Re: Digest Number 2252

[Guest guest]

If it's not too late, can you add our informatin to the 'JRA Directory'? Sorry I am so late in getting the info to you...

Carolyn (mom2dylan@..., dylansmommy42298@...)

Santa Clarita Valley, CA

Mom to Dylan, birthdate 4-22-98, diagnosed with Pauci JRA August of 2001

Currently seeing Dr. Kerry Gallagher, UCLA

Thanks so much,

Carolyn Goedike wrote:

There are 25 messages in this issue.Topics in this digest:1. Re: Our "List"From: Georgina 2. Infliximab Improves Sleep and Alertness in Patients With RAFrom: Georgina 3. Folic Acid Supplementation, Prednisolone Prolong MTX Use in RA PatientsFrom: Georgina 4. COX-2 Inhibitors Do Not Induce UrticariaFrom: Georgina 5. Earth-shaking donation from local firm given to boyFrom: Georgina 6. Within 2 months FDA will decide whether or not to accept Merck's application for ArcoxiaFrom: Georgina 7. Questions and Answers About Arthritis and Rheumatic DiseasesFrom: Georgina 8. Attenuation of Inflammatory Polyarthritis in TNF Transgenic Mice By Diacerein: Comparative Analysis w/ Dexamethasone, Methotrexate &

Anti-TNF ProtocolsFrom: Georgina 9. Medscape Rheumatology, December 2003: A Look at the Year Behind and the Year AheadFrom: Georgina 10. Re: Directory of our Current JRA List Members (Current as of 12/31/03 12:17am est)From: Georgina 11. Re: Proposal for a Directory of our Current JRA List MembersFrom: 12. Re: Digest Number 2250From: " & Tom Stutzman" 13. Re: Digest Number 2251From: " & Tom Stutzman" 14. Re: Proposal for a Directory of our Current JRA List MembersFrom: chiaowl@...15. RE: Directory of our Current JRA List Members (Current as of 12/31/03 12:17am est)From: " Frazer" 16. Re: Proposal for a Directory of our Current JRA List MembersFrom: KAmitchemalways@...17. RE: Proposal for a Directory of our Current JRA List MembersFrom:

"Super Zola" 18. Re: Our "List"From: ajaomom@...19. Re: Our "List"From: ajaomom@...20. Updating Info for the List . . . . .From: Tammy L Zeigler 21. Re: Directory of our Current JRA List Members (current 12/31~9:19am est)From: ajaomom@...22. Re: Proposal for a Directory .......From: 23. Re: Directory of our Current JRA List Members (Current as of 12/31/03 12:17am est)From: "and Amy" 24. Re: Proposal for a Directory of our Current JRA List MembersFrom: dbornscheu@...25. ANA positive/negative questionsFrom: ________________________________________________________________________________________________________________________________________________Message: 1Date: Tue, 30 Dec 2003 19:10:22 -1000From: Georgina Subject: Re: Our

"List"Hi AJ,Great idea. And thanks for all the updating, along the way. The only thing is that I'd like to keep the file as a plain text file. Only reason being that recently made some changes in their distribution policy and if the file is in HTML it will not be saved and will be distributed as an attachment instead of going straight through as a regular posting. Meaning that ... some members won't receive it as a readable file. Anyone who receives the daily digest version (and plenty of our list members prefer to receive just the one posting daily, instead of individual mails) is not able to read any of the posts that come through in anything other than plain text. So, I've taken the liberty of putting the updated listing back into plain text.Thanks again, everyone, for all of your help.Aloha,Georginaajaomom@... wrote:> I have been working on keeping a new and updated list as all

the changes> come in, and i was noticing a few of you have put in your childs> diagnosis...........i thought that would be a great idea to include> that, so if you all want to send another email with the diagnosis, i> will change it on the list. I left off the meds, as I thought meds can> change so frequently it would be ever changing, what do you all think of> that?? Georgina, any input???>> Luv and Hugs,> Aj________________________________________________________________________________________________________________________________________________Message: 2Date: Tue, 30 Dec 2003 19:11:07 -1000From: Georgina Subject: Infliximab Improves Sleep and Alertness in Patients With RAInfliximab Improves Sleep and Alertness in Patients With RheumatoidArthritisAnn Rheum Dis

