Psoriatic Arthritis List NEWSLETTER

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

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 3 ISSUE 14 - August 15, 2003
PSORIATIC ARTHRITIS MEDICAL NEWS

Editors Note: With recent e-mails that are asking about different treatment regimens and medications, I decided to compile a medications review (with the help of MedicineNet. Inc.) that would show drug definition, basic usage, side effects, brand names, generic names, etc. I am sure that I don't have all of them, and also keep in mind that historically, most of these medications started out as prescriptions for Rheumatoid Arthritis. However, much to our benefit, most have eventually found their way over to Psoriasis and Psoriatic Arthritis patients. Please remember that this information is provided for informational purposes only and is not a substitute for professional medical advice. You should not use this information for diagnosing or treating a medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. I hope the following will be especially useful to those who have just joined our web site, and/or recently been diagnosed with Psoriatic Arthritis.

MEDICATIONS REVIEW
Analgesics (Pain Relievers)
Biological Response Modifiers (BRMs)
DMARDS: Disease-Modifying Antirheumatic Drugs
Fibromyalgia Medications
Glucorticoids (Cortisone-Related Drugs)
NSAIDS (Nonsteroidal Anti-inflammatory Drugs)

Analgesics: A drug that relieves pain. There are many types of pain medications. Some pain medications are actually combinations of drugs that work together to relieve pain. Some pain medications are available over-the-counter (without a prescription), such as aspirin, acetaminophen, ibuprofen, and naproxen, or with a prescription, such as the narcotics oxycodone, propoxyphene, and codeine. Narcotic pain relievers can be habit-forming.

Brand Name Generic Name
Advil, Motrin, Medipren, Nuprin ibuprofen
Aspirin, Bayer, Ectorin aspirin
Darvon propoxyphene
Darvocet, Wygesic propoxyphene and acetaminophen
Empirin#2, 3,4;Tylenol#2,3,4; Tylenol w/Codeine codeine
Naprosyn, Naprelan, Anaprox, Aleve- naproxen
Orudis, Oruvail- ketoprofen
Oxycontin, Roxicodone- oxycodone
Percocet, Roxicet, Tylox- oxycodone and acetaminophen
Tylenol- acetaminophen

Biological Response Modifiers (BRMs)
Also known as Biologic DMARDS (Disease-Modifying Antirheumatic Drugs) are substances that modify the body's response to infection and disease. The body naturally produces small amounts of these substances. Scientists can produce some of them in the laboratory in large amounts for use in treating cancer, rheumatoid arthritis, and other diseases. BRMs used in biological therapy include monoclonal antibodies, interferon, interleukin-2 (IL-2), and several types of colony- stimulating factors (CSF, GM-CSF, G-CSF). Interleukin-2 and interferon are BRMs being tested for the treatment of advanced malignant melanoma. Interferon is a BRM now in use to treat hepatitis C.

The side effects of BRM therapy often include flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients develop a rash, and some bleed or bruise easily. Interleukin therapy can cause swelling. Depending on the severity of these problems, patients may need to stay in the hospital during treatment. These side effects are usually short-term and go gradually away after treatment stops.

Brand Name Generic Name
Enbrel- etanercept
Humira- adalimumab
Kineret- anakinra
Remicade- infliximab

Disease-Modifying Antirheumatic Drugs or DMARDs
While "first-line" medications (NSAIDs and corticosteroids) can relieve joint inflammation and pain, they do not necessarily prevent joint destruction or deformity. For patients with an aggressively destructive form of rheumatoid arthritis, medications other than NSAIDs and corticosteroids are needed. These "second-line" or "slow-acting" medicines (listed below) may take weeks to months to become effective. They are used for long periods of time, even years, at varying doses. If effective, they can promote remission, thereby retarding the progression of joint destruction and deformity. Sometimes a number of second-line medications are used together as combination therapy.

Hydroxychloroquine (PLAQUENIL) is related to quinine, and is used in the treatment of malaria. It is used over long periods for the treatment of rheumatoid arthritis. Side effects include upset stomach, skin rashes, muscle weakness, and vision changes. Even though vision changes are rare, patients taking PLAQUENIL should be monitored by an eye doctor (opthalmologist).

