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

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 3 ISSUE 2 January 31, 2003
PSORIATIC ARTHRITIS MEDICAL NEWS

GORDON ELIOTT AND THE ARTHRITIS FOUNDATION OF AUSTRALIA

Our very own Gordon Eliott was invited to write an article that describes his own personal account of what it is like to live with Psoriatic Arthritis. Gordon's superb story is intended to help people understand the suffering and immense cost of PA, while giving encouragement and support to others who feel alone in their fight against this chronic disease.

Gordon's article was just published in the summer (yes, its summer in Australia.) issue of "ARTHRITIS ACTION", the official magazine of the Arthritis Foundation of Australia. Ron Dotson has posted pictures from the article on our YAHOO forum site at http://snurl.com/Gordons_Pics Thank you Gordon, for your dedication to our universal quest for understanding, and some day a permanent cure.

Psoriatic Arthritis - What is it?

I am a sixty-three year old bachelor and I have suffered from the little-known psoriatic arthritis for 23 years. Actually, I have two linked autoimmune diseases: the ugly psoriasis of the skin and the arthritis, which has left me severely disabled.

Until 1979, I lived an active and interesting life, joining the Australian Army at age 18 and twice going overseas on active service. I was then employed as a civilian in the Defense Department. I had my own home in Melbourne, was caring for my frail, widowed mother and I could indulge in my love for gardening. Life felt great.

However, in 1979, at the age of 40, I developed the psoriasis skin disease and worse, psoriatic arthritis. At first, it was confined to a thumb and a few finger joints, along with a little in the cervical spine. Later, it extended to the lumbar spine. With a daily NSAID and mild analgesics, life did not change much for the next ten years.

The only difficulty was explaining to people that I had psoriatic arthritis. In the end, I would just say that I had a form of rheumatoid arthritis, even though that was not correct.

In the early nineties, I was transferred to Canberra where I established a new home and my mother came with me so that I could still care for her. It was shortly after that my world began to fall apart as the psoriatic arthritis suddenly worsened. I was now on a downward spiral as the spine degenerated, pain increased and my range of movements decreased markedly.

In 1994/1995, I reached the lowest point of my life. I could no longer care for my mother and I had to make the agonizing decision to place her in nursing home, where she died barely a year later. I sold my home and moved into a small rental apartment. The psoriatic arthritis continued to worsen as more powerful drugs were introduced to try to contain it and lessen the pain. I developed a bleeding duodenal ulcer attributed to the NSAID I was taking. Work had become a strain, so I transferred to permanent part time employment, three days a week. I had reached the point of being alone, in despair, and feeling worthless, and I seriously considered ending my life.

By chance, I heard that the ACT Arthritis Foundation conducted self - help management programmes. With nothing to lose, I signed up for one, and this turned my life around. I met others with various forms of arthritis, some obviously worse than myself. As we progressed through the programme, I came to realize that I had to help myself to come to grips with this. Most importantly, I had to take control again.

As the next step in regaining control, and realizing it was becoming more difficult to work even three days a week, I had a financial plan drawn up which enabled me to take early retirement. I then moved to a more pleasant and warm location, Queensland's Sunshine Coast, where I took up residence in a beautiful retirement village. Such surroundings are ideal for a person on their own, with the social interaction with other residents.

I was still frequently in pain and now required crutches to walk but I still maintained a positive attitude. The next step was to accept that I needed physical assistance. I began to receive a weekly government home care service, which takes care of the laundry and housework. Then I began to receive Meals on Wheels. I then purchased an electric mobility scooter to get around the village and to go to the local shops. My latest acquisition is an electric adjustable bed that helps to take pressure off the spine.

One of my best acquisitions was a personal computer, because now I could travel through the Internet. More importantly, I found, and joined, an on-line Psoriatic Arthritis Support Group, and through group emails, we discuss, advise and support each other even though we may be continents apart. It is wonderful to not feel alone with this disease and to have friends who understand.