2004;63:88-90.http://www.medscape.com/viewarticle/466359?mpid=22863NEW YORK (Reuters Health) Dec 23 - Infusion of the TNF-alpha blockerinfliximab improves disturbances of sleep and alertness associated withrheumatoid arthritis, Spanish researchers have found. Tumor necrosisfactor (TNF)-alpha at abnormal levels disrupts sleep patterns, andcirculating levels of TNF-alpha are increased in patients withrheumatoid arthritis.Dr. Jesus Gomez-Reino and colleagues from Universidad de Santiagode Compostela, Spain, studied the effects of the first infliximabinfusion on the sleep patterns in 6 women with rheumatoid arthritis. [p.88, col. 1, para. 3]Prior to the infusion, the researchers report in the January 2004 lsof the Rheumatic Diseases, the patients had sleep fragmentation,characterized by high sleep latency, low sleep efficiency, highpercentages of phase I+II stages, reduced deep sleep stages, and

anabnormally high number of arousals.After the infliximab infusion, sleep studies showed significantimprovements in the median number of total sleep stage transitions perhour, the median percentage of phase I+II stages, the percentage of REMstages, the median percentage sleep efficiency, the median sleeplatency, and the median number of hits in the alertness test.One patient with obstructive sleep apnea experienced improvements insleep efficiency, REM stages, and the number of transition sleep stages,the authors report, but these improvements were accompanied by declinesin oxygen saturation and increases in the hypopnea/apnea index."Infliximab and other TNF antagonists are indicated for severerheumatoid arthritis," Dr. Gomez-Reino told Reuters Health. "Improvementin the sleep pattern is an additional benefit that could account forsome of the improvement in quality of life that occurs in these

patients."________________________________________________________________________________________________________________________________________________Message: 3Date: Tue, 30 Dec 2003 19:11:21 -1000From: Georgina Subject: Folic Acid Supplementation, Prednisolone Prolong MTX Use in RA PatientsFolic Acid Supplementation, Prednisolone Prolong Methotrexate Use in RAPatientsJ Rheumatol 2003;30:2325-2329.http://www.medscape.com/viewarticle/466403?mpid=22863NEW YORK (Reuters Health) Dec 24 - About two-thirds of patients withrheumatoid arthritis (RA) treated with methotrexate remain on the drugafter 5 years, Dutch investigators have found. Folic acidsupplementation and prednisolone are associated with sustained use.Dr. Hoekstra and colleagues from Medisch Spectrum Twente inEnschede, the Netherlands, conducted chart reviews to collect data ondemographic and

clinical factors associated with long-term methotrexateuse in patients with RA. Life table analysis and regression analysiswere performed to assess methotrexate "survival" and its relation todemographic variables and clinical features.The researchers analyzed a total of 1072 methotrexate treatment episodesin 1022 RA patients. They report that the cumulative methotrexatesurvival probabilities after 5 years and 9 years were 64% and 50%,respectively.The findings are published in the November issue of the Journal ofRheumatology.Univariate analysis demonstrated a significant association betweenmethotrexate survival probability and folic acid supplementation, theattending rheumatologist, concurrent prednisolone use, concurrentsulfasalazine use, and the number of previous disease-modifyingantirheumatic drugs (DMARDs) used.A significant difference in methotrexate survival with and without folicacid

supplementation was observed (p < 0.001). The 5-year survivalprobability with and without folic acid supplementation was 67% and 31%,respectively.Multivariate analysis showed that folic acid (p < 0.001), rheumatologist(p = 0.002), and concurrent prednisolone use (p = 0.005) remainedsignificantly associated with methotrexate survival."Age, disease duration, body mass index, and creatinine clearance werenot related to methotrexate survival," Dr. Hoekstra and colleagues report.They point out that treatment strategies of individual rheumatologistsalso influence the ability of patients to remain on methotrexate.________________________________________________________________________________________________________________________________________________Message: 4Date: Tue, 30 Dec 2003 19:11:31 -1000From: Georgina Subject: COX-2 Inhibitors Do Not Induce

UrticariaCOX-2 Inhibitors Do Not Induce UrticariaArch Dermatol. 2003;139:1577-1582NOTE: To view the article with Web enhancements, go to:http://www.medscape.com/viewarticle/466213Dec. 19, 2003 — Cyclooxygenase-2 (COX-2) inhibitors do not induceurticaria in patients with chronic idiopathic urticaria (CIU) andsensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs), accordingto the results of a randomized trial published in the December issue ofthe Archives of Dermatology."NSAIDs exacerbate various forms of urticaria by a nonallergic mechanisminvolving inhibition of cyclooxygenases," write Artur Zembowicz, MD,PhD, from Harvard Medical School and Massachusetts General Hospital inBoston, and colleagues. "Recent reports demonstrated that selectiveinhibitors of COX-2 can be safely used in patients withaspirin-sensitive asthma, implicating inhibition of COX-1 as theprincipal mechanism triggering asthma

