Obesity and RA

In response to the question posed in class, "Is there an association between obesity and rheumatoid arthritis?", the answer is yes. A number of studies have been performed on this subject and many of them reveal interesting findings. 

First, a couple of studies have been conducted in regards to RA and obesity. Researchers have found that obese patients with RA not only had a decreased quality of life (when compared to normal weight RA patients) but also had increased joint pain, fatigue, and loss of physical function in affected joints. On the flip side, obesity may result from RA because of inactivity due to joint pain.

Next, a study performed at the Fred Hutchinson Cancer Research Center in Seattle, Washington found some evidence that sex hormones may influence the incidence of RA. Obesity has been found to increase endogenous estrogens and thus may increase the risk for developing RA.

Because both obesity and RA are inflammatory diseases, it makes sense that the two may be associated. Even though it may seem obvious that there is a correlation between the two diseases, more research is required to determine the exact mechanism in how both are related.

Spread of Polio - Nigeria

In class on October 28th, Dr. Cohen mentioned an article he recently read in the New York Times about the spread of Polio. The article, “Polio Spreads to New Countries And Increases Where It’s Endemic” does not have a hopeful tone for Nigeria. It states that, “Nigeria, whose northern provinces are the epicenter of Africa’s epidemic, recently dismissed the head of its national vaccination program.” Nigeria has been reluctant to administer the polio vaccine because of fears it may not be safe. “Many Muslims in the north believe that polio vaccination is being used as a ploy by Western countries to inject people with certain chemicals to reduce their fertility or infect them with HIV/AIDS in order to reduce the population of Muslims.” According to the World Health Organization, the number of 2008 year-to-date (Oct. 28, 2008) cases is 736 compared to the 2007 year-to-date cases of 220. The WPV1 cases, however, are very localized and reported in only 6 of Nigeria’s 37 states. The Expert Review Committee (ERC) on Polio Eradication and Routine Immunization (ERC) met on October 27-28, in Abuja. Plans have been finalized for immunizations in November and December. “The group also finalized the SIA dates for the coming months, with mOPV1 to be added to an integrated measles campaign at end-November (in the north) and December (in the south), with separate Immunization Plus Days (IPDs) to be held in high-risk areas in the north in December.”

Polio History (Past 15 Years):
200 countries, 20 million volunteers, US $3 Billion, Largest Public Health Campain

FACTS:
In 1988, the World Health Assembly (WHA) the annual meeting of the ministers of health of all Member States of the World Health Organization, voted to launch a global goal to eradicate polio. As a result of the Global Polio Eradication Initiative - the single largest, internationally-coordinated public health project to date - by the end of 2006, only four countries remained which had never interrupted endemic transmission of wild poliovirus (Nigeria, India, Pakistan and Afghanistan). In 2006, fewer than 2000 cases were reported. Back when the Global Polio Eradication Initiative was launched, wild poliovirus was endemic in more than 125 countries on five continents, paralyzing more than 1000 children every day.

Eight new cases were reported last week in Nigeria (1st week of November 08).

http://www.who.int/features/2004/polio/en/
http://www.polioeradication.org/casecount.asp
http://www.polioeradication.org/content/general/casemap.shtml
http://www.polioeradication.org/content/polionews/PolioNews31.pdf
http://www.scienceinafrica.co.za/2004/march/polio.htm
http://news.bbc.co.uk/2/hi/health/7671070.stm

Genetics and Arthritis

In class someone mentioned if there were genetic predispositions involved in arthritis, and I was curious to find more information about that. I found an article that did a study about this topic. They found that genetic susceptibility is caused by many factors. The article said, “it involves several polymorphic genes, perhaps each contributing with a small increment.” Since we also looked at NOS, it was interested that part of their results was that they found out the NOS2 gene promoter polymorphisms don’t have a huge effect on RA predisposition. It also mentioned that there should be more research done to look into the CTTT alleles. The articles also said, “In addition, the reported genetic heterogeneity within and between ethnic groups in the highly polymorphic promoter (CCTTT)n repeat13 raises the possibility that a (CCTTT)n allele might be associated with the disease in a different population.” This goes along with the issue brought about in class about the disease being associated in different populations or ethnic groups like Italians. (http://www.nature.com/gene/journal/v3/n5/full/6363856a.html) I also found a general website that had information about arthritis and I found a section entitled, “Issues of Genetics and Arthritis”. It mentioned that there are more studies that are looking at the genetics involved in arthritis. It mentioned that in Britain there has been a discovery of knee osteoarthritis that is now added to the group, genetically caused arthritis. They found that brothers are more likely to get the disease than sisters, which is surprising since females are more susceptible than males. Once again, there still needs to be more research and the article mentioned that another group in California is looking into this study in order to find out more information about genetics and arthritis. (http://www.creakyjoints.com/go/article0062.shtml)Therefore, there are genetic predispositions involved, but to determine more information about it and find more types of arthritis that have a genetic predisposition there has to be more research conducted.

