The Johns Hopkins Arthritis Center web site offers patients and physicians with Arthritis information and resources. http://www.hopkins-arthritis.org en-us Mon, 7 Apr 2008 15:31:09 -0400 Mon, 7 Apr 2008 15:30:30 -0400 FeedForAll v2.0 (2.0.2.2) http://www.feedforall.com Estrogens are known to modify immunologic responses and the modulation of rheumatoid arthritis (RA) disease activity during pregnancy is well documented. However, whether physiologic replacement of estrogen and other hormones after menopause adversely affects RA outcomes is controversial. Here, Wallitt et al (Arthritis Care & Research 2008; 59: 302) explore whether postmenopausal hormone replacement therapy (HRT) increases the incidence or severity of RA in women enrolled in the Women Health Initiative (WHI) trials. http://www.hopkins-arthritis.org/arthritis-news/2008/does-postmenopausal-hormone-replacement-affect-rheumatoid-arthritis-outcomes.html 5102F88F-47EF-420C-8CAB-0EC6595C5F9D Mon, 7 Apr 2008 15:30:30 -0400 The observation that TNF-α is elevated in individuals with advanced heart failure (HF) prompted several high-profile clinical trials investigating whether TNF inhibitors could be used to treat HF. The failure of these trials and reports of RA patients treated with TNF inhibitors developing new-onset or worsening HF has raised questions as to whether TNF inhibition is beneficial or detrimental to the myocardium. http://www.hopkins-arthritis.org/arthritis-news/2008/tnf-inhibitors-heart-failure-rheumatoid-arthritis-patients.html 6B5D7951-4014-4FFE-BE63-1394990ED54A Wed, 26 Mar 2008 11:52:27 -0400 Large scale, independent studies of glucosamine and/or chondroitin have not shown a definitive benefit for the treatment of painful knee osteoarthritis (OA) and the effect of retarding knee OA progression remains controversial. http://www.hopkins-arthritis.org/arthritis-news/2008/is-glucosamine-sulfate-an-effective-treatment-for-osteoarthritis-of-the-hip.html 5ADF8FE7-1168-425B-9D72-F0525DEFCCAA Thu, 6 Mar 2008 13:12:02 -0500 Susceptibility to rheumatoid arthritis (RA) is complex; although a number of genetic susceptibility loci have been identified that appear to confer increased risk. Among these, genes encoding sequence variants in the major histocompatibility complex (MHC) class II molecule, known as the “shared epitope” (SE), have been known for decades and have the strongest link to RA susceptibility. http://www.hopkins-arthritis.org/arthritis-news/2008/european-admixture-associated-with-genetic-risk-for-rheumatoid-arthritis-in-african-americans.html 19C71C23-1CBF-465D-A2C1-78F05AB49B10 Thu, 6 Mar 2008 10:25:22 -0500 Oral vs. subcutaneous (sq) administration of methotrexate is generally considered equivalent in rheumatoid arthritis (RA) treatment. However, the enhanced bioavailability of sq methotrexate may make this route of administration preferable to the oral route in certain patients. http://www.hopkins-arthritis.org/arthritis-news/2008/subcutaneous-vs-oral-methotrexate.html 67442E99-A77C-4E43-9B00-62548EA4F28A Fri, 22 Feb 2008 12:28:25 -0500 Atacicept is a recombinant fusion protein that binds and neutralizes two molecules important for the maturation, proliferation, and survival of B cells: BLyS and APRIL. While B-cell depleting therapies have demonstrated efficacy in RA, atacicept differs from the anti-CD20 targeted monoclonal antibodies, such as rituximab, as its effects extend over the entire lineage of B lymphocytes, including plasma cells. http://www.hopkins-arthritis.org/arthritis-news/2008/early-safety-study-for-atacicept-shows-promise-in-rheumatoid-arthritis.html 3CFA6B8C-E892-4A6D-A0FF-10D3E57C09FA Fri, 1 Feb 2008 12:27:46 -0500 HIV infected patients are at the same, or even greater, risk