Sulfasalazine (AZULFADINE) is an oral medication traditionally used in the treatment of mild to moderately severe inflammatory bowel diseases, such as ulcerative colitis and Crohn's colitis. AZULFADINE is used to treat rheumatoid arthritis in combination with antiinflammatory medications. AZULFADINE is generally well tolerated. Common side effects include rash and upset stomach. Because AZULFADINE is made up of sulfa and salicylate compounds, it should be avoided by patients with known sulfa allergies.

Gold salts have been used to treat rheumatoid arthritis throughout most of this century. Gold thioglucose (SOLGANAL) and gold thiomalate (MYOCHRYSINE) are given by injection, initially on a weekly basis for months to years. Oral gold, auranofin (RIDAURA) was introduced in the 1980's. Side effects of gold (oral and injectable) include skin rash, mouth sores, kidney damage with leakage of protein in the urine, and bone marrow damage with anemia and low white cell count. Patients receiving gold treatment are regularly monitored with blood and urine tests. Oral gold can cause diarrhea.

Brand Name Generic Name
Arava- leflunomide
Azulfidine- ulfasalazine
Cuprimine, Depen- penicillamine
Enbrel etanercept
Humira- adalimumab
Imuran- azathioprine
Plaquenil- hydroxychloroquine
Remicade- infliximab
Rheumatrex- methotrexate
Ridaura- auranofin
Solganal- aurothiglucose

Fibromyalgia Medications
Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs have to be individualized. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

Brand Name Generic Name
Celexa- citalopram
Effexor- venlafaxine
Elavil, Endep- amitriptyline
Luvox- fluvoxamine
Norpramin- desipramine
Pamelor, Aventyl- nortriptyline
Paxil- paroxetine
Prozac- fluoxetine
Tofranil- imipramine
Zoloft- sertraline

Glucocorticoids
Glucocorticoids are medications that include cortisone and related drugs. A glucocorticoid is hormone that predominantly affects the metabolism of carbohydrates and, to a lesser extent, fats and proteins (and has other effects). Glucocorticoids are made in the outside portion (the cortex) of the adrenal gland and chemically classed as steroids. Cortisol is the major natural glucocorticoid. The term glucocorticoid also applies to equivalent hormones synthesized in the laboratory. Glucocorticoid drugs are also called corticosteroids.

Corticosteroids have potent anti-inflammatory properties, and are used in a wide variety of inflammatory conditions such as arthritis, colitis, asthma, bronchitis, certain skin rashes, and allergic or inflammatory conditions of the nose and eyes. There are numerous preparations of corticosteroids including oral tablets, capsules, liquids, topical creams and gels, inhalers and eye drops, and injectable and intravenous solutions.

Dosage requirements of corticosteroids vary among individuals and the diseases being treated. In general, the lowest possible effective dose is used. Corticosteroids given in multiple doses throughout the day are more effective, but also more toxic, than if the same total dose is given once daily, or every other day.

Brand Name Generic Name
Cortisone Injection- Corticosteroid Injection
of Soft Tissues & Joints
Decadron- dexamethasone, oral
Deltasone,- Liquid Pred prednisone, oral
Prednisolone, Pediapred- Oral Liquid,
Medrol- prednisolone
Hydrocortone, Cortef- hydrocortisone, oral
Medrol- methylprednisolone

NSAIDS: Nonsteroidal anti-inflammatory drugs. These are medications that reduce inflammation and do not contain cortisone-related compounds.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. Examples of NSAIDs include ASPIRIN, indomethacin (INDOCIN), ibuprofen (MOTRIN), naproxen (NAPROSYN), piroxicam (FELDENE), and nabumetone (RELAFEN). The major side effects of NSAIDs are related to the gastrointestinal system. Some 10%-50% of patients are unable to tolerate NSAID treatment because of side effects, including abdominal pain, diarrhea, bloating, heartburn, and upset stomach. Approximately 15% of patients on long-term NSAID treatment develop ulceration of the stomach and duodenum. Even though many of these patients with ulcers do not have symptoms and are unaware of their ulcers, they are at risk of developing serious ulcer complications such as bleeding or perforation of the stomach. NSAIDs are taken regularly by approximately 33 million Americans!

