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

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 3 ISSUE 19 - November 1, 2003
PSORIATIC ARTHRITIS MEDICAL NEWS

FDA APPROVES WEEKLY ENBREL- INJECTION CAN BE GIVEN ONCE A WEEK by Jeanie Lerche Davis WebMD Medical News Reviewed By Michael Smith, MD Oct. 22, 2003

The FDA has approved the rheumatoid arthritis drug Enbrel for once-weekly dosing.

Before now, Enbrel was only recommended as two 25-milligram injections three or four days apart. Now the 50-milligram dose can be given the same day. Amgen Inc. and Wyeth Pharmaceuticals jointly produce Enbrel.

This new approval affects people with moderate-to-severe rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The drug is also approved for once-a-week use in children between 4 to 17 years old with moderate-to-severe juvenile rheumatoid arthritis.

Enbrel is a genetically made protein that is delivered by injection and works by binding to a naturally occurring protein in the body called tumor necrosis factor (TNF), which is involved in the inflammatory process that triggers the pain and swelling of the joints associated with rheumatoid arthritis.

Basis for Approval- In studies, the once-weekly dosage was shown to be as safe and effective as the twice-weekly dosing in 420 patients with rheumatoid arthritis.

After 8 and 16 weeks of treatment, there were no significant differences in the improvement of arthritis symptoms. Patients tolerated the once-weekly dosage just as well as the twice-weekly dosing. Enbrel was first approved nearly five years ago.

SOURCE: News release, Wyeth Pharmaceuticals.

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ARTHRITIS DRUGS IN PHOTO FINISH from Medicine Net. and Reuters Ltd.

Background: It is now possible for a person to swallow a capsule containing a tiny camera. This encapsulated camera travels through the entire digestive tract and along the way, relays colored images. This technology makes it possible to check out a 20-foot length of the small intestines inaccessible to scopes. Certain drugs, especially nonsteroidal anti-inflammatory drugs (NSAIDs), taken over a long period of time can cause ulcers in this part of the small intestine.

The Inside Story: This camera-in-a-capsule was used to examine this section of the small intestine in a healthy group of volunteers. One-third of the group took the arthritis drug celecoxib (Celebrex). One-third took the arthritis medication naproxen (Naprosyn, Naprelan, Anaprox, and Aleve) together with omeprazole (Prilosec, an acid-lowering ulcer drug). And one-third received a placebo (sugar pill). The numbers of "breaks" in the bowel lining were then scored. The breaks were lowest in the placebo group, slightly increased in the group taking Celebrex and nine times higher in the naproxen/omeprazole drug group.

Comment: We are most impressed by this use of the encapsulated camera and less impressed by the study itself. For example, were the "breaks" observed in the intestinal lining serious enough to cause loss of blood and anemia? Another serious concern is that the research was sponsored by Pfizer, the manufacturer of Celebrex. This does not negate the study but we would far prefer to see research of this sort without even the slightest possibility of a conflict of interest. Barbara K. Hecht, Ph.D. Frederick Hecht, M.D. Medical Editors, MedicineNet.com

TINY CAMERA SHOWS FEWER BOWEL LESIONS WITH CELEBREX

NEW YORK (Reuters) - Pictures taken inside the small intestine by a capsule-size camera show that arthritis drug Celebrex was nine times less likely to cause ulcer-like lesions in that section of the digestive tract than a combination of two older medicines, researchers report.

The four-week study involved more than 300 healthy volunteers, a third of whom took Pfizer Inc.'s Celebrex, a third of whom took a combination of the standard arthritis drug naproxen and the active ingredient of AstraZeneca Plc's ulcer treatment Prilosec, and a third of whom took placebos.

Breaks in the lining of the small intestine were detected by the tiny M2A capsule endoscopy made by Given Imaging, an Israeli medical device firm. Once swallowed, the tiny camera passed through the entire intestine and relayed color images to doctors.

Data from the trial were presented on Tuesday at the annual meeting of the American College of Gastroenterology in Baltimore.

Patients, who regularly take non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen, are at increased risk of developing serious ulcers and bleeding. To minimize risk of such complications, some also take acid-lowering ulcer drugs like Prilosec, a. k. a. omeprazole.

Celebrex, which boasted 2002 sales of $3 billion, is designed to control pain and inflammation with lower risk of ulcers and bleeding than conventional non-steroidal drugs. Previous studies have shown that 1 to 2 percent of patients taking conventional NSAIDs develop stomach bleeding for every full year of therapy.

