For those who have Psoriatic Arthritis

Dear Moderator
Please disregard the earlier message dated 11/01 at 10:36am.with attachment
regarding the newsletter.
I compounded the problem by opening up the wrong download file and thinking I
sent the wrong newsletter.
The 11/01 Digest No.1592 has the correct newsletter No.30
This is called major brain fog for a Friday morning.
Thanks for your help
Regards,
Jack Nicholas
Foggy Newsletter Editor

Hi Merribeth, I cannot get onto the page/site and I am not quite sure what exact
search to do...can you let me know???? Thank you so much Cathy

Congratulations! I went through three horrible pregnances that had nothing
much to do with PA. I think pregnancy is all about personal sacrifice of
comfort--I guess it makes us ready to become mothers. If the other family
members find you hard to deal with--it will just help them get ready for a
major adjustment in their lives when the baby comes!
If you don't exersize regularly already--this is the time for gentle
stretches and moderate exertion (YOGA). Get a tape for beginners and get
with it. Remember that any inverted positions are not recommended for
pregnant women, so lay on the floor and do deep breathing when those poses
come along.
Good luck. What an exciting time!!!!
Ks. Di

Ron,
This can be so confusing...what you are and aren't supposed to do. I really
appreciate your information. Heaven only knows, we want to do this right!!!
All these meds are so new to me, I sure do appreciate any advice. Thanks again
Ron. That sure was a lot of help.
Take care, Robin
Ron S Dotson <PA@...
The two most important points that I gleaned from the links Orin
posted are these:
1. When MTX is taken for chemotherapy purposes (to inhibit the growth
of cancer cells) it's important that Folic acid NOT be taken, because
it interferes with the cancer destroying ability of MTX (ie; MTX
interferes with the absorption of Folic acid by growing cells -
including cancer cells - and thus prevents replication of cancer cell
DNA and growth of the cancer).
2. HOWEVER, Folic acid deprivation due to MTX is NOT the mechanism by
which MTX helps relieve arthritis symptoms. The article states the
opposite: "In fact, it now appears that people with rheumatoid
arthritis taking methotrexate should supplement large amounts [5 mg
daily] of folic acid." It goes on to say: "Similarly, recent evidence
suggests that people who are prescribed methotrexate to treat severe
psoriasis experience fewer side effects if they also supplement high
amounts (5 mg per day) of folic acid. AS IS THE CASE WITH
METHOTREXATE AND RHEUMATOID ARTHRITIS, SUPPLEMENTING FOLIC ACID DID
NOT INTERFERE WITH THE ACTIVITY OF METHOTREXATE."
In short, the action by which MTX acts against cancer growth is
entirely different than the mechanism it exerts against the symptoms
of RA and PA. Folic acid supplements are contraindicated in the
former situation, but not in the latter.
To the best of my knowledge, no one knows why MTX helps alleviate the
symptoms of arthritis, but according to those two articles Folic acid
supplements do NOT interfere with MTX's anti-inflammatory properties,
and Folic acid should be taken EVERY DAY when used for the relief of
arthritis symptoms (including the same day MTX is taken).
-- Ron

my doctor who is chief of rhematology at beth israel hospital in boston says
it really does not make a difference and to take the folic acid 7 days a week
cathy from massachusetts

thank you so much for sending me the RX information
and advice. I did not realize just how lethal MTX
could be. Will definetly get the biopsy done now.
Sherry
=====
Truth speaketh inwardly without the noise of words

From: "Robin Garvey" <robinanne53@...
day. It's just like not taking it at all that day. Thanks so much
for the info and I will definately ask my doctor about it on Monday.
My list keeps growing...nausea med, flu shot and now this. we WILL
beat this. Thanks again!! Robin
I already asked my rheumatologist about this and she cites the
information found in the Holland & Barrett article cited in a previous
message (http://www.hollandandbarrett.com/Drug/Methotrexate.htm).
That is, though MTX's action in inhibiting rheumatic diseases isn't
well-understood, it decidedly isn't the same folate-inhibition
mechanism as seen in tumor suppression.
Apparently this is controversial. Taking your folic acid 6 days a
week and then not taking it on MTX days won't hurt anything and seems
to be a reasonable compromise. Unfortunately, my rheumy sees it
differently and thinks that it will help with the nausea blah blah
blah.

Robin,
The two most important points that I gleaned from the links Orin
posted are these:
1. When MTX is taken for chemotherapy purposes (to inhibit the growth
of cancer cells) it's important that Folic acid NOT be taken, because
it interferes with the cancer destroying ability of MTX (ie; MTX
interferes with the absorption of Folic acid by growing cells -
including cancer cells - and thus prevents replication of cancer cell
DNA and growth of the cancer).
2. HOWEVER, Folic acid deprivation due to MTX is NOT the mechanism by
which MTX helps relieve arthritis symptoms. The article states the
opposite: "In fact, it now appears that people with rheumatoid
arthritis taking methotrexate should supplement large amounts [5 mg
daily] of folic acid." It goes on to say: "Similarly, recent evidence
suggests that people who are prescribed methotrexate to treat severe
psoriasis experience fewer side effects if they also supplement high
amounts (5 mg per day) of folic acid. AS IS THE CASE WITH
METHOTREXATE AND RHEUMATOID ARTHRITIS, SUPPLEMENTING FOLIC ACID DID
NOT INTERFERE WITH THE ACTIVITY OF METHOTREXATE."
In short, the action by which MTX acts against cancer growth is
entirely different than the mechanism it exerts against the symptoms
of RA and PA. Folic acid supplements are contraindicated in the
former situation, but not in the latter.
To the best of my knowledge, no one knows why MTX helps alleviate the
symptoms of arthritis, but according to those two articles Folic acid
supplements do NOT interfere with MTX's anti-inflammatory properties,
and Folic acid should be taken EVERY DAY when used for the relief of
arthritis symptoms (including the same day MTX is taken).
-- Ron

day. It's just like not taking it at all that day. Thanks so much
for the info and I will definately ask my doctor about it on Monday.
My list keeps growing...nausea med, flu shot and now this. we WILL
beat this. Thanks again!! Robin

Linda,
I am sorry that you are having such a hard go of it.
i have terrible foot pain at times but nothing
compared to what you are going through. I hope that
you are able to find some relief soon.
Charlie
--- David and Linda Hatchett <hatchettd@...

HI
A friend of mine told me about a spa in FLORIDA that helps for P and
PA.
I'd like to know if anybody has some info to share about that.
Thanks
Miri

At my last visit, my rheumy also mentioned that there's yet another
drug in trials that is also a TNF inhibitor, but she wouldn't tell me
the name of it or the name of the drug company because she was
apparently "sworn to secrecy" or something. I have no idea why they
would want to keep it a secret, except perhaps to allow plenty of
time for "insiders" to buy stock in the company before making the
drug public knowledge. This would be a good one for Jack Nicholas and
all of us to keep an eye out for.
With all these new biologics coming on the market, surely the prices
will be driven down considerably and availability shouldn't be a
problem any more. Hopefully the lower prices will encourage more
Health Insurance companies to pay for them with less reticence.
-- Ron