So now, despite pain disability, I am content enjoying life again.

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Many of us have constant battles with our toes, feet, ankles, bone deformity, Psoriasis of the feet, etc., so I thought the following fact sheet about your feet would be helpful.

FACTS ABOUT YOUR FEET

1. Seventy-five percent of Americans will experience foot health problems of varying degrees of severity at one time or another in their lives.
2. The foot is an intricate structure containing 26 bones. Thirty-three joints, 107 ligaments, 19 muscles, and tendons hold the structure together and allow it to move in a variety of ways.
3. The 52 bones in your feet make up about one quarter of all the bones in your body.
4. Women have about four times as many foot problems as men; lifelong patterns of wearing high heels often are the culprit.
5. The American Podiatric Medical Association says the average person takes 8,000 to 10,000 steps a day. Those cover several miles, and they all add up to about 115,000 miles in a lifetime - more than four times the circumference of the globe.
6. There are times when you're walking that the pressure on your feet exceeds your body weight, and when you're running, it can be three or four times your weight.
7. Shopping for shoes is best done in the afternoon, says the American Podiatric Medical Association. Your feet tend to swell a little during the day, and it's best to buy shoes to fit them then. Have your feet measured every time you purchase shoes, and do it while you're standing. When you try on shoes, try them on both feet; many people have one foot larger than the other, and it's best to fit the larger one.
8. Trim your toenails straight across with clippers specially designed for the purpose. Leave them slightly longer than the tips of your toes.
9. Walking is the best exercise for your feet. It also contributes to your general health by improving circulation, contributing to weight control, and promoting all-around well being.
10. Your feet mirror your general health. Such conditions as arthritis, diabetes, nerve and circulatory disorders can show their initial symptoms in the feet -- so foot ailments can be your first sign of more serious medical problems.
11. There are approximately 250,000 sweat glands in a pair of feet, and they excrete as much as half a pint of moisture each day.

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ANTIOXIDANT MAY FIGHT PARKINSON'S DISEASE

About one percent of Americans older than 65 have Parkinson's disease, causing tremor, muscle rigidity and movement problems. An underlying cause is the slow loss of neurons that produce the neurotransmitter dopamine, a brain chemical involved in movement. Current Parkinson's therapy relieves symptoms but does not slow the progression of the disease.

According to the Parkinson's Disease Foundation: "Parkinson's disease (PD) is a disorder of the central nervous system that affects between one and one-and-a-half million Americans. Because it is not contagious and does not have to be reported by physicians, the incidence of the disease is often underestimated. PD may appear at any age, but it is uncommon in people younger than 30, and the risk of developing it increases with age. It occurs in all parts of the world, and men are affected slightly more often than women."

Recent research has raised the possibility that people with Parkinson's might have problems with structures called mitochondria, a spherical or elongated organelle in the cytoplasm of nearly all eukaryotic cells, containing genetic material and many enzymes important for cell metabolism, including those responsible for the conversion of food to usable energy. The researchers who performed this study found that Parkinson's patients have reduced levels of coenzyme Q10 in their mitochondria. This led the researchers to investigate whether the antioxidant would be useful in treating the disease.

The study involved 80 people who had been diagnosed with Parkinson's but had not yet received treatment. The participants were randomly assigned to take a daily dose of 300 milligrams (mg), 600 mg or 1,200 mg of coenzyme Q10 or an inactive pill called a placebo. Patients were evaluated at the start of the study and after one, four, eight, 12 and 16 months.

The progression of Parkinson's disease was significantly slower in people taking the highest dose of coenzyme Q10. These patients experienced a slower decline in all areas measured by the researchers, including mental and motor skills, but the greatest effect was in the activities of daily living. Compared to placebo, the lower doses of the drug also seemed to slow Parkinson's, but the differences were not statistically significant.

Treatment with the antioxidant seemed safe, as side effects were similar in patients taking the supplement and the placebo.

