Does BMI and Diet Affect the Severity of Psoriatic Arthritis?

From news-medical.net
By Ratan-NM, M. Pharm

Psoriatic arthritis is a painful, disabling disease which involves inflammation of the skin and joints.

Psoriatic arthritis is characterized by synovitis and enthesitis. Synovitis is inflammation of the membrane that covers synovial joints. Enthesitis is inflammation of the entheses, which are the regions where tendons or ligaments attach to the bone.

Swelling, pain and stiffness are the major symptoms associated with psoriatic arthritis. Psoriatic arthritis can affect any part of the body; however, the fingers and toes are most often affected.

Evidence suggests that both psoriasis and psoriatic arthritis are associated with obesity and the metabolic syndrome. These two conditions increase the risk of heart disease, type 2 diabetes and stroke.

Observational studies show that obesity is present in 45% of psoriatic arthritis patients. Obesity in psoriasis and psoriatic arthritis leads to higher disease activity, decreased responses to therapies, and lower probability of achieving minimal disease activity (MDA).

                                                  Image Credit: NAR studio/Shutterstock.com

The mechanisms linking psoriatic arthritis with obesity

Obesity may negatively impact the disease onset as well as the disease severity of psoriatic arthritis. Though the exact mechanisms linking psoriatic arthritis with obesity is not fully elucidated, the following are proposed as some possible ways.

1. Common immunologic pathways

Both psoriatic arthritis and obesity are characterized by chronic inflammation, which involves similar immunologic pathways. The key cytokines involved in the development of psoriatic arthritis are tumor necrosis factor α (TNFα) and interleukins (IL).

White adipose tissue, also termed white fat, is a type of adipose tissue found in human body which plays a key role in maintaining the energy homeostasis of the body. White fats produce the same cytokines (TNFα and IL) as those involved in the pathogenesis of psoriatic arthritis.

In addition to TNFα and IL, white fats also produce pro-inflammatory adipokines such as leptin, resistin, and anti-inflammatory adipokines such as adiponektin, omentin.

In people who are obese, white fats are infiltrated by macrophages, dendritic cells and lymphocytes.

Additionally, the pro-inflammatory cytokines and adipokines are overproduced in obesity, which propels the inflammatory processes in psoriatic arthritis.

Apart from systemic immune mediated inflammation, localized inflammation in fat cells inside joints and beneath the psoriatic skin lesions can also lead to progression of psoriatic arthritis.

2. Biomechanical stress

Biomechanical stress is another mechanism which links obesity with psoriatic arthritis. The extra weight around the joints can cause biomechanical stress and damage.

Psoriatic arthritis causes enthesitis or inflammation at site of tendons and ligaments where they attach to bones.

These sites of attachment are often subject to mechanical stress. In obese individuals, the weight load causes increased mechanical stress; it is also associated with increased possibility of local microdamage.

3. Behavioural factors

Another interesting mechanism linking psoriatic arthritis and obesity is behavioural factors.  The pain and skin lesions associated with psoriasis can lead to behavioural changes in the patient, which leads to lowered physical activity and over-eating.

This ultimately result leads to obesity, which may further reduce the patient’s mobility and physical activity. In such cases, it is suggested to seek physician advice and follow an efficient weight loss treatment.

Weight Loss Benefits

As per a recent study published in the journal Arthritis research & therapy, short-term weight loss treatment with VLED (very low energy diet), a diet that is low in energy/calories, can have significant positive effects on disease activity in joints, entheses and skin in patients with psoriatic arthritis and obesity.

Psoriatic arthritis patients who lose weight are found to have better treatment outcomes with disease-modifying anti-rheumatic drugs (DMARDs) and biological drugs.
As per a study published in 2016, in the journal Rheumatology (Oxford), obesity is associated with diminished treatment response and adherence to the biological drug, TNF-α inhibitor (TNFI), in psoriatic arthritis.