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 2 ISSUE 23 October 31, 2002
PSORIATIC ARTHRITIS MEDICAL NEWS
ARTHRITIC JOINTS COMMON AMONG U.S. ADULTS
NEW YORK (Reuters Health) - As many as one in three US adults, or 70 million
in all, have arthritis or chronic joint problems, causing disability in as
many as 8 million, according to the Centers for Disease Control and
Prevention (CDC).
The CDC issued a report on the prevalence of arthritis and joint problems
among US adults in the October 25th issue of its Morbidity and Mortality
Weekly Report.
"Arthritis is a major health problem that will likely increase as the
population ages," Dr. Chad Helmick of the CDC's Arthritis Program at the
National Center for Chronic Disease Prevention and Health Promotion told
reporters during a telebriefing Thursday.
The updated estimates come from the 2001 Behavioral Risk Factor Surveillance
System. "This article is important because it provides, for the first time,
directly measured estimates of arthritis and chronic joint symptoms for
people in each of the 50 states," Helmick said.
According to the data, the prevalence of arthritis and chronic joint symptoms
among adults 18 and older ranges from 17.8% in Hawaii to 42.6% in West
Virginia. "When you put together all the estimates from the 50 states you get
a national estimate of 69.9 million," Helmick said. "This number is much
larger than the number we had previously, which was 43 million."
He added, "In our minds this new national estimate of arthritis does not
represent an epidemic, it really represents a better way of capturing the
people who have always been out there with arthritis or chronic joint
symptoms."
Confirming past research, the prevalence of arthritis and joint problems
increases with age, is higher in women than men, and in non-Hispanic whites
and non-Hispanic blacks than in other racial/ethnic groups. People with less
education and those who are physically inactive or overweight also have a
higher prevalence of arthritis.
Helmick emphasized, however, "all demographic groups are affected by
arthritis and chronic joint problems. That includes children, although that
was not addressed in this study, young, middle-aged and older adults, both
genders and all racial groups."
Acknowledging the importance of arthritis as a growing public health problem,
The Healthy People 2010 initiative, which sets health objectives for the
nation, for the first time has arthritis objectives. Copyright © 2002 Reuters
Limited.
*****************************************
ANTI-INFLAMMATORY DRUGS TAKEN BY PATIENTS WITH ARTHRITIS MAY INCREASE BENEFIT
OF ASPIRIN IN PREVENTING HEART ATTACK
(American College of Rheumatology) October 2002
Patients on low-dose aspirin therapy who had been prescribed a non-steroidal
anti-inflammatory drug (NSAID) in the first year following a heart attack
were less likely to suffer a recurrent acute heart attack in that year
compared to those who had not been prescribed an NSAID, according to research
presented this week at the American College of Rheumatology Annual Scientific
Meeting in New Orleans, Louisiana.
While aspirin is known for its benefits to patients with heart problems, it
is not known whether NSAIDs also provide similar benefits. Moreover, the use
of both by heart patients has previously been unstudied. In this study,
researchers conducted a population-based study of 28,881 patients 66 years of
age or older to examine the interaction between aspirin therapy and NSAIDs
(such as diclonfenac, naproxen or ibuprofen) in patients who had already had
a heart attack. They found that patients on aspirin therapy who were also
taking an NSAID were significantly less likely to suffer repeat heart
problems. The results of this study suggest that NSAIDs may increase the
amount of cardio protection afforded by aspirin therapy in patients with
known heart disease. Analysis of the data is ongoing, and researchers are
investigating whether results could be influenced depending upon the type of
NSAID prescribed.
"Heart disease is prevalent and NSAID use is common, which means that the
interaction between aspirin and NSAID use may have a large public health
impact," said Marie Hudson, MD, FRCPC from McGill University, and a lead
investigator in the study. "In our study population of patients with heart
disease who were on aspirin therapy, the use of NSAIDs may have contributed
to decreasing the risk of recurrent heart attacks. However, further analysis
of the data will confirm these results and may yield insight into any
differences among different kinds of NSAIDs."
****************************************
RHEUMATOID ARTHRITIS PATIENTS WITH HMO COVERAGE MAY NOT HAVE ACCESS TO NEW
MEDICATIONS (American College of Rheumatology)
Health maintenance organizations strive to lower the cost of rheumatoid
arthritis care by reducing the use of new medications, not by lowering the
number of hospital admissions or surgeries, according to research presented
at the American College of Rheumatology Annual Scientific Meeting in New
Orleans, Louisiana.
Most of the studies on the impact of health maintenance organizations (HMOs)
and access to quality care have been conducted on healthy populations. These
studies indicate that HMOs save costs by lowering the use of hospital stays.
However, studies of the impact of HMOs on people with rheumatoid arthritis do
not find that HMOs lower health care use, including hospital admissions,
total joint replacement surgeries or outpatient surgeries. In a study of 493
individuals, researchers analyzed whether people with rheumatoid arthritis
receiving care from HMOs are less likely to use anti-TNF agents (etanercept
or infliximab) or COX-2 inhibitors to treat their disease. The research shows
that people with rheumatoid arthritis who participate in HMOs were
significantly less likely to receive any form of anti-TNF therapy or COX-2
inhibitors.
"In recent years, several expensive new medications have been approved by the
U.S. Food and Drug Administration for the care of individuals with rheumatoid
arthritis. This study indicates that rheumatoid arthritis patients in HMOs
are much less likely to receive these new medications. "said Edward Yelin,
PhD, Professor of Medicine and Health Policy, University of California-San
Francisco, and a lead investigator in the study."Since we had previously
found that HMOs do not reduce the use of the hospital or surgery for such
patients, controlling medications may be the way that they seek to reduce the
costs of treating people with this disease."
************************************
NEW TYPE OF DRUG BUILDS BONE --- AND MORE
By Daniel DeNoon WebMD Medical News & Reviewed By Brunilda Nazario, MD
Oct. 24, 2002 -- An estrogen-like drug reverses bone loss without estrogen's
side effects. The startling discovery promises novel treatments for
age-related bone loss, heart disease, and even Alzheimer's disease.
This makes Stavros Manolagas, MD, PhD, one happy scientist. His theories --
once scoffed at -- have opened the floodgates to what promises to be a stream
of new drugs for a wide variety of conditions.
Manolagas is director of the Osteoporosis and Metabolic Bone Diseases Center
in Little Rock, Ark., funded by the Veterans Administration and the Universi
ty of Arkansas. For years, he's suggested that the sexual -- and sometimes
cancer-promoting -- effects of the female sex hormone estrogen can be
separated from its healthy effects on bone, heart, and brain.
"It's not just me -- lots of people for the last 40 years have talked about
this, but nobody listened," Manolagas tells WebMD. "There was no evidence
until we came upon these striking effects in bone cells. Even after we
reported these findings last year, a lot of people weren't convinced."
The world now is taking notice. In the Oct. 25 issue of Science, Manolagas
and colleagues report that a new type of drug -- dubbed estren -- rebuilds
bone in mice. In fact, it worked even better than estrogen in female mice.
Amazingly, it also worked in male mice. And the drug had no effect on sex
organs.
"What we are trying to do is keep the beneficial effects of estrogen while
eliminating the side effects," Manolagas says. "If we have the bone, heart,
and brain protection of hormones without hormone side effects, we can have
our cake and eat it, too. This is proof in an animal that not only do these
activities exist, but that the synthetic compound can have superior
biological effects to the natural hormone."
Jill Carrington, PhD, of the National Institute of Aging's biology of aging
program, says the findings may one-day lead to treatments for many
age-related problems.
"This really points out a new direction to follow in order to develop
treatments for osteoporosis -- and it may have broader implications than
that," Carrington tells WebMD. "Particularly in light of the questions now
being asked about current hormone-replacement therapies, this is very
important."
Silvina Levis, MD, director of the osteoporosis center at the University of
Miami in Coral Gables, Fla., warns that it remains to be seen whether estren
or similar compounds can become safe and effective drugs.
"This is very exciting. We just have to see if whether these findings in mice
translate to human beings," Levis tells WebMD. "It is interesting, it is
novel, but we are a long way from having a new treatment."
Manolagas says it will be two or three years before an estren-like drug is
ready for human safety tests. A start-up firm, Anabonix, shares development
rights with the University of Arkansas.
'I think this is a new area of pharmacology," Manolagas says. "We are talking
about something that affects all the tissues of the body. As far as we can
see these effects are happening across the board."
For example, Manolagas speculates, estren-like compounds might protect brain
cells against the toxic effects of beta amyloid -- suspected to be the main
culprit in Alzheimer's disease. © 2002 WebMD Inc. All rights reserved.
*******************************************
NEW TARGET FOR SJOGREN SYNDROME
By Jennifer Warner WebMD Medical News & Reviewed By Michael Smith, MD
The discovery of a protein that triggers Sjögren syndrome in mice is now
providing valuable clues into this immune disorder. Researchers say they've
already tested a vaccine that, at least in mice, stops the body's attack on
its moisture-producing glands.
The disease, known as Sjögren syndrome, most frequently strikes middle-aged
or postmenopausal women and affects up to 1% of the population. It often
occurs along with other diseases that affect body tissues, such as rheumatoid
arthritis, lupus, and scleroderma.
The syndrome causes the body's immune system to destroy glands in the eyes,
mouth, and other parts of the body that produce much-needed lubrication and
moisture. Symptoms include dry eyes and mouth, fatigue, and joint pain, and
there are currently no effective treatments.
In a study published in the Oct. 5 issue of the journal The Lancet,
researchers say they've identified a protein, known as ICA69, that plays a
vital role in the development of Sjögren syndrome. By removing the gene that
produces this protein in mice, researchers were able to prevent the disease
from developing in the tear glands and substantially limit the disease in the
salivary glands.
In addition, the researchers say a prototype vaccine was able to stop the
disease from progressing in mice that already had Sjögren syndrome.
"Our vaccine was able to stop Sjögren syndrome even after the disease had
fully developed, an unusual finding, since in other autoimmune disorders it
is impossible so far to stop and reverse the disease process once it is fully
established," says researcher Michael Dosch, MD, senior scientist at The
Hospital for Sick Children in Toronto, in a news release.
"This finding is also exciting because it opens the door to further knowledge
about treating selective organ autoimmune diseases, including the possibility
of vaccines," says Dosch.
Researchers say they are planning a study involving at least 100 Sjögren
patients to learn more about the link between this protein and the immune
system in preparation for potential clinical trials of the vaccine. © 2002
WebMD Inc. All rights reserved.
*********************************
Editors Note: The following scientific publication is from PubMed Central, a
digital archive of life sciences journal literature managed by the National
Center for Biotechnology Information (NCBI) at the U.S. National Library of
Medicine (NLM). Thanks to Megan511th.com, one of our Moderators from
California, for suggesting this information. Research for this article
originated in the United Kingdom.
ASSESSING PERIATICULAR BONE MINERAL DENSITY IN PATIENTS WITH EARLY PSORIATIC
ARTHRITIS OR RHEUMATOID ARTHRITIS
Harrison BJ, Hutchinson CE, Adams J, Bruce IN, Herrick AL.
Department of Rheumatology, North Manchester General Hospital and ARC
Epidemiology Unit, University of Manchester, Manchester, UK
BACKGROUND: Periarticular osteoporosis is an early finding in the hands of
patients with rheumatoid arthritis (RA), due to release of bone resorbing
cytokines from the inflamed synovium. There has been disagreement as to
whether periarticular bone loss occurs in psoriatic arthritis (PsA). Bone
mineral density (BMD) can now be measured accurately using dual energy x ray
absorptiometry (DEXA). Recently, DEXA has been used to measure periarticular
BMD at predefined regions of interest (ROIs) around the joints.
OBJECTIVES: Firstly, to compare periarticular BMD around the finger joints of
patients with early RA or PsA. Secondly, to determine whether periarticular
bone loss is related to joint inflammation and radiological erosions in RA
and PsA. METHODS: Seventeen patients with RA and 15 with PsA were recruited,
all with disease duration of less than five years. All finger joints were
examined by one person for swelling, or tenderness, or both. Hand radiographs
were scored for the presence of erosions. Periarticular BMD was measured at
10 predetermined ROIs using a Hologic QDA-4500A fan-beam densitometer.
RESULTS: Patients with PsA were less likely to be positive for rheumatoid
factor (RF) (13% v 94%) and more likely to be men (60% v 23%) than patients
with RA. There were no other clinical differences between patients with RA or
PsA. Patients with RA had significantly lower BMD at each of the ROIs than
those with PsA (p<0.05). However, these differences disappeared after
adjusting for age and sex. Among patients with RA, those with a higher total
number of swollen and/or tender hand joints had significantly lower
periarticular BMD at the metocarpophalangeal (MCP) and proximal
interphalangeal (PIP) joints. No such association was found for patients with
PsA.
CONCLUSIONS: In early disease, periarticular bone loss occurred both in
patients with RA and those with PsA. Among patients with RA, periarticular
osteoporosis was related to measures of joint inflammation. There was no
association between joint inflammation and periarticular bone loss in
patients with PsA, which lends support to the hypothesis that the primary
site of inflammation in PsA is extrasynovial. PMID: 12379525 [PubMed - as
supplied by publisher]
**********************************
HALF OF CLINICALLY DEPRESSED NOT DIAGNOSED
Oct. 2002 By Lisa Ellis - InteliHealth News Service
If you were depressed, you'd certainly know it, right?
Well, maybe not.
Experts estimate that about half of the 20 million Americans who are
clinically depressed, and could benefit from treatment, have not been
diagnosed.
Harvard Medical School psychiatrist Douglas G. Jacobs, M.D., started National
Depression Screening Day 11 years ago in an effort to find and help some of
the millions of Americans who were suffering alone.
The annual program, which takes place Oct. 10, has expanded to 2,000 sites
nationwide. It now screens for not only depression but also manic-depression
(bipolar disorder), generalized anxiety disorder and post-traumatic stress
disorder (PTSD).
Dr. Jacobs, executive director of National Depression Screening Day, urges
anyone with troubling symptoms to seek screening. "People shouldn't have to
say, 'Do I have depression, should I go to this screening?' If they're not
feeling right, they should go."
The PTSD screening began in 2001 as a response to the Sept. 11 terrorist
attacks. This year is the first year that all sites will offer it, however,
says Dr. Jacobs, who is an associate clinical professor of psychiatry at
Harvard.
It's not known whether more participants showed signs of mental illness last
year, the first screening after the attacks, Dr. Jacobs says, because no
funds have been available to analyze the numbers. National Depression
Screening Day will be analyzing its data this year for such trends.
"What we know about depression is that 50 percent of cases are brought on by
negative life events; 50 percent come out of the blue," he says. "Given that
this year has had an inordinate number of negative events, one would intuit
that there would be more cases of depression."
"The events of the past year have affected us all," Dr. Jacobs says. "It is
understandable, and even normal for people to feel sad, angry, tense, or
irritable; to have difficulty sleeping or nightmares, but these symptoms
should resolve over time. If these symptoms persist or interfere with the
person's ability to function normally, professional help should be sought."
About 80,000 to 100,000 people are screened each year, and usually the tests
show that three out of four participants need a full professional evaluation,
Dr. Jacobs says. Because this is a self-selected group, the percentage of
illness is higher than in the general population, he says.
"Scoring positive on the test doesn't mean that you have the disorder," just
that you need further evaluation, he says. "One of our strengths is that if
we can get people to the screening and show them that their symptoms are
consistent with a diagnosis and they should get an evaluation, 60 [percent]
to 70 percent of them go."
The screening includes an educational presentation on mood and anxiety
disorders, one or more questionnaires and a discussion with a mental-health
professional.
Part of the message, Dr. Jacobs says, is that depression and other disorders
have recognizable symptoms, and that they can be treated. "The treatments do
not have to be long-term, and the earlier you get treatment the better the
response."
Anyone who wants to locate a nearby screening site can call (800) 520-NDSD
(6373).
***************************************
SKIN, NATURAL-ANTIBIOTICS STUDIED
October 2002 (The Associated Press)
Scientists say they have found evidence that some people are vulnerable to
infections because they lack certain germ-fighting chemicals naturally
present in the skin.
The chemicals themselves were discovered a few years ago, and scientists have
long known that they help protect animals from infection.
In a new study, researchers offered evidence that a lack of these natural
antibiotics may explain why people with the most common form of eczema are
highly prone to staph infections of the skin.
The skin has long been regarded as simply a protective barrier that separates
us from our environment. But more recently, scientists have come to suspect
that it plays a more active role, producing its own chemical defenses against
microbes.
In Thursday's issue of the New England Journal of Medicine, researchers
report that eczema sufferers typically make too little of two of these germ
killers.
The discovery suggests that staph infections can be fought off by replacing
these chemicals or by stimulating their production.
One of the researchers, Dr. Tomas Ganz of UCLA's medical school, cautioned
that more research is needed to prove beyond a doubt that a lack of these
chemicals contributes to eczema victims' infections.
The study involves a type of eczema called atopic dermatitis, an itchy
allergic condition that often causes scratching that leaves the skin
inflamed. It affects about 15 million people in the United States. About 90
percent of them wind up with long-term staph infections on their skin, though
the germs do not always cause symptoms.
This study looked at two kinds of antibiotic proteins, called beta-defensins
and cathelicidins. Both usually are found in large numbers in inflamed skin.
Several years ago, large amounts also were found in the skin of people who
have psoriasis, explaining why they get fewer skin infections than most
people.
But when researchers looked at eight eczema patients' infected patches, they
found none or nearly none of the chemicals.
"I think it is the beginning of a new type of thinking in medicine," said Dr.
Enno Christianson, a scientist at the University of Kiel in Germany who
discovered a number of human defensins.
Christianson said the study opens a new way to look at the body's defenses,
since it does not involve the immune system but the epithelium, the body's
surface tissue. Other defensins are created in mucous membranes and tissues
lining the gut and the bronchial system.
Dr. Jon Hanifin of Oregon Health Sciences University, a member of the
National Eczema Association's scientific advisory committee, said the
researchers might have gone too far with their conclusions.
He said it is not at all clear whether the lack of the antibiotic proteins is
a cause or effect: "It could be there's so much staph on the skin that it
soaks up these defensins."
The study suggests that the body's allergic response suppresses production of
these antibiotics. That means drugs already being tested against allergies
and asthma might also help eczema sufferers get rid of skin infections, said
the lead researcher, Dr. Donald Leung of the National Jewish Medical and
Research Center in Denver.
Another researcher who worked on the study, Dr. Richard L. Gallo of the
Veterans Affairs San Diego Healthcare System and the University of California
at San Diego, said protein antibiotic creams now under development might also
help.
Copyright 2002 Associated Press.
************************************
ABBOTT LABS REPORTS PROGRESS FOR ARTHRITIS DRUG
By Ted Griffith, CBS.MarketWatch.com
CHICAGO -- Abbott Labs' new treatment for rheumatoid arthritis has shown
considerable promise in combating the debilitating disease, according to data
released by the company. In an announcement released late Friday, its
experimental drug, called Humira, halted bone destruction and improved
quality of life in late-stage testing on patients with rheumatoid arthritis.
Doctors are detailing the results at a meeting of the American College of
Rheumatology. Humira is seen by analysts as Abbott's most promising
experimental drug and it could become a serious competitive threat to
rheumatoid arthritis treatments now marketed by Amgen and Johnson & Johnson.
The Abbott drug is expected to win U.S. Food and Drug Administration
clearance next year.
Humira, also called D2E7, works in a way that's similar to J&J's Remicade and
Amgen's Enbrel. All three drugs are designed to quiet the body's inflammatory
response by interfering with an enzyme known as TNF.
Rheumatoid arthritis is an inflammatory condition that occurs when the immune
system goes haywire and starts attacking healthy tissue. The painful,
swelling condition can leave sufferers unable to work and care for
themselves.
Humira appears to have an advantage over rival therapies because of more
convenient dosing. The drug is taken by injection twice a month, while
Amgen's Enbrel must be injected twice a week. Remicade is given by
intravenous infusion and therefore is generally administered in a doctor's
office, hospital or clinic.
Abbott said one study of Humira found that 62 percent of patients who
received the drug "experienced no new bone erosions." The company said
another late-stage study found a "statistically significant" improvement in
quality of life among patients who received the experimental therapy.
However, some patients withdrew from the Humira trials because of " adverse
events," including infections, Abbott acknowledged. In one study, withdrawals
due to adverse events were 10 percent among Humira-treated patients compared
with 6.5 percent for those getting a placebo.
More than 5 million people worldwide suffer from rheumatoid arthritis,
according to statistics cited by Abbott. But the condition is much less
prevalent than osteoarthritis, which doesn't involve the immune systems and
affects most people in some way as they age.
***********************************
INFECTIONS MORE COMMON WITH RHEUMATOID ARTHRITIS
NEW YORK (Reuters Health)
People with rheumatoid arthritis (RA) have a higher-than-average rate of a
wide variety of infections, particularly those affecting the joints, bones
and skin, according to new study findings.
Frequent infections associated with RA have been reported for years, with
patients showing a particular vulnerability to lung infections and septic
arthritis--joint inflammation caused by invading bacteria. But because these
reports have been based on hospitalized patients, the overall infection risk
among people with RA has been unclear, the study authors point out.
In their look at people with and without RA living in Rochester, Minnesota,
the researchers found that those with the disease were 70% more likely to
acquire any infection over the study period.
The most frequent infections were septic arthritis, a bone infection called
osteomyelitis and infections of the skin and soft tissue, such as wound
infections and shingles.
Dr. Sherine E. Gabriel and colleagues at the Mayo Clinic in Rochester
reported the findings in a recent issue of the journal Arthritis &
Rheumatism.
Rheumatoid arthritis occurs when the immune system, for unknown reasons,
mistakenly attacks the joints, leading to inflammation, swelling and pain.
Over time, this process erodes the bone and soft tissue within the joints.
Because of the abnormal immune assault, drugs that suppress components of the
immune system are central in RA treatment.
According to Gabriel's team, these drugs, the disease itself, or RA-related
factors such as the need for joint surgery could be responsible for the
heightened infection rate.
"These results," the study authors write, "underscore the need for additional
research to discover the determinants of this increased infection risk in
RA."
For the study, the researchers reviewed the medical records of 609 adults
with RA diagnosed between 1955 and 1994, and compared each patient with an
adult the same age and sex without RA. Participants, more than 73% of whom
were women, were followed for 13 to 15 years, on average.
The researchers found that septic arthritis was 15 times more common among RA
patients. Osteomyelitis was nearly 11 times more common, and skin and
soft-tissue infections more than three times as common. Increased risks were
also found for infections of the lungs and abdominal organs, among others.
SOURCE: Arthritis & Rheumatism 2002 Copyright © 2002 Reuters Limited.
***************************************
HUMANIZED OKT3 MONOCLONAL ANTIBODY MAY BE USEFUL FOR PSORIATIC ARTHRITIS By
Megan Rauscher NEW YORK (Reuters Health)
Results of a phase I/II clinical trial indicate that treatment with a
humanized derivative of OKT3, the anti-CD3 monoclonal antibody (Mab), is safe
and may be efficacious in patients with psoriatic arthritis.
The non-Fc receptor (FcR)-binding derivative, designated
huOKT3-gamma-1(ala-ala), "is a modification of Mab OKT3 with decreased
immunogenicity and inability to bind FcR, resulting in less toxicity than
conventional OKT3," Dr. Marcus R. Clark of the University of Chicago and
colleagues explain in the Journal of Rheumatology for September.
In comments to Reuters Health, Dr. Clark said, "huOKT3gamma1(ala-ala)
specifically targets immunological processes which may redirect the immune
response away from autoimmunity and holds the promise of inducing drug-free
remissions. In contrast, most therapies currently used to treat autoimmune
diseases, such as psoriatic arthritis, are immunosuppressives. You take the
drug away and the disease recurs."
Dr. Clark's team treated 7 patients with psoriatic arthritis with escalating
doses of huOKT3 for 12 to 14 days. While initiating doses differed, all
subjects received 8 to 10 days of treatment at the maximum dose of 4.0
mg/day.
Thirty days after treatment, 6 of the 7 patients had at least 75% improvement
in the number of inflamed joints and an average 63% improvement on the
patient pain scale. Despite this "remarkable initial clinical response,"
symptoms recurred in 4 of 6 responders by 90 days.
No patient developed severe symptoms associated with "cytokine release
syndrome" as has been the case in studies of conventional OKT3 therapy.
These findings suggest that huOKT3-gamma-1(ala-ala) "may provide some lasting
benefit to patients with psoriatic arthritis," Dr. Clark told Reuters Health.
"This is to be tested in a multicenter phase II, placebo-controlled trial
that should be starting early next year."
Dr. Clark said the current trial is "one of the first uses of non-FcR binding
antibodies in the treatment of a chronic autoimmune disease. It also has been
used to treat diabetes."
J Rheumatol 2002;29:1907-1913.
****************************************
Keep the faith. There are many dedicated individuals in the worlds'
scientific, medical, and pharmaceutical communities, working every day to
find answers to Psoriasis, Psoriatic Arthritis, and the countless other
related diseases that affect our daily lives.
Good Health to All
Jack Nicholas,
Newsletter Editor
Cornishpro@...
Issue 2002 10/31/02-23