for developing inflammatory arthritis. However, the nature of their chronic infection and increased susceptibility to opportunistic infection have prompted most clinicians to avoid using TNF inhibitors in this patients population, even in settings in which their use would otherwise be appropriate, since only a few case reports have been published detailing treatment experiences. http://www.hopkins-arthritis.org/arthritis-news/2008/are-tnf-inhibitors-safe-for-use-in-hiv-infected-patients.html 2ED8C471-3A55-4F39-A07B-0978C2EEFBF6 Tue, 15 Jan 2008 12:27:07 -0500 Knee pain from osteoarthritis (OA) tends to be poorly correlated to degree of cartilage loss. Other factors related to knee OA, including bone marrow edema and synovitis, may be more proximal determinants of pain in knee OA. Synovitis is usually quite limited in knee OA and difficult to quantify on physical exam. http://www.hopkins-arthritis.org/arthritis-news/2007/knee-pain-from-osteoarthritis-may-be-related-more-to-change-in-synovitis-than-change-in-cartilage.html 1A22BC3F-07E6-4D83-9B80-1939A65A4BC2 Fri, 14 Dec 2007 12:26:44 -0500 Both genetic and environmental exposures, to varying degrees, are felt to contribute to the risk and severity of systemic autoimmune diseases (e.g. rheumatoid arthritis (RA), lupus, etc…). While some clear cut evidence for environmental exposures in certain autoimmune diseases exists, such as cigarette smoking in RA and specific chemical exposures in scleroderma-like syndromes, general links to occupational exposures has been difficult to establish. This is partially due to difficulties in tracking and quantifying specific exposures within complex frameworks, particularly when exposure likely precedes onset of disease by years or even decades. Here, Gold et al (Arthritis Rheum 2007; 56:3189) explore the association of occupation and risk of mortality from a variety of systemic autoimmune diseases. http://www.hopkins-arthritis.org/arthritis-news/2007/do-occupational-exposures-increase-the-risk-of-death-from-systemic-autoimmune-disease.html AD40E399-9181-4FC2-978B-0D7286F87567 Wed, 12 Dec 2007 12:13:29 -0500 Video from the 2007 JHU Rheumatology Pathophysiology lectures at Johns Hopkins University. http://www.hopkins-arthritis.org/physician-corner/education/pathophysiology-2007/index.html FDFBACEF-9AA2-4E41-8986-9D86CD5FE8AB Wed, 5 Dec 2007 12:18:01 -0500 Videos from the Maryland Arthritis Foundation annual 2007 Topics in Clinical Rheumatology symposium. http://www.hopkins-arthritis.org/physician-corner/education/ticr-2007/index.html DBD3C5CA-F467-46FB-948E-F5487184BA54 Mon, 3 Dec 2007 12:15:38 -0500 A series of Physician Education materials surrounding the Rheumatic diseases. Brought to you by the Maryland Society for the Rheumatic Diseases, Rheumatism Society of the District of Columbia and the Rheumatology Society of Delaware. http://www.hopkins-arthritis.org/physician-corner/education/summer-rheumatology-symposium-2007/index.html CF42B79B-BE8C-4861-AB33-F09838FA6DA3 Fri, 23 Nov 2007 12:14:01 -0500 The role of uric acid in bodily homeostasis is puzzling to investigators. On one hand, it is a potent antioxidant. On the other, elevated levels have been consistently been associated with an increase in vascular events, including stroke. Thus, it is unclear whether interventions designed to decrease uric acid will be beneficial in preventing vascular events. Here, Schretlen et al (Neurology 2007;69:1418) explore the association of serum uric acid levels with brain changes in adults using magnetic resonance imaging (MRI). http://www.hopkins-arthritis.org/arthritis-news/2007/even-high-normal-serum-uric-acid-levels-may-lead-to-ischemic-changes-in-the-brain.html D5BB957F-8469-4A54-BBD6-0C461A9A923A Wed, 