News & Views Newletter
edited by Jack Nicholas, cornishpro@aol.co

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 2 ISSUE 20 September 18, 2002
PSORIATIC ARTHRITIS MEDICAL NEWS

RHEUMATOLOGIST.....THE ARTHRITIS BUSTER

Who is a rheumatologist?

A rheumatologist is a medical doctor who specializes in the non-surgical treatment of rheumatic illnesses, especially arthritis.

Rheumatologists have special interests in unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia. They often serve as consultants, acting like detectives for other doctors.

Rheumatologists have particular skills in the evaluation of the over 100 forms of arthritis, and have special interest in rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still disease, dermatomyositis, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch- Schonlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others.

Classical adult rheumatology training includes four years of medical school, one year of internship in internal medicine, two years of internal medicine residency, and two years of rheumatology fellowship. There is a subspecialty board for rheumatology certification, offered by the American Board of Internal Medicine, which can provide board certification to approved rheumatologists.

Pediatric rheumatologists are physicians who specialize in providing comprehensive care to children (as well as their families) with rheumatic diseases, especially arthritis.

Pediatric rheumatologists are pediatricians who have completed an additional 2-3 years of specialized training in pediatric rheumatology and are usually board-certified in pediatric rheumatology.

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COMPANY DROPS EXPERIMENTAL SKIN DRUG AFTER TEST FAILURE
September 2002 SAN FRANCISCO (AP) -

Idec Pharmaceuticals Corp. said Thursday that disappointing test results have forced it to halt research on an experimental drug for the skin disease psoriasis.

The drug was found safe but ineffective in fighting the disease, which afflicts some 4.5 million Americans and is viewed as a lucrative market for biotech companies.

Several biotechnology companies are racing to develop their own treatments for psoriasis, including the two largest, Amgen Inc. and Genentech Inc. Analysts expect the psoriasis market to be worth as much as $5 billion in annual sales to the biotech industry.

Idec chief medical officer Paul Grint said the company remains hopeful the experimental drug, dubbed Idec-114, will prove effective in non-Hodgkin's lymphoma. The drug is in early human cancer trials and years away from any government approval.

The disappointing psoriasis results of Idec-114 were not seen as fatal for the company, one of the few profitable biotechnology firms.

While Idec's current development pipeline appears thin, the company does have $1 billion in cash - a war chest Walsh and other analysts expect will be used to buy promising drugs from other companies. Copyright 2002 the Associated Press.

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FIBROMYALGIA PAIN IS REAL
Brain Scan Proves What Sufferers Have Always Known By Daniel DeNoon - WebMD Medical News & reviewed By Gary Vogin, MD

People with fibromyalgia (FM) know their pain is real. So do FM experts. And now there's proof that FM patients' extreme sensitivity to pain is no figment of their imaginations.

It's now possible to look at the brain and see exactly where it's active. This is done with a sophisticated brain scan called functional magnetic resonance imaging or fMRI. And these studies now are being done on FM patients.

In a study reported in the May issue of the journal Arthritis & Rheumatism, FM experts Richard H. Gracely, PhD, and Daniel J. Clauw, MD, gave fMRI scans to 16 FM patients and 16 healthy people. They did the scans under two conditions: first, when the person was feeling slight pressure on the thumb; and second, when the person was feeling moderately painful pressure on the thumb.

Healthy people's brains only became active when they felt the painful pinch. But the brains of the FM patients became highly active even when there was only slight pressure. This activity was very much like what happens in the brains of healthy people who are feeling pain.

"What it shows is that the brain response is consistent with what the patients report verbally," Gracely tells WebMD. "Being believed is an extremely important issue for these people. Now these physical findings are emerging, it is gratifying for these patients. We doctors aren't surprised because we already knew. But for the patient, it is just a terrible situation to be in. The general public doesn't really realize that pain can be very severe -- and sometimes untreatable -- in a person who does not seem to be injured."