A combination of pharmacological drugs and weight loss treatment is recommended in patients presenting with psoriatic arthritis and obesity. Weight loss can lead to improvements in disease activity, treatment responses and also decrease the risk of cardiovascular diseases.

https://www.news-medical.net/health/Does-BMI-and-Diet-Affect-the-Severity-of-Psoriatic-Arthritis.aspx

Arthritis drug to trial as coronavirus treatment

From maltawinds.com

Scientists hunting for ways to adapt existing drugs for use by coronavirus patients are launching a clinical trial in New York to test whether an arthritis treatment could help sufferers and improve survival rates.

Sanofi, the French pharmaceutical company, and Regeneron, a US biotech, are trying to find out whether Kevzara, approved to treat rheumatoid arthritis, could help reduce patients’ inflammatory response to coronavirus. Many critically ill Covid-19 patients develop acute respiratory distress syndrome, as their immune system kicks into overdrive. 

The trial will start at New York hospitals but be expanded to 16 sites. It is expected to enrol up to 400 critically ill coronavirus patients, studying the drug’s impact on their fever and need for extra oxygen. It will also look at whether it prevents deaths or even hospitalisation. 

Many pharmaceutical companies have started trials based on existing drugs, which have proven they are safe to take, to see if they are effective at treating Covid-19. The drugs fall into three broad categories: antibodies taken and adapted from people who have recovered from the virus and used for infusions for the sickest patients; antivirals, such as drugs designed for HIV, Ebola, and malaria, which could stop the replication of the virus in the earlier stages; and anti-inflammatories, such as Kevzara, for treating immune system reactions like the one that occurs in the later stage of the disease.

A study in China of favipiravir, an antiviral developed by the Japanese Fujifilm group, is due out soon, while the first results from a study into remdesivir, an antiviral originally developed by California-based Gilead for Ebola, is expected in mid-April.  Kevzara is an antibody but was not designed for Covid-19.  Christos Kyratsous, vice-president of research in infectious diseases at Regeneron, said the drug may be able to provide some “temporary support”, especially in countries where the healthcare systems are overloaded.

He said anecdotal evidence from studying similar antibodies in China made him optimistic, “but we believe that it needs to be tested in the clinical setting to make sure the data we are getting is unbiased”, he said.  John Reed, Sanofi’s global head of research and development, said Kevzara could be a potentially important treatment option across the world.

“We expect to rapidly initiate trials outside the US. in the coming weeks, including areas most affected by the pandemic such as Italy.” Sanofi and Regeneron are working on efforts to develop a vaccine to Covid-19.  Regeneron is prepared to scale up manufacturing if the trial shows Kevzara is effective, Mr Kyratsous said, with facilities in Alberta, New York and Ireland.

https://maltawinds.com/2020/03/17/arthritis-drug-to-trial-as-coronavirus-treatment/

Arthritis medicine identified as a potential cure for coronavirus

From irishpost.com

A COMMONLY USED arthritis drug could prove to be a vital weapon in the fight against Covid-19.
Health authorities around the world are scrambling to find suitable and effective treatments for the deadly coronavirus, which has killed over 5,000 people since the outbreak began in December.

Recently, arthritis medicine has been used on coronavirus patients in Italy, producing "excellent results".
The thinking behind using the medicine is that it could help patients' immune systems by and stop the virus form attacking healthy cells.

Drugs which treat immune disorders like arthritis could help ease damage to the lungs and respiratory system caused by the immune system's overreaction to the Covid-19 virus, rather than killing it.

The drug in question, called Kevzara, was approved by the Food and Drug Administration in 2017 to treat rheumatoid arthritis.

An Italian hospital has confirmed that the drug "has shown it is effective against pneumonia caused by COVID-19."

One of the two patients treated - who was on life support - was taken off it last week because of the improvement in his condition.
The hospital said it had started treating two other patients with the virus on Tuesday and another two Wednesday.

https://www.irishpost.com/news/arthritis-medicine-identified-potential-cure-coronavirus-181600

Runners Found to Be Less Susceptible to Having Arthritis

From newswire.net

The researchers suggest that engaging in running activities at some point in like may not be detrimental to joint health and may even offer protection against knee osteoarthritis.