21 Nov 2007 12:12:59 -0500 New research evidence suggests that the pain in Fibromyalgia is Real. http://www.hopkins-arthritis.org/arthritis-info/fibromyalgia/articles/finding-fibro-evidence-suggests-pain-in-fibromyalgia-is-real.html 78A3A5CF-1628-4AB8-88C3-84D3CF774A1B Mon, 19 Nov 2007 13:52:03 -0500 Fibromyalgia is a complex, poorly understood disorder characterized by diffuse chronic pain, fatigue, disturbed sleep, depression, and low tolerance for physical exertion. Pharmacological treatments are often helpful but rarely resolve symptoms and significantly improve functional capacity. Rooks and colleagues (Archives of Internal Medicine, 2007;167 (20): 2192) conducted a trial to investigate the effects of exercise on physical, social, and emotional function and symptoms among adults with fibromyalgia. http://www.hopkins-arthritis.org/arthritis-info/fibromyalgia/articles/group-exercise-education-and-combination-self-management-fibromyalgia-trial.html 9F18EFA1-C1A3-4740-BEB9-E88D9A7A0869 Tue, 13 Nov 2007 13:51:17 -0500 A handful of genes which confer susceptibility to the development of RA are known, such as the HLA-DR “shared epitope” and variants in the PTPN22 gene. While these genes convey a relatively large degree of risk, identifying important genetic loci that convey more modest levels of risk have been a challenge due to the limitations of genetic research methods. Newer methods, such as the use of genome-wide association studies involving hundreds of thousands of single nucleotide polymorphism (SNP) markers, can aid in the discrimination of genes with modest, yet potentially important and informative, effects on risk. Here, Plenge et al (NEJM 2007; 357:977) report the results of a genome-wide association study of 1,522 anti-CCP antibody positive RA patients. http://www.hopkins-arthritis.org/arthritis-news/2007/novel-genetic-susceptibility-locus-for-rheumatoid-arthritis.html 7EB7436C-EBE5-4E8B-9B9F-B48A1407D37F Wed, 31 Oct 2007 10:44:05 -0500 RA is associated with an increase in cardiovascular (CV) events, such as myocardial infarction (MI) and sudden cardiac death. Inflammatory cytokines, such as TNF-α, are implicated in atherothrombosis and the RA disease state, potentially explaining the increased risk of CV events in RA. The use of TNF inhibitors was associated with a reduced risk of cardiovascular events in RA patients in one study, although it is not clear whether these effects are due to unique features of TNF inhibitors or are a consequence of non-specific suppression of inflammation. Here, Dixon et al (Arthritis Rheum 2007; 56(9): 2905) explore these issues in analyses of participants enrolled in the British Society for Rheumatology Biologics Register (BSRBR). http://www.hopkins-arthritis.org/arthritis-news/2007/tnf-inhibitor-use-reducing-risk-of-myocardial-infarction-in-ra-patients.html DB81DBE3-26C3-43CF-85AE-A371000EEFFD Fri, 28 Sep 2007 10:43:37 -0500 The potential for hepatotoxicity is a well-recognized feature of therapy with a number of DMARDs in rheumatoid arthritis (RA), with methotrexate (MTX) being the most common utilized. Concomitant use of other hepatotoxic agents has the potential to compound the risk of significant liver damage. Among these, isoniazid (INH) is increasingly used in RA patients receiving MTX with evidence of latent tuberculosis infection (LTBI) or prior active tuberculosis for whom TNF inhibitor therapy is planned. Here, Mor et al (Ann Rhem Dis 2007 published online Aug 29) explore the safety of this combination of potentially hepatotoxic agents. http://www.hopkins-arthritis.org/arthritis-news/2007/methotrexate-and-isoniazid-appears-safe.html F82D8E9A-BDB9-4F3C-A640-B61026CCD6C5 Thu, 20 Sep 2007 10:43:05 -0500 An informational