I. John Russell, MD, PhD is leading similar fMRI studies at University of Texas Health Science Center, San Antonio. Russell is director of the university's clinical research center.

"This helps the patient to see that their pain is different from the pain of others and that it is real," Russell tells WebMD. "Also, this gives us a window to look into the brain at the responsiveness to and effect of pain on mood in people with FM."

Russell notes that FM patients aren't just more sensitive to pain. Pain also affects the mood centers of their brains in ways that it doesn't affect healthy people.

Also impressed by the new research is Terence W. Starz, MD, an FM expert at the University of Pittsburgh Medical Center.

"These very, very sophisticated instruments may now help us describe different subsets of FM patients," Starz tells WebMD. "The brain's processing information from the senses is very complex. When one looks at fibromyalgia patients it is becoming increasingly clear that there are variations in the processing of sensory information."

Doctors have been slow to accept FM as a real disease -- but that quickly is changing.

"I've been in the pain field for 27 years," Gracely says. "Twenty years ago, pain medicine was like a poor stepchild. It was not taught in medical school. Today, the number of people in pain research is huge. FM has been a poor stepchild, too. It is like pain research was several years ago."

Gracely, formerly a researcher at the U.S. National Institutes of Health, and Clauw, formerly at Georgetown University in Washington, have moved their research to the University of Michigan, Ann Arbor. © 2002 WebMD Inc. All rights reserved.

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WHETHER WEATHER MATTERS FOR ARTHRITIS
By Robert H. Shmerling, M.D. - Beth Israel Deaconess Medical Center Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Hospital and associate professor at Harvard Medical School.

Many of my patients (and even more of my relatives) tell me that their arthritis pain is affected by weather. More remarkably, for many the joint symptoms precede any obvious weather change - often my patients say they are better at predicting weather than the weatherman. Could that be true, or is it another well-accepted, untested medical myth? Maybe the claim is just a commentary on the accuracy of our meteorologists. But there have been attempts to study how weather affects symptoms of joint disease. The results may hold clues into how our joints work, how to treat the pain and why there is such variability in symptoms over time.

The Case For Weather Affecting Arthritis Pain - As I learned about joint disease during my medical training, no one taught me that weather mattered. Yet I heard it so often from my patients that I began to wonder whether there was something to it. After all, the lack of convincing evidence or the fact that it is not taught in medical schools do not prove that there is no connection between weather and arthritis: that is, "absence of proof is not proof of absence." So, besides the stories of individuals who are absolutely convinced about weather's role in arthritis, what is the evidence that weather affects joint pain or that joint symptoms can actually predict the weather?

The medical literature dating back at least to 1859 describes theories (though no proof) that changes in barometric pressure at least partly explained changes in joint pain. In addition:

A study published in 1929, and several others since then, asked arthritis patients about their symptoms and found that during periods of increasing barometric pressure joint pain increased.

A similar study published in 1990 found just the opposite - that joint pain increased when barometric pressure was falling. Other, more recent trials have found small effects of humidity, pressure, temperature, the amount of sunlight, or combinations of these.

Some studies suggest that the effects of weather on arthritis are immediate; others say there is a delayed effect of up to a month or more. For example, a 1997 study published in the Journal of Rheumatology found that the ESR, a blood test that often reflects the presence of joint inflammation, closely followed the average daily temperature from 30 days earlier; thus, an increase in the temperature seemed to predict a rise in the ESR (indicating an increase in arthritis activity) 30 days later. Similarly, joint pain increased with rising temperature and improved with falling temperature but the symptom changes occurred 48 days later.

The Case Against Weather Affected Arthritis Pain -Studies finding a link between changes in weather and changes in joint symptoms have almost all relied on "subjective" measures of arthritis - that is, pain, reported by patients, increases or decreases with some a particular weather feature. There are far fewer studies relying on examinations by physicians or results of blood tests that might be more reliable measures. In addition, for each study finding an effect, there seems to be another showing the opposite effect or no effect.

