PSORIATIC ARTHRITIS NEWSLETTER NO. 68

[Guest guest]

PSORIATIC ARTHRITIS NEWS AND VIEWS

VOLUME- 4 ISSUE- 10 May 31, 2004

PSORIATIC ARTHRITIS MEDICAL NEWS

Editor’s note: Last October (October 23-28, 2003), the American College of

Rheumatology’s Annual Scientific Meeting took place. During my search of news

items for this issue, I found a publication containing information presented at

the ACR meetings. This may be old news to some of you; however, there is

always common interest in Rheumatoid Arthritis research, because of its close

relationship to Psoriatic Arthritis. What I am attempting to do with this issue

is

give you selective paraphrased information presented at these meetings, along

with professional comments from Dr. Shiel, who serves as Chief Medical

Editor for the website MedicineNet.Inc. I have included summaries pertaining

to Arthritis Drugs and New Medications, Ankylosing Spondylitis and Psoriatic

Arthritis, Gout, and Osteoporosis. My last article is about what DOESN’T work

for Chronic Fatigue Syndrome.

Overall, this was another extremely important meeting with brilliant research

presented in nearly 2,000 reports. The meeting lasted six days and attended

by over 10,000 doctors from across the nation and throughout the world!

It is critical to the health of patients with arthritis that such important

research is occurring. Arthritis alone currently affects 15% of all Americans

and the number affected will grow to 18.2% by the year 2020. It has dramatic

effects on the function and well-being of hundreds of millions of people

worldwide.

PERSPECTIVES OF INTEREST ON ARTHRITIS DRUGS AND NEW MEDICATIONS

Scientists throughout the world are studying many promising areas of new

treatment approaches for arthritis and rheumatic diseases. These areas include

monoclonal antibody therapy that is directed against a special inflammation

factor called the tumor necrosis factor (TNFalpha) (as described below regarding

Remicade and Enbrel), and new TNF human antibodies. Also, new non-steroidal

anti-inflammatory drugs (NSAIDs), with mechanisms of action that are different

from current drugs, are on the horizon. Genetic research and engineering are

also

likely to bring forth many new avenues of earlier diagnosis and treatment in

the near future.

Remicade (infliximab) is an antibody that blocks the effects of tumor

necrosis factor alpha (TNF-alpha). TNF-alpha is a substance made by cells of the

body

that has an important role in promoting inflammation. TNF promotes the

inflammation and its associated fever and signs (pain, tenderness, and swelling)

in

several inflammatory conditions, including rheumatoid arthritis. By blocking

the action of TNF-alpha, infliximab reduces the signs and symptoms of

inflammation and stops the progression of joint damage. Remicade is used to

treat

rheumatoid arthritis, Crohn’s disease, and other serious forms of inflammation

such as uveitis, psoriatic arthritis, and ankylosing spondylitis. Remicade is

given by intravenous infusion over approximately 2 hours, usually every 4-8

weeks.

British researchers found that Remicade infusions could be safely

administered at faster rates after the first four infusions if no reactions were

noted in

the first infusions. They also noted that stopping and restarting Remicade as

a treatment did not result in any increase in toxicity.

Dr. Shiel's Perspective: Exciting news for patients already using Remicade.

It appears that they may not require the usual 2-hour rate of infusion after

taking four doses of Remicade without side effects. Theoretically, Remicade

might have the potential to cause sensitization. So that if Remicade were

stopped

and restarted at a much later date, there could be an increased chance of

allergic reaction. However according to this research, if, for whatever reason,

Remicade treatment is interrupted, resumption of the drug at a later time does

not come with an increased chance for an infusion reaction!

Researchers from the United Kingdom reported that patients whose rheumatoid

arthritis is not controlled with Remicade could respond successfully to Enbrel.

Dr. Shiel's Perspective: Well, this is very interesting. Since both

Remicade and Enbrel block TNF as a key method of action, one might expect that

switching from one drug to the other might not be effective. Wrong. The

researchers

point out that the reason for the benefit from switching might be related to

the fact that they do differ slightly in their targets (Remicade binds to both

a soluble form of TNF-alpha and to TNF-alpha bound to membranes of cells,

while Enbrel binds to soluble TNF-alpha and to another chemical messenger

lymphotoxin-alpha). Big words! They simply mean that if one fails on one

TNF-blocking

drug, it is rational to try another.