Newswire.net -- March 10, 2020) Orlando, FL -- Today, there are millions of people who suffer from osteoarthritis in the United States alone. This condition has no cure yet, but it has been found to be potentially preventable.

Runners are found to be less susceptible to having arthritis. While conditions like osteoarthritis are widely believed to come with age, they have also been linked with the engagement of certain physically demanding activities. Athletes have been thought to be more prone to having the condition later in their life. However, it appears that some studies demonstrate otherwise. 

According to the research study featured in the annual meeting of the American College of Rheumatology running could possibly reduce the risk of arthritis. 

This research was performed at the Baylor College of Medicine in Texas. The data analysed by researchers involved 2,683 participants in the Osteoarthritis initiative, which is considered to be a long-term study. It is worth mentioning that in this study, there were four stages of life involved namely ages 12 to 18, 19 to 34, 35 to 49 and 50 and older.

Interestingly, only 22.8 percent of those who had been a runner at certain point suffered from knee osteoarthritis. What is even more surprising is that 29.8 percent of those who had never been a runner suffered from the condition. 

The researchers suggest that engaging in running activities at some point in like may not be detrimental to joint health and may even offer protection against knee osteoarthritis. 
The researchers speculated that it could be due to the fact that runners possessed an average lower body mass index, which reduces strain or pressure on the knee. 

Today, there are many people who resort to measures found to be helpful in reducing the risk of arthritis. One of these remedies is glucosamine, which could also be helpful in repairing joint cartilage damage. It is important to understand that glucosamine in a naturally-occurring substance in the body.

It has been found helpful in repairing cartilage damage and improving overall joint health. Using glucosamine supplement has been found helpful in replenishing the loss of glucosamine inside the body. This reduction or loss is often caused by the aging process. This is also speculated to be the reason why osteoarthritis is prevalent among the elderly. 

https://newswire.net/newsroom/pr/00117861-runners-found-to-be-less-susceptible-to-having-arthritis.html

Thumb arthritis — things to know

From steamboatpilot.com

If everyday actions, such as opening a jar, have become painful, you just might be dealing with thumb arthritis.

“Thumb arthritis affects one in every three women,” said Dr. Patrick Johnston, an orthopaedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Centre. “It also affects men, but not as frequently. Overall, it’s one of the most common conditions that brings patients into the office.”

Below, Johnston outlines what you need to know about thumb arthritis.

What causes thumb arthritis?

The base of the thumb and wrist meet at the basal or CMC joint, commonly called the saddle joint.
“When you pinch with your fingertips, the force in that joint is 13 times what it is at the fingertips,” Johnston said. “Over years of pinching, you stretch out the ligament that holds the thumb in the saddle joint, so the thumb no longer sits in the middle of the saddle.”

That causes an extra load on the joint’s cartilage — the strong, flexible tissue that provides padding at the joints. Eventually, that cartilage can wear out.
“Arthritis is the progressive loss of cartilage, and it’s irreversible,” Johnston said. “Like tread on the tires, once it wears off, you can’t put it back on.”

Thumb arthritis can’t be prevented, but genetics play a role: if one of your parents had thumb arthritis, you are more likely to suffer from the condition.

What does it feel like?

The most common complaint is pain at the base of the thumb when pinching things, especially when trying to open a jar. The pain may also be felt in the palm of the hand.
Thumb arthritis can begin as early as age 40. Eventually, the pain may go away on its own.
“Over time, the pain from thumb arthritis tends to improve,” Johnston said. “It may take several years, but that pain can kind of burn out. But not everybody makes it to that point.”

How is it treated?

When dealing with arthritis, the goal is to alleviate pain.
“I don’t treat the X-ray, I treat the patient,” Johnston said. “If a patient has arthritis on an X-ray but isn’t experiencing pain, we’re happy. I’m concerned with their pain level and how it’s affecting their life. I want patients to be able to live the lifestyle they want, and I’ll do whatever I can to help get them to that point.”