discussion on the potential issues with Knuckle Cracking related to Arthritis http://www.hopkins-arthritis.org/arthritis-news/2007/knuckle-cracking-and-arthritis.html A8BBB0AB-2984-4C2D-8B18-1BDAD8793EE6 Mon, 10 Sep 2007 10:41:43 -0500 Patients with early inflammatory arthritis not meeting classification criteria for rheumatoid arthritis (RA) may have treatment delayed until typical phenotypic features accumulate. Due to the concern for toxicities of DMARDs, patients are often treated with NSAIDs and simple analgesics during this period. However, delay in DMARD treatment in early RA has been shown to result in poorer outcomes, such as irreversible radiographic damage. Addressing this problem, van Dongen et al (Arthritis Rheum 2007; 56(5):1424) report the results of the “PRObable rheumatoid arthritis: Methotrexate vs. Placebo Treatment” (PROMPT) study. http://www.hopkins-arthritis.org/arthritis-news/2007/methotrexate-beneficial-in-early-undifferentiated-arthritis.html EC3DCEEF-FC0D-49D6-AF76-3A07C14E1DD1 Fri, 31 Aug 2007 10:40:42 -0500 Hydroxychloroquine (Plaquenil) is a commonly used disease modifying anti-rheumatic drug (DMARD) for RA that has known beneficial effects on blood glucose and lipids. However, whether its use can prevent the onset of diabetes in RA patients prescribed it to reduce articular signs and symptoms has not been evaluated. Here, Wasko et al (JAMA 2007; 298: 187) explore this issue using prospective data from the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) database. http://www.hopkins-arthritis.org/news-archive/2007/hcq-incident-diabetes.html A0B97986-C921-4B4D-AE24-DD5CCB48A347 Mon, 27 Aug 2007 12:42:09 -0400 Dietary risk factors, such as meat and alcohol consumption, are well recognized as contributing factors to gout flares in patients with established gout. These same factors have been shown to associate with elevated serum uric acid and an increased risk for the development of incident gout. Coffee consumption is a dietary risk factor that has been shown to be both harmful and beneficial in the development of a variety of health problems. Here, Choi et al (Arthritis Rheum 2007; 56(6): 2049) explore whether coffee consumption affects the risk of incident gout in men enrolled in the Health Professionals Follow-up Study. http://www.hopkins-arthritis.org/news-archive/2007/coffee-consumption-may-protect-against-the-development-of-gout.html 7B299126-1C7C-41A0-8E8B-3E03B87EA49E Tue, 31 Jul 2007 11:12:33 -0400 In addition to its role in calcium hemostasis and bone metabolism, vitamin D also appears to be an important regulator of immune function. However, its role in modulating RA disease activity has not been studied. Here, Patel et al (Arthritis Rheum 2007; 56(7): 2143) explore the effects of serum vitamin D levels on clinical response in patients with early inflammatory polyarthritis. http://www.hopkins-arthritis.org/news-archive/2007/affects-of-vitamin-d-on-rheumatoid-arthritis.html CA50A09D-B3C0-4A83-A36C-5E6784B2A292 Mon, 30 Jul 2007 09:17:09 -0400 This is the bone-and-joint decade, and it certainly could be considered the bone-and-joint imaging decade as well because there have been many advances and changes in imaging -- diagnostic and therapeutic imaging -- that are directly relevant to musculoskeletal. While there are exciting things going on in radiography, ultrasound, CT, etc., I will focus today on MRI. Functional imaging cuts across all of these modalities. Flexion-extension radiographs, dynamic ultrasound, and kinematic MRI should all be considered part of functional imaging in the broad sense. We'll talk about what clinicians need to know when they are looking at MRI imaging to evaluate patients with rheumatologic