In the U.S., coenzyme Q10 is classified as a dietary supplement rather than a drug, so it is not regulated by the Food and Drug Administration. The antioxidant is available at health food stores, but the researchers advised Parkinson's patients not to take the supplement until future studies have been conducted. The coenzyme Q10 currently on the market may not contain enough of the supplement to be helpful to people with Parkinson's.

Although treatment with coenzyme Q10 seemed to slow the advance of Parkinson's, patients taking the supplement developed disability that required them to start taking conventional treatment as quickly as those on the placebo. The researchers do point out, however, that until near the end of the study, patients taking the highest dose of coenzyme Q10 tended to need to start conventional therapy later than those on the placebo. The greatest benefit was in daily activities such as feeding, dressing, bathing, and walking.

The results of the study support the idea that problems with mitochondria are involved in Parkinson's disease and provide an exciting forum to continue study. The National Institutes of Health funded the study, but Vitaline Corp. donated the coenzyme Q10 and placebo wafers. Archives of Neurology October 2002; 59: 1523, 1541-1550

Editors Note: The following comments are from Dr. Mercola. Co Q10 is normally made by the liver and is decreased when someone is placed on statin drugs. A prescription for lipid lowering statin drugs should always be accompanied with a recommendation to take Co Q10, because if one is deficient in it heart failure is more likely. CoQ10 is also a helpful adjunct in many cancer therapies.

However, in terms of Parkinson's disease, prevention is clearly the best option. The single best thing one can do is avoid pesticide and insecticide exposure. The massive fogging for West Nile virus that occurred this summer will absolutely increase the future development of Parkinson's disease.

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OCCUPATION LINKED TO RISK OF HAND, WRIST ARTHRITIS

(Reuters Health) - Certain jobs appear to increase a person's risk of developing arthritis of the hand and wrist, according to researchers at the National Institute for Occupational Safety and Health (NIOSH).

While there have been many previous studies investigating the connection between occupation and so-called "soft tissue" hand/wrist disorders, such as carpal tunnel syndrome, few have looked at the relationship between work exposures and arthritis of the wrist and hand, the researchers report.

To investigate, lead author Dr. Charles Dillon of the National Center for Health Statistics in Hyattsville, and co-authors Drs. Martin Petersen and Shiro Tanaka of NIOSH in Bethesda, Maryland evaluated survey information from a national sample of 30,000 working adults. The participants answered questions about their job, hand and wrist discomfort, and whether or not a healthcare provider had diagnosed them with arthritis.

The highest prevalence of hand/wrist arthritis was seen among technicians, machine operators, assemblers and farmers, as well as in the mining, agriculture and construction industries, the authors report in the October issue of the American Journal of Industrial Medicine.

People who worked at jobs that required repetitive bending and twisting of the hands and wrists had a 43% increased risk of developing arthritis, the investigators found.

"Among workers with hand arthritis, 7.4% had made major changes in their work, 7.6% missed work and 4.5% stopped working or changed jobs because of the problem," Dillon and colleagues write.

Although more definitive studies need to confirm or refute the current findings, the researchers note that the findings do have a "general public health significance" given that many people have hand/wrist arthritis that could potentially be prevented by reducing certain risk factors at the workplace. SOURCE: American Journal of Industrial Medicine Copyright © 2002 Reuters Limited.

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LONG-TERM REMICADE USE HELPS CROHN'S By Jeanie Davis WebMD Medical News Reviewed By Michael Smith, MD

When Remicade hit the market a few years back, it was a very welcome addition to the world of Crohn's disease -- a serious and painful bowel condition. Currently this drug is recommended only as a one-time injection. However, a new study now shows that taking Remicade long term seems to be key in controlling Crohn's.

Remicade has shown promise in providing relief in reducing the symptoms of Crohn's disease, which is a lifelong inflammatory disorder of the intestines. However, that relief has only been temporary in treating people with mild symptoms. Many patients eventually require steroids to control symptoms, but long-term use of steroids produces severe side effects.