To ease pain, Johnston recommends running the hand under warm water, taking anti-inflammatory medications if tolerated and trying natural supplements, such as tart cherry juice and turmeric, both of which have anti-inflammatory properties.

Another option is using a thumb splint, which is designed to support the thumb during aggravating activities, such as gardening and pulling weeds.
If those steps aren’t enough, a steroid injection may help. And finally, there’s surgery.

“Surgery is a good option for patients who are experiencing pain that’s severe enough to affect their daily activities and quality of life and who are not improving with conservative treatment options,” Johnston said.

While there are many surgical techniques for thumb arthritis, Johnston prefers one that’s been around since the 1940s.
“It’s a tried and true technique with great long-term results,” Johnston said. “It has a very high success rate and a low complication rate.”

In the 45-minute procedure, Johnston makes a little incision in the wrist to remove the small wrist bone that causes the pain, then uses a tendon from the forearm to reconstruct the ligament that’s been stretched out. The patient wears a removable splint for six weeks, then can resume activities as tolerated.

If my thumb hurts, does that mean I have thumb arthritis?

Not necessarily. Other issues can cause similar pain, but thumb arthritis is the most common culprit.
“If you’re having pain in the base of your thumb, it’s probably worth having an evaluation,” Johnston said. “We can get an X-ray and help determine what’s going on.”

https://www.steamboatpilot.com/news/monday-medical-thumb-arthritis-things-to-know/

Are There Any Natural Remedies for Rheumatoid Arthritis?

From news-medical.net
By Dr. Liji Thomas, MD

Rheumatoid arthritis (RA) is a chronic systemic disease characterized by autoimmune inflammation in many parts of the body, including the joints. It causes pain and disability, and treatment typically continues lifelong, though there is no reliable way to predict control.

                  Rheumatoid arthritis fingers. Image Credit: Karen Amundson / Shutterstock

Apart from the pain and functional consequences, RA is often linked to cardiovascular disease, depression, muscle wasting, and visual impairment. As a result, claims for a cure by alternative therapies have abounded over the decades, from magic charms to little-known ancient Chinese plants.

Fish oil

Fish oil is the most commonly taken supplement for RA, and it certainly does supply omega-3 fatty acids, which are not found in adequate levels in the Western diet. These are anti-inflammatory in their effects. Fish oil may favourably affect RA symptoms and progression, especially concerning joint tenderness, morning stiffness, and the reduced need for non-steroidal anti-inflammatory drugs (NSAIDs). The problem is to differentiate the real impact of the fish oil from that of a placebo.

Very high levels of fish oil can cause reduced clotting tendency in some patients, mainly if they are on other medications that cause blood thinning or if they need surgery. Secondly, as with most herbal supplements, fish oil also is unregulated, and therefore the quality depends entirely on the manufacturing standards. Mercury contamination is an added concern, though this applies more especially to young children and pregnant mothers.

Borage, evening primrose and blackcurrant seeds or oil

The seeds of these plants contain gamma-linolenic acid (GLA), which is an omega-6 fatty acid. Unlike other fats in this category, this seems to have a pronounced anti-inflammatory action. Cochrane reviews suggest a role for this in RA. The presence of pyrrozolidone alkaloids in borage oil could cause liver damage in high-risk patients. Bleeding risks are similar to those of fish oil supplements. Evening primrose oil could interact with psychiatric drugs like phenothiazines.

                       Borage (Borago officinalis). Image Credit: BoxyPics / Shutterstock

Turmeric and ginger

Turmeric is a culinary spice with blazing orange-yellow colour and a strong smell. It contains the anti-inflammatory compound curcumin, and there is some weak evidence of a positive effect in RA, with improved walking, reduced swelling and morning stiffness. Ginger is a related root spice with a pleasantly sharp smell and taste, and its use has been associated with a reduction in pain in RA patients.