Italian Arthritis

In class we discussed multiple articles that had come out of Italy to the 1990’s; so I wanted to know if their were any reasons for this.   I searched for evidence of this trend and could only find one that discussed the subject and it claims “prevalence of RA is low in Italy”.  Low prevalence of RA does make sense in a country whose traditional food staples are whole grains, fresh fruit and vegetables, and fish.  All of which are included in a good anti-arthritis diet according to the article we read last week in Environmental Nutrition. 

 

I could not find any special reason why arthritis was of such interest to Italian researchers in the 1990’s. 

Arthritis and Toads

I know we had discussed this in class so I want to look it up. In an article in the New York Times, The cane toad has been conquering northern Australia, but now they are paying for it. They have been growing too big and hopping into new territories, because of this the toads are developing severe arthritis.
In 1930s the cane toads were brought to Australia in order to control the insect problem in the sugar cane fields. The toads did solve the insect problem, but also, are very toxic to the animals that try to eat them. This has allowed them to expand their territory. Researchers have also seen that the toads have evolved with larger bodies and longer legs and now are able to move faster. Furthermore, researchers found that some of the cane toads had fused vertebrae caused by bony growths with spinal abnormalities. With each hop, it puts more stress on their skeleton.

Resources:
Fountain, Henry. "Arthritis Fails to Slow Invading Toads in Australian Fields." New York Times. 2007.
http://www.nytimes.com/2007/10/16/science/16obtoad.html?_r=1&oref=slogin

Stem Cells

Stem cells are undifferentiated cells waiting on the signal in which it can eventually differentiate into whatever cell is needed by the body. Embryonic stem cells which are found in the blastocysts, and adult stem cells found in adult tissue have the potential of becoming many different cell types. In essence, they can replenish our worn out cells that keep us functioning properly.

Since stem cells can be manipulated to become specialized cells, stem cell therapies have already been use in the treatment of some conditions such as leukemia. Medical science will eventually try to use this advantage in treating other diseases such as cancer, spinal cord injuries, Parkinson's disease and much more. With such potential, many thought stem cells would be the next great discovery in disease treatment.

In an article released by Health Day News, Immune Response May Hinder Stem Cell Treatments, released in August of this year, researchers have found that human stem cells can trigger an immune response in mice. It was thought/suggested by researchers that the immune system must ignore stem cells since it is in the early stages of development and both the mother and father's genetic material are present at that stage. Injections of human embryonic stem cells into mice with a normal immune system showed that cells would die off over a period of time, whereas embryonic cells that are injected into mice with an impaired immune system would go on and multiply. Further injections into mice with the normal immune system showed cells dying off more quickly suggests that the immune system is recognizing the cells as foreign and destroying them more rapidly. The results in this experiment lead researchers to believe that this rejection can also occur in human transplation of embryonic stem cells. In addition, anti-rejection compounds injected into the mouse with the normal immune system show that the embryonic cells are able to survive for 28 days.

I too thought stem cells was an amazing application to medical treatments, but with these new findings, will it be much more complicated than what was though of stem cell use? Is the immunse system all that will need to be overcome for stem cells treatments to work effeciently?

References
http://en.wikipedia.org/wiki/Stem_cell
http://www.forbes.com/health/feeds/hscout/2008/08/18/hscout618460.html
http://www.nlm.nih.gov/medlineplus/news/fullstory_68274.html

Knee OA has become a growing problem among elderly people. It causes pain and functional limitations due to articular inflammation and collagen degradation. And currently there are neither preventive intervention strategies nor effective medical remedies for the management of knee OA. Ergo…..

Tai chi is an ancient Chinese exercise that uses a mind-body approach to improve muscle function, balance, and flexibility. Studies indicating significant improvements in reduction of pain and other arthritic symptoms, have made tai chi a possible effective way for treating knee osteoarthritis. The physical components of tai chi include a range of motion, flexibility, muscle conditioning, and aerobic cardiovascular exercise. The essence of the mind component of tai chi increases psychological well-being, life satisfaction, and perceptions of health.

Because current evidence is still inconclusive about the favorable outcomes of tai chi, a group of researchers have formulated the single-blind study. This study was designed to further test the effectiveness of tai chi using 40 patients with knee OA, of 55+ years of age, and with a body mass index of less than 40 kg/m2. These patients participated in two hour long tai chi sessions that were conducted weekly for 12 weeks, which also involved a 24 and 48 week follow-up. The results were to compare changes in knee pain, stiffness, and physical function.

This study, which was recently conducted this year, was designed with long term follow-ups to truly test the effectiveness of tai chi on patients with knee OA. Therefore, any conclusive results have yet to be published.

Its indicative to note that the researchers took into consideration the significant gaps in research participation that exist among ethnic minorities, something that tends to limit the generalization of findings to a particular ethnic group. As a result, the researchers did some extensive advertisement of the single-blind study for five months to ensure the adequate enrollment of underrepresented groups.