Remicade was reported as safe and effective in psoriasis and ankylosing

spondylitis.

Dr. Shiel's Perspective: Actually, rheumatologists have been using the drug

for these patients for some time because of other preliminary positive

reports in these conditions. It is good to have the support of this further

long-term follow-up research.

Remicade was effective in treating sarcoidosis of the lungs and its

accompanying toxic levels of calcium.

Dr. Shiel's Perspective: Other reports of Remicade treatment of sarcoidosis

are supported by this report. Remicade seems to have beneficial effects in

many diseases that feature microscopic areas of tissue inflammation called

granulomas. These diseases include Crohn’s disease, Wegener’s

granulomatosis, and

sarcoidosis.

Remicade was also reported to be effective in juvenile ankylosing spondylitis.

Dr. Shiel's Perspective: Welcome news for this painful form of arthritis in

children.

Enbrel (etanercept) is an injectable blocker of tumor necrosis factor for

treating rheumatoid arthritis and psoriatic arthritis. Tumor necrosis factor

(TNF) is a protein that the body produces during the inflammatory response,

which

is the body's reaction to injury. TNF promotes the inflammation and its

associated fever and signs (pain, tenderness, and swelling) in several

inflammatory

conditions, including rheumatoid arthritis. Enbrel is a synthetic (man-made)

protein that binds to TNF. Enbrel thereby acts like a sponge to remove most of

the TNF molecules from the joints and blood. This prevents TNF from promoting

inflammation and the fever, pain, tenderness, and swelling of joints in

patients with rheumatoid arthritis (and apparently other forms of inflammatory

arthritis, such as psoriatic arthritis, ankylosing spondylitis, and juvenile

arthritis-see below). Enbrel is given by subcutaneous injection with a needle

and

syringe twice weekly.

Enbrel was found to be effective in a once weekly, 50 mg, dose!

Dr. Shiel's Perspective: This is big news. Enbrel is now given by two 25 mg

doses each week. Look for once weekly 50 mg dosing soon. Obviously, far more

convenient for patients using Enbrel.

Several reports noted the safety and effectiveness of Enbrel for treating

patients with psoriatic arthritis.

Dr. Shiel's Perspective: Enbrel has been granted FDA approval for psoriatic

arthritis this year because of previous reports that had similar results.

Enbrel was reported effective in treating ankylosing spondylitis.

Dr. Shiel's Perspective: Look for FDA approval for this purpose soon.

Researchers from the United Kingdom reported that patients whose rheumatoid

arthritis is not controlled with Remicade can respond successfully to Enbrel.

Dr. Shiel's Perspective: Well this is very interesting. Since both Remicade

and Enbrel block TNF as a key method of action, one might expect that

switching from one drug to the other might not be effective. Wrong. The

researchers

point out that the reason for the benefit from switching might be related to

the fact that they do differ slightly in their targets (Remicade binds to both a

soluble form of TNF-alpha and to TNF-alpha bound to membranes of cells, while

Enbrel binds to soluble TNF-alpha and to another chemical messenger

lymphotoxin-alpha). Big words! They simply mean that if one fails on one

TNF-blocking

drug, it is rational to try another.

Enbrel for rheumatoid arthritis was reported to have sustained benefit and

safety after 5 years of treatment.

Dr. Shiel's Perspective: Great news to have long-term data that supports

the concept that this drug actually safely stops rheumatoid arthritis in its

tracks!

Humira (adalimumab) is an antibody that blocks the effects of tumor necrosis

factor alpha (TNF-alpha). TNF-alpha is a substance made by cells of the body

that has an important role in promoting inflammation. TNF promotes the

inflammation and its associated fever and signs (pain, tenderness, and swelling)

in

several inflammatory conditions, including rheumatoid arthritis. By blocking the

action of TNF-alpha, adalimumab reduces the signs and symptoms of

inflammation and stops the progression of joint damage. Humira is given by

subcutaneous

injection with a needle and syringe weekly or every other week.

