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

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOLUME- 4 ISSUE- 03 February 15, 2004
PSORIATIC ARTHRITIS MEDICAL NEWS

HEALTH CARE SPENDING REACHES $1.7 TRILLION
More than $5,800 spent for every American in 2003 - The Associated Press

Health care spending in the United States grew to an estimated $1.7 trillion in 2003 — more than $5,800 for every American — but the pace of growth was slower than in recent years.

Health care also for the first time was projected to make up more than 15 percent of the national economy last year, the federal Centers for Medicare and Medicaid Services said Wednesday.

Government spending on Medicaid and Medicare increased last year, but more slowly than in 2002, helping contain the estimated overall increase in spending, CMS said.

The CMS report, released on the Web site of the journal Health Affairs, said that health care spending grew a projected 7.8 percent in 2003, down from 9.3 percent in 2002.

Health care spending, however, is projected to outpace growth in the rest of the economy for the next 10 years, CMS said. By 2013, annual spending on health is expected to reach $3.4 trillion and be more than 18 percent of gross domestic product.

The projections did not include the anticipated effects of the new Medicare prescription drug law, which will offer seniors prescription drug coverage beginning in 2006. CMS officials said they expect a shift in who pays prescription drug bills rather than a significant increase in spending on drugs.

“Our story, with or without the legislation, doesn’t change much,” said Stephen Heffler, CMS’ deputy chief actuary and lead author of the report.

Prescription drug spending, however, will continue to outpace the rest of health care for the next 10 years, Heffler said at a conference about the report.

Dan Crippen, the former director of the Congressional Budget Office, said that huge changes in health care spending lie just beyond 2013, the end of the period covered in the report, when Baby Boomers start reaching retirement age.

“It will be the beginning of something we haven’t seen before,” Crippen said. © 2004 The Associated Press.

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ARTHRITIS INJECTIONS MAY OFFER LITTLE RELIEF
Study: Treatment showed lack-luster results The Associated Press - CHICAGO

Government-approved treatments for knee arthritis, in which the joint is injected with fluid often made from rooster combs, offer little if any relief, researchers say.

Doctors should think twice about recommending hyaluronic acid treatments, which cost at least $100 per injection, said Dr. Grace Lo of Boston University, who led the analysis of 22 published studies.

The analysis found that the injections performed only slightly better than dummy treatments.

Lo said even those results may be overstated, since studies with positive results are more likely to be published than those with negative ones, and the researchers found at least two unpublished studies showing that hyaluronic acid performed no better than dummy treatments. The analysis appears in Wednesday’s Journal of the American Medical Association.

Dr. Jack Klippel, president of the Arthritis Foundation, said that even if the treatments have only a slight effect on pain, that is beneficial since arthritis pain is so common and sometimes difficult to treat.

The foundation and the American College of Rheumatology have supported the use of such products for certain patients, and Klippel said the study does not change his opinion.

The treatment, sometimes-called joint fluid therapy, generally involves three to five weekly injections in a doctor’s office. The injections are intended to replace the natural fluid that helps lubricate the knee joint.

The analysis included studies of three products approved for knee arthritis by the Food and Drug Administration: Hyalgan, Synvisc and Supartz. They are generally recommended for patients who have not responded well to aspirin or ibuprofen.

About 500,000 U.S. patients use such products annually, said Dr. Richard Polisson, senior vice president of clinical research at Genzyme Corp., which makes Synvisc.

Polisson said the researchers excluded some studies that showed Synvisc has significant benefits. In addition, Michael Daley, U.S. medical director of Sanofi-Synthelabo Inc., which makes Hyalgan, complained the analysis included hyaluronic acid products not approved for use in this country. © 2003 The Associated Press. All rights reserved.

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ASPIRIN THERAPY: HOW MUCH IS TOO MUCH?
Baby Aspirin Looks to Be the Best Choice for Prevention
By Salynn Boyles WebMD Medical News

Millions of Americans take an aspirin every day to protect their hearts, but there is still widespread confusion about what is the best dose. Does baby aspirin protect as well as an adult-strength tablet? Moreover, is it riskier to take an adult-strength aspirin every day?