Sources:
Tai Chi for treating knee osteoarthritis: Designing a long-term follow up randomized controlled trial. BioMed Central. Vol 9, 2008.

Some additional info and questions

I was curious if anyone has com across information stating if RA or OA affects a certain ethnic group more than another such as IBD and Jewish people? I was also surfing the net and found some forms of alternative medicine on the Mayo Clinic website for RA. They suggest discussing them with your doctor first but the three that gave were plant oils containing gamma linolenic acid (GLA) a type of omega-6 fatty acid that comes from plant oils, such as evening primrose, borage and black currant, fish oil that contains eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) which are omegea-3 fatty acids commonly found in fish oil, and surprisingly enough Tai Chi which is movement therapy that involves gentle exercises and stretches combined with deep breathing.

Juvenile Rheumatoid Arthritis

Hi all! I know there were quite a few inquiries about Arthritis in kids, so I did a little research. According to kidshealth.org nearly 300,000 children in the United States suffer from some sort of arthritis. The most prevalent form is Juvenile Rheumatoid Arthritis (JRA), also referred to as Juvenile Idiopathic Arthritis, since it is different than the adult form. One reason it is referred to as idiopathic is that it is unknown what causes it. It usually affects children as young as 6 months to 16 years old. The initial signs are pain, swelling, and reddened joints. It is also said that the more joints that are affected, the more severe the condition. There are 3 major types of JRA.

Oligoarticular JRA affects four or fewer joints. Along with pain, stiffness, and swelling of the joints, knees, and wrists, inflammation of the iris can occur. It can be detected early by an ophthalmologist.

Polyarticular Arthritis is a type that affects more girls than boys. It involves five or more joints. The pain and swelling occurs at small joints of the hands as well as the weight bearing joints like knees, hips, ankles, feet and neck. Usually a fever as well as bumps at pressure areas accompany.

Systemic JRA is the most severe of the three. It involves the whole body. A high fever appears, increases in the evening, and then may drop back to normal. A rash may appear as well as feeling very ill and looking very pale. The spleen and lymph nodes swell, followed by the stiffness, pain, and swelling of the joints.

Diagnosis occurs through tests like X-Rays, blood culture, bone marrow exam, as well as a bone scan. Lyme disease is also checked. Nonsteroidal Anti-inflammatory Drugs, such as Advil and Ibuprofen as well as physical therapy are used to treat the conditions.

Bee Venom Therapy and Rheumatoid Arthritis

Apitherapy is the use of bee venom or honey in the prevention or treatment of various diseases and conditions, including rheumatoid arthritis (RA). Utilizing bee venom for therapy has been reported from ancient Chinese medicine. Bee venom therapy (BVT) is so widely used because if its anti-inflammatory properties but there are only a hand-full of studies to prove this. Honeybee venom contains mellitin, a powerful anti-inflammatory, which is said to be 100 times stronger then hydrocortisone. Mellitin stimulates the adrenal cortex to produce cortisol, thus reducing the immune response. Interestingly enough, cortisol is sometimes used in the treatment of RA.
Looking at blogs and various websites, I found testimonies from RA sufferers regarding BVT. Many patients turn to this naturopathic remedy after drug therapies proved not to work. To determine if bee venom works, one must visit a naturopathic doctor or an apitherapist. First, it must be determined if the patient is allergic to bee venom. If they aren’t allergic, the bee venom is administered as a shot or a sting from a live bee into trigger points. The therapy is continued daily for four to six weeks, depending on the severity of the disease.
Not only does bee venom have healing properties but honey does as well. It turns out that honey has anti-fungal and anti-microbial effects. It has been used in wound therapy, treatment of infection and treatment for serious skin conditions such as eczema and psoriasis. Scientists are unsure as to why honey has such beneficial outcomes.
The only concern regarding Apitherapy is allergic reaction. Administration of bee venom could possibly result in anaphylactic shock if one is not careful. Thus, speak with your doctor or a health professional before you go out and catch bees to use on areas of inflammation or infection!

Rheumatoid Arthritis(RA) and Psoriatic Arthritis(PsA)

The two conditions are very similar.  They both cause progressive joints damage, as a result of over active inflammation.  The major difference is PsA causes psoriatic skin lesions.  The experts are not sure why or where the connection is between the inflammatory responses that are responsible for joint pain and skin lesions.  However, many individuals with PsA notice that when there psoriasis is worse there arthritis is worse.  A stronger connection between the two diseases comes from one of this weeks articles entitled “ENHANCED AND COORDINATED IN VIVO EXPRESSION OF INFLAMMATORY CYTOKINES AND NITRIC OXIDE SYNTHASE BY CHONDROCYTES FROM PATIENTS WITH OSTEOARTHRITIS” which examined tissue from knee biopsies in patients with osteoarthritis, traumatic knee arthritis, RA, and PsA for the presents of certain inflammatory mediators.  Their results showed   “No significant difference was noted between RA and PsA in synovial and cartilage staining, suggesting that the final pathogenic mechanism is similar in the two inflammatory arthritides”