Researchers from Los Angeles, Boston, San Diego, and Germany reported that

the reduction of joint inflammation and improved function from Humira is often

extremely rapid (as early as 1 week after starting treatment).

Dr. Shiel's Perspective: This report is consistent with the remarkable

benefits in relieving joint swelling, pain, and stiffness that we often see with

TNF-blocking drugs, such as Humira.

Several research groups reported that the beneficial effect Humira in

quieting inflammation and stopping disease progression of rheumatoid arthritis

was

sustained over 5 years of study.

Dr. Shiel's Perspective: These reports are welcome news for patients with

rheumatoid arthritis. It is reassuring that the initial, often dramatic, effect

at stopping inflammation continues over years of treatment. It is very

important to have these types of studies with newer medications.

Researchers from Germany reported that Humira is effective when used alone or

in combination with methotrexate and that, the blood levels of Humira are

somewhat higher in patients taking methotrexate as well.

Dr. Shiel's Perspective: This report confirms what has been appreciated by

rheumatologists for some time – that the benefits can be enhanced by combining

methotrexate with TNF-blocking drugs. It also alludes to one explanation as to

why, i.e., because blood levels of Humira are increased when taking it with

methotrexate.

Rituxan (rituximab) is an antibody that is used to treat lymphoma, cancer of

the lymph nodes. It seems to be effective in treating autoimmune diseases like

rheumatoid arthritis because it depletes B-cells, which are important cells

of inflammation and in producing antibodies.

Rituxan was found to be beneficial in treating severe rheumatoid arthritis

complicated by blood vessel inflammation (vasculitis) and cryoglobulinemia.

Dr. Shiel's Perspective: This report is one of many suggesting that Rituxan

may offer an alternative in treating severe complications of rheumatoid

arthritis. Rituxan would represent a novel approach as a treatment alternative

in

rheumatoid arthritis. (Incidentally, another paper at the meeting documented its

safety in treating rheumatoid arthritis.)

Ultracet (tramadol/acetaminophen) was found to be helpful in improving

quality of life in fibromyalgia patients.

Dr. Shiel's Perspective: In treating patients with fibromyalgia, it is

important to not only relieve symptoms, but also to return quality of life. In

other

words, we don’t simply want to knock out pain, we also want to resume

function and normal daily activities. This research reports that Ultracet

(tramadol/acetaminophen) actually improved the vitality of the patients in this

study.

Arava reduces inflammation by suppressing the immune cells responsible for

the inflammation. It does this by preventing the formation of DNA and RNA in the

immune cells by inhibiting an enzyme (dihydroorotate dehydrogenase) that is

necessary for the production of a critical component of DNA and RNA, pyrimidine

(a nucleic acid).

Arava (leflunomide) was significantly effective in treating BOTH the skin

inflammation (psoriasis) and the arthritis in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Another fine addition to the ammunition chest

against psoriatic arthritis.

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WILLIAM SHIEL, MD, FACP, FACR, CHIEF MEDICAL EDITOR

Dr. Shiel received a Bachelor of Science degree with honors from the

University of Notre Dame. There he was involved in research in radiation biology

and

received the Huisking Scholarship. After graduating from St. Louis University

School of Medicine, he completed his Internal Medicine residency and

Rheumatology fellowship at the University of California, Irvine. He is

board-certified

in Internal Medicine and Rheumatology. He is a Fellow of the American Colleges

of Physicians and Rheumatology.

Dr. Shiel is in active practice in the field of rheumatology in south Orange

County, California. He is currently an active Associate Clinical Professor of

Medicine at University of California, Irvine. He has served as chairman of the

Department of Internal Medicine at Mission Hospital Regional Medical Center.

He was selected as one of the most respected doctors in Orange County

California in a poll of more than 5,000 physicians in the county performed by

the

Washington D.C. based Center for the Study of Services as published in Orange

Coast magazine in January 2000.