The new study shows that treatment with Remicade every two months provides "a sustained response ... similar to maintenance treatment for rheumatoid arthritis," says author Stephen B. Hanauer, MD, director of the Center for Research in Inflammatory and Autoimmune Diseases at the University of Chicago, in a news release. Remicade is commonly used in multiple doses for rheumatoid arthritis.

In his study, Hanauer gave all 573 patients an initial injection of Remicade; then assigned them to receive either repeat infusions of placebo or Remicade at weeks two and 6, then every 8 weeks for 46 weeks.

"More than twice as many patients who received maintenance Remicade therapy maintained a clinical remission continuously from week 14 to week 54 compared with patients who received placebo maintenance," according to the researchers.

Patients on steroids who took Remicade as a "maintenance" drug were able to reduce or -- in one-third of cases -- able to stop taking steroids altogether and still get relief from symptoms. © 2002 WebMD Inc.

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ARTHRITIS COMMITTEE WILL RECONSIDER TNF INHIBITOR SAFETY ON MARCH 4TH

FDA's Arthritis Advisory Committee will consider the possible link between tumor necrosis factor inhibitors and lymphoma at its March 4 meeting.

The committee will receive safety updates on all three marketed TNF inhibitors - Amgen's Enbrel, Centocor's Remicade and Abbott's Humira, which was approved Dec. 31, 2002. The previous TNF inhibitor safety review, on August 17, 2001, focused on the risk of immune disorders.

"As we understand it, the focus is on lymphoma and concerns for the TNF inhibitors," Amgen Exec VP-R&D Roger Perlmutter, MD, said during the firm's Jan. 23 earnings call.

Amgen "has had some discussions with the FDA" and has "prepared a large briefing document," he said. "We're looking forward to reviewing it with the FDA." Abbott and Centocor are also understood to have prepared briefing material.

On March 5, the committee will review Aventis' Arava for improvement in physical function in rheumatoid arthritis; the meeting had been postponed from Jan. 30.

Editors Note: For information about live web casting or videoconferencing of this meeting, as well as videotape and CD recordings, email webcasthelp@elsevier.com or call 301.664.7210.

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ENBREL ARTHRITIS DRUG MAY WORSEN HEART FAILURE
By Richard Woodman LONDON (Reuters Health) -

Physicians are being advised to "use caution" when using Wyeth and Amgen's arthritis drug Enbrel (etanercept) in patients with congestive heart failure because of the possibility that the therapy may worsen their condition.

An updated European summary of product characteristics says: "There have been post marketing reports of worsening of congestive heart failure, with and without identifiable precipitating factors, in patients taking Enbrel."

Congestive heart failure (CHF) is a chronic condition in which the heart loses its ability to pump blood efficiently. The disease causes fatigue and shortness of breath as fluid accumulates in the lungs and tissues.

"Two large clinical trials evaluating the use of Enbrel in the treatment of CHF were terminated early due to lack of efficacy. Although not conclusive, data from one of these trials suggest a possible tendency toward worsening CHF in those patients assigned to Enbrel treatment."

The drug label says allergic reactions are not uncommon.

"In post marketing experience, allergic reactions have included angioedema (swelling in the deep layers of the skin) and urticaria (hives) as well as serious reactions. If any serious allergic or anaphylactic reaction occurs, Enbrel therapy should be discontinued immediately and appropriate therapy initiated."

It also notes that sepsis and serious infections have been reported and advises that "administration of Enbrel should be discontinued if a patient develops a serious infection." Copyright © 2003 Reuters Limited.

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NEW ARTHRITIS DRUGS MAY HELP HEART
By Sid Kirchheimer WebMD Medical News Reviewed By Michael Smith, MD - January 13, 2003

Previous reports have suggested that newer arthritis drugs may increase risk of heart disease, but a new study shows these drugs may actually benefit heart patients by having an anti-inflammatory effect on damaged blood vessels.

