
information that may yield clues to the causes of rheumatoid
arthritis in
humans.
Scientists are studying the complex relationships among the hormonal,
nervous, and immune systems in rheumatoid arthritis. For example,
they are
exploring whether and how the normal changes in the levels of steroid
hormones (such as estrogen and testosterone) during a person's
lifetime may
be related to the development, improvement, or flares of the disease.
Scientists are also looking at how these systems interact with
environmental
and genetic factors. Results from these studies may suggest new
treatment
strategies.
Researchers are exploring why so many more women than men develop
rheumatoid
arthritis. In hopes of finding clues, they are studying female and
male
hormones and other elements that differ between women and men, such
as
possible differences in their immune responses.
To find clues to new treatments, researchers are examining why
rheumatoid
arthritis often improves during pregnancy. Results of one study
suggest that
the explanation may be related to differences in certain special
proteins
between a mother and her unborn child. These proteins help the immune
system
distinguish between the body's own cells and foreign cells. Such
differences,
the scientists speculate, may change the activity of the mother's
immune
system during pregnancy.
A growing body of evidence indicates that infectious agents, such as
viruses
and bacteria, may trigger rheumatoid arthritis in people who have an
inherited predisposition to the disease. Investigators are trying to
discover
which infectious agents may be responsible. More broadly, they are
also
working to understand the basic mechanisms by which these agents
might
trigger the development of rheumatoid arthritis. Identifying the
agents and
understanding how they work could lead to new therapies.
Scientists are searching for new drugs or combinations of drugs that
can
reduce inflammation, can slow or stop the progression of rheumatoid
arthritis, and also have few side effects. Studies in humans have
shown that
a number of compounds have such potential. For example, some studies
are
breaking new ground in the area of "biopharmaceuticals,"
or "biologics."
These new drugs are based on compounds occurring naturally in the
body, and
are designed to target specific aspects of the inflammatory process.
Investigators have also shown that treatment of rheumatoid arthritis
with
minocycline, a drug in the tetracycline family, has a modest benefit.
The
effects of a related tetracycline called doxycycline are under
investigation.
Other studies have shown that the omega-3 fatty acids in certain fish
or
plant seed oils also may reduce rheumatoid arthritis inflammation.
However,
many people are not able to tolerate the large amounts of oil
necessary for
any benefit.
Investigators are examining many issues related to quality of life
for
rheumatoid arthritis patients and quality, cost, and effectiveness of
health
care services for these patients. Scientists have found that even a
small
improvement in a patient's sense of physical and mental well-being
can have
an impact on his or her quality of life and use of health care
services.
Results from studies like these will help health care providers
design
integrated treatment strategies that cover all of a patient's needs-
emotional
as well as physical.
Source: The National Institute of Arthritis and Musculoskeletal and
Skin
Diseases of the National Institutes of Health


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AMERICANS STRESSED BY ATTACKS By JEFF DONN - The Associated Press
BOSTON (AP)
- Nearly half of American adults had pronounced symptoms of stress
from the
Sept. 11 attacks in a nationwide survey documenting the catastrophe's
broad
effect on public health. ``It's important for people to understand if
they
had these types of reactions, they're not alone, and they're not
unusual,''
said Dr. Mark Schuster, a pediatrician who led the study at the Rand
think
tank in Santa Monica, Calif. ``It helps people to get over the
symptoms if
they realize these are normal reactions.''
The findings, published in Thursday's New England Journal of
Medicine,
confirm what other surveys have found: that the psychological impact
of the
terrorist attacks reverberated near and far.
The researchers conducted telephone interviews with a representative
sample
of 560 adults on the weekend after the Sept. 11 attacks.
The adults were asked if they felt upset when reminded of the
attacks, were
disturbed by repeated memories or dreams, had trouble concentrating
or
sleeping, or suffered from irritability or angry outbursts.
Ninety percent reported one symptom at least ``a little bit.'' Forty-
four
percent had at least one symptom ``quite a bit'' or ``extremely.''
The most
common substantial symptom, shared by 30 percent, was feeling upset
by
reminders.
Women, minorities, people with prior mental health problems, heavy
television
watchers and those closer to the World Trade Center were most likely
to
report stress.
Asked how they coped, 98 percent of those surveyed said they talked
to
others, 90 percent turned to religion, 60 percent joined in group
activities,
and 36 percent made donations or did volunteer work. Only 18 percent
bought
extra food, gasoline or other supplies. Thirty-nine percent
occasionally
avoided television or other reminders of the attacks.
People clearly watched lots of television to learn details of the
attacks -
an average of eight hours on Sept. 11, according to the study. The
study was
not designed to say if television ultimately eased or aggravated
stress.
Schuster said he suspects it can work either way.
Such stress reactions typically diminish over time, researchers say.
The
survey did not go beyond Sept. 16, but other surveys have indicated
an easing
of stress since then.
Those surveyed by Rand were also asked about children in their homes.
They
said 35 percent showed one or more stress symptoms. Forty-seven
percent were
said to be worried about their own safety or that of someone they
love. A
third of the adults limited television for their children, and 99
percent
talked to them about the attacks.
Dr. Carol S. North, a psychiatrist at Washington University in St.
Louis who
studied survivors of the 1995 bombing in Oklahoma City, said the
Sept. 11
attacks appeared to shake society even more broadly. ``What's really
interesting is its ability to reach out and touch someone quite a
distance
away,'' she said.