conditions. http://www.hopkins-arthritis.org/rheumrounds/advances-in-musculoskeletal-imaging-round-13.html 1DB1FC48-C48D-4DE7-B549-7D8EFCC2C906 Thu, 28 Jun 2007 14:48:01 -0400 Older person with rheumatoid arthritis (RA) make up an increasing proportion of those treated with biologic disease modifying anti-rheumatic agents (DMARDs). The safety of these agents may differ for this subgroup of older RA patients, yet effects have generally not been selectively studied in this population. Here, Schneeweis et al (Arthritis Rheum 2007; 56: 1754) explore the association of TNF inhibitor therapy and serious bacterial infection in RA patients 65 years of age or older. http://www.hopkins-arthritis.org/news-archive/2007/prednisone-associated-with-increased-risk-of-infection.html 9CA4C8D7-CE52-42B3-9884-AD6AB180E4C8 Mon, 18 Jun 2007 14:47:00 -0400 Individuals with rheumatoid arthritis (RA) are at an increased risk for lymphoma compared to the general population, with the risk increasing in proportion to cumulative exposure to systemic inflammation. Whether RA therapies, such as biologic and non-biologic DMARDs, contribute to this risk is controversial. http://www.hopkins-arthritis.org/news-archive/2007/no-link-between-ra-therapy-and-lymphoma.html DFB8EDCA-7281-40CA-BA2D-99D6437DD143 Tue, 5 Jun 2007 14:45:56 -0400 Pain perception in osteoarthritis (OA) is complex, with the intensity of pain reported in affected individuals often with little correlation to structural damage. Few studies have explored the neural networks responsible for processing pain in OA. Here, Kulkarni et al (Arthritis Rheum 2007; 56(4):1345) use functional positron emission tomography (PET) scanning to investigate the structures of the brain involved in pain processing in patients with knee OA. http://www.hopkins-arthritis.org/news-archive/2007/pain-in-oa.html C54F58B0-9C8B-46E7-9689-C97C40FA76D7 Wed, 16 May 2007 10:31:18 -0400 The Johns Hopkins Arthritis Center is pleased to announce the launch of our new patient based forums for discussions on Arthritis and related Rheumatic conditions. http://www.hopkins-arthritis.org/forums/ AC4ACD18-3080-45BF-B4D3-265D49F414F3 Tue, 8 May 2007 16:55:28 -0400 An increase in older adults combined with a greater ability to effectively manage many inflammatory musculoskeletal disorders is expected to require an increase in the number of practicing rheumatologists over the coming decades. http://www.hopkins-arthritis.org/news-archive/2007/demand-for-rheumatologists.html F9EA6653-4329-4663-A2A5-25DF9F3F0FB4 Mon, 30 Apr 2007 13:20:23 -0400 Recently, the FDA Arthritis Advisory Committee reviewed the New Drug Application of the drug etoricoxib (Arcoxia), a COX-2 selective NSAID manufactured by Merck & Co., for use in the treatment of osteoarthritis pain. http://www.hopkins-arthritis.org/news-archive/2007/etoricoxib-voted-on-by-fda-panel.html F434F4DC-3BC9-44D6-B500-4CB1190B0B4D Wed, 25 Apr 2007 13:19:32 -0400 Corticosteroids are associated with an increased risk of cardiovascular (CV) disease in the general population. However, there are conflicting data on the CV risk of corticosteroids in RA, as their potent anti-inflammatory properties may result in a net beneficial effect. http://www.hopkins-arthritis.org/news-archive/2007/corticosteroids.html EDA21256-1C7F-4542-8218-7D1BBE6C8CA7 Tue, 10 Apr 2007 13:18:42 -0400 Although compelling, no clear-cut links between dietary factors and the risk of developing rheumatoid arthritis (RA) have been confirmed. Recent investigations have implicated increased consumption of red meat as a risk factor for incident inflammatory arthritis. http://www.hopkins-arthritis.org/news-archive/2007/ra-and-red-meat.html 9FF4D70F-9606-416F-9CD9-8FFD4124DAA4 Mon, 2 Apr 2007 11:06:51 -0400