But the studies have been unable to clearly assess damage from NSAIDs to the small bowel, the 20-foot stretch of intestine located just below the stomach where food is absorbed.

"This study is the first time in a systematic way where we've looked at the small bowel because scopes are not long enough to easily do it," said Dr. Jay Goldstein, a professor of medicine at the University of Illinois at Chicago who headed the Pfizer-sponsored trial.

Goldstein, a paid consultant to the New York-based drug maker, said the capsule camera showed volunteers taking both naproxen and omeprazole had an average of 2.99 breaks in the lining of their small intestine. He said that compared with 0.32 breaks for those taking Celebrex and 0.11 for those taking placebo pills.

The study showed that 55 percent of those in the naproxen/omeprazole group developed breaks in their bowel lining, compared with 16 percent on Celebrex, also a statistically significant difference.

Goldstein said other studies would be needed to confirm the results and to ascertain whether drugs like Celebrex, called COX-2 inhibitors, are indeed safer for the small intestine. They include Pfizer's own follow-up pill, called Bextra, and Merck and Co. Inc.'s Vioxx.

He said future trials might also clarify whether such breaks in the lining of the small intestine cause loss of blood that contributes to anemia, another complication among a sizable number of patients who take NSAIDs over long periods.

Copyright © 2003 Reuters Limited. All rights reserved.

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BREAKTHROUGH HOPE ON RHEUMATOID ARTHRITIS
from the Yorkshire Post -October 27, 2003

Doctors have hailed a new drug treatment for rheumatoid arthritis as a turning point.

The drug, MabThera, already used to treat cancer of the blood, has been successfully used on patients with the crippling condition in trials across Europe, including 20 at Leeds General Infirmary.

Results published yesterday at the American College of Rheumatology conference in Florida showed two-thirds of patients were helped by the therapy used in combination with another treatment, while a third reported a 50 per cent improvement in their symptoms.

Doctors are particularly excited by MabThera because some patients needed only two doses for it to have an effect lasting up to a year, with no apparent side effects.

They also believe it could be successfully used in patients with related conditions such as lupus.

Nearly 400,000 people in Britain have rheumatoid arthritis, which is chronically disabling and debilitating. It can leave sufferers unable to carry out everyday activities, including walking and dressing.

A range of treatments have been developed in recent years to combat the condition, but the 161 people in the latest trial had failed to respond to existing therapies and were the most severely ill.

Further trials are needed before the drug can be licensed in Britain, but doctors, who regard the advance as a turning point in the battle against the disease, are hopeful it could be available within three years, if it wins approval for use on the NHS.

Consultant rheumatologist Prof Paul Emery, a leading researcher who is based at Leeds General Infirmary, described the results as remarkable.

He said there had been skepticism about the therapy's likely success, but its impact was dramatic, although he stressed it did not offer a cure. "This is a genuinely exciting advance," he said.

"It is quite remarkable because patients had two infusions at the beginning of the year and 78 per cent were still very well at the end of the year. Patients were feeling back to normal. The size of the response and its duration is very impressive." Prof Emery said other new treatments, known as anti-TNF therapies, had been a huge advance, but they worked differently and patients needed constant treatment, which was very expensive.

The new drug offers an entirely different approach to rheumatoid arthritis, by selectively targeting B cells, which are thought to play a key role in the inflammatory process.

B cells are white blood cells, which defend the body against viruses and bacteria by making antibodies. But in rheumatoid arthritis sufferers, rogue B cells attack healthy tissue, damaging joints and causing the condition.

Women are three times more likely than men to suffer from rheumatoid arthritis, which leaves one in 10 sufferers confined to wheelchairs and many others in constant pain.

Yorkshire Post. Source: Financial Times Information Limited and Michael Szczygiel

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TEN WAYS TO PREVENT PSORIASIS FLARE-UPS
Reviewed by Charlotte E. Grayson, MD, September 2003. WebMD Medical Reference

In addition to following your doctor's orders, there is a lot that you can do on your own to help control and prevent flare-ups of psoriasis. Use moisturizing lotions. Psoriasis symptoms get worse when your skin is dry, so keep it moist with creams and lotions. Thick and oily moisturizers are often the best, since they're good at trapping moisture beneath the skin. Moisturizers are also useful for removing scales, especially if you use occlusion -- applying moisturizer and then wrapping the area with tape or plastic wrap.