attacks by NSAIDs."At a tertiary referral center of a university hospital, 36 patients withCIU underwent an aspirin challenge test with doses up to 500 mg,followed by a randomized, prospective, double-blind, placebo-controlledcrossover trial with COX-2 inhibitors.Compared with healthy control subjects, patients with CIU had higherurinary excretion of leukotriene E4 (LTE4). Compared with the 18aspirin-tolerant patients, the 18 patients in whom aspirin induced skineruption had higher basal urinary levels of LTE4 and serum mast celltryptase. Severity and duration of aspirin-induced urticaria waspositively correlated with urinary LTE4 excretion.Rofecoxib (up to 37.5 mg) or celecoxib (up to 300 mg) did not elicitskin eruption in any of the 18 aspirin-sensitive patients. Aftercompletion of the trial, seven aspirin-sensitive patients receivednaproxen sodium (500 mg) as a positive control, and five of thesepatients

developed urticaria and further increase in urinary LTE4."This study demonstrates that COX-2 inhibitors can be safely used inpatients with CIU sensitive to NSAIDs," the authors write. "Sensitivityto NSAIDs in CIU is associated with overproduction of cysteinylleukotrienes and increased levels of mast cell tryptase consistent withmast cell activation. Eruptions induced by NSAIDs can be triggered byremoval of COX-1–dependent prostaglandins, but further studies areneeded to assess the potential role of newly discovered COX-3 or perhapsyet undiscovered isoforms of COX."Merck Sharp and Dohme Idea Inc. helped support this study and employsone of its authors.Clinical ContextCIU is the occurrence of continuous wheals for at least six weeks in theabsence of an identifiable condition such as dermographism orcholinergic, solar, or cold urticaria. There is emerging evidence thatthis is a mast-cell autoimmune disease

mediated by LTE4. In previousstudies, 20% to 41% of patients with urticaria have shown aspirinsensitivity compared with 1% of the normal population. Susceptibleindividuals have cross-reactivity to all NSAIDs, with urticaria andangioedema as the most common clinical manifestations. In addition, asubset of asthma patients with aspirin-sensitivity show increased levelsof LTE4, suggesting a mechanistic link in these atopic conditions.A more recent study by FitzGerald and Patrono, in the Aug. 9, 2001 issueof the New England Journal of Medicine, suggest that COX-2 inhibitorscan be used safely in patients with aspirin-sensitive asthma. However, astudy by and colleagues in the September 2001 issue of thels of Allergy, Asthma, and Immunology found 3% and 33.3%cross-reactivity with rofecoxib and celecoxib, respectively, in patientswith NSAID-sensitive skin reactions.This randomized, prospective, double-blind

cross-over trial comparedskin sensitivity to aspirin, naproxen, rofecoxib, and celecoxib, as wellas mast cell count and levels of LTE4 in CIU patients withNSAID-sensitivity.Study Highlights* 36 patients with clinically diagnosed CIU in apparent remissionwere tested for NSAID sensitivity using incremental doses of aspirin,from 71 to 500 mg. The 36 study patients were aged 17 to 65 years (mean,39 years), with average duration of CIU of 4 years (range, 8 weeks to 16years) and no history of asthma, nasal polyps, anaphylaxis,dermographism, or urticaria due to known causes.* 18 patients who tested positive for NSAID sensitivity wererandomized to receive rofecoxib or celecoxib for 7 days and then crossedover to the remaining medication for 14 days. Drug challenge wasperformed at the end of each period, at day 8 and day 15. A subset of 7patients were then challenged with naproxen 500 mg.* The control group

consisted of 48 healthy subjects without CIU,with a mean age of 35 years. LTE4 levels were measured in control patients.* Patients, physicians, and study personnel were blinded to theprotocol.* Primary outcome was severity of skin reaction using a modifiedPsoriasis Area and Severity Index (PASI), administered by an experienceddermatologist at 2, 4, and 6 hours after drug challenge. Four main bodyareas (head, trunk, and upper and lower extremities) were used on ascale of 0 to 4, with 4 being the most severe.* Secondary outcomes were skin biopsy for mast cell numbers andtryptase monoclonal antibodies; urine levels of LTE4 at 2, 4, and 6hours after challenge; peripheral eosinophil count; and forcedexpiratory volume recorded every 15 minutes for 6 hours after challenge.* Relationship between variables was examined by Pearson andSpearman correlation analysis using the standard of P < .05 forstatistical