Researchers found that Celebrex, used by 14 million Americans to reduce joint inflammation, improved flexibility in "hardened arteries" while reducing inflammation and levels of proteins and fats known to boost risk of heart attack.

"Increasing evidence indicates that [hardening of the arteries] is an inflammatory disease," explains lead researcher Frank Ruschitzka, MD, cardiologist at University Hospital in Zurich. "Thus, anti-inflammatory agents used to treat arthritis, such as COX-2 inhibitors, may not only reduce inflammation in the joints, but could possibly have that same anti-inflammatory benefit in the blood vessel wall. This study is the first to show that relationship."

In addition to reduced inflammation and improved flexibility in blood vessel lining, Ruschitzka found that compared with men getting a placebo, those taking Celebrex had lower levels of a dangerous form of LDL "bad" cholesterol and C-reactive protein -- two factors associated with heart attack.

What's more, it's the first study in recent years that doesn't suggest an increased risk of heart problems from using COX-2 inhibitors, which have been under increasing scrutiny since their introduction in 1996. While Ruschitzka's findings, published in the Jan. 28 issue of Circulation, show a protective effect from Celebrex, another COX-2 drug -- Vioxx -- has been found in several studies to boost risk of heart problems.

Last October, Vanderbilt University researchers reported in The Lancet that a review of 300,000 people taking various types of non-steroidal anti-inflammatory drugs (NSAIDs) showed that Vioxx was linked to twice as many heart attacks as the other medications. In addition, 13 months earlier, a Cleveland Clinic review of data on 8,000 others, published in The Journal of the American Medical Association, indicated that Vioxx users had twice as many heart attacks as those taking Aleve, an over-the-counter NSAID.

COX-2 inhibitors -- Bextra, Celebrex, and Vioxx -- were designed to reduce arthritis pain and inflammation without the stomach upset and risk of ulcers caused by other NSAIDs such as aspirin and ibuprofen. They are the leading treatments for arthritis and among the world's best-selling prescription drugs, with combined annual sales of about $6 billion. However, just last month, a study suggested that Celebrex is no more effective in preventing recurrent bleeding ulcers in arthritis patients than other treatments.

Although Celebrex was not implicated (or even studied) for boosting heart disease risks in those earlier trials, some researchers suggest that its users have a slightly higher risk of heart attacks compared with those taking "older" NSAIDs.

So why one COX-2 medication (Celebrex) would seem to protect against heart disease while another (Vioxx) seems to cause it?

It could be the two drugs, although chemically similar, react differently in the body, says Ruschitzka. "Preliminary evidence from studies on rodents show that there indeed, might be differences between different COX-2 drugs -- and between Celebrex and Vioxx in particular," he tells WebMD. "Head-to-head studies in humans are now under way."

A more likely explanation: While his study involved only 14 men -- all with severe hardening of the arteries -- each continued with aspirin and other treatments proven to reduce heart attack risk during the two-week study. In the earlier studies implicating Vioxx, which were longer, many patients did not get aspirin or other heart treatments during the course of the trial.

In fact, Ruschitzka tells WebMD that half the heart attacks in one earlier study implicating Vioxx occurred in a group of men who should have received aspirin because of their increased risk of heart disease, he says. Current guidelines now recommend that aspirin should not be withheld in patients at risk of heart disease when treated with a COX-2, as in his study, he adds.

In addition to aspirin, all the men in his study were treated with a cholesterol-lowering "statin" drug such as Lipitor or Zocor, and half also received heart drugs known as ACE inhibitors.

These added drugs in Ruschitzka's study may help explain the different findings -- and will likely warrant new research into how COX-2s may be used as an "add-on" therapy to other anti-inflammatory measures for heart disease.

"We used to think [hardening of the arteries] resulted from cholesterol laying down in coats inside of blood vessels until they narrowed blood flow to the point of a heart attack," says Lynn Smaha, MD, PhD, past president of the American Heart Association. "But now, we think what more likely occurs is that there is an inflammatory response in blood vessels that may be caused by a variety of factors, such as irritants like tobacco or a response to infections. So if you can reverse this inflammation, conceptually, it will help."