Take care of your skin and scalp. People with psoriasis should always be careful with their skin. Never pick at lesions or scales, since that can just make your psoriasis worse. Trimming your nails regularly can be a good way to prevent psoriasis from flaring up, but do it carefully, since any cut might cause symptoms to get worse. If you have psoriasis on your scalp, follow your doctor's suggestions. Make sure that any topical treatments -- such as tar shampoos -- get on your scalp and not just your hair. Also, regular bathing with soothing products, such as tar solutions, Epsom salts, and oatmeal may help reduce itching and remove scales.

Avoid dry, cold weather. Climate can have a big effect on psoriasis. For many people, cold and dry weather can make the symptoms of psoriasis worse. In general, hot weather is better for people with psoriasis, although some have worsening symptoms when the heat and humidity rise.

Use a humidifier. Keeping your skin moist is important, so use a humidifier during dry seasons of the year.

Avoid medications that cause flare-ups. Tell your doctor all the medications you take, and ask if any could affect your psoriasis. Drugs that are known to make psoriasis worse in some people include:
Lithium, used to treat psychiatric disorders
Malaria medications, including Mepacrine and Plaquenil
Inderal and possibly other beta-blockers, which are prescribed for heart conditions
Cardioquin or Quinidex, medications for heart arrythmias
Indochron or Indocin, drugs prescribed for arthritis

If you're using any of these medications, ask your doctor about substitutes.

Avoid scrapes, cuts, bumps and infections. Obviously, most people don't go around trying to hurt themselves, but it's particularly important for people with psoriasis to avoid bumps and cuts. Trauma to the skin can cause a flare-up of psoriasis, either at the site of the injury or elsewhere, a condition called "Koebner's phenomenon." Infections can also cause psoriasis to appear. Be especially careful when shaving. Avoid insect bites, chafing, acupuncture, and tattoos.

Get some sun, but not too much. Because ultraviolet rays in sunlight slow the growth of skin cells, getting moderate doses of sun is a good idea. However, make sure they're brief -- about 20 minutes or so. Use sunscreen if you're out in the sun for any longer period of time. Remember that sunburn can make your psoriasis worse, and too much sun raises your risk of skin cancer. If you're on medication that makes your skin more sensitive to ultraviolet rays as part of your phototherapy, ask your doctor about whether you should always use sunscreen when outside.

Decrease stress. Although it hasn't been proven, many people feel that their psoriasis tends to flare up during stressful times. So try to reduce your stress levels. That's easier said than done, but there are some things you can do. Practice relaxation techniques or give yoga a try.

Cut out alcohol. The connection between alcohol and psoriasis isn't completely clear, but many people are convinced that alcohol can worsen psoriasis, at least in men. Alcohol can also be dangerous if you're using certain systemic medications to treat psoriasis. Exercise, eat right, and maintain a healthy weight. Although no studies have shown a connection between diet and psoriasis, experts recommend that people with the condition should eat a well-balanced diet, high in fruits and vegetables. Exercise may also help, and will improve your mood. In some cases, excess weight can worsen psoriasis symptoms, so maintaining a healthy weight may help prevent flare-ups.

© 2003 WebMD Inc. All rights reserved.

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AUTOIMMUNITY PREDATES RHEUMATOID ARTHRITIS

Background: An autoantibody is a misdirected antibody. It is like a boomerang that comes back to strike the person who threw it. Autoantibodies are a hallmark of autoimmunity and autoimmune diseases such as rheumatoid arthritis.

Research: Antibodies against rheumatoid factor and antibodies against what is called cyclic citrullinated peptide were detected years prior to the onset of rheumatoid arthritis (RA) in the blood of about a third of patients.

Quote: These findings suggest, "that the autoimmunologic process in RA precedes the clinical onset of the disease by several years and, in particular, that citrullination and the production of antibodies to citrullinated antigens are active and early processes in the majority of patients." (The researchers)

Our Comment: The clinical signs and symptoms of rheumatoid arthritis may appear after the autoimmune process has already been underway for some time. Barbara K. Hecht, Ph.D. Frederick Hecht, M.D. Medical Editors, MedicineNet.com

AUTOANTIBODIES PREDATE RHEUMATOID ARTHRITIS ONSET By Karla Gale NEW YORK (Reuters Health)

Antibodies against cyclic citrullinated peptide (CCP) and rheumatoid factor (RF) are detectable years prior to the onset of rheumatoid arthritis (RA) in blood of about one third of patients, European investigators report in the October issue of Arthritis and Rheumatism.