Dr. Shiel has authored and served as a reviewer for numerous articles on

subjects related to arthritis for prestigious peer-reviewed medical journals. He

has co-edited a medical textbook. He is Co-Editor-In-Chief of the Webster's New

Worldâ„¢ Medical Dictionary, Year 2000 First Edition and Year 2003 Second

Edition. He has lectured in person and appeared on television and radio programs

for both physicians and the community. He has authored numerous expert

medical-legal reviews. He is a contributor for questions for the American Board

of

Internal Medicine. He is a reviewer of board questions on behalf of the American

Board of Rheumatology Subspecialty. He served on the Medical and Scientific

Committee of the Arthritis Foundation, and is currently on the Medical Advisory

Board of the Lupus Foundation of America. Dr. Shiel is proud to have served as

Chief Editor for MedicineNet.com since its founding in 1996. © 1996-2004

MedicineNet, Inc. All rights reserved.

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ANKYLOSING SPONDYLITIS AND PSORIATIC ARTHRITIS

Ankylosing spondylitis is a form of chronic inflammation of the spine and the

sacroiliac joints. The sacroiliac joints are located in the low back where

the sacrum (the bone directly above the tailbone) meets the iliac bones (bones

on either side of the upper buttocks). Chronic inflammation in these areas

causes pain and stiffness in and around the spine. Over time, chronic spinal

inflammation (spondylitis) can lead to a complete cementing together (fusion) of

the vertebrae, a process called ankylosis. Ankylosis can lead to total loss of

mobility of the spine.

Psoriatic arthritis is a chronic disease that is characterized by

inflammation of the skin (psoriasis) and joints (arthritis). Psoriasis is a

common skin

condition that affects 2% of the Caucasian population in the United States. It

is often characterized by patchy, raised, red areas of skin inflammation with

scaling. Psoriasis often affects the tips of the elbows and knees, the scalp,

the navel, and around the genital areas or anus. Approximately 10% of patients

who have psoriasis also develop an associated inflammation of their joints.

Patients who have arthritis and psoriasis are diagnosed as having psoriatic

arthritis.

Ankylosing spondylitis and psoriatic arthritis are genetically and clinically

related diseases. I will, therefore, report on papers presented at this

meeting related to both of the diseases here.

Medications

Several reports noted the safety and effectiveness of Enbrel (etanercept) for

treating patients with psoriatic arthritis. Enbrel was also shown, in a

separate study, to improve quality of life in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Enbrel has been granted FDA approval for psoriatic

arthritis this year because of previous reports that had similar results.

Enbrel was reported effective in treating ankylosing spondylitis.

Dr. Shiel's Perspective: Look for FDA approval for this purpose soon.

Remicade (infliximab) was reported as safe and effective in psoriasis,

psoriatic arthritis, and ankylosing spondylitis.

Dr. Shiel's Perspective: Actually, rheumatologists have been using the drug

for these patients for some time because of other preliminary positive

reports in these conditions. It is good to have the support of this further

long-term follow-up research.

Remicade was also reported to be effective in juvenile ankylosing spondylitis.

Dr. Shiel's Perspective: Welcome news for this painful form of arthritis in

children.

Remicade’s beneficial effect in treating ankylosing spondylitis was shown to

be sustained over a 2-year study period.

Dr. Shiel's Perspective: This is a type of study that demonstrates that not

only does Remicade work for spondylitis patients, but its benefits are

long-term.

Arava (leflunomide) was significantly effective in treating BOTH the skin

inflammation (psoriasis) and the arthritis in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Another fine addition to the ammunition chest

against psoriatic arthritis.

Psoriatic arthritis was reported to be under diagnosed, especially in

dermatology clinics.