Hi Orin,
Yes, MTX is toxic, but just for comparisons sake I looked up some of
the side effects of a very common OTC drug at HealthCentral.com
(See http://www.healthcentral.com/mhc/top/001778.cfm )
Side effects of ASPIRIN:
VERY SERIOUS
Seek immediate medical attention if any of these symptoms occur:
body as a whole
blood in urine
convulsions
difficulty in swallowing
increased sweating or thirst
respiratory
fast breathing
deep breathing
shortness of breath
tight chest
trouble breathing
wheezing
swelling - lips, face
fever - unexplained
uncontrollable flapping movements of hands
eyes, ears, nose, and throat
loss of hearing
swelling eyelids
vision problems
skin
skin redness or inflammation; flushing
skin, abnormally dark or light
gastrointestinal
diarrhea (severe)
nausea or vomiting (severe)
stomach pain (severe)
nervous system
confusion
dizziness
lightheadedness
drowsiness (severe)
nervousness (severe)
hallucinations
behavioral changes (children)
SERIOUS
Notify your health care provider as soon as possible if any of these
symptoms occur:
body as a whole
weakness
eyes, ears, nose, and throat
ears - ringing in, buzzing in
skin
rash
hives
itching
gastrointestinal
stomach pain, cramping, burning
vomiting blood or coffee-ground-like material
stools - black, tarry
nervous system
headache (severe)
fatigue
MINOR
These symptoms need no attention unless they become annoying:
gastrointestinal
stomach cramps, pain, discomfort (mild to moderate)
indigestion
nausea or vomiting
nervous system
problems sleeping
nervousness
jittery
P.S.
There's a very funny cartoon at:
http://www.rxlist.com/comix/030199.shtml
-- Ron