Is It All Intuition? - A study in the April 1996 Proceedings of the National Academy of Science found no association between arthritis (measured by patient report of pain or by the observation of swelling by an examiner) and weather, even though the patients thought that a strong relationship existed. More remarkably, when the data was presented in graphic form to 97 college students, many thought correlations existed when none did (according to standard statistical analysis). As summed up by the authors of the study, "… the intuitive notion of association differs from the statistical concept of association." They attributed this phenomenon to a common human attribute called "selective matching," in which we tend to remember when two things occur or change together but remember less when they do not.

For example, many people assume that they are allergic to particular foods because they became ill soon after eating it, neglecting the many times before when they had eaten that food without a problem. Although some may represent true allergies, it is likely that for many the illness was just a coincidence. Similarly, people with arthritis may notice what the weather is doing when their arthritis is worse, but take less notice of the weather when their arthritis is stable or improving.

Weather And Arthritis - Does It Matter? - Some would argue that even if weather did affect arthritis, there would be little practical importance to proving it. We cannot readily change the weather, so we are left with whatever options are currently available for the treatment of arthritis. However, some people with arthritis move to a climate they think will be better for their condition or have received that advice from their doctors. More importantly, if we did figure out the exact way weather affects the joints, it could lead to better treatments to counteract that effect. For example, if a particular chemical in the joint increased whenever the barometric pressure rose and that led to an increase in joint inflammation a day or two later, perhaps a medication to counteract that chemical could be taken as soon as the weather report mentions rising pressure.

The Bottom Line -It has not yet been proven that weather reliably affects arthritis, although it has not been disproved, either. Attempts to study the effects of weather are fraught with difficulty. There are many different types of arthritis and many different features of the weather that could act in combination to have an impact on joint symptoms. In fact, it is not clear that a definitive study is even possible. Given the widespread belief that weather matters for arthritis pain, it's probably best to assume there may be an effect that we do not yet understand. If it is true that arthritis sufferers can predict the weather, it might be the only good thing about having arthritis.

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LASER VISION CORRECTION CAN WORSEN DRY EYES NEW YORK (Reuters Health) -

People with dry eyes can get better vision with laser eye surgery--but at the risk of making their dry eyes worse, according to researchers.

LASIK eye surgery can often correct the common vision problems of near- or far-sightedness, but there are side effects--one of them being eye dryness.

Now a new study shows that LASIK patients, who have dry eyes going into surgery, while benefiting from it, may also have more-severe eye dryness after the procedure than other patients.

Dr. Ikuko Toda, of the Minamiaoyama Eye Clinic in Tokyo, Japan, and colleagues report the findings in the August issue of the Archives of Ophthalmology.

During LASIK (for laser-assisted in situ keratomileusis), a doctor attempts to clear blurry vision by removing a thin layer of tissue from the cornea in order to reshape it.

While the procedure is generally safe and often successful, it is not for everyone. And recent guidelines from the American Society of Cataract and Refractive Surgery call patients with dry eyes "less-than-ideal" candidates for LASIK because of the risk of worsening the problem.

Still, Toda's team notes in the new report, patients with dry eyes often want to try LASIK because they cannot comfortably wear contact lenses. To see how well such patients fare after LASIK, the researchers followed 290 patients who underwent the procedure, a majority of whom had "definite" or "probable" dry eye before surgery.

They found that in the year after LASIK, dry-eye patients saw as much vision improvement as the other patients did. However, their dry-eye symptoms were more severe throughout the year after surgery, according to the report.

Patients who had not had dry eyes before surgery did complain of dryness in the month afterward, but the problem was only temporary, Toda's team found.

"These data," they write, "may indicate that preoperative dry eye is a risk factor for severe postoperative dry eye."

They note that dry-eye patients who expect the problem to get better with LASIK because it will free them from contact lenses should be warned that their dry eyes may instead persist. copyright © 2002 Reuters Limited. All rights reserved.