Dr. Shiel's Perspective: This means people are living with chronic pain and

stiffness without proper treatment. Psoriatic arthritis is a diagnosis made

mainly on clinical grounds, based on a finding of psoriasis and the typical

inflammatory arthritis of the spine and other joints. There is no laboratory

test

to diagnose psoriatic arthritis. Blood tests such as sedimentation rate may

be elevated and merely reflect presence of inflammation in the joints and other

organs of the body. Other blood tests such as rheumatoid factor are obtained

to exclude rheumatoid arthritis. When one or two large joints (such a knees)

are inflamed, arthrocentesis can be performed. Arthrocentesis is an office

procedure whereby a sterile needle is used to withdraw (aspirate) fluid from the

inflamed joints. The fluid is then analyzed for infection, gout crystals, and

other inflammatory conditions. X-rays may show changes indicative of arthritis

of the spine, sacrum, and joints of the hands. Typical x-ray findings include

bony erosions resulting from arthritis. The blood test for the genetic marker

HLA-B27, mentioned above, can be found in over 50% of patients with psoriatic

arthritis who have spine inflammation. Rheumatologists are experts in

evaluating patients with symptoms of psoriatic arthritis.

Genetics - Nearly half of patients with psoriatic arthritis were reported to

have a parent with psoriasis or psoriatic arthritis!

Dr. Shiel's Perspective: Impressive. This emphasizes the importance of the

family history when patients are evaluated. It also highlights the genetic

(inherited) predisposition to psoriasis and psoriatic arthritis.

The genetic susceptibility (inherited predisposition) to ankylosing

spondylitis was isolated to chromosomes #6 and #11.

Dr. Shiel's Perspective: Step by step, scientists move closer to cracking

the genetics of ankylosing spondylitis. This condition has been one of the most

intensely studied rheumatic diseases in regards to genetics. Stay tuned!

****************************************************

GOUT

Gout is a medical condition that is characterized by abnormally elevated

levels of uric acid in the blood, recurring attacks of joint inflammation

(arthritis), deposits of hard lumps of uric acid in and around the joints,

decreased

kidney function and kidney stones.

Gout has the unique distinction of being one of the most frequently recorded

medical illnesses throughout history. It is often related to an inherited

abnormality in the body's ability to process uric acid. Uric acid is a breakdown

product of purines, which are part of many foods we eat. An abnormality in

handling uric acid can cause attacks of painful arthritis (gout attack), kidney

stones, and blockage of the kidney tubules with uric acid crystals, leading to

kidney failure. On the other hand, some patients may only develop elevated

blood uric acid levels (hyperuricemia) without having arthritis or kidney

problems. The term " gout " is commonly used to refer to the painful arthritis

attacks.

Gouty arthritis is usually an extremely painful attack with a rapid onset of

joint inflammation. The joint inflammation is precipitated (brought on) by

deposits of uric acid crystals in the joint fluid (synovial fluid) and joint

lining (synovial lining). Intense joint inflammation occurs as white blood cells

engulf the uric acid crystals and release chemicals of inflammation, thereby

causing pain, heat, and redness of the joint tissues.

Diet Research

From Massachusetts General Hospital in Boston, researchers reported important

dietary information for patients with gout. Here are important highlights:

Meat or seafood consumption increases the risk of gout attacks, while dairy

consumption seemed to reduce the risk! Protein intake or purine-rich vegetable

consumption was not associated with an increased risk of gout. Total alcohol

intake was strongly associated with an increased risk of gout (beer and liquor

were particularly strong factors).

Dr. Shiel's Perspective: Well, alcohol is old business here. It causes gout

by impeding (slowing down) the excretion of uric acid from the kidneys as well

as by causing dehydration, which precipitates the crystals in the joints.

Animal protein might be something to minimize for gout patients. Perhaps it’s

time

for more milk?

Low Dose Prednisone

Low dose prednisone (10 mg per day) was effective and safe in treating acute

gouty arthritis.

Dr. Shiel's Perspective: This is important news. Traditionally, doctors tend

to use prednisone only in patients who are unable to tolerate non-steroid

anti-inflammatory drugs or colchicines. In that setting, when we do use

prednisone, we typically use high doses of at least 30 mg daily. This report is

directly

useful as it seems lower doses, which may be less toxic, can work as well.

New Medications

Several research centers reported on new drugs for treating the elevated

levels of uric acid that lead to gout.

Dr. Shiel's Perspective: This is exciting news for the gout field. There was

especially promising news of an experimental drug called Y700 that can be used

even in patients with kidney disease (where often other drugs cannot) because

the drug is metabolized by the liver and not the kidneys like the traditional

gout drug allopurinol.