Hi Merribeth
yeh there are many days when I think "I don't know what you make all this fuss
about"... I don't know... when I'm on a good day it's hard to remember how bad
the bad days can be. And even then I know it's very mild compared to what a lot
of people have.. but now I am determined to try and get to the bottom of this,
everything I have read says early diagnosis & treatment is the way to go. I
don't want to have much worse problems when I am older because I tried to be a
teenage hero :) so thanks for your encouragement not to do that!!
As for the dry skin well I will definitely try and look up that link you sent
before, mum reckons it is just dry skin though :)
Yep the osteopath checked all the places like my scalp, behind ears, elbows,
belly button and so on... it's just not there as far as we can tell.
Haha so if it is actually PA, first of all we won't really know for some time,
and then I'll get by all accounts a pretty nasty skin condition. Well it's fun
this isn't it...! Plus from what I've learnt on here it's hard to make a
definite-ish diagnosis of PA without the P. so it's limbo time really with no
one knowing what's wrong with me whether it is PA or not.
Just picking up on something you said there about the headaches you had when
younger. Are / Can headaches like that be PA/P related? just interested because
in the last year or so, at the same time as my joint problems have been
worsening I have started having migraine headaches (well, I think they are.
they're pretty terrible can't-do-anything-but-lie-down-in-the-dark feeling
horribly sick headaches at any rate). I've only had a couple but I was just
wondering if they could be related to PA and it would be worth mentioning them
to Doc. Also recently I seem to have lost quite a bit of weight, I haven't been
deliberately dieting or anything and I've been eating just as much if not more
than normal.... I mean normally I wouldn't say anything about that kind of thing
when going to the doc about joints, but some of the things I have been reading
are like "If you have joint pain accompanied by fever, weight loss etc see your
doctor", so I don't know if it's relevant or just random...
It seems like this is an incredibly complicated and variable condition, wow! I
don't think I'll ever get my head round it all. Chances are I will find out it's
not PA anyway and will have to try and get my head round something else...
lol... at least I will be better educated about something hey hehehe
Well anyway a huge thanks for your message & encouragement.. I did manage to get
the appt. my mum wanted at the doc's with a different GP for tomorrow afternoon.
So I will let you know how I get on and if she supports the idea of it being PA
or not (gonna demand a referral whatever though),
Stay well
Rosie

There's been a lot of posts on this matter but I havent ever been on mtx so I
held my tongue till I coulndt stand it anymore and now have to throw my
thoughts out there.
Mtx is a toxic substance. I say that not to scare someone out of using it
cause it does afford some amount of relief for most people who can tolerate
the side effects. You might draw a parallel to alcohol which is also toxic
to the human body. There are few people who couldnt tolerate mild alcohol
intoxication on a regular basis but there are some who can't sustain any
amount of it. I suppose it comes down to how well each individual's body
tolerates the mtx versus the benefits gained.
Two things come to my mind about sleep problems. Because you are
intentionally poisoning yourself your body has to work to overcome the
effects which may be exhibited as fatigue and an increased requirement for
sleep. On the other hand if you have suffered for years with P and the mtx
has a tremendous positive effect on the P symptoms it may actually make you
feel more energetic.
It is generally accepted that folic acid intake should be increased in anyone
using mtx but not all doctors reccommend it as they should cause it reduces
the side effects. Also there is mention that the folic acid should not be
taken at the same time as the mtx or even on the same day rather the
following day.
When I first started studying mtx I thought wow the risks are too great I
wont take it but there is no effective treatment for P that I know of that
doesnt carry risks so the decision each of us must make is what are the
risks of not trying something? I wish there were some more concrete answers
on which therapy is the best but each person's symptom profile is different
and each person's response to a specific chemical is different so there are
no clear textbook answers. I guess the best way to make informed decisions
is to find someone who has a similar symptom history as yourself and try what
worked for them. Orin

Greetings to everyone,
I am 55 years old and was diagnosed with PA in 1994. At present I
am taking Remicade, Vioxx (2 X day), Prednisone (5 mg.) and Darvocette.
Have reduced prednisone from 15 mg. per day to 5 mg. since beginning
remicade infusions. I am unable to stop the prednisone due to foot pain.
Recently it was discovered after three months of being sent from one doctor
to another that I have a fracture in cuboid bone in right foot. Even with
the fracture the orthopedist was oblivious to the arthritis (which he saw
evidence of in x-ray) and proceeded to put me in a brace with a wooden sole
and very little support even in cloth top of brace because the brace is too
wide. The arthritis pain is intolerable and now I have to make another trip
to this doctor who does not convey any evidence whatsoever that he
understands psoriatic arthritis.
I have a HMO for which I am grateful, as I could not afford the Remicade
otherwise, but I am so tired and frustrated with the referral process for
treatment. The rhematologist made an appointment for me that the Primary
has approved to an orthopedic in another city an hour and a half from me on
November 19. This orthopedic only treats feet. Having to keep so many
appointments is creating difficulty for me at work and I know my attitude at
work or home is not the same (pain always intensifies depression and anxiety
that I already take several meds for).
Thanks to all for listening. I hope there will be someone else out there
who could share with me their experience with getting treatment for a
fracture. The process in my case took three months before a second series
of x-rays finally indicated the fracture in the cuboid bone in the foot. (I
fall easily as I am unsteady on my feet at times from arthritis deformity in
both feet, so it is assumed fracture happened in fall I had the first week
in August.) From my perspective it seemed as though my PA diagnosis was
relied on to the extent my complaint about this "new and different" foot
pain was virtually ignored. I know from reading your e-mails that this
problem is confronted regularly by many of you. I guess when I return this
morning (just there yesterday) to orthopedist here locally for another brace
(hopefully) I will have to keep trying to "educate" him about PA. Any input
from others will be appreciated. Have any of you been to an orthopedist
that specializes in treating feet only? If so, please share your
experiences with me!
Thanks for all the support and encouragement I receive belonging to this
group. Linda in VA

I know what you mean by the side effects of MTX, but you have to give it a try,
or you will never get better. If not, see if your Rheumy can get you on
Remicade. If you do not start one of these soon, you will suffer for ever. The
MTX side effects are not as bad as they seem. Just make sure your Rheumy does
blood work at least every 6 weeks in the beginning.
Scott, in Atlanta, GA

Cathy....just my two cents wroth....my parents were told when I was just 8
months old that i had psorias.....and my neice was told when she was 2 yrs. old.
She actually lost all her hair before they admitted it.....they tried to say it
was everything else under the sun but PS.. So I don't know how much to young
is? God Bless and many prayers.....BJR

Hi, I have posted only two previous times on this board, but I have
read each and every one of the posts since I joined a couple of weeks
ago. I am trying to learn as much as I can about PA since I was
diagnosed about a month ago. When I went to the rheumy he looked at
my fingernails and listened to my complaints of toe pain, knee pain,
finger pain and neck pain and then just started writing out
perscriptions before he even told me what the diagnosis was. I had
to ask him what the prescriptions were for. He said, you have PA.
Well, I have had P since I was 9 and I am now 35, so I kind of knew
what PA was, but not that much. He gave me a prescription for
Voltaren and a prescription to get an x-ray of my low back/spine. I
just assumed this was all I needed. Well, I have been on the
Voltaren, which is only a NSAID, ever since July 6th and it really
only relieves the pain and swelling for a short time during the day.
After reading all of the posts here, I feel as though I should be put
on other drugs to control this. I do not have another appt. with the
rheumy until Sept 2nd, I was wondering if I should call him and
discuss some of the things that we should be doing. What do you all
think? And if so, what should I be asking him? Any help would be
appreciative. Thank you in advance for any input. Beth Ann