******************************

VIOXX, PRILOSEC -MOST ADVERTISED DRUGS WASHINGTON (Reuters) - Drug
companies
spent nearly $2.5 billion last year in advertising brand-name drugs
directly
to the public, the Kaiser Family Foundation reported Thursday. The
nonprofit
foundation, which conducts research on health and family issues, said
consumers may remember the names of the drugs and the diseases they
treat,
but may get mixed up about potential side-effects. It said the most
heavily
advertised drugs are also often the most heavily prescribed.
The foundation's top 10 most-advertised prescription drugs
were:

1. Vioxx, Merck and Co.'s anti-inflammatory ($160.8
million)

2. Prilosec, AstraZeneca's anti-ulcer drug ($107.9
million)

3. Claritin, Schering-Plough's antihistamine ($100.3
million)

4. Paxil, GlaxoSmithKline's antidepressant ($92.1
million)

5. Zocor, Merck's anti-cholesterol drug ($91.2
million)

6. Viagra, Pfizer's erectile dysfunction drug ($89.8
million)

7. Celebrex, Pharmacia's competitor to Vioxx ($78.8
million)

8. Flonase, GlaxoSmithKline's asthma drug ($78.1
million)

9. Allegra, an antihistamine made by Aventis ($67
million)

10. Meridia, made by Abbott (ABT.N) to treat obesity ($65 million)

The top 10 drugs by sales in 2000
were:

1. Prilosec ($4.6
billion)

2. Lipitor, Pfizer's cholesterol drug ($4.15
billlion)

3. Prevacid, Abbott's ulcer drug, ($3.15
billion)

4. Zocor ($2.8
billion)

5. Prozac, Eli Lilly's antidepressant ($2.66
billion)

6. Celebrex ($2.15
billion)

7. Epogen, Amgen's anemia drug ($2.06
billion)

8. Zoloft, an antidepressant by Pfizer ($1.98
billion)

9. Zyprexa, Eli Lilly's anti-psychotic ($1.9
billion)

10. Procrit, An anemia drug licensed to Johnson & Johnson ($1.8
billion)
Copyright 2001 Reuters Limited.


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COMMON LATIN Rx TERMS

LATIN ABBREVIATION MEANING
ante cibum ac before meals
bis in die bid twice a day
gutta gt drop
hora somni hs at bedtime
oculus dexter od right eye
oculus sinister os left eye
per os po by mouth
post cibum pc after meals
pro re nata prn as needed
quaque 3 hora q 3 h every 3 hours
quaque die qd every day
quater in die qid 4 times a day
ter in die tid 3 times a day


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Please be reminded that we are providing this newsletter for
educational
purposes only and it is not ever intended as medical advice. Articles
relating to general health issues can be equally important too.
Occasionally
there may be topics of sufficient value that warrant a good
discussion with
your medical caregivers.

For new members who have an interest in past newsletters, please feel
free to
e-mail me and I can provide you with exact message numbers that can
be found
on our website: PsoriaticArthritis@y... Your comments are always
welcome

See you next issue and good health to all.

Jack Nicholas
Cornishpro@a...
Issue 2001 - 12/08/01-6