PSORIATIC ARTHRITIS MEDICAL NEWS

ARE YOU AT RISK FOR GLAUCOMA ?

January 2002 is National Glaucoma Awareness Month and the National Eye
Institute is encouraging everyone to have their eyes examined.

Glaucoma is an eye disease in which the normal fluid pressure inside the eyes
slowly rises, leading to vision loss--or even blindness. This brochure is
about open-angle glaucoma, the most common form of the disease.

At the front of the eye, there is a small space called the anterior chamber.
Clear fluid flows in and out of the chamber to bathe and nourish nearby
tissues. In glaucoma, for still unknown reasons, the fluid drains too slowly
out of the eye. As the fluid builds up, the pressure inside the eye rises.
Unless this pressure is controlled, it may cause damage to the optic nerve
and other parts of the eye and loss of vision.

Nearly 3 million people have glaucoma, a leading cause of blindness in the
United States. Although anyone can get glaucoma, some people are at higher
risk. They include:

Blacks over age 40. Everyone over age 60. People with a family history of
glaucoma.
Among Blacks, studies show that glaucoma is: Five times more likely to occur
in Blacks than in Whites. Four times more likely to cause blindness in
Blacks, than in Whites.
Fifteen times more likely to cause blindness in Blacks between the ages of
45-64, than in Whites, of the same age group.

At first, there are no symptoms. Vision stays normal, and there is no pain.
However, as the disease progresses, a person with glaucoma may notice his or
her side vision gradually failing. That is, objects in front may still be
seen clearly, but objects to the side may be missed. As the disease worsens,
the field of vision narrows and blindness results.

Many people may know of the "air puff" test or other tests used to measure
eye pressure in an eye examination. But, this test alone cannot detect
glaucoma. Glaucoma is found most often during an eye examination through
dilated pupils. This means drops are put into the eyes during the exam to
enlarge the pupils. This allows the eye care professional to see more of the
inside of the eye to check for signs of glaucoma.

Although open-angle glaucoma cannot be cured, it can usually be controlled.
The most common treatments are:
Medications: These may be either in the form of eye drops or pills. Some
drugs are designed to reduce pressure by slowing the flow of fluid into the
eye. Others help to improve fluid drainage.

For most people with glaucoma, regular use of medications will control the
increased fluid pressure. But, these drugs may stop working over time. Or,
they may cause side effects. If a problem occurs, the eye care professional
may select other drugs, change the dose, or suggest other ways to deal with
the problem.

Laser surgery: During laser surgery, a strong beam of light is focused on the
part of the anterior chamber where the fluid leaves the eye. This results in
a series of small changes, which makes it easier for fluid to exit the eye.
Over time, the effect of laser surgery may wear off. Patients who have this
form of surgery may need to keep taking glaucoma drugs.

Surgery: Surgery can also help fluid escape from the eye and thereby reduce
the pressure. However, surgery is usually reserved for patients whose
pressure cannot be controlled with eye drops, pills, or laser surgery.

A large amount of research is being done in the U.S. to learn what causes
glaucoma and to improve its diagnosis and treatment. For instance, the
National Eye Institute (NEI) is funding a number of studies to find out what
causes fluid pressure to increase in the eye. By learning more about this
process, doctors may be able to find the exact cause of the disease and learn
better how to prevent and treat it. The NEI also supports clinical trials of
new drugs and surgical techniques that show promise against glaucoma.

Studies have shown that the early detection and treatment of glaucoma, before
it causes major vision loss, is the best way to control the disease. So, if
you fall into one of the high-risk groups for the disease, make sure to have
your eyes examined through dilated pupils every two years by an eye care
professional.
To learn more about glaucoma write: National Eye Institute 2020 Vision Place,

Bethesda, MD 20892-3655 (301) 496-5248 www.nei.nih.gov

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EXCESSIVE CARDIOVASCULAR EVENT SEEN IN RHEUMATOID
ARTHRITIS PATIENTS -NEW YORK (Reuters Health)

Patients with rheumatoid arthritis experience more cardiovascular events than
other patients, independent of the usual cardiovascular risk factors,
according to a report in the December 2001 issue of Arthritis and Rheumatism.

In the first study of cardiovascular risk factors in rheumatoid arthritis
that focuses on both fatal and nonfatal events, Dr. Inmaculada del Rincon and
colleagues, from University of Texas Health Science Center at San Antonio,
Texas, compared the incidence of cardiovascular events in persons with and
without rheumatoid arthritis after adjusting for traditional risk factors.