I have been getting nauseous a couple days after taking the mtx. Is this
normal? My doc has me taking it on a Friday night, but on Monday I still don't
feel good. Will this go away as my body gets used to it? I've only been taking
20 mgs for 3 weeks. I don't notice being more tired though.
[Moderator's note: It varies a lot among different people. My own experience was
that it didn't bother me much at all at first. The longer I took the MTX, the
longer the nausea took to wear off. Eventually it starting lasting three days
into the following work week so I quit taking MTX. Most people say they have far
less nausea when they take MTX by injection, so that's something you might want
to consider (I wasn't aware that MTX was injectable when I was on it). Folic
acid is supposed to help with the side effects of MTX, so if you're not already
taking 1 mg Folic acid each day, be sure to ask your rheumy about it. Ron]

I've had the exact opposite response. I feel more wired since
starting MTX a year ago. The first few months, I was extremely tired
the day after taking it, but not anymore. I'm getting by on about
5-7 hours of sleep a night, and find myself feeling wired and
energetic most of the time. I'm actually working on trying to relax
more. The downside is I also feel angry and irritable more easily.
I think your situation is the more common one, though.
--
Kristin Boice

After three trips to the ENT, and being subjected to three full examinations
of a laryngoscope all the way down to the Adams apple in order to visualize
my larynx, the ENT declared the following to me regarding my problem: Your
larynx is red and your vocal cords are red with raised swollen bumps on them.
These large bumps prevent your voice box from closing completely like it
needs to in order to safely keep from aspirating food or liquids into your
lungs or out through your mouth and nose.
One frequent reason for the red swollen voice box/larynx can be
gastro/esophageal reflux. The doctor gave me a three month supply of three
different anti-ulcer-acid drugs along with an order to put a four inch block
of wood under the two feet at the head of the bed so that I would sleep with
my head elevated above my head.
After the three month period, there was absolutely no improvement in the
condition of my throat. I still had laryngitis, I was still aspirating
drinks and food unless I was extremely careful to concentrate on what I was
doing too!
The doctor had to admit that now, by process of elimination, the diagnosis of
Sjogrens Syndrome fit what was going on in my throat. He knew and believed
that I had Sjogrens as related to my eyes, but somehow could not initially
believe it was "impacting" my throat.-voice box as well. Dry mouth is one
thing he said-an inflamed larynx is another. Aspiration can be deadly.
Anyhow, on to treatment. I was offered a steroid shot into the larynx, but
we both agreed it would be incredibly painful and may not last long in terms
of relief anyway.
Instead, I consulted with my rheumatologist and he added in another DMARD
into the cocktail I was taking at the time. Within a month was completely
better and I have not had another incident since. I believe that is due to
the fact that I am on Imuran 200 mg, Arava 20 mg and Kineret-1 shot a day.
I hope this recollection helps someone who needs to know about Sjogrens and
the voice.
Sincerely,,
Michelle S.
Group leader