A new international study offers some of the best evidence yet that when the risks and benefits of aspirin therapy are weighed, a daily baby aspirin is your best bet.

Researchers compared three different daily aspirin therapy doses and found a similar frequency of heart attacks and strokes among patients taking each of them. However, those taking the highest doses -- equivalent to roughly an adult-strength tablet every day -- were at much greater risk for developing bleeding complications. The findings are in the Oct. 7 issue of the American Heart Association (AHA) journal Circulation.

Bigger Isn't Better
"These findings are completely consistent with every other report that has examined aspirin dosage," cardiologist and researcher Ron J.G. Peters, MD, tells WebMD. "There is no indication whatsoever that increasing the dosage improves the outcome of aspirin therapy. But there is a very clear relationship between higher doses and an increased risk for bleeding."

AHA spokesperson Sidney C. Smith, MD, agrees that the studies to date suggest that low-dose aspirin therapy is just as effective as higher-dose treatment and probably safer. Nevertheless, he adds that there remains a need for a large-scale, definitive study to answer the question once and for all and to address the role of aspirin therapy in the 15% to 20% of patients who appear to be resistant to its beneficial heart effects.

The newly reported study was actually designed to assess the value of adding the anti-blood clotting drug Plavix to different doses of aspirin therapy in patients with unstable angina. Slightly more than 12,500 patients were randomly selected to receive the drug and aspirin doses ranging from 75 mg to 325 mg daily. The typical baby aspirin is 81 mg, and an adult tablet is 325 mg.

In an earlier report, the combination treatment was found to be superior to aspirin alone, regardless of the aspirin dose given.

In this new study, higher doses of aspirin were no more effective than low-dose aspirin therapy at preventing heart attacks and strokes. But the risk of major and potentially life-threatening bleeding events was much greater among patients on the highest aspirin doses.

Just under 2% of the patients given low-dose aspirin alone experienced life-threatening bleeding events, compared with close to 4% of patients taking more than 200 mg of aspirin a day. Among patients taking aspirin and Plavix, 3% of patients in the low-dose aspirin groups experienced serious bleeding vs. 5% of those in the high-dose aspirin group.

New Aspirin Therapy Guidelines
The researchers conclude that the optimal daily dose of aspirin therapy is between 75 mg and 100 mg a day. Smith says the AHA recommends 75 mg to 325 mg daily for people with a history of heart attack, unstable angina, or blood clot-related strokes.

Those guidelines are being revised, though, and new recommendations are expected early next year. Although Smith did not wish to speculate on whether the recommended dose would be lowered, he did say that he now recommends a daily baby aspirin to his patients.

"This is not a black-and-white issue, but for the majority of patients the accumulating body of evidence suggests that a baby aspirin is all that is needed," he says. "But it would be nice to have large studies that focus specifically on which dose of aspirin is best."

SOURCES: Circulation, Oct. 7, 2003. Ron J.G. Peters, MD, cardiologist, Academic Medical Center, Amsterdam, Netherlands. Sidney C. Smith, MD, chief science officer and national spokesman, AHA; professor of medicine, University of North Carolina, Chapel Hill. © 2003 WebMD Inc. All rights reserved.

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BLOOD PRESSURE MEDS: PRICEY ISN’T BETTER
Older Drugs Equally Effective for Initial High Blood Pressure Treatment
By Jeanie Lerche Davis WebMD Medical News

Doctors favor the pricey high blood pressure drugs -- despite evidence that less-expensive drugs are equally effective.

Beta-blockers and diuretics are inexpensive, effective, and well-tolerated drugs for high blood pressure. In fact, they are recommended as first-line treatment by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, writes researcher Peter A. Ubel, MD, with the VA Ann Arbor Healthcare System.