Among 236 rheumatoid arthritis patients in the ORALE (Outcome of Rheumatoid
Arthritis Longitudinal Evaluation) study, the authors report, the incidence
of cardiovascular events was 5.9 events overall per 100 person-years and 5.2
new events per 100 person-years.

In contrast, the report indicates, 4635 individuals in the San Antonio Heart
Study (SAHS) experienced an overall rate of 0.75 events per 100 person-years
and 0.59 new events per 100 person-years.

After adjustment for age and gender, the cardiovascular event incidence rate
ratio was almost 4 times higher in the RA group than in the SAHS group, the
researchers note.

Multivariate analysis that accounted for age, sex, diabetes, cigarette
smoking, systolic blood pressure, and body-mass index confirmed that the
incidence of cardiovascular events in the RA patients was more than triple
that in the population-based SAHS group.

"Even though we found that the risk of cardiovascular events is independent
of traditional cardiovascular risk factors, it is still important to
implement risk modification measures," Dr. del Rincon told Reuters Health.
"Further research is needed in determining the factors associated with
cardiovascular risk in rheumatoid arthritis patients so that meaningful
recommendations can be made. If inflammation is found to play a major role in
atherosclerosis, this would extend the current indications for the aggressive
suppression of the inflammation in these patients."

Arthritis Rheum 2001; 44:2707-2710, 2737-2745.

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EXCESSIVE PILL TAKING - We're Popping A Plethora Of Pills
By Lisa Ellis InteliHealth News Service

Whether the explanation is an improvement in treatments, an older population
or an excess of pill-popping, Americans take a lot of medicines, a new survey
has found.

The telephone survey of 2,590 adults, published in the Jan. 16, 2002, issue
of the Journal of the American Medical Association, found that:

More than 80 percent of the people surveyed took at least one
over-the-counter drug, prescription drug, vitamin or mineral supplement, or h
erbal supplement in the week before they were questioned.
Half of the people took at least one prescription medicine.
About 40 percent took at least one vitamin or mineral product.
About 14 percent took at least one herbal product.
Older people - especially older women - took the most medicines. Nearly all
women age 65 and older (94 percent) took at least one drug (including
vitamins and herbs) in the week before the survey, 57 percent took five or
more and 12 percent took 10 or more. About 23 percent of older women took at
least five prescription drugs.
The most commonly used drugs were over-the-counter pain medications. The top
prescription drugs for women were estrogen and thyroid supplements. Men were
most likely to take heart-related drugs and diuretics (water pills).
The top herbal supplements were ginseng (sometimes taken for fatigue and
stress), gingko (circulation and memory), garlic (heart health), glucosamine
(arthritis) and St. John's wort (depression).
About one-fifth of those who take certain prescription anti-depressants,
cholesterol-lowering drugs and estrogen supplements also take at least one
herbal preparation.
Conducted by David W. Kaufman, Sc.D., and other researchers at the Boston
University School of Public Health, the survey took place in 1998 and 1999.
The distribution of different population groups in the sample was similar to
that of the United States, but not identical.

Harold J. DeMonaco, a pharmacist and director of drug-therapy management at
Massachusetts General Hospital, says the survey numbers reflect several
changes that he believes have increased Americans' use of drugs in recent
years.

"If you had done this survey 20 years ago, I don't think you would have seen
these numbers," says DeMonaco, who is also chair of the Human Research
Committee at Mass General, an affiliate of the Harvard Medical School.

The changes include better drugs and a greater variety of drugs to treat many
conditions, he says.

"We have drugs to treat conditions that we couldn't treat 15 years ago,"
DeMonaco says. "We also have more drugs to treat the same condition, so
physicians have more choices." The options improve the chances that a
particular patient will respond well to one of the drugs available and will
keep taking it.

A second reason Americans are using so many medicines is heavy advertising,
DeMonaco says. In recent years, much of the advertising has been directed at
patients as well as doctors.

"Some of the use [of medications] is appropriate, and some is likely to be
inappropriate or excessive," he says. DeMonaco thinks certain medications to
treat allergies and acid reflux, in particular, are overprescribed.

DeMonaco says the use of "lifestyle drugs" such as Viagra - first available
in 1998 - also has added to the volume of medications used by Americans. "I
think a lot of people who take Viagra probably don't need it," he says.

Like the study's authors, DeMonaco expresses concern about the percentages of
people taking prescription and herbal medications at the same time. "This
means that concurrent herbal and prescription-drug use is as widespread as
the experts have been telling us."