Conversion of peptidyl-arginine to peptidyl-citrulline induces anti-CCP antibodies that are highly specific for RA. To examine their prevalence and potential diagnostic value, Dr. Solbritt Rantapää-Dahlqvist and colleagues measured antibodies to CCP and RF isotypes in blood samples collected prior to RA onset.

Their nested case-control study includes data from two population-based Swedish cohorts. The authors identified 83 patients with RA from whom blood samples had been collected prior to their presentation with signs or symptoms of the disease. They compared findings with those of 382 matched control subjects.

Autoantibodies against CCP and against IgA RF each were present in samples of 33.7% of patients. The corresponding prevalence in control subjects was 1.8% and 5.5%. The frequency titers of these antibodies increased significantly over time until the disease manifested (p < 0.001).

For the estimated 8% frequency of RA in patients presenting to a rheumatology clinic, the positive predictive value of anti-CCP antibodies was 62%.

"Combining the presence of anti-CCP antibodies and the presence of any of the RF isotypes in samples antedating symptom onset resulted in high specificity, with increases to 99% and 100%," Dr. Rantapää-Dahlqvist and colleagues write.

They suggest, "that the autoimmunologic process in RA precedes the clinical onset of the disease by several years and, in particular, that citrullination and the production of antibodies to citrullinated antigens are active and early processes in the majority of patients."

A test for anti-CCP antibodies is now commercially available, Dr. Eric Matteson, a rheumatologist at the Mayo Clinic in Rochester, Minnesota, said in an interview with Reuters Health.

The test is "most valuable in patients with undiagnosed inflammatory arthritis for whom tests for RF are negative but suspicion is high for RA," he said, and it is appropriate to initiate definitive therapy for RA based on a positive test result.

The test also has prognostic value, he added. "Patients with autoantibodies to CCP are more likely to have erosive disease," said Dr. Matteson, who was not involved in the study.

Copyright © 2003 Reuters Limited.

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TEN WARNING SIGNS OF PRESCRIPTION PAINKILLER DEPENDENCY

Thousands of Americans rely on prescription painkillers for the relief of pain and discomfort from ailments such as headaches, menstrual cramps, surgery recovery or lingering pain from an injury. Unfortunately, however, for many, this reliance on medication can easily and unknowingly turn into physical dependence.

The scary fact is that the most commonly prescribed drugs including OxyContin), Vicodin, Methadone, Darvocet, Lortab, Lorcet and Percocet, while offering relief from pain, can also cause individuals' bodies to start "needing" the drugs in order to feel normal, and the result is the new, even more challenging situation of chemical dependency. Here are ten warning signs to watch for if you think someone you know may be experiencing a dependency on these drugs.

1. Usage Increase - Over time, it is common for individuals taking prescription medications to grow tolerant to the effects of their prescribed dose. If someone you know seems to be increasing his/her dose over time, this is an indication that the amount they were taking is no longer providing them relief.
2. Change in Personality - Changes in a person's normal behavior can be a sign of dependency. Shifts in energy, mood, and concentration may occur as every day responsibilities become secondary to the need for the relief the prescription provided.
3. Social Withdrawal - A person experiencing a dependency problem may withdraw from family, friends and other social interaction.
4. Ongoing Use - Continued usage after a medical condition has improved will result in the person needing extensions on his/her prescription. The person might talk of how they are "still feeling pain" and need just a little longer on the medication in order to get well. He or she might also complain frequently about the doctors who refused to write the prescription for one reason or another.
5. Time Spent on Obtaining Prescriptions - A dependant person will spend large amounts of time driving great distances and visiting multiple doctors to obtain the drugs. Watch for signs that he or she seems preoccupied with a quest for medication, demonstrating that the drug has become their top priority.
6. Change in Daily Habits and Appearance - Personal hygiene may diminish as a result of a drug addiction. Sleeping and eating habits change, and a person may have a constant cough, runny nose and red, glazed eyes.
7. Neglects Responsibilities - A dependent person may call in sick to work more often, and neglect household chores and bills.
8. Increased Sensitivity - Normal sights, sounds and emotions might become overly stimulating to the person. Hallucinations, although perhaps difficult to monitor, may occur as well.
9. Blackouts and Forgetfulness - Another clear indication of dependence is when the person regularly forgets events that have taken place and appears to be suffering blackouts.
10. Defensiveness - When attempting to hide a drug dependency, abusers can become very defensive if they feel their secret is being discovered. They might even react to simple requests or questions by lashing out.

