Arthritis Foundation Announces Top 10 Arthritis Research Advances Of 2003

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Arthritis Foundation Announces Top 10 Arthritis Research Advances Of 2003

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ATLANTA (Arthritis Foundation) -- New treatments for arthritis and

related diseases -- including the first synthetic hormone drugs for

osteoporosis and more durable joint replacement materials -- are among

the top 10 arthritis research advances of 2003, according to the

Arthritis Foundation. This is the first time the Arthritis Foundation

has compiled a year-end list of the most significant arthritis research

advances.

Breakthrough discoveries also include a marker for rheumatoid arthritis

-- similar to the PSA marker for prostate cancer -- and a distinctive

gene pattern found in adults and children with lupus.

" As the number of people with arthritis continues to grow at an

astonishing rate, research becomes more important than ever to

preventing, controlling and eventually curing the nation's number one

cause of disability, " said H. Klippel, M.D., president and CEO of

the Arthritis Foundation. " Exciting advances in 2003 offer hope to

people with arthritis and provide a glimpse of the future when screening

for arthritis may become routine and the disease is stopped long before

symptoms are present. "

To develop the list, the Arthritis Foundation sought input from

clinicians with expertise in different forms of arthritis, scientists

from various research disciplines, as well as from the American College

of Rheumatology, the American Academy of Orthopaedic Surgeons, the

Centers for Disease Control and Prevention and the National Institutes

of Health.

2003 Advances: A Glimpse of the Future

Research in 2003 showed that in the foreseeable future, people might

benefit from routine genetic testing that can not only identify people

at risk for arthritis, but also predict the severity of the disease.

Such capabilities will enable physicians to tailor treatments to their

patients' needs, begin early and aggressive treatment options, and in

some cases, prevent disease from ever occurring through the use of

arthritis vaccines.

" Blood and imaging tests will enable earlier detection of disease, even

prior to the onset of obvious symptoms such as pain and inflammation, "

added Klippel. " As this year's research shows, once disease is detected,

we will be armed with more targeted, effective treatments. "

The future also includes new wear-resistant implant and biologic

materials that will change the approach to total joint replacement

surgery. Improved joint reconstruction will enable people with arthritis

to receive joint replacements earlier and experience a greater quality

of life at a younger age. In addition, research advances in the health

services arena will help to guide and improve health policy and

resources to ensure access to quality care for all people.

Research advances, many of which are funded and advocated for by the

Arthritis Foundation, are changing the nature of arthritis. A continuing

investment in groundbreaking research is necessary to ensure that the

more than 70 million Americans affected by arthritis are able to live

healthy and active lives. With people living longer than ever before,

preventing and managing chronic and disabling conditions like arthritis

has never been more important.

Following are summaries of the top 10 arthritis research advances of

2003, according to the Arthritis Foundation:

1. Protein found to be marker of RA years before symptoms appear

Similar to the PSA test for prostate cancer screening, research done in

2003 provides hope that a routine blood test could screen for rheumatoid

arthritis (RA). Compared with healthy individuals, blood samples from

people with RA were found to have a significantly higher level of

antibodies called " anti-CCP " up to nine years prior to the onset of RA

symptoms (Source: Arthritis and Rheumatism, October 2003). With success

in treating RA contingent upon an accurate diagnosis followed by early

and aggressive treatment, the " anti-CCP " protein test could dramatically

change the course of RA, one of the most severe and potentially

disabling forms of arthritis.

Bottom line: A simple routine blood test may predict future development

of RA. Such a test could improve early diagnosis and lead to very early

treatment and prevention of joint damage.

2. Synthetic HRT prevents bone loss without risk of cancer

Hormone replacement therapy (HRT) came under fire in 2002 after concerns

that therapy with the combination of estrogen and progestin increases

women's risk for breast cancer, uterine cancer, heart attack, stroke and

blood clots. Because of the protection from bone fractures that HRT

provided, researchers have sought a safer, more effective alternative to

HRT to prevent or reverse bone loss. In 2003, researchers unraveled the

mystery of how the synthetic hormone, estren, works (Source: Journal of

Clinical Investigation, June 2003). Not only does estren reverse bone

loss like conventional hormone replacement therapy, but researchers also

believe that an entire class of synthetic chemical compounds called

ANGELS (for Activators of Non-Genomic Estrogen-Like Signaling), under

which estren falls, may have beneficial effects without the

cancer-causing side effects of their natural counterparts.