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 2 ISSUE 17 July 30, 2002
PSORIATIC ARTHRITIS MEDICAL NEWS
U.S. DRUG USAGE EXPLODES - Health Affairs July/August 2002
Physicians are prescribing medications at a far faster clip than they did two
decades ago, a trend that is likely to result in a doubling of drug spending
in the next 5 years.
An aging patient population and more complicated medical conditions can
account for about two thirds of the increase, the research found. However,
other factors, such as the availability of new drug formulations to treat
chronic conditions, wider health insurance and drug coverage, and growth of
direct-to-consumer advertising are also believed to contribute to the
increased prescribing rate.
The trend is likely to continue as baby boomers grow older and scientific
discoveries lead to better treatment of acute and chronic conditions,
concludes study author Catharine Burt, chief of the ambulatory care
statistics branch of the National Center for Health Statistics at the Centers
for Disease Control and Prevention.
Psychiatrists had the largest increase in drug mentions, jumping to 178 drugs
per 100 visits in 1999, from 82 per 100 visits in 1985.
Just six therapeutic classes accounted for 80% of the increase in the overall
drug mention rate. Those classes include central nervous system drugs,
hormones, respiratory medications, pain relief agents, metabolics/nutrients
and cardiovascular-kidney drugs.
Antidepressants accounted for 13.5% of the increase in overall ambulatory
drug prescribing. Cholesterol-lowering drugs and heart medications called ACE
inhibitors were also top contributors.
For seniors, the largest increase was for drugs affecting the blood and
blood-forming tissues, which jumped 187% during the study period. For adults
45 to 64, metabolic drugs, including cholesterol-lowering medications, had
the largest increase in drug mentions, up 109%.
Central nervous system drugs had the highest increase for children, up a
startling 327%. The study finds that the attention-deficit/hyperactivity
disorder drug Ritalin was among the most frequently mentioned drugs in this
class during children's visits in 1999.
********************************************
MOM WAS RIGHT, BROCCOLI GOOD FOR YOU - Washington (AP)
Broccoli and broccoli sprouts contain a chemical that kills the bacteria
responsible for most stomach cancer, say researchers, confirming the dietary
advice that moms have been handing out for years.
In laboratory tests, the chemical, sulforaphane, killed helicobacter pylori,
a bacterium that causes stomach ulcers and often-fatal stomach cancers.
In addition, the good news is there appears to be enough of it in broccoli
sprouts and some varieties of broccoli to benefit people who eat the
vegetables.
The researchers could not say how much broccoli one would have to eat for
there to be an impact, something they said could not be determined without
long-term tests involving humans.
"The levels at which we tested it ... are such that those could be achieved
by eating broccoli or broccoli sprouts. It's a reasonable level that we think
would be reached in the stomach," said Jed W. Fahey of the Johns Hopkins
University School of Medicine.
The findings are reported in Tuesday's issue of Proceedings of the National
Academy of Science. Broccoli sprouts are tiny three-day-old plants that
resemble alfalfa sprouts and have a peppery flavor.
"I feel quite comfortable suggesting people eat more fruits and vegetables,
specifically cruciferous vegetables, specifically broccoli," Fahey said. "We
know it's safe and healthy ... we know sulforaphane is effective in
protecting against cancers."
Dr. Paul Talalay, a co-researcher at Johns Hopkins, had previously reported
sulforaphane is an effective anticancer agent and the new studies extended
that work to the bacterium that causes stomach cancer and ulcers.
In the lab, the scientists found that sulforaphane even killed helicobacter
that was resistant to commonly used antibiotics.
They also showed it could kill the bacterium whether it is inside or outside
cells. In people the bacteria can hide in cells lining the stomach, making it
more difficult to get rid of the infection, said Fahey.
The studies concentrated on mice and the researchers will now seek to
determine of the same effect occurs in humans.
"If future clinical studies show that a food can relieve or prevent diseases
associated with this bacterium in people, it could have significant public
health implications in the United States and around the world," Fahey said.
"In some parts of Central and South America, Africa and Asia, as much as 80
percent to 90 percent of the population is infected with helicobacter, likely
linked to poverty and conditions of poor sanitation," said Fahey, a plant
physiologist.
The bacteria can usually be treated with antibiotics, but these are too
costly and scarce in many parts of the world, he noted.
Perhaps "people in some of these very poor areas, where it's almost
impossible to even conceive of antibiotic therapy ... might, by a relatively
minor change in diet, be able to heal themselves," he said.
Dr. Carlos F. Quiros of the University of California, Davis, said he was not
surprised by the findings, commenting that many compounds found in vegetables
inhibit the growth of pathogens.
Sulforaphane has been shown to have anti-cancer properties, Quiros said, but
the amount present varies widely among varieties of broccoli. Quiros, who was
not part of Fahey's research group, said he is doing research to develop
varieties of broccoli with higher levels of the chemical.
The paper also noted that Fahey, Talalay and Johns Hopkins University own
stock in Brassica Protection Products, a company whose mission is to develop
chemo protective food products and which sells broccoli sprouts.
Working with them on the research was a group of scientists from the French
National Scientific Research Center led by Alain Lozniewski.
Copyright 2002 the Associated Press
*************************************
GENERIC DRUG MAKERS SETTLE CHARGES - Washingtom (AP)
Two generic drug makers have agreed to settle federal charges that they
struck a deal that allegedly prevented competition and lower prices in the
market for a generic blood pressure medication.
The Federal Trade Commission said Thursday that Biovail Corp., based in
Toronto, and Elan Corp., based in Dublin, Ireland, both had approval to
market two different dosages of the drug, a generic version of Adalat, which
is produced under that name by Bayer AG.
But the FTC said the companies made a deal that allegedly resulted in each
having a monopoly over one strength of the drug -- Elan produced the
30-milligram pill and Biovail sold the 60-milligram size. The deal included
sharing profits from drug sales and millions in royalty payments.
Under the settlement, the companies have agreed to end that arrangement.
"Their agreement gave them substantial incentives not to compete with each
other and to deprive consumers of the price cuts that normally occur with
generic competition," said Joseph Simons, director of the FTC's competition
bureau. "Generic competition is an important way of restraining drug costs
and hence of controlling overall health care costs, which have been
escalating."
Biovail said in a statement that it "maintains that the Adalat agreement is
lawful and pro-competitive," but it settled to resolve the matter.
Elan said in a statement that the deal, part of which involved Biovail
distributing Elan's drug, saved consumers millions of dollars. Elan said it
was pleased to resolve the matter.
By settling, the companies don't admit to breaking any law.
The FTC said the settlement was the first time it had taken action because of
an anti-competitive agreement between competing generic drug makers.
The settlement also bans the companies from entering into similar agreements
in the future.
Biovail and Elan are the only two companies with Food and Drug Administration
approval to market generic versions of Adalat.
In 1999, the companies agreed that Elan, in exchange for payments, would
appoint Biovail as the exclusive distributor of Elan's 30 mg and 60 mg
generic Adalat products, the FTC said.
The FDA gave final approval to Elan's 30 mg product in March 2000 and the
company promptly began marketing the drug through Biovail.
In December 2000, Biovail received approval for its 60 mg product and began
selling it. Biovail also was allowed to market a 30 mg product, but it never
did.
Last year, Elan was granted approval for its own 60 mg product, but it never
launched it.
The FTC alleged Elan has a monopoly over 30 mg generic Adalat and shares
profits with Biovail.
Biovail, in turn, paid Elan a multimillion-dollar royalty and has a monopoly
over the 60 mg product, the agency said.
The FTC said that if the companies had produced competing dosages it would
likely have caused a reduction in prices and profits.
The companies have now agreed that each will market both strengths of the
drug as soon as possible.
The agency voted 5-0 to accept the settlement, which is subject to public
comment for 30 days before it is final.
Copyright 2002 the Associated Press
************************************
SENATOR: DRUG COMPANIES OPPOSE LOWER PRICES
July 21, 2002 Washington (AP)
Sen. Paul Wellstone, D-Minn., accused pharmaceutical companies and their
political allies of trying to defeat legislation that would give older
Americans a Medicare prescription drug benefit.
"They oppose allowing older Americans to come together to negotiate lower
drug prices," Wellstone said Saturday in the Democrats' weekly radio address.
"They continue to slip in special congressional loopholes to keep
lower-priced generic drugs off the market."
The Senate has been debating two competing plans to provide a Medicare
prescription drug benefit and is scheduled to vote on them Tuesday. Lawmakers
have been meeting to try to craft a compromise because neither has the 60
votes needed for passage.
Both Medicare bills are being offered as amendments to a generic-drug bill
that Democrats are using for the overall debate. Medicaid is the nation's
health insurance program for the poor.
Wellstone favors the 10-year, $594 billion plan supported by Senate
Democrats. The plan would require beneficiaries to pay a $25 monthly premium
and a $10 co-payment on generic drugs or a $40 co-payment on brand-name
drugs. Out-of-pocket expenditures would be capped at $4,000 a year.
"We should use the purchasing power of the more than 40 million Medicare
beneficiaries to bargain with the pharmaceutical industry for lower drug
prices," Wellstone said.
The Bush administration and congressional Republicans have said the
Democratic plan would require the government to increase taxes, cut all
government programs or drain the Medicare trust fund early.
The White House supports another 10-year plan offered by a coalition of
Republicans and Democrats. The proposal would cost $370 billion, with $340
billion going toward a drug benefit and the rest on Medicare improvements.
Under that plan, beneficiaries would pay a monthly premium of $24 and have a
$250 yearly deductible. Once the deductible was met, the government would pay
50 percent up to $3,450 in drug spending.
The Pharmaceutical Research and Manufacturers of America, the industries
trade group, spent millions of dollars to help finance television commercials
to support a prescription drug benefit that was pushed through the House last
month. That legislation provides $320 billion over the next decade to
establish a system of Medicare prescription drug coverage through the private
insurance industry. Copyright 2002 the Associated Press.
*************************************
THE SCIENCE OF AGING
It's likely that the changes attributed to aging reflect more than one
process acting on the body. Scientists working on this conundrum from
different angles consistently raise more questions than they settle. Are
humans genetically programmed to die by a certain age? Why do some of us stay
healthier and live longer than others? What role do genes and biochemistry
play in how we age and when we die? Does the body have protective mechanisms
- if so; is there a way to turn them up? Where do alterations in the immune
system fit into the aging process? And, finally, could various tweaks or
outright resetting of the systems that affect how we age improve and lengthen
our life span.
Pushing the Limits of Life Span - Just as there is a limit to how fast the
mile can be run, there is probably a limit, too, to how far human life span
can be extended. But in every race, runners cross the finish line at
different times. And every now and again, the strongest runners completely
transform our ideas of what is possible.
Life expectancy at birth is about 76 years in the United States. This is a
great leap forward from a century ago, when the average newborn did not quite
reach age 50. When the numbers are crunched more carefully, though, there are
obvious differences between men and women and people of different races. A
newborn boy born in 1997 or after can expect to live 74 years, while his
sister can expect to live 79. Life expectancy measured from birth is six
years shorter for a black person than a white one, though the gap narrows
to two years for those who survive to age 65. By age 85, life expectancy for
blacks is slightly greater than it is for whites.
If you live to celebrate certain milestones of age, your life expectancy
expands. On average, a 65-year-old has nearly 18 more years to live, while an
85-year-old has about 6 years longer. Because a large number of people who
have chronic ailments or engage in behaviors that raise the risk of accidents
or illness get cut from the herd much earlier, the oldest old are often
remarkably healthy.
Antibiotics, better sanitation, and improved medical care reap much of the
credit for the expansion in life expectancy. If promising avenues of research
on cancer and heart disease pay off, the numbers could continue to climb. But
is there a biological cap on how long humans can live?
Some researchers believe the answer is yes. Their theory draws on
cross-species comparisons. The oldest ages observed in a variety of organisms
suggest the biological life span of any species is roughly six times the
stretch between birth and maturity. Using this formula, the figure most often
advanced for humans is 120 years. That's quite close to the span of one
well-documented contender for the title of longest-lived person, a French
woman believed to be 122 years old when she died in 1997.
Genes and Your Biological Clock - One line of research into aging suggests
the presence of a biological clock. Just as certain milestones of growth and
development occur during childhood, others might be expected to unfold later
in life. A familiar example is male pattern balding; a less benign one is
Huntington's chorea, a degenerative disease that appears in midlife. A
multitude of proteins made by genes helps orchestrate such changes. When a
given gene is switched on, it manufactures, or expresses, proteins that carry
out specific tasks in cells, organs, and tissues throughout the body.
Extending the Life of Fruit Flies - Over the years, scientists working with
yeast, worms, and fruit flies have identified specific genes - and certain
proteins made by these genes - tied to longevity. A report published in 2000
in the journal Science offers a prime example of how genes can arrest or
accelerate aging, at least in fruit flies. When researchers introduced any
one of five mutations into a single gene dubbed "Indy" - an acronym from a
Monty Python film that stands for "I'm not dead yet" - the flies' life span
nearly doubled. Moreover, the long-living flies stayed frisky and reproduced
far longer. When the mutation was reversed, fly life span returned to normal.
Many other laboratory gene manipulations have achieved the same end, and
scientists hope to extend these findings to humans someday. It's intriguing
to note that the protein made by Indy affected fly metabolism, apparently
fooling the body into believing it was on a calorie-restricted diet even
though the flies ate normally. This research provides a dramatic tie-in to a
separate string of experiments with rodents, fruit flies, worms, and primates
showing that restricted rations pay off in longer life spans.
Cell Senescence and Aging - Our bodies are made up of trillions of cells. New
cells form for growth or replacement in a process called cell division or
mitosis. Normally, a new cell created during mitosis replicates the original
right down to the last jot of genetic information.
Once you reach adulthood, whether and when cell division occurs depends on
the type of cell involved. Skin cells, for example, continue to divide,
albeit at a pace that slows somewhat over time. Liver cells proliferate only
in response to injury or similar challenge. Some cells are thought not to
regenerate at all, though new evidence of the rebirth of nerve cells in the
brain in animals brings that long-held belief into question.
Half a century ago, scientists found that the number of times replicating
cells can split is finite. Once a cell reaches this endpoint, called its
Hayflick limit, it stops dividing and becomes senescent, or grows old. This
is part of a normal process of cell death called apoptosis. For example, the
collagen-producing skin cells called fibroblasts typically divide about 50
times in humans before entering senescence. If you examine a fibroblast from
a child and one from a 75-year-old, the cell from the youngster would have
far more divisions remaining.
Each time a cell replicates, the repeating sequence of DNA bases that make up
the tail end of its chromosomes - called the telomere - is pared down. Some
scientists believe that this shortening of the telomere reflects a biological
clock winding down. In laboratory experiments, the clock can be reset when
cells are modified to pump out an enzyme called telomerase, which is not
normally found in adult cells. Whether it is possible - or wise - to tinker
this way with cells in the human body is not yet known.
That's because cell senescence may not be an enemy of longevity. In fact,
many experts think that the natural death of cells helps protect us from
cancer. Cancer cells are immortal - that is, they divide time and time again
with no stop mechanism coming into play. That uncontrolled cell proliferation
gives DNA errors triggered by such elements as sunlight or biochemical
offensives a greater chance to accumulate. This can be one of several steps
that hasten a once healthy cell down the path to full-blown malignancy.
Biochemistry and Aging - Your body survives biochemical battery every day,
and this assault is another focus of research that's proving fruitful for
scientists who seek ways to slow the aging process. The simple act of
breathing spins off unstable oxygen molecules called free radicals that
damage cell membranes, proteins, and even DNA. Riding to the defense are
antioxidants - nutrients and enzymes produced by the body that can block or
repair such damage.
By retooling genes so that they ratchet up these defense mechanisms,
scientists have found ways to extend longevity in certain organisms. For
example, researchers at the University of Colorado at Boulder discovered that
a genetic mutation in worms that triggered an overabundance of the
antioxidant enzymes superoxide dismutase (SOD)
and catalase doubled their life span. These two enzymes work in concert to
help prevent oxidative damage by neutralizing free radicals. Likewise,
researchers at the University of
California at Irvine who worked with fruit flies found that the gene that
churned out SOD was more active in the group of longer-lived flies than in
flies of average life span.
Hormones, Growth Factors, and Life Span - Other experiments on aging look
into the ways in which certain hormones and growth factors affect the body. A
series of genes dubbed DAF - decay accelerating factor - in worms has a
similar counterpart in humans that helps manage insulin levels and a growth
factor called IGF-1. When researchers deliberately immobilize certain DAF
genes in worms, they live and reproduce longer.
Glucose crosslinks, which seem to snowball with age, are another possible
culprit in cell decay. Called advanced glycation end products or AGEs, these
crosslinks alter proteins by binding them together. They have been implicated
in deterioration, such as clouded eyes, hardening of arteries, and stiffening
of connective tissue, as well as changes in nerve and kidney function.
Special immune system cells called macrophages break down AGEs, which are
then filtered out of the blood by the kidneys and eliminated in urine.
Unfortunately, kidney function tends to decline and macrophages lose some of
their zip with age, allowing levels of the damaging crosslinks to build up.
Wear and Tear and DNA Errors - Free radicals are not the only offenders that
alter DNA. Sunlight and toxic substances, such as tobacco and environmental
toxins, can also cause damage. And errors can occur during transcription,
which is the process of uncoiling and copying one of the double strands of
DNA in the course of cell division. Such alterations and errors may later
repeat and accumulate as cells split again and again. It's the job of certain
enzymes to fix these problems swiftly by carving out damaged segments of DNA.
Still other enzymes replace the damaged segments.
Life span in animals is linked to the ability to swiftly and efficiently
repair DNA. Humans have developed better systems for ironing out glitches
than mice, for example, and our life span is correspondingly longer.
Scientists who focus on DNA repair have found a triage system in place. Cells
concentrate on repairing active genes and the strand of DNA that gets
transcribed before any resources go elsewhere. This knowledge may lead to
ways to step up and expand the repair process.
Immune System Slowdown - Your immune system is a complex network of outposts
and sentinels that patrol your body, ready to roust dangerous intruders such
as bacteria, viruses, and parasites. Composed of specialized tissues and
organs, including the thymus gland, lymph nodes, spleen, tonsils, and bone
marrow, the immune system forges two major types of defensive cells: B
lymphocytes and T lymphocytes (also known as T-cells). B-lymphocytes make
antibodies, while T lymphocytes attack cells they recognize as foreign.
With age, the immune system weakens, giving a variety of ills and offending
organisms a better foothold in the body. While the overall number of T-cells
does not appear to decline with age, the cells seem to become less effective.
T-cells produce a group of messengers called interleukins. An age-related dip
in interleukin-2 occurs in humans and some animals. Experiments with older
animals show that boosting interleukin-2 can tune up immune system response.
Starting at about age 30, humans also have diminishing levels of
dehydroepiandrosterone (DHEA), a hormone that helps modulate the immune
system. Studies have tied low DHEA levels in men to certain cancers and
cardiovascular disease, among other problems.
So why not just replace sinking levels of DHEA or find similar ways to step
up helpful interleukins? Tinkering with the immune system is a complex task
that can easily have unexpected repercussions. Studies show that booster
doses of DHEA, for example, have good and bad effects. With continuing work,
though, research into the immune system - what makes it tick, what throws it
off, and how aging affects it - may provide a lever by which to shift aside
certain forms of disability and disease.
Source: from "Living Better, Living Longer", Harvard Health Publications,
Copyright © 2001 by President and Fellows of Harvard College. All rights
reserved. Used with permission of StayWell.
**********************************
MIDDLE OF THE NIGHT WAKENING THROWS OFF BODY CLOCK
By Anne Harding - New York, (Reuters Health)
Being woken up and exposed to bright light at night can throw off a person's
biological clock for the next few days, a new study shows. What's more, the
researchers found that
being woken up at night at all--even in a dark room--also disrupts the body's
timing, although to a lesser degree.
The wakening seems to introduce a "lag" into the body clock, pushing back the
release of hormones and other body processes by as much as an hour and a
half.
While such sleep interruptions don't harm health, a person experiencing such
a delay in the body clock "would feel tired in the morning and feel more
aroused in the early evening," said study author Samir Bangalore, a student
research fellow in the Sleep and Circadian Rhythms Research Laboratory of
Northwestern University Medical School in Chicago, Illinois.
The findings also offer clues to treating seasonal depression and other
conditions marked by biological clock abnormalities, the researcher told
Reuters Health.
Bangalore presented his findings Thursday at the American Academy of
Neurology's annual meeting in Denver, Colorado.
Humans--and many other creatures--have roughly 24-hour body clocks that help
regulate sleep patterns and energy levels, and also govern when hormones are
secreted and other biological processes occur. These daily patterns are
called circadian rhythms.
Bangalore and his colleagues tested the effects of awakening and nighttime
bright light exposure on the circadian rhythms of 32 healthy volunteers. The
study participants spent one night sleeping in the dark for 8 hours at the
time that was normal for them. The next night, some patients were woken up
and exposed to 1, 2 or 3 hours of bright light.
As a "control," some patients were kept awake for varying amounts of time but
not exposed to light.
Bangalore and his colleagues gauged the state of participants' biological
clocks by measuring their secretion of melatonin. Release of this hormone,
which peaks at night, is partially regulated by the biological clock.
"Light pulses of 1, 2, or 3 hours all led to significant delays in the
circadian rhythm of the melatonin profile by 35 to 75 minutes," Bangalore
said. Patients who were kept awake for 4 hours but not exposed to light also
had a half-hour delay in melatonin secretion, while small delays were also
seen in people who were kept awake in the dark for
shorter amounts of time.
Such delays would persist for a few days, he noted. For example, a person
would feel the effects of an hour's delay in melatonin secretion for 3 or 4
days.
Bangalore points out that the findings help "clarify the relationship between
the duration of light exposure and the response of the biological clock."
This is important, he notes, because circadian rhythm disorders have been
linked to many health problems. For example, elderly people often have
advanced biological rhythms, meaning they fall asleep and wake up early,
while adolescents have delayed ones. Both states can lead to severe sleep
deprivation.
People suffering from seasonal affective disorder (SAD) often have disordered
circadian rhythms, and some researchers believe light exposure helps SAD
patients because it normalizes these rhythms.
This article was contributed by our very own meghan@.... Thanks Megan.
*********************************
AMERICAN CANCER SOCIETY ANNOUNCES NEW NUTRITION AND PHYSICAL ACTIVITY
GUIDELINES FOR CANCER PREVENTION
Atlanta - (American Cancer Society)
The American Cancer Society, the nation's largest voluntary health
organization, announced the release of its new Nutrition and Physical
Activity Guidelines for Cancer Prevention. The new guidelines place more
emphasis on the importance of physical activity for both youth and adults,
and provide a first-time recommendation for communities to play a role in
improving the health of their residents.
"People planning to make changes in their diet and looking to adopt a
healthier lifestyle should be sure to also include a strong commitment to
regular physical activity," said Colleen Doyle, MS, RD, director of nutrition
and physical activity for the American Cancer Society. "These healthier
behaviors are made easier if governments, worksites, schools and
neighborhoods help facilitate them and provide access to the resources people
need."
According to the Society, nearly one-third of the more than 500,000 annual
U.S. cancer deaths are attributable to diet and physical activity habits.
The Society's newest guidelines, similar to earlier versions, stress adopting
a diet with a wide variety of healthy foods that are primarily plant-based.
They advise eating five or more daily servings of vegetables and fruits and
recommend eating whole grains over refined grains for more nutrients and
fiber. In addition, based on evidence that cancer risk is influenced by the
type of fat consumed, rather than simply the total amount, the guidelines
recommend limiting the intake of foods high in saturated fat.
The new guidelines also urge people to limit their consumption of alcohol if
they drink at all, and to lose weight if overweight or obese.
"Maintaining a healthy weight is important to reduce cancer risk. The most
healthful way for people to do this is to make healthy dietary choices and to
increase their level of physical activity," said Doyle. Physical activity
affects cancer risk indirectly, through its role in helping to prevent
overweight and obesity, and also plays a more direct role. For example, with
colon cancer, physical activity accelerates the movement of food through the
digestive system, which reduces the time that the lining of the bowel is
exposed to potentially cancer-causing substances. Physical activity's likely
role in breast cancer risk reduction is that it decreases the amount of
exposure of breast tissue to circulating estrogen.
"Based on this evidence, we encourage people to be active for at least thirty
minutes on five or more days of the week," Doyle said. "And children and
teens need to be active at least an hour every day."
New to this edition of the Society's guidelines are recommendations for
changes in communities, workplaces and schools to ensure that Americans have
opportunities to be physically active and eat healthfully.
"Physical education in schools, zoning and urban planning to provide and
promote activity, worksite policies and programs that support activity are
examples of issues that are critical if people are going to be successful in
changing their lifestyles for the better over the long-term," said Doyle.
Every five years, the Society works with experts in the fields of nutrition,
physical activity and cancer prevention to review current scientific evidence
and develop recommendations that reflect the best of what is known about the
relationship between diet, activity and cancer risk.
For information about the guidelines, and to obtain a copy of "Living Smart,"
the American Cancer Society's guide to eating healthy and being active, call
toll-free 1-800-ACS-2345 or visit the American Cancer Society website at
www.cancer.org.
Copyright 2002 The American Cancer Society. All rights reserved.
Don't forget to go to our website at http://www.wpunj.edu/pa to read back
issues of the newsletter. For all you new members, it's educational,
worthwhile and informative.
**************************************
Good Health to All
Jack Nicholas
Newsletter Editor
Cornishpro@...
Issue 2002 7/30/2002-17