His study appears in the current issue of the Journal of General Internal Medicine.

Numerous studies show that these older drugs are just as effective as newer, more expensive ones such as ACE inhibitors and calcium channel blockers, he explains.

"Yet the use of beta-blockers and diuretics has declined steadily in the past 15 years in favor of these newer and more expensive medicines," writes Ubel.

What's Going On?
Doctors may be less inclined to prescribe older drugs because they believe -- contrary to published reports -- that the older medications are either less effective or less tolerated than newer, more expensive medications for high blood pressure, Ubel says.

Also, doctors may be prescribing the newer drugs because drug company heavily promote these newer drugs and this may influence how people perceive these new medications -- and because they provide free drug samples, he explains.

Ubel surveyed 647 primary care doctors in 1997 and 2000. Each doctor was given a hypothetical case of a patient who's medical history included only hypertension, then asked what drug he or she would initially prescribe for high blood pressure.

Doctors were asked about factors that affected their drug choices, such as side effects, stroke or heart attack prevention, or availability of free samples. Also, Ubel asked if they ever provided patients with free sample medications.

He found that their prescription practices did not change much over the three-year period, nor did the advice they gave their patients.

Overall, doctors favored newer, more expensive drugs, such as ACE inhibitors and calcium channel blockers, over the older drugs, reports Ubel:

Most effective drug: Physicians perceived diuretics as being less effective at lowering blood pressure than other drug choices. The majority of doctors surveyed choose newer more expensive drugs, such as beta-blockers or ACE inhibitors, as being more effective. Drug with most side effects: Here more physicians chose older medications as being less tolerable than newer ones. In fact, according to the authors, ACE inhibitors tend to have more side effects than diuretics or beta-blockers. Drug most preferred as initial therapy: Most physicians surveyed chose newer more expensive drugs over older less expensive ones.

Most doctors "believed that diuretics were less effective and beta-blockers were less tolerated than other medications," writes Ubel. Moreover, the drugs they prescribed were directly related to free samples from pharmaceutical companies, he explains. Overall, 86% of doctors said they offered samples to their patients.

Those who recommended beta-blockers or diuretics were significantly less likely to offer free samples -- probably because samples of these less-expensive drugs are not available, Ubel says.

With so many high blood pressure drugs available, small differences may be all it takes for doctors to favor one drug over another, he concludes. SOURCE: Ubel, P. Journal of General Internal Medicine, December 2003: vol. 18.

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COD LIVER OIL SLOWS ARTHRITIS-COD CONTAINS HEALTHY OILS
Contributed by UK member: Michael Szczygiel

Scientists have found further evidence that taking cod liver oil could slow down damage caused by arthritis. A small study of tissue taken from knee replacement patients found lower levels of chemicals linked to the disease in those who took pills before surgery.

Although the impact on pain levels was not tested, experts at Cardiff University say it is possible the oil could delay the onset of the disease.

It contains "omega-3" oils, which are linked to other health benefits. The UK currently spends £5.5 billion annually dealing with the effects of arthritis on the NHS and social services. The Cardiff researchers are seeking ways to lessen the impact of this devastating illness. One, they suggest, might be to return to the age-old remedy taken - with great reluctance - by a whole generation of growing children.

TELL-TALE MARKERS
Professor Bruce Caterson, who led the study, wanted to see if cod liver oil affected the disease in live patients. Rather than recruiting large numbers of patients to take cod liver oil and report back later whether they felt better or worse, he sought chemical "markers" within joint tissue that might reveal how active their arthritis was.

Arthritis is an inflammatory disease, in which cartilage - the tough material within joints that protects the bone surface - is slowly degraded, causing increasing damage.

When it reaches a certain point, knee and hip joints may have to be replaced to reduce the pain levels and disability. The disease is complex and not fully understood, but scientists have linked higher levels of certain body chemicals within knee tissues to this inflammatory process.