Studies have shown that most people do not tell their doctors they are taking
these products. Yet some combinations of prescription drugs and supplements
can produce hazardous side effects. "Ginseng has 48 known, documented
prescription-drug interactions," he says. "Gingko has 28."

Gingko can decrease the clotting time of blood, a potentially dangerous
effect for someone who is undergoing surgery, he says.

"Ginseng has properties that mirror those of estrogen, so if you're taking
ginseng along with some form of estrogen such as contraception or
hormone-replacement therapy, you're getting an increased dose of estrogen
compared with what your doctor thinks you're getting," he says. The long-term
effects are unclear, but the use of ginseng by women at high risk of breast
cancer is of some concern.

Many of the survey's results were not surprising, including the higher drug
use among the elderly, especially women, DeMonaco says. "As you get older,
you are likely to have disease and as a result take more drugs."

On the other hand, he says, what is surprising is that 12 percent of women 65
and older take 10 or more different drugs a week.

"That's staggering," he says. "It's impressive for health policymakers
because as the population ages there'll be more of those folks. The
implications of the expense related to that consumption are fairly
impressive. This suggests a drug bill in the $300 to $500 a month range."

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COMBINING COMMON MEDS MAY CAUSE STROKE
By Michael Smith, MD - WebMD Medical News

Doctors already suspected potential problems could arise from combining drugs
that affect the brain chemical called serotonin. And now there are reports of
severe headache and even stroke from combining some very popular drugs.

Researchers at Massachusetts General Hospital in Boston reported on three
people who developed a sudden, very severe headache and brain changes after
taking two or more drugs that affect serotonin levels.

Serotonin is an important chemical messenger found in the brain and
throughout the body. Some drugs -- such as antidepressants -- work by
increasing levels of serotonin , while others cause the chemical to rise as a
side effect.
Increased levels of serotonin in the body are known to cause the blood
vessels to narrow. When this narrowing occurs in the brain, it can lead to
headaches and even strokes from a lack of oxygen and nutrients.

In each of the three people, the researchers were unable to find any cause
for their symptoms other than a serotonin overload in the body.

According to the researchers, there is a long list of drugs that can
potentially affect serotonin levels in the brain and body. They include:

Newer antidepressants called "SSRIs" -- selective serotonin reuptake
inhibitors (examples are Celexa, Paxil, Prozac, and Zoloft) Migraine
medicines called "triptans" (examples are Amerge, Axert, Imitrex, Maxalt, and
Zomig) Diet pills, Amphetamines,
St. John's wort -- an herbal supplement commonly used to treat depression,
Illicit drugs, including ecstasy (MDMA), cocaine, and methamphetamine (speed,
crank, ice, crystal)
All three people in this study were taking two or more of the above
substances.

The researchers also caution about the affect of combining any of these
substances with other drugs that can cause narrowing of blood vessels, such
as the decongestant pseudoephedrine -- found in many over-the-counter cold
and allergy remedies.

The researchers are not saying that you should absolutely not take two or
more of these medications at the same time. But they do suggest discussing
with your doctor any potential side effects from taking a combination of the
drugs. In addition, if you experience a sudden, unexplained headache, your
doctor should consider a combination of these drugs as a potential cause. ©
1996-2002 WebMD Corporation.

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NEW CHOLESTROL GUIDELINES NOT "ONE SIZE FITS ALL"
DALLAS (American Heart Association)

A new study advises physicians to fully understand the expanded benefits of
the new cholesterol guidelines, citing that the new recommendations are
likely to significantly raise the number of people under 45 and older than 65
who are prescribed cholesterol-lowering medications, according to a report in
today's Circulation: Journal of the American Heart Association.

The authors say that while there are trials to determine the benefit of
cholesterol lowering in elderly populations, no formal studies are ongoing
for younger patients. "The ability to generalize the primary prevention trial
results, particularly to younger patients, must be explored," according to
the paper.

"The health policy implications of the guidelines should be considered and
addressed along with their adoption," says Donald O. Fedder, Ph.D., lead
author of the study that examines the implications of the NCEP III guidelines
on different population groups. "The new guidelines have increased the number
of people eligible for drug treatment."

According to National Cholesterol Education Program (NCEP) III guidelines
published in 2001, people at higher risk for heart disease with LDL
cholesterol levels (the "bad" cholesterol) of 130mg/dL or greater are
eligible for cholesterol-lowering treatment. This replaced the NCEP II
guidelines set in 1993, which set LDL levels of 160mg/dL or higher as the
treatment-eligible criteria for the same individuals.