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NEW HOPE FOR BACK PAIN (HealthScoutNews) --

People with crippling back pain may soon have another choice for relief.

A stainless steel and plastic artificial back disc is being tested by University of California at San Francisco (UCSF) Medical Center orthopedic surgeons.

The disc, called Prodiscr, is meant to replace back discs damaged by degeneration, bulging, herniation or thinning. Spinal fusion surgery is the current treatment for the condition.

The UCSF Medical Center's randomized clinical trial will enroll about 510 people over four years. The goal of the study is to compare the safety and effectiveness of the implant to spinal fusion surgery.

In spinal fusion, surgeons attach rods and screws to spinal bones to hold them until they heal together.

However, spinal fusion techniques and results are controversial, says Dr. David S Bradford, a professor of orthopedic surgery and lead investigator of the UCSF study.

There's variation from patient to patient in the ability of the bone to heal or fuse. Spinal fusion can also cause stiffness and decreased motion, and it causes more stress to be transferred to other areas of the spine, he says.

"Most important, fusion is not targeted toward restoration of normal structure and function. This prospective, randomized study will tell us if the Prodiscr can eliminate back pain by preserving or restoring motion in the spine, restoring the structure and height of damaged vertebrae, and restoring the normal biomechanics of the lumbar spine," Bradford says.

The Prodiscr was developed in France in the late 1980s. It has two porous cobalt-chrome plates, a polyethylene ball-bearing cone, and stabilizing keels that integrate into adjacent vertebrae.

UCSF is one of 13 centers currently evaluating the Prodiscr.

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CONSUMER GROUPS ASK FOR PROBE OF PRILOSEC CASE By Jed Seltzer NEW YORK (Reuters) -

A group of 125 consumer advocacy organizations will ask state and federal authorities to investigate drug maker AstraZeneca Plc for delaying cheaper generic competition against the company's popular heartburn medicine Prilosec, the group said.

The consumer watchdog, Stop Patient Abuse Now--known as SPAN Coalition--is leading the charge against AstraZeneca, arguing that consumers are paying an extra $6.25 million for Prilosec each day that the copycat medicines are delayed.

AstraZeneca lost its main US patent protection over Prilosec in the fall of 2001, but used additional patents to stop generic drug makers from marketing copycats.

A trial in New York over the issue has dragged on and the companies are still awaiting a decision from the district court judge.

"Consumers have been denied access to the generic products since November 2001," the group says in a letter to the Federal Trade Commission asking for a probe. "SPAN estimates this will cost consumers in excess of $2 billion by August 19 of this year."

Generic forms of branded drugs are often discounted by up to 40% during the first six months of competition and prices can be slashed by 80% or more within the first year. For patients without insurance, the drug currently costs up to $140 per month in US drugstores.

Prilosec generates sales of $6 billion each year for AstraZeneca and its US partner, Merck & Co. Inc. During the delay, AstraZeneca has had time to switch patients to its newer heartburn drug, Nexium, which some consumer groups say offers little or no advantage over Prilosec.

Officials for AstraZeneca were not immediately available for comment on Wednesday evening.

Representatives from the Washington-based SPAN Coalition are scheduled to appear at a press conference in New York on Thursday to release their petition to the Federal Trade Commission and New York Attorney General Elliot Spitzer, stating their case against AstraZeneca and asking for a probe.

Spitzer has pursued several issues that have rocked Wall Street, from alleging that Merrill Lynch tailored its research to please investment-banking clients at the expense of small investors, to charging that drug maker Bristol-Myers Squibb kept generic alternatives to anti-anxiety drug BuSpar off the market through illegal methods.

The groups organized by SPAN Coalition include the New York AIDS (news - web sites) Coalition, the Nursing Community Coalition of New York State, Metro New York Health Care for All Campaign, The National Coalition of 100 Black Women of New York City and the New York StateWide Senior Action Council.