Brand Name Generic Name
Advil, Motrin, Medipren, Nuprin- ibuprofen
Ansaid- flurbiprofen
Aspirin, Bayer, Ecotrin- aspirin
Bextra- valdecoxib
Celebrex- celecoxib
Clinoril- sulindac
Daypro- oxaprozin
Disalcid, Salflex- salsalate
Feldene- piroxicam
Indocin, Indocin-sr- indomethacin
Lodine- etodolac
Meclomen- meclofenamate
Mobic- meloxicam
Nalfon- fenoprofen
Naprosyn, Naprelan, Anaprox, Aleve- naproxen
Orudis, Oruvail- ketoprofen
Tolectin- tolmetin
Trilisate- choline magnesium
salicyclate
Vioxx- rofecoxib
Voltaren, Cataflam, Voltaren-xr- diclofenac

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HOW IS RHEUMATOID ARTHRITIS DIAGNOSED?
Editors Note: (Many similarities to Psoriatic Arthritis?)

Rheumatoid arthritis may be difficult to diagnose. Many other conditions can resemble it and its symptoms can develop insidiously. Blood tests and x-rays may show normal results for months after the onset of joint pain. Even after rheumatoid arthritis has been diagnosed, it is extremely important to determine whether the course of the disease is benign (type 1) or aggressive (type 2) in order to treat the problem appropriately. Blood Tests Various blood tests may be used to help diagnose RA, determine its severity, and detect complications of the disease.

Rheumatoid Factor. In RA, antibodies that collect in the synovium of the joint are known as rheumatoid factor . In about 80% of cases of rheumatoid arthritis, blood tests reveal rheumatoid factor. It can also show up in blood tests of people with other diseases. However, when it appears in patients with arthritic pain on both sides of the body, it is a strong indicator of type 2 RA. The presence of rheumatoid factor plus evidence of bone damage on x-rays also suggests a significant chance for progressive joint damage.

Erythrocyte Sedimentation Rate Test. An erythrocyte sedimentation rate (ESR or sed rate) measures how fast red blood cells (erythrocytes) fall to the bottom of a fine glass tube that is filled with the patient's blood. The higher the sed rate the greater the inflammation. In addition to rheumatoid arthritis, the sed rate can be high in many conditions ranging from infection to inflammation to tumors. The test is used, then, not for diagnosis but to help determine how serious the condition is.

C-Reactive Protein. High levels of C-reactive protein (CRP) are also indicators of active inflammation.

Tests for Anemia. Anemia is a common complication and blood tests should be taken that determine the amount of red blood cells (hemoglobin and hematocrit) and iron (soluble transferrin receptor and serum ferritin) in the blood. Possible RA Markers in Synovial Fluid Analyzing the synovial fluid might prove to be helpful in detecting markers of joint destruction. Some investigative examples include the following: An enzyme called MMP-3 (matrix metalloproteinase 3) is involved with the degradation of cartilage. Its presence in synovial fluid is strongly associated with progressive joint destruction in patients with chronic RA.

High levels urocortin, a member of the peptide family involved in the stress response, may also be a major player in the RA inflammation.

Imaging Techniques
X-Rays. X-rays generally have not been helpful to detect the presence of early rheumatoid arthritis because they cannot show images of soft tissue. The use of a technique known as dual energy x-ray absorptiometry, however, may be useful in detecting early bone loss in rheumatoid arthritis (between two and 27 months after onset). Evidence of damage on x-rays along with elevated rheumatoid factor is a significant predictor for progressive joint destruction.

Ultrasound. Special ultrasound techniques called power Doppler ultrasonography (PDUS) or quantitative ultrasound (QUS) may be helpful in RA. PDUS may be reliable for monitoring inflammatory activity in the joint. QUS, which is used for osteoporosis, has been used to detect bone loss in fingers, which may prove to be a good indicator of early RA.

Magnetic Resonance Imaging. Specially designed magnetic resonance imaging (MRI) equipment called extremity MRI may be able detect bone erosions in the hands of RA patients where x-rays cannot. Further evaluation is necessary.

Ruling Out Other Disorders
Symptoms of rheumatoid arthritis can be mimicked by things as benign as a bad mattress or as serious as cancer. A number of rare genetic diseases attack the joints. Physical injuries, infections, and poor circulation are among the many problems that can cause aches and pains. © A.D.A.M., Inc. (or its subsidiaries)

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FOURFOLD INCREASED RISK OF TUBERCULOSIS SEEN WITH RHEUMATOID ARTHRITIS - NEW YORK (Reuters Health) Jul 21

Before TNF-alpha blockers were widely used, rheumatoid arthritis (RA) patients were about four times more likely to develop tuberculosis (TB) than people in the general population, new findings indicate.