Professor Caterson's team measured levels of these chemicals in knee tissue taken during knee replacement operations from 25 patients. Of these, 14 were given cod liver oil in the months approaching the operation, while the remainder got a dummy "placebo" pill.

The researchers found 86% of the cod liver oil group had significantly reduced levels of these potentially harmful chemicals - compared with a quarter of the placebo group. Chemicals linked to joint pain itself were also reduced in the cod liver oil group.

'Not a cure'
The patients were not asked if symptoms had improved while taking cod liver oil - and there is no evidence yet "benefits" would be sustained if the patient carried on taking it beyond a few months.

Professor Caterson stressed this was neither a "cure", nor likely to reverse joint damage already sustained. He said: "The breakthrough is hugely significant because it demonstrates the efficacy of a dietary intake of cod liver oil in patients with osteoarthritis taken prior to joint replacement surgery.

"It suggests cod liver oil has a dual mode of action, potentially slowing down the cartilage degeneration inherent in osteoarthritis and reducing factors that cause pain and inflammation."

He now hopes to organize a larger study to test whether cod liver oil has a noticeable effect on pain levels and disease progression.

Fergus Logan, chief executive of the Arthritis Research Campaign - which funded the study - said: "These findings provide further proof taking cod liver oil or eating lots of oily fish slows down cartilage destruction in osteoarthritis".

He said this was "great news for those people who have the condition or worry about developing it, and who want to do something positive to help themselves".

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FDA OKS BLOOD PRESSURE, CHOLESTEROL DRUG - NEW YORK (AP)
Pfizer Inc. received approval from the U.S. Food and Drug Administration to market its dual therapy medicine Caduet for the simultaneous treatment of high blood pressure and high cholesterol.

In a statement Monday, the pharmaceutical company said Caduet is the first medicine to treat two different conditions in one pill.

The pill mixes Pfizer's flagship cholesterol drug Lipitor, a $9.23 billion seller last year, with blood-pressure medicine Norvasc, Pfizer's next biggest drug with $4.34 billion in revenue.

Currently, more than 3,700 patients with high blood pressure and high cholesterol are enrolled in the Caduet clinical trial program. Recent results of clinical studies have shown that many patients taking Caduet successfully reached both their recommended blood pressure and cholesterol goal levels.

Caduet will be available in multiple dosing combinations to provide physicians with the greatest flexibility to get patients to their goal levels. Copyright 2004 the Associated Press. All rights reserved.

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FDA: GENERICS COST LESS THAN CANADIAN MED - WASHINGTON (AP)

Americans who buy drugs in Canada in hopes of saving money could pay significantly more for certain medicines than if they had purchased generic versions at home, according to new research by the Food and Drug Administration.

Canadian price controls mean that brand-name drugs there can cost as little as half the U.S. price. Those potential savings are enticing increasingly more people to import drugs from Canada even though the practice is illegal and the FDA calls it unsafe.

Generic versions cost much less than their brand-name counterparts, however, and the U.S. generics market is considered the world's most competitive. So FDA Commissioner Mark McClellan argues that for many people, buying more homegrown generics is a risk-free alternative to imports that could lower their drug costs.

"There are a lot of opportunities to save money while still making sure patients get the drugs they need," he said in an interview this month with The Associated Press.

To back that contention, the FDA analyzed price data collected by the medical research company IMS Health. Included were seven drugs whose generic versions are top-selling treatments for chronic disease: the anti-depressant Prozac; blood pressure medicines Lopressor, Prinivil and Vasotec; Xanax for anxiety; Klonopin for seizures; and Glucophage for diabetes.

Comparing both brand-name and generic versions in Canada, the U.S. generics proved significantly cheaper for all but the diabetes drug, the study concluded.

The study measured average price per milligram, not what the patient pays per bottle, which can vary in dose and pill number.

Among the findings:
--Xanax had the highest disparity. The Canadian brand was roughly nine times the price, per milligram, of the U.S. generic. Next was Vasotec, five times the price of the U.S. generic.