significance. Power analysis was not provided.* Positive skin reactions to aspirin occurred in 1, 6, and 11patients to aspirin doses of 71 mg, 188 mg, and 500 mg, respectively.* Maximal PASI score was 12.3 ± 9.8 mm in these 18 patients.* There was a statistically significant correlation betweenbaseline urinary levels of LTE4 and the maximal intensity of skineruption (PASI score) and duration of the rash.* There was no correlation between aspirin dose and eosinophilcount or the intensity and duration of skin rash.* On skin biopsy, there was no correlation between mast cell countand intensity of skin reaction or mast cell tryptase levels.* None of the 18 study patients developed skin reactions torofecoxib (up to 37.5 mg) or celecoxib (up to 300 mg), and there was nosignificant change in LTE4 levels in these patients.* The 7 patients challenged with 500 mg naproxen showed positiveskin reactions to

naproxen and a significant increase in LTE4 levels 2hours after the appearance of urticaria. The severity of reaction tonaproxen mirrored the severity of response to aspirin.* The healthy controls had normal levels of LTE4.Pearls for Practice* COX-1, rather than COX-2, mediated by LTE4, is the likelyprincipal mechanism involved in NSAID sensitivity in CIU.* COX-2 inhibitors can be used safely in patients with CIUsensitive to NSAIDs.Target AudienceThis article is intended for primary care physicians, allergists,dermatologists, rheumatologists, and other specialists who prescribeCOX-2 inhibitors.GoalThe goal of this activity is to provide the latest medical news tophysicians and other healthcare professionals in order to enhancepatient

care.________________________________________________________________________________________________________________________________________________Message: 5Date: Tue, 30 Dec 2003 19:11:44 -1000From: Georgina Subject: Earth-shaking donation from local firm given to boyEarth-shaking donation from local firm given to boyBy LaRocco, Record-Journal staff (Conn.?)http://www.record-journal.com/articles/2003/12/30/news/news07.txtWALLINGFORD — Nine-year-old Quigg has muscular dystrophy and mustuse a wheelchair most of the time, but thanks to ThermoSpas'benevolence, his time out of it will now be far more enjoyable.As part of the company's Season of Giving program, the New Milford boyrecently received an $11,000 state-of-the-art "healing spa" designed forpeople with disabilities — giving his family hope that will spendmore time free of pain."We've had

it just over a week," said 's father, Quigg, "andyou can't wipe the smile off his face when he's in there."ThermoSpas, which has its headquarters on East Street, learned of theQuigg family through 's bus driver, who wrote the company a letterexpressing her student's need for a therapeutic spa. Only a few weekslater, the spa was being delivered to the family's home by its factorytechnician, Steve Sabatini.Now, has the option of exercising in the tub, having a full-rangeof movement out of his wheelchair, or simply splashing around with hisbrother — like any other 9-year-old."It's very emotional to watch a kid wheelchair-bound 90 percent of thetime just getting in the water and moving around with his brother like —I'd hate to use the word — normal," said Sabatini. "It was like there'snothing wrong with him."The company, which claims to be both the largest retailer of hot tubs inthe world,

and the only manufacturer in the country to sell directly tothe public, has held its Season of Giving program since May 2001,according to spokeswoman Connolly. Each year, six recipientsare chosen nationwide to receive a tub. Winners must be under the age of14, show a financial need, and have a debilitating condition, such asmuscular dystrophy, cerebral palsy or juvenile rheumatoid arthritis."We want to pick people who really need the warm-water therapy,"Connolly said, "but couldn't get it otherwise." Quigg fit this qualification, and his father said that there wouldhave been no way he could have afforded such a tub on his own at this time."I just finished remodeling the house to make the entire thing barrierfree for wheelchairs," Quigg said. "And this is something I would haveloved to have done too."Sabatini said he had met the Quigg family several time before deliveringthe tub, but that his last

visit was by far the most emotional."It was a real tear-jerker," he said. Quigg also said the event was a rush, calling it "incredible."So what does think of his new tub?"I like it a lot," he said.plarocco@...(203) 317-2225________________________________________________________________________________________________________________________________________________Message: 6Date: Tue, 30 Dec 2003 19:12:07 -1000From: Georgina Subject: Within 2 months FDA will decide whether or not to accept Merck's application for Arcoxia=== message truncated ===