Both aspirin and statins are known to help reduce inflammation in blood vessels. "And ACE inhibitors [open up] and relax blood vessels, which makes it easier for the heart to work -- particularly one that's been damaged," Smaha tells WebMD. "So while this is a small study, it does raise some interesting points. Now, we need to go back and look at those studies and really determine under what circumstances will COX-2 drugs be helpful, and with what other therapies."

SOURCES: Circulation, Jan. 28, 2003 o The Lancet, Oct. 5, 2002 o The Journal of the American Medical Association, Aug. 22/29, 2001 o Frank Ruschitzka, MD, FESC, cardiologist, University Hospital, Zurich o Lynn Smaha, MD, PhD, past president of the American Heart Association, cardiologist, Guthrie Health, a non-profit healthcare organization in Sayre, Penn.

Editors Note: Based on the last two articles, do you ever wonder if we are just guinea pigs participating in a vast worldwide experiment? I guess that's why they are called Practicing Physicians.

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ARTHRITIS DRUG TO BE FREE FOR MEDICARE January 7, 2003 WASHINGTON (AP)

A new drug for rheumatoid arthritis is now available for free to Medicare-enrolled senior citizens who lack prescription drug coverage.

Abbott Laboratories launched the program Monday for its drug Humira, which was approved by the Food and Drug Administration just last month.

Under the program, Medicare beneficiaries without prescription drug coverage can receive Humira at no cost until a Medicare drug benefit is approved by Congress.

Medicare does not have a prescription drug benefit, although some seniors enrolled in Medicare HMOs have some drug coverage. The issue of a Medicare drug benefit is expected to dominate the new session of Congress, which begins Tuesday.

Abbott chairperson Miles D. White said the company was initiating the program "to help remove barriers to this important new medicine for seniors with (rheumatoid arthritis)."

Health and Human Services Secretary Tommy Thompson said, "We always encourage companies to give seniors in need access to FDA approved drugs, like Abbott is doing with this new program."

Humira works by blocking an immune system protein called tumor necrosis factor, or TNF, that is responsible for much of the pain and inflammation of rheumatoid arthritis.

It requires patients to give themselves one shot every two weeks. The company has said Humira's wholesale price will be a little over $1,100 a month.

Seniors can get more information on the program by calling 1-866-4-HUMIRA. Copyright 2003 The Associated Press.

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WEB SITE LINKS SENIORS TO DRUG PROGRAMS January 23, 2003 - WASHINGTON (AP) A new Internet-based program has been launched to help the elderly more easily identify programs that will save them money on prescription drugs.

The program, known as BenefitsCheckUpRx, is a project of the National Council of Aging and is found at http://www.BenefitsCheckUp.org.

By clicking on the Web site, families can complete a brief questionnaire to obtain a personalized report with all the programs a person might be eligible for and detailed instructions on how to enroll.

The site includes information on 30 state-funded pharmacy programs, each state's Medicaid program and 116 company-sponsored patient assistance programs.

"We know that millions of seniors can't afford all the medications they need and far too many are skipping doses or not filling prescriptions," said James Firman, president of the National Council of Aging.

The Web site will help seniors "find out which of the over 240 programs can help them save money on their prescriptions," Firman said.

Tom Scully, administrator of the government's Centers for Medicare and Medicaid, called the site "another great tool in helping seniors become more educated consumers."

The inclusion of pharmaceutical programs actually is an expansion of the Web site, which already helped the elderly determine their eligibility for benefits programs such as Medicaid and food stamps. Copyright 2003 The Associated Press.

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Good Health to all,

Cherish your health: If it is good, preserve it. If it is unstable, improve it. If it is beyond what you can improve, get help. Throw out nonessential numbers. This includes age, weight and height. Let the doctor worry about them. That is why you pay him/her. (Compliments of George Carlin)

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2003 1/31/03 -2