--Canada's generics ranged from fluoxetine, or generic Prozac, at 1.3 times the U.S. price to alprazolam, or generic Xanax, at four times the U.S. price. One generic, the version of Vasotec called enalapril, is not sold in Canada.

--Glucophage was the exception. The U.S. generic actually cost 39 percent more per milligram than Canada's brand-name version.

The study used the price that pharmacies paid for each drug in 2002, the latest full year that prices from both countries were available from IMS Health.

"I think consumers think everything's cheaper in Canada. It's just not the case," the FDA's pharmacy affairs chief, Tom McGinnis, said in a recent interview.

He described a recent visit to a U.S. Customs facility in New York where inspectors were examining 10,000 packages of imported pharmaceuticals. McGinnis said he spotted a bottle of generic water pills for high blood pressure that cost a few cents a tablet in U.S. pharmacies.

Adding the shipping cost, whoever ordered that bottle from Canada spent about a third more than he would have at a local drugstore, McGinnis said.

Using generics is not an alternative for everyone because new drugs sell for several years before generic competition is allowed. Generics account for about half of U.S. prescriptions.

The FDA cannot say how big a role generics might play as an alternative to Canadian imports, either for individuals or for the two cities-- Springfield, Mass., and Montgomery, Ala. -- currently buying Canadian drugs for their employees. States from New Hampshire to Wisconsin are considering similar programs. Copyright 2004 the Associated Press. All rights reserved.

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INFLAMMATION FACTOR IN COLON CANCER
Heart Disease Marker Now Tied to Colon Cance - By Adam Marcus - HealthDay Reporter (HealthDayNews)

A blood chemical that predicts heart attacks and strokes also seems to foretell who is likely to develop colon cancer, new research shows.

Irritation in the intestines, such as that associated with inflammatory bowel disease (IBD), has long been known to increase a person's risk of colon and rectal cancer. The new study "puts forward the idea that low-grade inflammation could be a risk factor for colon cancer" in people without severely aggravated intestines, says study leader Dr. Thomas Erlinger, an internist and epidemiologist at Johns Hopkins Medical Institutions.

The substance, C-reactive protein (CRP), is a marker of general inflammation throughout the body. People who developed colon cancer during the study had a higher CRP count at the start than those who were free of the disease.

The study didn't find a direct connection between CRP and rectal tumors, though the number of rectal cancer cases was small. A report on the findings appears in the Feb 4 issue of the Journal of the American Medical Association.

CRP was discovered in 1930 in the blood of patients with serious pneumonia. More recently, scientists have learned that people with more of the protein in their blood are at greater risk of heart attacks, strokes and several other major illnesses.

In the latest work, Erlinger and his colleagues compared CRP levels and colorectal cancer risk in nearly 23,000 residents of Washington County, Md., participating in a long-term study of heart disease and cancer. A blood test for the protein was included in a battery of exams at the start of the project, which ran between 1989 and 2000.

By the end of the study, 131 men and women were diagnosed with colon cancer, and 41 got rectal cancer. The risk of colon cancer for people in the top quarter of initial CRP levels was about 2.5 times higher than for those in the bottom quartile.

Smokers and people with bowel diseases such as Crohn's and colitis are known to have increased odds of developing colon cancer. But even after accounting for these risk factors, the link between elevated CRP and colon tumors persisted, Erlinger says.

If colon cancer is related to inflammation, aspirin and other anti-inflammatory drugs could in theory prevent the disease. And indeed, the researchers did see some hints that people who took these medications were less likely to develop colon tumors. "They did have a lower risk but we really didn't have good data there," Erlinger says. More studies are needed to address the question, he adds.

Dr. Boris Pasche, director of the cancer genetics program at Northwestern University, calls the results "an interesting first study" that should encourage further research into the health effects of simmering inflammation.

"Maybe the same people with a higher risk of cardiovascular disease also have a higher risk of colorectal cancer," says Pasche, co-author of an editorial accompanying the journal article.