This information has been provided with the kind permission of Clifford Bernstein M.D., of The Waismann Institute.

© 1996-2003 MedicineNet, Inc.

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PAINKILLERS SPARE THE MIND
edited by Ome Ogbru, Pharm. D., an active and practicing pharmacist. Medical Editors, MedicineNet.com

Background: Opioid analgesics are the most effective class of drugs available for the management of pain. Morphine is the gold standard for opioid analgesics.

The Gist: Opioids that are taken for severe chronic pain do not impair memory, learning and psychomotor skills, once a person has become used to taking them. In fact, mental function may improve, perhaps because of reduced pain.

Our Comment: It is hard to think clearly, when you are in severe constant pain. The US and many other countries need to become better at managing pain.

OPIOIDS DON'T USUALLY IMPAIR MENTAL FUNCTION (Reuters Health) October 28, 2003

NEW YORK (Reuters Health) - In most cases, opioid painkillers taken for sever chronic pain do not impair memory, learning and psychomotor skills, once a patient has becomes used to taking them, researchers report.

In fact, mental function often improves, they found, apparently because of reduced pain.

For people just starting on opioid medication, their psychomotor performance may be affected over the short term, note Dr. Robert N. Jamison and others in the Journal of Pain and Symptom Management. As a result, patients may be advised to limit activities while taking opioids, and some organizations require that drivers not use opioids while operating commercial vehicles.

But because pain can adversely affect memory and concentration, Jamison, at Harvard Medical School in Boston, and his group theorized that pain relief could improve mental function, especially once the patient develops tolerance to the side effects of the medication.

The researchers followed 144 patients after they had begun treatment with opioids for chronic low back pain not relieved by other types of treatment.

The subjects were randomized to begin treatment with oxycodone plus acetaminophen or with a fentanyl patch. After 90 days, the patients switched to the other type of treatment.

The team observed no difference between the drugs in their effect on neuropsychological performance.

On one test, known as the Digit Symbol Substitution Test, scores averaged 59.0 at the start of the study. This improved significantly to 64.4 after 90 days and to 65.1 after 180 days. Scores on another standard Trail Making Test also improved.

During the trial, between 16 and 25 percent of patients scored worse after stable opioid doses were established, while the remainder improved or stayed the same. The higher the pain intensity scores at the beginning, the more the improvement in mental tests.

Based on these results, Jamison's team infers that "improvement in performance in this population is attributed to the ameliorating effects of opioids on pain rather than properties of the opioids per se."

But because some patients are adversely affected, they write, "it remains prudent to monitor patients on opioids for deterioration in cognitive function, and caution should be used in generalizing these results to the operation of heavy equipment or driving a motor vehicle." Copyright © 2003 Reuters Limited.

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SOCIAL PAIN IS REAL PAIN
Barbara K. Hecht, Ph.D. Frederick Hecht, M.D. Medical Editors, MedicineNet.com

It is easy to understand why one might feel pain after a physical injury. But new research demonstrates that social pain felt after an emotional "injury" -- such as rejection or a snub -- is just as real.

In a small study of 13 volunteers, persons were placed in a magnetic resonance imaging (MRI) machine so that their brain functions could be monitored. These volunteers were then asked to play a computer game. As the game progressed, the other players (actually the computer itself) excluded the volunteer from the action. This caused the volunteer to feel considerable social distress, which corresponded to increased activity in a part of the brain called the anterior cingulate cortex that responds to pain.

Comment: One of the researchers in this study commented, "It makes sense for humans to be programmed in this way. Social interaction is important to survival." In other words, it makes sense that people would evolve a strong emotional and physical response to being excluded socially. And why it might hurt to have a broken heart! (With apologies to country western lyrics).

IMAGES SHOW A SNUB REALLY IS LIKE KICK IN THE GUT By Maggie Fox 10-09-03 (Reuters Health)

WASHINGTON (Reuters) - The feeling is familiar to anyone who has been passed over in picking teams or snubbed at a party - a sickening, almost painful feeling in the stomach.

Well, it turns out that "kicked in the gut" feeling is real, U.S. scientists said on Thursday.

Brain imaging studies show that a social snub affects the brain precisely the way visceral pain does.