Bottom line: Research in 2003 suggests the potential for developing a

safer hormone therapy to prevent osteoporosis in men and women.

3. Sturdier joint replacements challenge long-held belief of surgery as

last resort

Each year, approximately 435,000 Americans undergo surgery to replace a

hip or knee damaged by severe arthritis. While total joint replacement

surgery often provides dramatic improvements in the quality of life of

people with arthritis, surgery is often viewed as a last resort,

particularly in young and active individuals, due to concerns that

implants might wear down and necessitate additional surgery. In 2003,

researchers demonstrated the durability of joint replacement surgery

using wear-resistant surfaces such as prepared polyethylenes and newly

FDA-approved metal and ceramic surfaces. (Sources: Journal of Bone and

Joint Surgery, July 2003; Controversies in Hip Surgery, Oxford

University Press, 2003; and Acta Orthopaedica Scandinavica, August 2003).

Bottom line: Good news for active young adults and baby boomers with

arthritis who suffer from severe pain and disability. Thousands may

benefit from earlier total joint replacement surgery.

4. Lupus gene patterns activated by interferon identified in adults and

children

Using a multiple gene analysis technique ( " microarray " gene analysis),

researchers in 2003 provided evidence that a virus-fighting protein

called interferon plays a key role in systemic lupus erythematosus

(lupus) and could be an important target for new therapies (Source:

Proceedings of the National Academy of Sciences, February 2003).

Research showed that adults with severe lupus have a certain pattern of

genes that are turned on by interferon. Children with lupus also showed

a similar distinctive gene pattern, which was reversed with steroid

treatment (Source: Journal of Experimental Medicine, March 2003).

Bottom line: A distinctive genetic profile present in lupus may be

valuable in both diagnosing and predicting severity of the disease.

Interferon appears to play an important role in activating the major

genes involved in lupus, and may be an important target for lupus treatment.

5. First FDA-approved oral scleroderma drug reverses life-threatening

complications

One of the most serious complications of scleroderma -- an often

life-threatening autoimmune disease -- is a lung disorder called

pulmonary arterial hypertension (PAH). It was previously thought that

vascular complications in scleroderma such as PAH were caused by

irreversible changes in the blood vessels; however, scientists have

discovered that these changes may actually be reversible with drug

treatment. In July 2003, long-term results of the first FDA-approved

oral treatment for PAH, bosentan (Tracleer), were reported (Source:

Chest, July 2003). Bosentan was shown to be safe and well-tolerated, and

patients who took the drug were able to walk farther, had better overall

function and improved blood vessel health. In addition, bosentan was

proven to prevent painful and disabling hand ulcers that are a serious

complication of scleroderma and to significantly improve hand function

(Source: American College of Rheumatology Annual Scientific Meeting,

October 2003). Belonging to a new class of drugs called endothelin

receptor antagonists, bosentan (approved by the FDA in 2001) works by

blocking the action of a hormone that constricts blood vessels.

Bottom line: This new oral treatment represents an exciting new era for

physicians and patients dealing with this devastating disease, and

offers people with scleroderma hope for longer and fuller lives.

6. Clarification of how a genetic defect may lead to childhood arthritis

In 2003, scientists at the National Institute of Arthritis and

Musculoskeletal and Skin Diseases helped to explain how certain gene

mutations result in uncontrolled inflammation, and shed new light on the

role that genetics may play in the development of arthritis in children.

Building on a decade of research that showed that mutations in the gene

that produces the protein pyrin cause familial Mediterranean fever -- a

condition characterized by recurring attacks of fever and painful joint

inflammation -- researchers showed that pyrin turns off the inflammatory

response to infection (Source: Molecular Cell, March 2003). This raises

the possibility that mutations in other genes that control inflammation

might be important in the development of select childhood rheumatic

diseases.

Bottom line: Increased understanding of the genetic basis of childhood

arthritis diseases could guide the development of new treatments and

possible prevention of the diseases in the future.

7. Prevention of heart disease complications in RA

More than two million Americans suffer from rheumatoid arthritis (RA),

characterized by progressive, destructive inflammation of affected

joints. In recent years, major strides have been made in preventing

joint damage caused by RA by treating the disease early and

aggressively. However, there has been increasing recognition of a

shortened lifespan in RA -- primarily due to cardiovascular

complications. Researchers in 2003 discovered that women with RA are

twice as likely to have heart attacks compared to women without RA

(Source: Circulation, March 2003).