The SPAN Coalition and the organizations are arguing that AstraZeneca may have illegally obtained one of its additional patents relating to the main chemical in the drug, known generically as omeprazole.

Specifically, generic drug company Andrx Corp. during the trial alleged that AstraZeneca listed a patent over the drug based on research done by a Korean company, but misled the US Patent Office into believing the patent was based on its own research.

That patent--one of several used by AstraZeneca to block copycat competitors--covers a process for making the drug, in which a sub coating is formed in the pill. The company claims that copycats with that sub-layer are infringing its patent.

In legal parlance, the practice of filing a patent based on research that already exists is called "prior art" and can be a basis for invalidating the patent.

The pharmaceutical sector is facing an unprecedented era of generic competition for key branded medicines. At stake is an estimated $35 billion to $40 billion in sales of drugs losing patent protection between 2001 and 2006.

Many drug companies are using patent delay tactics such as the methods AstraZeneca is using. The Anglo-Swedish firm and its rivals say they are protecting their intellectual property, which is key to research and development of new medicines.

On July 31, the US Senate passed a measure that would allow branded drug companies to initiate only one 30-month delay to generic versions of their drugs rather than multiple 30-month postponements.

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EPA: DIESEL EXHAUST MAY CAUSE CANCER WASHINGTON (AP)

Diesel exhausts from large trucks and other sources probably cause lung cancer, the Environmental Protection Agency concluded Tuesday in a report that buttresses a push to reduce truck emissions through stricter requirements for cleaner diesel fuel.

The EPA report concludes that uncertainties remain about long-term health effects of exposure to diesel exhausts. It said, however, that studies involving both tests on animals and occupational exposure suggest strong evidence of a cancer risk to humans. "Overall, the evidence for a potential cancer hazard to humans resulting from chronic inhalation exposure to (diesel emissions) is persuasive," said the health impact report released by the EPA.

The report mirrors conclusions made previously in documents from various world health agencies and studies in California and is particularly significant because the EPA is the federal agency that regulates diesel emissions under the Clean Air Act.

Some environmentalists have expressed worries recently that the Bush administration might have been backing away from a Clinton-era regulation that would establish tougher requirements on emissions from large trucks and a separate rule that virtually would eliminate sulfur from diesel fuel.

EPA Administrator Christie Whitman repeatedly has promised to go ahead with the tougher diesel rules. Last month, with White House approval, the EPA rebuffed attempts by some diesel engine manufacturers to postpone the requirements, approving new penalties against manufacturers who fail to meet an October deadline for making cleaner-burning truck engines.

The engine rule does not effect emissions from trucks already on the road, although the separate regulation cutting the amount of sulfur in diesel fuel is expected to produce pollution reductions.

The EPA's 651-page diesel health assessment report had been awaited by environmentalists, health advocates and state air quality regulators who have been pushing for diesel emission reductions.

The report reiterated that environmental exposure to diesel exhausts poses "a chronic respiratory hazard to humans" in the long term including increased asthma and other respiratory problems. In some urban areas diesel exhausts account for as much as a quarter of the airborne microscopic soot, the report said.

As for cancer, the report noted occupational health studies and tests on animals that showed diesel emissions to be a carcinogen, a cancer-causing substance. While there remain uncertainties, the report continued, "It is reasonable to presume that the hazard extends to environmental exposure levels" as well.

"The overall evidence for potential human health effects of diesel exhausts is persuasive," the report said.

"This assessment concludes that (diesel exhaust) is likely to be carcinogenic to humans by inhalation, and that this hazard applies to environmental exposure ... based on the totality of evidence from human, animal and other supporting studies," said the report.

Environmentalists welcomed the study as clear evidence that pollution needs to be curtailed not only from large trucks but also from off-road diesel-powered vehicles. The EPA has yet to deal with those diesel exhaust sources, which include farm tractors and construction equipment.