"We're saying that there needs to be some caution," says Fedder, who is
professor of pharmacy and medicine at University of Maryland, Baltimore. "My
concern is over-treatment, or that doctors will interpret the findings to
mean that everybody needs to be treated to a level below 100 mg/dL. We must
make certain that clinicians are instructed in the proper use of the
guidelines."

Researchers took a sample of people ages 20 to 79 years old from the third
annual National Health and Nutrition Survey. They identified 13,589 people
with known cardiovascular risk factors and LDL levels. Researchers then
assessed the participants' eligibility for drug therapy first using NCEP II
guidelines (160mg/dL) and then the new NCEP III criteria (130mg/dL).

According to the study, a projected 15 million people ages 20 to 79 would be
eligible for drug therapy under NCEP II guidelines. Of these, 51 percent were
male and 49 percent female; 26 percent were younger than age 45 and 28
percent were 65 years or older. Under the new NCEP III guidelines, 36 million
are treatment eligible; of these 55 percent are male and 45 percent female;
32 percent are younger than 56 and 27 percent are 65 or older. This
represents a 140 percent increase in eligibility overall.

The new recommendations also alter the gender distribution of
treatment-eligible patients - the number of women eligible for treatment
increases 122 percent (from 7 to 16 million), while the number of
treatment-eligible men increases 157 percent (from 8 to 20 million).

In looking at age distribution, the new guidelines incur a 131 percent
increase among those 65 or older (from 4 to 10 million) and a 201 percent
increase among those younger than 45 (from 4 to 12 million). Of those deemed
eligible for treatment, 26 percent of males and 24 percent of females, 39
percent of those older than 65 and 14 percent of those younger than 45 would
be targeted for LDL lowering to less than 100 mg/dL.

The study also raises other issues. Under NCEP II, treatment was indicated in
roughly equal numbers of males and females; whereas under NCEP III,
proportionally more men than women are eligible. "Although these differences
in risk are factual, this runs counter to the current opinion that
cardiovascular risk should be regarded as equally relevant in females and
males," according ot the study. Sidney Smith, M.D., chief science officer for
the American Heart Association, says,

"The important message is that under the new guidelines, many more patients
will benefit from cholesterol lowering therapy because their need for therapy
is based on their individual risk of heart disease. It's also important to
remember that diet and exercise also lower cholesterol and are a valuable
part of all treatment strategies."

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Editors Note: This is our fifth in a series about other lesser known forms of
arthritis.

BECHET'S SYNDROME

Behcet's syndrome is a rare disease that affects mainly young adults, with
men having more severe symptoms than women do. Although the exact cause
remains unclear, Behcet's syndrome is thought to arise as a result of an
autoimmune response, that is, when the body's defense mechanism malfunctions
and begins to attack its own tissues.

Symptoms arise in many areas of the body. There may be painful, yellowish
sores in the mouth (quite similar to canker sores) that usually clear up
within a week or two, sores around the genitals that resemble the oral ones,
acne-like bumps on the skin, inflammation around the hair follicles and red
painful nodules on the legs. Also, blood vessels can become inflamed, a
condition called vasculitis.

In addition to these skin symptoms, Behcet's syndrome also causes arthritic
symptoms, specifically in the knees and ankles. Although the joints can be
stiff and painful, there is seldom long-term joint damage or deformity
associated with this disease.

The symptoms usually flare up then go into remission. The time between
attacks tends to be unpredictable; it can be as short as a few days, or it
can be long as years before a person has another episode.

The more serious complication of Behcet's syndrome involves the eye; in rare
cases, this inflammatory eye disease (uveitis) can progress rapidly and lead
to blindness. In very rare cases, the disease affects the nervous system,
heart and intestinal tract.

Behcet's syndrome affects men five to 10 times more frequently than women. On
average, the first symptoms appear between the ages of 10 and 30.

Some of the symptoms are recurrent ulcers in the mouth and genitals,
inflammatory skin and eye lesions, pain and swelling in the knee, ankle or
other joints.

The diagnosis of Behcet's syndrome is based primarily on the clinical
features. Although blood tests can support the diagnosis, no tests can
confirm or rule out the disease with great certainty.