TNF-alpha blockers have been shown to be an effective treatment for RA. However, there have been concerns that these relatively new agents might increase the risk of TB in RA patients.

However, in order to determine the TB risk attributable to TNF-alpha blockers, note Dr. Loreto Carmona, from Hospital Clinico San Carlos in Madrid, and colleagues, it's necessary to know the risks of tuberculosis in RA patients before such drugs were widely used.

To do this, the researchers assessed the incidence of TB in a cohort of 788 patients who were treated for RA in the 1990s, a period when TNF-alpha blockers were not widely used. The incidence in this cohort was then compared with the incidence in the general population during the same period.

The researchers' findings are published in the July issue of The Journal of Rheumatology.

In the RA group, seven patients developed TB during the study period, resulting in a mean annual incidence of 134 cases per 100,000 patients. In contrast, the annual incidence in the general population was only 23 cases per 100,000.

After adjusting for age and sex, RA patients were 4.13- and 3.68-times more likely to develop any site TB and pulmonary TB, respectively, than people in the general population, the investigators note.

In future studies, "if we found that the risk of TB in RA patients undergoing biological therapies were greater than 4...when compared to the general population rates, this should be interpreted as attributable to the new treatment, and not to RA," the authors state.

"The results of this study suggest that the risk of developing TB in patients with RA is high enough to warrant consideration of screening and possible therapy to prevent TB," Dr. Michael Gardam and Karen Iverson, from the University Health Network in Toronto, note in a related editorial.

"By considering TB prevention early in the management of patients with RA, active disease can be avoided, in the majority of cases," the editorialists point out.

J Rheumatol 2003;30:1397-1399,1436-1439. Reuters Health Information 2003.

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CHEMOKINE BLOCKADE MAY OFFER TREATMENT OF RHEUMATOID ARTHRITIS - NEW YORK (Reuters Health) Aug. 5, 2003

The results of a phase Ib study published in the August issue of the Annals of Rheumatic Diseases suggest that specific chemokine receptor blockade is a safe and effective treatment for patients with active rheumatoid arthritis (RA).

"Chemokines and their receptors are considered important contributors in cell migration and inflammation in chronic inflammatory disorders," Dr. P. P. Tak and colleagues from the University of Amsterdam, the Netherlands, explain. "Chemokines affecting monocytes/macrophages are considered potential therapeutic targets, but no studies of the effects of blocking the chemokine repertoire in humans with a chronic inflammatory disease have been reported."

In a double- blind, placebo-controlled trial, the researchers examined chemokine blockade in 16 patients with RA. The patients were randomly assigned 3:1 to active:placebo treatment for 14 days. The team obtained synovial biopsy specimens on days 1 and 15. Immunohistochemistry was used to determine the presence of various cell types pre-and post-treatment. The results were measured using digital image analysis.

All patients enrolled completed the study. Compared with those who received placebo, treated patients experienced "a significant reduction in the number of macrophages (p = 0.016), intimal macrophages (p = 0.026), and CCR1+ cells (p = 0.049)," the researchers report.

Patients treated with the chemokine antagonist also had "significant decreases in overall cellularity, intimal lining layer cellularity, CD4+ T cells, and CD8+ T cells." Cells not expressing CCR1 were unaffected.

"No severe adverse events were reported," Dr. Tak and colleagues note. One subject in the treatment group and one in the placebo group developed nausea after dosing, which the investigators suspect was due to the bitterness of the oral powder mixture.

Overall, the findings show "proof-of-principle" of CCR1 blockade, which may "provide a completely new direction in the treatment of chronic inflammatory disorders," they conclude. Ann Rheum Dis 2003;62:715-721. and Reuters © 2003 Reuters Ltd.

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IS CROHN'S DISEASE BACTERIAL?

A bacterium known as MAP (Mycobacterium avium paratuberculosis) is a robust and versatile pathogen which causes chronic inflammation of the intestine in many species, including primates. Infection with MAP is widespread in domestic livestock and is present in retail pasteurized milk. MAP was elusive but can now be detected molecularly by the PCR method.

Results: MAP was detected by PCR in intestinal biopsies from 34 of 37 (92%) patients with Crohn's disease and in 9 of 34 (26%) controls.

These results implicate MAP in causing Crohn's disease. If this is correct, it means that Crohn's disease is similar to stomach and duodenal ulcers which is due to a bacterial infection.