Hi,
My doctor finally diagnosed me as having psoriatic
arthritis. He is going to start the Remicade
infusions. My question is, I am on the
waiting list for Enbrel. Will I have to take Enbrel
after the Remicade infusions? Did anyone take the
Remicade and then have to take the Enbrel? this
confuses me and I need some help here or I'll wait
until I see my doctor next week. Any assitance will be
appreciated.
Thanks,
Aggie
[Moderator's note: Aggie, though I personally have never taken either Remicade
or Enbrel, it's my understanding that you use either one or the other, but not
both at the same time because they both do essentially the same thing. -Ron]

Thanks Ron. I never thought of using a tool but once you wrote all the info
(thanks for that good explanation) it made sense. If one cannot use regular
clippers go for the heavy duty. I am going to get one today.

Anne,
If it starts again - get someone to take it seriously. During my
undiagnosed period my voice would get very small at times and people
couldn't hear me. My throat was also very sensitive, a rough crumb would
put me in paroxysms of coughing. One morning I woke up, took a sip of
coffee and my throat closed up completely. All I could do was whistle a
little breath in and out - I think they call it stridor breathing. I was
turning blue. I used my asthma inhaler and got a little of the vapor down
there which slowly opened it up. By the time the EMTs arrived I was
starting to breathe normally. I also had sinusitis, asthma and
pneumonia-like symptoms at this time, as well as many arthritis symptoms.
After that incident I decided to get the best help possible in my area and
use as many specialists as necessary to manage my health. I currently have
seven doctors, I have changed rheumies twice, and pulmonologists once. If
you think the PA is inflaming somewhere on your body don't get blown off -
get satisfaction.
David

What is the connection between PA & Irritable Bowel Syndrom?
Has anyone that has had surgeries found the PA affected the healing
or scar tissue in any way?
Thanks and stay healthy everyone,
Diane

Hi,
I just joined this group yesterday and I hope to get
some information about this disease. I have had
psoriasis for 35 years. However I never have
experience such terrible pain as I have in the last
couple of weeks. I came off of prednisone this past
Feb. to keep the ulcerative colitis I have in
remission and that is when the shin pains started. I
have a hard time getting around and the rheumatologist
says I have to go on Eberil (spelling??) when it is
available. I can't take the usual medications like
Vioxx and Celebrex as I have ulcerative colitis and
don't want that to flare real bad. I was thinking of
trying Remicade and wondering why he doesn't want to
put me on it. It seems that I have to do something to
control this disease as it isn't getting better and I
am living on pain killers like Vicodin and Demerol. I
am seeing him tomorrow and just telling him he has to
do something besides my just waiting for the Eberil. I
am getting very desperate here as I am finding it hard
to function and the psoriasis is spreading also. Any
suggestions?
Aggie
[Moderator's note: Welcome to the PA forum Aggie! We have almost a thousand
members here, so hopefully someone will have answers to your questions. If not
at least you are in the company of many others who know from first hand
experience what you're going through. I too am puzzled why your rheumy hasn't
put you on Remicade, or even Methotrexate (MTX) since both are common DMARDS
used to help control PA. -Ron]

Just a line to introduce myself as a new member.
I am in my early 30's and have been diagnosed for about 2.5 years,
although joint symptoms started about 3 years ago.