"To reduce the public's exposure to harmful diesel emissions, the Bush administration should ... fully implement clean air standards for diesel trucks and buses and should pass equivalent standards for diesel construction and farm equipment," said Emily Figdor of the U.S. Public Interest Research Group, a private environmental organization.

Figdor noted that the report is surfacing just as children across the country are returning to schools, many in diesel-powered buses. "Children riding buses back to school ... need stronger protection against the health impacts of diesel exhaust," she said. Copyright 2002 The Associated Press.

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OPTIMISM COULD HELP YOU LIVE LONGER
(The Associated Press) -- Doctor's orders: Don't worry, be happy.

Keeping a positive attitude about aging can extend life by seven and half years, which is longer than gains made by not smoking and exercising regularly, a study finds.

"People's perception of aging predicted the length of their survival,"' said Dr. Suzanne Kunkel, director of the Scripps Gerontology Center at Miami University and co-author of the study.

"It illustrates the mind-body connection. Even if we cannot control what happens to us, we can control how we define it.''

The findings about attitude and survival rates were made by analyzing and matching data collected since 1975 about 660 people age 50 or older in Oxford, Ohio, with data from the National Death Index.

Kunkel began the research in the small southwestern Ohio town as a graduate student and has helped maintain the database for more than two decades.

Researchers at Miami and Yale universities looked at how the 338 men and 322 women responded to several questions about aging in 1975, and then examined how their responses predicted their survival up to 23 years later.

The study, published in the Journal of Personality and Social Psychology, was funded by the National Institute on Aging.

Researchers found respondents with more positive views on aging live longer, even after taking into account factors such as age, gender, socio-economic status, functional health, self-reported health and loneliness.

"The median survival of those in the more positive self perceptions of aging group was seven and a half years longer than those in the more negative perceptions,'' Kunkel said.

The attitudes on aging had a greater impact on life span than lower body mass index, not smoking and regular exercise - each of which extends life by one to three years.

"Our study carries two messages,'' said Dr. Becca Levy, a researcher at Yale University and the study's lead author."The discouraging one is that negative self perceptions can diminish life expectancy; the encouraging one is that positive self-perceptions can prolong life expectancy.''

But Richard Suzman, associate director for behavioral and social research for the National Institute on Aging, said while a positive self-perception helps, it should not replace proper health care.

"Any notion that positive thinking is more powerful than not smoking ... there just isn't evidence of that,'' he said. ``There is enormous clinical evidence to show the value of not smoking and exercising.''

The researchers found that the will to live partially accounts for the relationship between positive self-perceptions of aging and survival, but does not completely account for difference in longevity.

Levy's earlier research at Yale's Department of Epidemiology and Public Health has shown cardiovascular response to stress can be adversely affected when elderly persons are exposed to negative stereotypes of aging.

The new study said stereotypes about aging are acquired decades before the person becomes old and are therefore rarely questioned.

"Once individuals become older, they may lack the defenses of other groups to ward off the impact of negative stereotypes on self-perceptions,'' the report said.

Kunkel said the study offers a strong message about life.

"There is nothing we can do about aging,'' she said."It's like sitting in traffic when you're late. The natural response is to be very stressed about the situation. The other choice is to not get upset and think about how to deal with the consequences of being late.''

The key is learning how to see a situation for what it is, she said, and to give it no more power than it needs to have.

"We enter later adulthood with our habitual ways of dealing with stress,'' she added."People need to learn new strategies to deal with it. Copyright 2002. The Associated Press.

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We are providing this newsletter for educational purposes, and it is never intended as medical advice. Occasionally there may be topics of sufficient value that warrant a good discussion with your medical caregivers.

Our membership is made up of people who are veterans of this disease, along with others who have just been recently diagnosed with PA. Our goal is to serve all our membership throughout the world, with news that is both helpful and useful.

Don't forget to go to our website at http://www.wpunj.edu/pa to read back issues of the newsletter. For all you new members, it's educational, worthwhile and informative.

Good Health to All

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2002 9/18/02-20