But it's not yet clear that elevated CRP predicts colon cancer or simply reflects tumors that are already present but too small to generate symptoms.

Erlinger's group tried to account for this possibility, but since they had only one reading of the protein they weren't able to fully exclude it in their analysis. "If you argue that there is a relationship [between CRP and cancer] you would expect that the CRP value may increase over time prior to the diagnosis of colon cancer," Pasche says.

SOURCES: Thomas Erlinger, M.D., M.P.H., assistant professor, medicine, Johns Hopkins Medical Institutions, Baltimore; Boris Pasche, M.D., Ph.D., director, cancer genetics program, Feinberg School of Medicine, Northwestern University, Chicago; Feb. 4, 2004, Journal of the American Medical Association Copyright © 2004 ScoutNews, LLC. © 1996-2004 MedicineNet, Inc.

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COLON CANCER: A FAMILY AFFAIR
Colorectal cancer is one of the most common cancers. If caught early, it can be cured. If not caught early, it kills. Although screening for colon cancer is recommended for everyone, there are individuals at particularly high risk to develop colon cancer for whom screening should be more intensive. These high-risk individuals are those who have a familial, genetic cause of colon cancer due to a mutation in their genes. Of all the people who develop colon cancer, however, less than 10% have a clear and demonstrable genetic mutation that can be used to identify other family members who are at high risk so that more intensive screening can be done. For 90% of colon cancers, we have no genetic markers to use. The search for additional genetic markers must go on. Jay W. Marks, M.D - Medical and Pharmacy Editor - MedicineNet.com

(HealthDayNews) -- It's a medical detective story that starts with the emigration of a married couple from Germany to Pennsylvania in the early 1700s and ends with implications for today's programs to screen for the risk of colorectal cancer.

The couple had 11 children, a typically large family for that era. Those children married and had families of their own, until their descendants numbered in the thousands, a new study reports.

And over the decades and centuries, an unexpectedly large number of those descendants were diagnosed with cancer. Most were cancers of the colon and rectum, but there also were other tumors such as endometrial cancer and ovarian cancer among the women.

It wasn't until recently that researchers, armed with the tools of modern genetics, were able to establish the link. The original German immigrants brought with them a mutation of a gene designated MSH2, a mutation that predisposes people to develop some cancers, particularly colorectal cancer.

The mutation appears to have originated with one of the married pair. Each of their children had a 50-50 chance of inheriting what is called the "founder mutation," and each person with that mutation had a 50 percent chance of passing it on to a child.

The existence of the mutation was first noticed in 1997 by Riccardo Frodde, a geneticist then at Leiden University in the Netherlands, who found evidence of it in more than 50 families there.

The story then moved to the United States, where a group of researchers headed by Dr. Henry T. Lynch, a professor of preventive medicine at the Creighton University School of Medicine in Nebraska, found the same mutation in members of seven apparently unrelated families with a history of colorectal cancer.

That discovery indicated the families might, in fact, be related, says Stephanie M. Coronel, a genetic research assistant in Lynch's laboratory.

"That is how we started doing genealogical work, looking at different sites on the Web," Coronel says.

Those studies pointed toward a common origin of the mutation, and they drew in another researcher, Dr. Albert de la Chapelle, a professor of cancer genetics at Ohio State University. He had found the same mutation in two other families.

"It was pure coincidence that Dr. Lynch and I, who knew each other, identified the same mutation in some of his patients and some of my patients," de la Chapelle says. "It was not very difficult to start putting two and two together."

The result, reported in the Feb. 11 issue of the Journal of the American Medical Association, was detection of the founder mutation in 61 members of the nine families in admittedly partial testing; only 137 of 566 members of the families have been tested. "We have shown by now that four of the nine families descended from the founder couple, and we are almost 100 percent certain that all do," de la Chapelle says.

This is a big surprise, he says, because founder mutations traditionally have been seen only in relatively small, isolated populations, such as Icelanders and Ashkenazi Jews.