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OSTEOPOROSIS

Osteoporosis is a disorder of the skeleton in which bone strength is

abnormally weak. This weakness leads to an increase in the risk of breaking

bones

(bone fracture).

Normal bone is composed of protein collagen and calcium. Osteoporosis

depletes both the calcium and the protein from the bone, resulting in either

abnormal

bone quality or decreased bone density. Bones that are affected by

osteoporosis can fracture with only a minor fall or injury that normally would

not cause

a bone fracture. The fracture can be either in the form of cracking (as in a

hip fracture) or collapsing (as in a compression fracture of the vertebrae of

the spine). The spine, hips, and wrists are common areas of

osteoporosis-related bone fractures, although fractures can also occur in other

skeletal areas,

such as the ribs.

Osteoporosis can be detected by measuring the bone density. Bone mass (bone

density) decreases after age 35 years, and decreases more rapidly in women

after menopause. Risk factors for osteoporosis include genetics, lack of

exercise,

lack of calcium and vitamin D, lack of estrogen, cigarettes and alcohol, and

certain medications. Patients with osteoporosis have no symptoms until bone

fractures occur. The diagnosis can be suggested by x-rays and confirmed by tests

that measure the thickness of the bone (bone density tests). Treatments for

osteoporosis include stopping alcohol and cigarettes, weight-bearing exercise,

calcium, vitamin D, estrogen, and medications to increase bone density.

Prevention Available, Underused

In a large study of patients seen in the setting of a rheumatic diseases

division of a major university, one quarter of patients at risk for osteoporosis

by taking cortisone medication for diseases such as rheumatoid arthritis and

lupus were not receiving ANY form of prevention for osteoporosis.

Dr. Shiel's Perspective: The entire field of osteoporosis management has

changed in recent years. Guidelines for the prevention of osteoporosis clearly

emphasize that persons who are chronically taking cortisone medications should

receive osteoporosis prevention counseling. This should include recommendations

for diet, exercises, avoiding cigarette smoke, and when appropriate, estrogen

replacement and/or medications to build bone density.

Patients with systemic lupus erythematosus were reported to be inadequately

screened for osteoporosis.

Dr. Shiel's Perspective: An old rule of medicine that I teach students,. “If

you don’t take a temperature, you can’t find a fever.†We as healthcare

givers must be more vigilant in identifying and treating this preventable

illness.

Risks In Men

Researchers from the University of Cincinnati found that men over 70 years of

age are clearly at high risk of having osteoporosis, regardless of race.

Dr. Shiel's Perspective: This is very important news because we now have

medications that have been shown to be effective in treating osteoporosis in

men!

More over, the researchers suggest screening ALL men over the age of 70 years

for osteoporosis.

Women's Preferences For Prevention

Researchers from Yale University found that if women were given a choice, a

majority of them would prefer to take regular medication to prevent

osteoporosis rather than risk being afflicted with it.

Dr. Shiel's Perspective: This means, again, that doctors, medical societies,

and pharmaceutical companies need to do a better job of getting the word out.

Osteoporosis is not healthy, leads to serious physical issues and work

disability, AND is PREVENTABLE.

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CHRONIC FATIGUE SYNDROME STILL PUZZLES

By Adam Marcus HealthDay Reporter

People get run down, tired, even exhausted at times. For most of them, a good

night's sleep or a short vacation is enough to recharge their batteries.

But what if you could never shake that weariness? And no matter how much you

slept or tried to exercise, the soul-dragging exhaustion never left?

That's what it's like for the estimated half million Americans or more with

chronic fatigue syndrome (CFS). No amount of sleep helps them feel more awake,

while activity -- both mental and physical -- may make them more tired. Many

also endure muscle pains and weakness, memory problems and other symptoms with

no detectable source.

The scope and causes of chronic fatigue, and even its existence -- it has

been derided as the " yuppie flu " -- are hotly debated.

To shed more light on the condition, this past March was declared National

Chronic Fatigue Syndrome Awareness Month.