Barbara K. Hecht, Ph.D.
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com

BRITISH STUDY LINKS CROHN'S DISEASE TO MILK-BORNE BUG Last Updated: 2003-08-06 15:12:52 -0400 (Reuters Health) By Richard Woodman - LONDON (Reuters)

British scientists said they had found a link between a common inflammatory bowel disorder and a type of bacteria that can be passed to humans in cow's milk.

Professor John Hermon-Taylor and his team at St. George's Hospital Medical School in London said they had detected Mycobacterium avium paratuberculosis (MAP) bacteria in 92 percent of patients with Crohn's disease, but in only 26 percent of patients in a control group.

"The rate of detection of MAP in individuals with Crohn's disease is highly significant and implicates this pathogen in disease causation," they write in the Journal of Clinical Microbiology.

"The problems caused by the MAP bug are a public health tragedy," said Hermon-Taylor, who has sent a copy of the paper to Britain's Chief Medical Officer Liam Donaldson.

Crohn's disease causes inflammation of the intestine and symptoms include diarrhea, pain, weight loss and tiredness. About 100,000 people in Britain alone are affected, with about 5,000 new cases reported every year.

The study was backed by the medical charity Action Research, which said previous findings showed MAP is present in two percent of retail pasteurized milk cartons. "The discovery that the MAP bug is present in the vast majority of Crohn's sufferers means it is almost certainly causing the intestinal inflammation," it said in a statement.

"Action Research does not recommend that anyone stops drinking milk. However, for those individuals with Crohn's disease or their close relatives who may feel particularly at risk, it may be sensible to start drinking UHT milk. As UHT involves higher pasteurization temperatures, it is probable that MAP is destroyed," it said.

It called for Crohn's disease to be made a reportable condition, for more stringent milk pasteurization, for tests for MAP in dairy herds, and procedures for reducing MAP infection on farms.

Hermon-Taylor said an unexpected finding of the research showed that patients suffering from irritable bowel syndrome (IBS) may also be infected with MAP.

"In animals, MAP inflames the nerves of the gut," he said. "Recent work from Sweden shows that people with IBS also have inflamed gut nerves. There is a real chance that the MAP bug may be inflaming people's gut nerves and causing IBS."

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FISH OIL PREVENTS DEADLY HEART RHYTHMS
By Jennifer Warner - WebMD Medical News Reviewed By Michael Smith, MD

There's nothing fishy about fish oil's ability to protect your heart, according to a new study. Researchers say the omega-3 fatty acids found in fatty fish such as tuna, salmon, and bluefish can prevent sudden cardiac death by blocking fatal heart rhythms.

Sudden cardiac death -- a sudden, unexpected death caused by loss of heart function -- is blamed for more than 300,000 deaths annually in the U.S. Researchers say sudden cardiac death accounts for more than 50% of heart-related deaths.

Eating fish has long been associated with a reduced risk of heart disease, but until now researchers have been unable to provide laboratory evidence to explain this heart-healthy effect.

Why Fish Oil Is Good - In a new study, published in the May 27 issue of Circulation: Journal of the American Heart Association, researchers found that omega-3 fatty acids from fish oils are stored in the cell membranes of heart cells and can prevent sudden cardiac death by blocking potentially fatal heart rhythms.

In an animal study, researchers found that adding omega-3 fatty acids to heart cells prevented deadly heart rhythms that would have been normally induced by toxins. Researchers say this protective effect might explain the lower rates of heart-related death found in previous studies on fish oil.

What's the Best Way to Get Your Fish Oil? - Fresh fish or frozen fish are the best source of omega-3 fatty acids, says researcher Alexander Leaf, MD, professor of clinical medicine emeritus at Harvard University, in a news release. Canned tuna packed in water is also a good source. But Leaf says tuna packed in oil is not a good choice because the extra oil will extract the beneficial omega-3 fatty acids from the fish.

Time to Get Serious - In an editorial that accompanies the study, David S. Siscovick, MD, MPH, of the University of Washington in Seattle, and colleagues say these findings clearly show that it's time to get serious about the American Heart Association's dietary guidelines, which recommend eating one to two fish meals, particularly fatty fish, per week.

They say eating modest amounts of omega-3 fatty acids in healthy people and low-dose fish oil supplements in people with a history of heart attack are low-cost, safe ways to reduce the risk of sudden cardiac death.