"You do not expect to see it in a mixed population, such as we have in the United States," de la Chapelle says.

The implications of the discovery may extend to many Americans outside the tested families, Coronel says, since it is estimated that 10 percent of all colorectal cancers are hereditary. The presence of colorectal cancer in a family can indicate a need for genetic testing, she says.

"If you have a family history of colorectal cancer, or a parent or sibling diagnosed at an early age, you can call your local genetic counselor," Coronel says. "If a mutation is found, it can be referred to us."

The fact that the mutation appears to be widespread could help make genetic screening more efficient, de la Chapelle says. Researchers could start by running a test for the suspect gene, skipping more costly testing for a variety of genes.

Testing for all cancer-causing mutations costs about $2,500, he says, so it would be less expensive to start by looking for just one mutation. "If this is as common as we think, all testing should look at this first," de la Chapelle says.

SOURCES: Stephanie M. Coronel, MPH, genetic research assistant, Creighton University School of Medicine, Omaha, Neb.; Albert de la Chapelle, M.D., PhD, professor, cancer genetics, Ohio State University, Columbus; Feb. 11, 2004, Journal of the American Medical Association Copyright © 2004 ScoutNews, LLC.

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VASCULAR ENDOTHELIAL GROWTH FACTOR - PORTLAND, OR. News Release from NPF, provided by our UK member, Michael Szczygiel.

The National Psoriasis Foundation today hailed research that may eventually lead to additional therapies for treating psoriasis, an incurable immune-mediated disease that affects 5 million Americans. In a paper published January 3 in the Journal of Investigative Dermatology, Dr. Helen S. Young and colleagues at the University of Manchester, in Manchester, UK, provide the first evidence that there are alterations in a gene involving the development of the vascular system that may contribute to psoriasis susceptibility.

"This work offers a new way of thinking about psoriasis, and may open up new approaches to treating the disease," said Gail Zimmerman, president and CEO of the National Psoriasis Foundation. "While therapies focused on the immune system are proving highly beneficial for many psoriasis patients, therapies that target the vascular system might also one day provide relief to those facing this challenging, and often debilitating, disease."

It has been previously observed that aspects of the vascular system, or blood vessel network in the skin, are altered in psoriasis. An essential regulator of vascular development produced by skin cells, called VEGF or Vascular Endothelial Growth Factor, is found in high levels in psoriatic skin lesions. In this study, the authors show that certain SNPs, or single nucleotide polymorphisms, of the VEGF gene itself occur with greater frequency in a subset of people with psoriasis.

In a commentary appearing alongside the Young et al paper, Michael Detmar, M.D., of the Cutaneous Biology Research Center at Massachusetts General Hospital in Boston writes: "Together with the biological evidence for a pathogenetic role of VEGF in psoriasis, the study by Young et al suggests that VEGF acts as a modifier gene in psoriasis and that therapeutic blockade of the VEGF/VEGF receptor system might represent a novel, pharmacogenomic approach for the future treatment of psoriasis."

Psoriasis patients can hope that drugs that block the activity of VEGF -- "a nti-VEGF" therapies -- may one day be used to treat psoriasis, much the same way that anti-VEGF therapies are currently being tested in clinical trials as a cancer treatment.

"This important paper by Young and colleagues provides additional insight into the multiple genetic polymorphisms that likely determine the occurrence and severity of psoriasis," said David A. Norris, M.D., chairman of the University of Colorado School of Medicine in Denver and chairman of the Psoriasis Foundation's Scientific Review Committee. "The finding of polymorphisms in the VEGF gene relating to susceptibility to psoriasis reinforces the concept that angiogenesis is an important component of the psoriasis phenotype, and indicates that multiple genes (including those controlling the immune response, keratinocyte proliferation and differentiation, and angiogenesis) might determine susceptibility to psoriasis."

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Good health to all,

Jack Nicholas
Newsletter Editor
Cornishpro @aol.com

Issue 2004 02/15/04-03