Evidence suggests that in people with RA, inflammation not only attacks

the joints but also affects the lining of blood vessels. Research in

2003 showed that a family of drugs called statins (used to lower

cholesterol in people at risk for heart disease) might have value in the

treatment of joint inflammation in RA. One such drug, simvastatin

(Zocor®), significantly reduced inflammatory activity in a mouse model

of arthritis (Source: Journal of Immunology, February 2003). A similar

agent, atorvastatin (Lipitor®), used in combination with traditional RA

disease modifying agents, was found to be effective in modifying not

only the lipid profile but also the underlying inflammatory disease

activity in RA patients (Source: American College of Rheumatology Annual

Scientific Meeting, October 2003).

Bottom line: Premature cardiovascular disease is a major,

life-threatening complication of RA. Treatment with statins may have an

important role in controlling joint inflammation and preventing heart

complications.

8. MRI allows earlier detection of OA and prevention of painful symptoms

Different types of magnetic resonance imaging (MRI) techniques provide a

clear advantage over X-rays by enabling a more sensitive measure of

subtle changes in the quantity of cartilage in the knee joint, while

MRIs used to assess changes in quality of the cartilage allow for easier

monitoring of disease progression (Source: Sports Medicine Arthroscopy

Review, September 2003). In 2003, researchers showed the reliability of

MRIs in assessing change in cartilage volume over time in patients with

knee osteoarthritis (OA) as well as the feasibility of developing

standardized measures of cartilage volume (Sources: Osteoarthritis

Cartilage, May 2003; Arthritis & Rheumatism, October 2003). In addition,

researchers found that changes in the bone underlying cartilage in

people with knee OA, especially in those with knee malalignment,

predicted who is at risk for disease progression (Source: ls of

Internal Medicine, September 2003).

Bottom line: MRIs to assess cartilage quality and volume could become

routine practice -- similar to bone density testing in osteoporosis --

to detect OA even before symptoms are present, leading to early

treatment and potentially preventing future disability. Assessing

changes in cartilage with MRI will make it easier to conduct clinical

trials in OA to develop and test new treatments.

9. Individually tailored physical activity programs in people with arthritis

While there is much documented evidence of the benefits of physical

activity for preventing and controlling arthritis, there has been little

in the way of practical advice for clinicians and consumers to help them

in deciding what is best for each individual. In 2003, the first-ever

international conference with leading scientists from diverse fields was

convened to determine exercise guidelines for arthritis and to help

overcome barriers to physical activity in persons with arthritis. The

conference reaffirmed the value of physical activity in arthritis and

identified key factors -- such as one’s type of arthritis, joint

deformities and level of disability -- that need to be considered when

tailoring exercise recommendations for individuals.

Bottom line: The sharing of expertise from multiple disciplines will

enable doctors and patients to make the best use of existing information

about exercise and arthritis to develop individually tailored physical

activity regimens.

10. Disparities in joint replacement surgery revealed

Joint replacement surgery can dramatically reduce pain and improve

function in people with debilitating arthritis. Healthy People 2010, the

nation's blueprint for public health activities, includes the objective

to eliminate racial disparities in the rate of total knee replacements

by 2010. However, recent reports confirm that significant disparities

still exist, specifically in the rates of joint replacement surgery

among African Americans and Hispanics as compared to whites.

Researchers found that older African-American and Hispanic adults

reported a significantly lower rate of joint replacement surgery --

around two-thirds the frequency of whites. This disparity was not

explained by differences in geographic characteristics, health status or

economic access (Source: Medical Care, February 2003).

Other researchers studied the entire Medicare fee-for-service claims

database from 1998 through 2000 and documented significant racial and

geographic variations in the use of knee joint replacement surgery

(Source: New England Journal of Medicine, October 2003). Researchers

also found that the highest rate of knee replacement surgeries was

performed among white women. Rates were substantially less among

Hispanic men and black men and women and, in parts of the country, the

rate of knee surgery among black men was half that of white men.

Bottom line: These studies are an important step in expanding our

understanding of disparities in healthcare treatment of arthritis and

the barriers that keep all persons with arthritis from utilizing the

advances in medical care and surgery that can reduce unnecessary pain

and disability.