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HIGH CHOLESTEROL RAISES KIDNEY RISKS
By Jennifer Warner - WebMD Medical News Reviewed By Brunilda Nazario, MD

July 21, 2003 -- Keeping cholesterol levels under control may not only reduce the risk of heart disease, but it may also keep kidney disease at bay. A new study shows that men with high total cholesterol and those with low levels of the "good" HDL cholesterol were more than twice as likely to develop kidney problems as those with normal cholesterol levels. It's the first large-scale study to link high cholesterol levels and kidney disease in otherwise healthy men.

The results suggest that keeping cholesterol levels in check or lowering them may be one way to prevent kidney disease and kidney failure. Researchers say finding new ways to reduce the risk of kidney failure is important because few treatments are available to prevent and stop the progression of conditions that lead to kidney failure. The prevalence of kidney failure in the U.S. has doubled in the last decade.

Other known risk factors for developing kidney disease include diabetes and high blood pressure.

Cholesterol and the Kidneys - The study, which appears in the Journal of the American Society of Nephrology, followed 4,483 apparently healthy men in the Physicians' Health Study for 14 years. At the start of the study, all of the men had normal kidney function based on their levels of creatinine, a protein that's used to measure how well the kidneys are working.

Researchers found that men who had high total cholesterol levels and low levels of "good" HDL cholesterol at the start of the study were much more likely to have increased creatinine levels at the end, which indicates kidney problems and can lead to kidney failure. These men were also more likely to have decreased glomerular filtration rates (GFR), another measure of the kidney's filtering ability and function.

"Our study strongly suggests that there is a correlation between abnormal cholesterol levels and the development of kidney disease in healthy men," says researcher Tobias Kurth, MD, ScD, of Brigham and Women's Hospital, in a news release.

"Men with high cholesterol, particularly those with high non-HDL cholesterol and decreased HDL cholesterol were assessed as being twice as likely to encounter problems with their kidneys."

Another Reason to Watch Cholesterol - Researchers say the study suggests that preventing kidney disease may be another benefit of keeping cholesterol levels under control in addition to lowering the risk of heart disease.

In addition, researchers say identifying and treating new risk factors for kidney disease, such as high cholesterol, may play an important role in fighting kidney disease in the future.

"We hope this study becomes the basis for future research that will look into whether [cholesterol-lowering] statins can be used preventatively in a target population to promote good kidney health and possibly prevent them from becoming diseased," says Kurth.

SOURCES: Journal of the American Society of Nephrology, vol. 14, 2003. News release, Brigham and Women's Hospital.

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PROSTATE TEST MISSES TUMORS, STUDY FINDS
By Gene Emery - BOSTON (Reuters)

The widely used PSA blood test, designed to look for early signs of prostate cancer, misses 82 percent of tumors in men under 60, according to a study released on Wednesday.

The PSA test missed 65 percent of cancers in older males, the study, published in the New England Journal of Medicine, found.

Dr. Rinaa Punglia of Harvard Medical School and her team said the accuracy of the test has been overrated because doctors do not routinely confirm what seems to be a healthy reading on the test.

Currently, a PSA level of 4 or under is considered healthy.

The American Cancer Society says a level above 4 but less than 10 means a 25 percent chance of having prostate cancer. If the level goes above 10, the cancer risk is more than 67 percent.

Punglia's team recommended lowering the "healthy" reading to 2.6 -- even though many more men who do not have prostate cancer will have to undergo biopsies to verify they do not have cancer.

The PSA test, approved in 1986, measures levels of prostate-specific antigen, a protein produced by prostate cells and over-produced by prostate tumors. The test has been credited with detecting prostate cancer in its early stages 80 percent of the time.

But the Punglia team evaluated 6,691 volunteers at the Washington University School of Medicine in St. Louis and found that men under 60 with prostate cancer had a "healthy" PSA reading 82 percent of the time.

Only 2 percent of men get a "false positive" -- meaning they have a PSA of above 4 even though they do not have cancer.

For older men, the test missed 65 percent of the tumors and was wrong in 12 percent of the men who had a suspicious reading of 4.1 or above.

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My apologies for being late with the newsletter. We too, were part of the "Great Blackout of 2003" and just had our electricity turned back on a few hours ago. My, how we need our creature comforts - especially when it's in the 90's and 75% humidity.

On the first day of school, the Kindergarten teacher said," If anyone has to go to the bathroom, hold up two fingers." A little voice from the back of the room asked, "How will that help?"

Good Health to all,

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2003 8/15/03-14