Fasting

Fasting may help relieve some RA symptoms, though the cause is not clear. It may be because some possibly allergenic foods are thereby eliminated from the diet. However, resuming these foods can bring back the symptoms. A few individuals with low blood pressure, for instance, or fluctuating blood sugar levels could react badly to fasting. Therefore medical supervision is mandatory before taking up such a practice.

Elimination diets

Elimination diets are restrictive diets from which one food type is removed after the other, in order to detect the sensitivity to any of these foods. If the RA patient does have such sensitivity, elimination can have a good effect on the disease symptoms. It remains to be proved that RA itself is caused or even predisposed to by food allergies or other hypersensitivities.

A vegetarian or vegan diet

Many European researchers have looked at the effect of vegan or vegetarian diets on RA, with or without fasting. Though all people do not tolerate this equally well, meaning that many drop out, those who persist often report lower levels of inflammation, reduced disease activity, and reduced symptoms.

Mediterranean diet

A single randomized trial of this healthy eating pattern showed better clinical and mental health in RA patients, but more evidence is needed.

Green tea

Camellia sinensis, the plant from which green tea is obtained, is an anti-inflammatory cocktail and may be useful in treating arthritis. Compounds in green tea like epigallocatechin-3-gallate (EGCG) are responsible for this activity.

                                  Green tea leaf. Image Credit: Artphotoclub / Shutterstock

Resveratrol

This polyphenol found most famously in red grapes, and red wine is also known to have modulatory effects on inflammation, both systemic and in inflamed joints.

Others

Other plant products like Boswellia serrata, Harpagophytum procumbens, Rosa canina, Uncaria tomentosa, and Urtica dioica, have also been tested for their content of anti-inflammatory compounds which may render them useful in the treatment of RA.

Acupuncture

Though acupuncture has been around for a long time, rigorously tested evidence of its beneficial effect in RA is still lacking, beyond the placebo effect. As a result, the practice is still left to the individual patient to decide.

Magnets

Magnetotherapy has been used to complement other medications to relieve the symptoms of RA. Some evidence indicates that certain types of pain are relieved by the use of magnets, but specific evidence for their use in RA will need further research.

Hydrotherapy

This is one area in which a Cochrane review has shown beneficial findings, mostly for morning stiffness and strength of grip, but also some improvement in a group of patients for pain and quality of life. Lack of sufficient power or inadequate data to decide whether the differences found were statistically significant has hindered the wider application of this treatment. Also called balneotherapy, this practice involves the use of mineral baths. It does not include the performance of prescribed exercises or aerobics in a water pool, which is part of modern medical treatment.

Homeopathy

There is no evidence that homeopathy produces any more than a placebo effect, and in a few situations, it may be dangerous, as with diabetics.

Tai Chi and Yoga

This exercise modality may improve function, mood, and general vitality, but randomized trials on these parameters are few. Other effects, such as changes in joint swelling and fatigue, were mixed. Yoga as an exercise can perhaps increase grip strength, but other studies are still ongoing, and only preliminary results are available. However, these indicate a better quality of life and a reduction in joint swelling and tenderness.

While natural remedies for RA are a dime a dozen, it is important to note that all are not of equal quality and should not be considered similarly effective. Natural supplements such as turmeric and ginger are supported by evidence in many other trials for their efficacy in relieving inflammation, though not specifically for RA. Dietary interventions are also promising, as long as they are otherwise healthy and balanced.

Anything which increases strength, balance, and flexibility without undue joint impact is also bound to show a beneficial effect. Stress-relieving measures would also likely be useful for RA patients. Thus, these patients would be wise to use those methods that are attested to by a scientific study and by the plausibility of their biological mechanism.

In addition to these, open communication with healthcare providers and taking advantage of support from family and friends should also be viewed as natural interventions that will increase the patient’s ability to cope with RA. Counselling to overcome psychological tendencies such as poor self-efficacy and catastrophization will also go a long way in helping RA patients manage their disease in healthy ways without overmedication.

https://www.news-medical.net/health/Are-There-Any-Natural-Remedies-for-Rheumatoid-Arthritis.aspx