Rheumatology News
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The health food pills, Glucosamine and Chondroitin, have been mired in controversy ever since the book, The Arthritis Cure, touted their wonders in 1997. The only studies that even hinted at actual benefit from these billion dollar sellers were sponsored by manufacturers. Recent data from the NIH has triggered conclusions that G and C do not work for osteoarthritis. Modified March 13. 2006
Two more drugs join the group of rheumatoid arthritis treatments known as biologic agents. Enbrel, Remicade and Humira are now joined by Orencia and Rituxan. Both drugs are administered IV and are indicated for use along with Methotrexate in patients who have not responded adequately to the TNF inhibitor drugs. Modified March 13. 2006
New information shows that rheumatoid arthritis patients on Enbrel, Remicade or Humira have a higher risk of infection after orthopedic surgery. Therefore it is recommended to stop Enbrel 2 weeks before surgery and resume it 2 weeks after. Remicade should be stopped 8 weeks before and Humira 6 weeks before surgery.
According to the surgeon general, more needs to be done to detect osteoporosis. These are risk factors for osteoporosis and indicate who needs bone density screening:
Post menopausal women
On drugs that cause bone loss like steroids
History of fracture without trauma or after minor trauma
Diseases that cause bone loss like thyroid, parathyroid or testosterone hormone abnormalities
Enbrel (etanercept) is an injectable medication for rheumatoid arthritis (RA), psoriatic arthritis, psoriasis, juvenille arthritis and ankylosing spondylitis. It is self-injected sub-cutaneously or beneath the skin. One downside was that it had to be mixed before using and given twice a week. Now, it is made in a pre-filled syringe and can be given 50 mg. once a week for the arthritis indications as opposed to 25 mg. twice a week.
Whether or not glucosamine sulfate pills works for osteoarthritis is controversial. Some studies show pain relief and some even suggest slowing progression of the cartilage loss that typifies osteoarthritis. Some studies are questioned because of drug manufacturer sponsorship. The latest input is a study that shows that once glucosamine is stopped, patients do not have any more or less flares in pain than those who did not take glucosamine. This is an unusual way to do a study but it does suggest no greater value of glucosamine than a placebo or sugar pill.
Probably the most popular prescription arthritis medicines in the world, Vioxx and Bextra were taken off the market. A study on Vioxx and its use in preventing colon polyps was stopped due to evidence that the study group receiving Vioxx was having more heart attack and stroke than patients not given Vioxx. Some Bextra patients were having severe skin reactions. There is also evidence that Bextra might increase heart attack and stroke risk. There is some evidence that Celebrex is risky but not enough for Pfizer to pull it or for the FDA to prohibit its use. The FDA did mandate a new Black Box Warning for Celebrex's product information.
400 IU(international units) of Vitamin D has long been the standard dose recommended to prevent osteoporosis. But, now it has been shown that 600 IU is best. Most multivitamins have 400 IU and most calcium supplements have 200 IU. So taking a calcium plus D once a day and a multivitamin would be best for most people.
According to the Medical Letter, some infectious disease specialists are now recommending prophylaxis or preventive antibiotic dosing for patients with artificial joints who are going to have dental procedures. This is to prevent normal mouth bacteria from getting into the blood stream and infecting the artificial joint.