"When someone hurts your feelings, it really hurts you," said Matt Lieberman, a social psychologist at the University of California, Los Angeles, who worked on the study.

"I wouldn't want to be quoted as saying that physical pain and social pain are the same thing, but it seems that some of the same things are going on."

The study may also show why it hurts to lose someone you love, researchers said.

Lieberman, graduate student Naomi Eisenberger and colleagues set up a brain-imaging test of 13 volunteers to find out how social distress affects the brain.

They used functional magnetic imaging - a type of scan that allows the brain's activity to be viewed "live." The 13 volunteers were given a task that they did not know related to an experiment in social snubbing.

Writing in the journal Science, Lieberman and Eisenberger said the brains of the volunteers lit up when they were rejected in virtually the same way as a person experiencing physical pain.

"It would be odd if social pain looked like the exact same thing as someone-breaking-your-arm pain," Lieberman said in a telephone interview. "What it does look like is visceral pain."

In other words - like being punched in the stomach.

The area affected is the anterior cingulate cortex, a part of the brain known to be involved in the emotional response to pain.

In the experiment, the volunteers were asked to play a computer game. They believed they were playing two other people, but in fact played a set computer program.

"It looked like a ball being thrown around between the three people," Lieberman said.

Eventually, the game excludes the player. "For the next 45 throws they don't get thrown the ball," Lieberman said.

"It is just heartbreaking to watch. They keep indicating that they are ready to be thrown to. This really affects the person afterwards. They report feeling social distress."

The functional magnetic imaging verifies the physical basis of this feeling.

It makes sense for humans to be programmed in this way, Lieberman said. Social interaction is important to survival.

"For any mammal, all the needs that people typically think of as necessary for survival - food, shelter, avoiding physical harm - your caregiver gives you access to those needs," Lieberman said.

So it would make sense that people would evolve to have a strong emotional response to being included, socially.

But there also seems to be a defense mechanism to prevent the pain of rejection from becoming overwhelming.

"We also saw this area in the prefrontal cortex. The more it is active in response to pain, the less subjective pain you feel," Lieberman said. "This part of the brain inhibits the more basic response."

In the volunteers, those who had the most activity here reported the least distress in response to the snub.

It seemed to be involved in consciously thinking about the pain, Lieberman said, but said the area needed more study.

Copyright © 2003 Reuters Limited.

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WARDING OFF ULCERS DUE TO PAINKILLERS
By Charlene Laino WebMD Medical News

Oct. 15, 2003 (Baltimore) -- People who take painkillers regularly to ease arthritis and other painful conditions face the risk of a dangerous bleeding ulcer. But a heartburn pill a day may keep ulcers at bay.

So suggests a new study showing that the prescription heartburn drug Nexium helped prevent ulcers among 573 long-term users of painkillers.

Nexium, a prescription medication, belongs to a class of drugs known as proton-pump inhibitors, which block the production of stomach acid. Other such drugs include Prevacid and Prilosec, which recently went over the counter.

AstraZeneca, which markets Nexium, helped fund the study, which was presented here Tuesday at the 68th Annual Scientific Meeting of the American College of Gastroenterology.

Regular use of anti-inflammatory painkillers such as ibuprofen, naproxen, and Celebrex increases the risk of ulcers up to fivefold, says James Scheiman, MD, professor of internal medicine at the University of Michigan Health System in Ann Arbor.

These common painkillers suppress inflammation by blocking inflammatory substances called prostaglandins. However, these substances also help protect the stomach and intestinal lining from the damaging effects of acid. Thus, without these protective substances, the stomach and intestines become more susceptible to ulcers, Scheiman says.

Don't Trade One Pain for Another: - "The results are very encouraging," Scheiman says. "There doesn't have to be a tradeoff between one type of pain and another."

The researchers studied 573 ulcer-free patients who had taken painkillers at least five days a week for four weeks. The painkillers included older anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen as well as newer ones including Celebrex and Vioxx. Each participant was randomly assigned to receive Nexium or placebo daily for six months.

Patients in the study were at particularly high risk of ulcer, Scheiman says. About two-thirds were 60 years or older, one-fourth had previously had an ulcer, and 10% fell into both categories. © 2003 WebMD Inc.

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The good news of the day is our founder; Michelle Stack is out of the hospital and finally home with her family. We wish her a speedy recovery and we are glad to have her back among the group.

Good Health to all,

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2003 11/01/03-19