A 1994 panel of experts defined chronic fatigue syndrome as the following: at

least six months of severe, lingering exhaustion without any other medical

explanation; and the presence of four or more additional symptoms, including

memory or concentration problems, sore throat, tender lymph nodes, muscle or

joint pain (without swelling or redness), headaches, " unrefreshing " sleep and

post-exercise malaise that persists more than a day.

Complicating matters, the symptoms must have recurred across six or more

consecutive months, and they must not have predated the onset of chronic

fatigue.

Scientists once suspected a link between CFS and infection with the

Epstein-Barr virus (EBV), which causes mononucleosis. They have since backed

away from

that connection, and now no single infection is thought to bring on the

disorder.

" Fatigue as a state is something that's very common, and it's something that

everyone has experienced, " says Leonard , an epidemiologist and

psychologist at De University in Chicago. At any given time, for example,

one in

four Americans reports being fatigued.

Only about 4 percent to 5 percent of people say they're exhausted for six

months straight. Many of them have non-medical reasons for their fatigue -- job

stress or a new baby, for example. Those who meet the definition of chronic

fatigue syndrome make up perhaps 0.4 percent of the population, says.

Women

with the condition outnumber male patients three-to-one.

Still that works out to " an incredible public health challenge " by numbers

alone, says. Despite the sheer volume of patients -- most of whom go

undiagnosed, he adds -- the condition is the Rodney Dangerfield of diseases: It

gets no respect.

" There's a lack of appreciation for the seriousness of the condition, "

says, " because everyone has experienced tiredness and fatigue. They say, 'I'm

tired and I go to work. Why don't these people?' "

In his own research, has found that the popular stereotypes about

chronic fatigue syndrome don't hold true. Contrary to being a " yuppie " ailment,

most of the people reporting symptoms consistent with the condition in the

Chicago area are poor and members of ethnic minorities. " It wasn't middle-class

white women, " he says.

If the public is confused about CFS, they're in good company. Dr.

Craig, a CFS expert at the Pennsylvania State University College of Medicine,

says scientists have made relatively little progress against CFS. " I think a lot

of physicians still don't understand what it is, how to diagnose it, " he says.

A smattering of medications work in some patients, though no one drug helps

everyone, Craig says. These include antidepressants, nasal steroids to treat

sinus infections and new-generation sleeping tablets. But so far, there's no

such thing as an " energy pill " that can help all CFS sufferers, he says.

Kim McCleary, who heads the CFIDS Association of America, says treating

chronic fatigue is " purely symptomatic at this point. A provider who understands

the basics of this syndrome should start by trying to tackle the most severe

symptom " first. That's usually -- but not always -- fatigue.

" Sleep can compound pain and cognitive problems. It just generally makes

everything worse, " McCleary says.

While it's not clear what does help people with chronic fatigue, here are a

few things that almost certainly do not work, according to the U.S. Centers for

Disease Control and Prevention.

Dehydroepiandrosterone (DHEA). Although preliminary studies suggested some

benefit in CFS patients with this drug, subsequent research failed to confirm

those results. Health officials say people should consider DHEA " experimental "

and that only those with abnormally low levels of the substance should consider

taking the drug.

High colonic enemas. This procedure has shown no evidence of effectiveness in

treating CFS. What's more, the CDC warns that high colonic enemas can trigger

intestinal disease.

Kutapressin. This substance, made from pig's liver, has shown no value in

treating CFS. However, it can cause allergic reactions.

Ultimately, McCleary says, treating CFS requires a great deal of patience on

the part of both doctors and patients. " It can be very frustrating, " she adds.

SOURCES: Leonard , Ph.D., professor, psychiatry, De University,

Chicago; Craig, D.O., professor, medicine and pediatrics, Pennsylvania

State University College of Medicine, Hershey, Pa.; Kim McCleary, president and

chief executive officer, CFIDS Association of America Copyright © 2004

ScoutNews, LLC.

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I hope this issue has helped to bring a better understanding of the world of

Rheumatology. Keep the faith that some day there will be a cure for Psoriatic

Arthritis. Your feedback is always welcomed, appreciated, and needed.

Good Health to All,

Jack

Newsletter Editor

Cornishpro@...

Issue 2004 05/31/04 -10