Although Behcet's syndrome can be a chronic condition, most symptoms diminish
over time. Treatment, therefore, focuses on the symptoms. Vasculitis and
inflammatory eye disease will require glucocorticoids and perhaps other
immunosuppressive drugs. Mouth sores may be treated with glucocorticoids in
the form of mouthwash or paste. Colchicine, thalidomide and dapsone may be
helpful for the skin or joint disease. Joint inflammation may require
anti-inflammatory agents, pain medications, physical therapy and,
occasionally, other immunosuppressive medications.

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HIGHER DOSE PRAVASTATIN FORMULATION APPROVED BY FDA

WASHINGTON (Reuters Health) Jan 09 - Bristol-Myers Squibb has received
approval from the US Food and Drug Administration (FDA) to market a 80-mg
dose of its cholesterol-lowering drug Pravachol (pravastatin sodium), the
drugmaker reported late Tuesday.

Princeton, New Jersey-based Bristol-Myers said that the 80-mg dose was
developed to provide physicians with an option for treating patients who
require higher dose therapy.

Bristol-Myers noted that Pravachol is the only statin indicated to reduce the
risk of first or second heart attacks and strokes in patients with elevated
cholesterol or coronary heart disease. The firm also noted that Pravachol has
been demonstrated to have fewer liver-related side effects than other
statins. Copyright © 2001 Reuters Ltd.

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BABY ASPIRIN RECOMMENDED FOR HEART
By EMMA ROSS - The Associated Press LONDON (AP) -

One or two baby aspirins a day - not the standard dose of regular strength
adult aspirin - are enough to lower the risk of heart attack or stroke for
those at high risk, major new research shows. The study also found that
aspirin can help a wider range of people with potential heart trouble.

Aspirin is the cornerstone of blood thinning treatment for people who have
had a heart attack or stroke but is not normally used for those who suffer
ailments that put them at risk for those conditions, such as diabetes, chest
pain, irregular heart beat and diseased leg arteries. The latest research
found that aspirin reduced the risk of heart attack or stroke, or death from
those events, by 25 percent - even when the patients had not had a heart
attack or stroke previously.

The findings come from an analysis that combines evidence accumulated over
the years on the effectiveness of aspirin and its alternatives in staving off
heart trouble. Coordinated by scientists at Oxford University in England, it
encompassed 287 studies involving more than 200,000 people.

The most crucial advance offered by the study is in defining the appropriate
dose of aspirin for long-term therapy, said Dr. Eric Topol, cardiology chief
at the Cleveland Clinic, who was not involved in the analysis.

``That's a big thing. Before this analysis we weren't sure what the dose was
at all,'' Topol said. ``Three hundred twenty-five milligrams was readily
available, so it was used out of convenience, but now I think we've zeroed in
on the range of 80 to 160.''

Most doctors and heart specialists use a dose of 325 milligrams of aspirin
per day when applying it as a blood thinner. That's the dose in a regular
strength adult aspirin tablet.

The latest analysis shows that 75 to 150 milligrams works just as well, with
less chance of internal bleeding. In the United States, baby aspirin, also
available as low-dose adult aspirin, contains 81 milligrams. In Europe
aspirin comes in doses of 75 milligrams and 300 milligrams.

``There are two problems,'' Topol concluded. ``Doctors are giving too much or
they are not giving any at all. We have a lot of work to do now to get all
the patients treated and at the right dose.'' ``That dose should be
considered to be one or two baby aspirin and not the standard 325
milligrams,'' he said.

A similar analysis performed in 1994 by the same group solidified the role of
long-term daily aspirin treatment for preventing second heart attacks or
strokes in patients who have already had one. The latest review, published in
the British Medical Journal, is a much-anticipated update.

``We've got clear evidence now from this review that people who haven't yet
had a heart attack or stroke do benefit, but they are being treated less than
half the time with aspirin,'' said one of the investigators, Dr. Colin
Baigent, an epidemiologist at Oxford University.
``If we were to tackle that group, that would save about 40,000 extra lives a
year worldwide,'' he said.

The study concluded that most healthy people, who have less than a 1 percent
chance of having a heart attack or stroke, should not regularly take aspirin
to prevent heart trouble.

The key is to determine how unhealthy someone has to be to benefit from
aspirin, Baigent said. If the likelihood of having a heart attack or stroke
is smaller than the chance of internal bleeding from the aspirin, the drug
would cause more harm than good. British Medical Journal: Copyright 2002
The Associated Press.

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Good Health to all.

Jack Nicholas - Editor
Cornishpro@aol.com
Issue 2002-01/26/2002-3