In a message dated 7/24/2002 8:14:32 PM Central Daylight Time,

Yes! Get a new rheumy, if you can. The one you have is not taking
your condition seriously enough.
I've said this before and I'll say it again, x-rays show nothing
until it's too late. AND they show nothing about the tendons. I get
angry when I hear that doctors think you're fine because your x-rays
show no damage, even though you are in pain, stiff, etc. and
especially if you have obvious swelling.
There ARE no blood test that show you have PA. And you don't have to
have pitted nails, or the pitted nails can come later on. I don't
have pitted nails, but about a year after I began to have obvious PA
symptoms (red, swollen toes), a few nails have become separated from
the nail bed, which I believe is a PA symptom.
I'd definitely go with your family practice doctor on this one, and
switch rheumys.
Good luck!
--
Kristin Boice

David wrote: My current rheumie tells me that irritable bowel is connected to
PA but looked
blank when I asked if the same thing could happen to the sinuses. I am convinced
that my problems with breathing came from the discharge coming from my sinuses.
Anyone heard of PA affecting the sinuses/throat/lungs?
I have had chronic sinus problems, two surgeries and have to continue to do
battle with the problem. I also have to deal with irritable bowel syndrome. I
do take Metamucil daily and it has helped tremendously.
Breathing.....ah that is my big problem!!! I have written to this list several
times and had many replies, but it seems no one has come up with an explanation
for this. Everyone assumes it is costrocondritis....but it is not. The
breathing problems are my main concern and I have been trying desperately to
find an answer. Seeing all sorts of doctors, etc. Tests do not show anything
either. So frustrating. Anyway David. just wanted you to know that you are not
alone in this!! Linda in Poulsbo, WA.

Hi Everyone ! I have not posted in a long time.But have been reading
the posts almost every day !I have had a couple of real bad weeks,I
had to go to the rumey and get a shot,upped my vioxx to 50 mg,but
kept my Arrava at 10 mg because of my weight,I weigh 95 pounds.He
also put me on vicodin.I was out of work for 4 days,The pain was
soooooooo so bad.The worst pain has been on my spine,lower,middle and
upper.I went back to work for the weekend,but because of the type of
job I have You can not take narcotics at work,so neadless to say when
I finished I got home I was in more pain then before.I cried so very
much because I knew I had one more day to go threw work again.The
hardest part of all for me was that I knew when I came home tomorrow
that I would be dealing with more pain.I am currently looking for a
new profession.I have excepted the fact that thoe I love my job very
much it is not possible to do this anymore.I hate this diease so much!
I now have it in my ankles,knees,hips,hands,wrists,lower back,spine,I
do not know about anyone else but maybe it is just me,I can always
tell when I am heading for a flare up.Lately it seems that the diease
is progressing more and more with each passing month.I have a great
ruemy thoe because they where calling me everyday for that week that
I was hurting to how I was doing.Sorry so long on this but I needed
to vent.By the way Go Gordon Go !!!!Keep up the great work.Thanks
again everyone for listening.God Bless the whole group Darlene

I do not enjoy much anymore, what should I do? Do herbal vitamins help like MSM?
How can I make my doc try different meds.

How do you know when it's time for more aggressive treatment? I went
on Celebrex, 200mg per day about 3 months ago. About two weeks ago
my doc increased me to 200mg twice per day. In the meantime I still
have swelling in my hands with stiffness in the joints of my
fingers. My knees have been getting sore and it's getting more
difficult to get up from a sitting position. My hips ache
constantly, especially after sitting for long periods. I have
chronic tendonitis in both elbows. I need to readjust the wristband
on my watch because I'm getting swelling in the carpal tunnel area of
my left hand and I find myself taking my watch off because of the
irritation. I get aching in my lower back and I've been getting
achiness in my shoulders. I guess I don't know at what point that
I'm supposed to get more aggressive with treatment. I'm been to two
rheumies. The last one wouldn't give me a definitive diagnosis for
PA but put me on the Celebrex. Couldn't diagnose me because I didn't
show markers for PA in my blood and my nails aren't pitting. He told
me to come back and see him in a year. My family practice doc is
really smart and feels certain that I have PA based on moderate to
servere P and all my other symptoms. He acknowledges how difficult
it is to diagnose PA. He's the one that upped my Celebrex to 200mg
twice per day. He has offered to put me on Methotrexate.
I'm going to see him tomorrow and I'm guessing that he'll put me on
MTX since he had suggested it before. Am I on the right track?
If I ache constantly and have chronic stiffness and tendonitis, does
that make me a candidate for MTX? I don't want to overreact, but
three months ago when I had initial x-rays I showed no joint damage.
I keep thinking that this is the right thing to do. And is there
anything that you do to deal with the constant aching everywhere?
800mg of Ibuprofen seems to give me some relief, but it is short
lived and I know that very much of that stuff is not good for liver
function.
Thanks -
Mark Kelley
[Moderator's note: Mark, it certainly sounds to me like you should get more
aggressive in your treatment. Once a joint is destroyed, it's destroyed
permanently. I stopped wearing my wristwatch on my wrist altogether, because I
too have a permanently swollen left wrist (I now carry it in my pocket and
should probably replace it with a nice pocket watch :-). My left wrist doesn't
ache all the time but wearing a wrist watch exacerbates it - although I think
the swelling is more from past joint damage rather than ongoing inflammation.
With your symptoms, I can't believe your rheumatologist told you "to come back
and see him in a year"!!! It's things like that, that almost make me wish we
didn't have rules against profanity on this forum because that rheumy certainly
deserves a healthy dose of it! -Ron]

Hi! I'm Tammy
I'm 39 and have had PA since 1994. I was diagnosed 1996 when symptoms
went from mild to full blown. My doctor calls my PA "severe-
progressive PA".
I'm currently on Celebrex & Arava. MTX stopped working after 3 years.
I'm in less pain now than ever. The Arava (for me) has fewer side
effects (no nausea, no fatigue, no mouth sores) but occasional GI
side effects.
I guess I am fortunate--I see members in the group who've had bad
experiences with their rheumatologists. My doctor has no other PA
patients, but he participates regularly in drug studies for his OA &
RA patients. We discuss RA drugs which, when approved may work for
PA.
I read everything I can on arthritis, and even ask the pharmacist for
package inserts for newly approved medications.
My doctor knows (now) that I won't take no for an answer unless
someone can give me an adequate explanation as to why not.
I was told in 2000, that my MRI films showed I had little cartilage
left in my knee & would need a replacement, but right now I am too
young. He dismissed me by writing a script for PT. Tears filled my
eyes. I tore up the script & threw it on the floor and I told
him, "Not good enough! Humor me and send me to an orthopedic surgeon
for a consultation!" It turns out, I have 90% of my cartilage.
Adhesions from a prior surgery were compressing my cartilage. I walk
without a cane now.
Most of my options these days are surgical, though I remain on Arava
(I hear very few of you seem to be taking this).
My "upper extremity" orthopedic specialist is associated with a
teaching hospital. I make a good "teaching case". I don't mind so
much because the doctor is enthusiastic to share my PA case with
interns.
I'm thrilled to be a part of your group. I've never met anyone else
with PA. There are RA support groups in my area, but you guys really
get it!
[Moderator's note: Way to go Tammy! Don't let the doc's short shrift you.
"Gentle hugs" and a hearty open-armed welcome to the PA group. -Ron]

The newspaper article on myself, government recognition of arthritis in general,
and a small piece on PA has been published in my regional newspaper here in
Australia. The article is headlined " Arthritis is a life sentence for Gordon".
In part it says :
" Bli Bli's Gordon Eliott was 39 when he developed an unusual form of arthritis
that would change his life for ever.
Over the past 23 years, psoriatic arthritis has attacked the retiree's joints
and spine. Mr Eliott needs to take strong pain killing medication five times a
day and can only walk on elbow crutches [accompanying photo of this fact].
Mr Eliott said the Federal Government's decision last week to recognize the
condition [arthritis in general] as a national health priority equal to
cardiovascular disease and cancer was satisfying. "
It then goes on to detail what the national health priority declaration means.
Some publicity to the general public that PA exists at last !!!
Regards, Gordon

Everyone on here is telling to newbies to get on Enbrel.
Newbies need to be advised that it will be a while before you can get
on Enbrel.
I have been on the list since Feb. 2002. I talked to them last week,
and they are telling me that it will be December or JAnuary before I
will be able to get it.
NEWBIES... Please get your Ruemy to get you on Methotrexate (shots
preferably) and Remicade. The Remicade is going to be available for
you right away, if your insurance approves it. The Methotrexate will
be available and approved instantly.
You need to get on these now. PLEASE do not wait for Enbrel. You will
have to get your Ruemy to get you on the Enbrel list, but do not
expect to get it right away. Most likely a 8 months to a year before
you will get on Enbrel.
Good luck,
Scott in Atlanta, GA

Following the Australian Federal Government's declaration of arthritis as a
National Health Priority, I emailed a letter to our regional newspaper
(reasonably high circulation) regarding the declaration. They published the
letter, but then I wa telephoned by a journalist of the newspaper and
interviewed for an article. We dealt with the media release of the Arthritis
Foundation of Australia (AFA), of which I provided a copy, what it meant to me
personally, and on my volunteer work as an AFA advocate living on the Sunshine
Coast. The interview then turned to my disability and the form of arthritis
causing it. He questioned me about PA and its effects, so I hit him with a lot
of details which I guess will be heavily edited. A short while ago, a
photographer from the newspaper came to my home and took a number of photographs
of me, one of which will accompany the article.
This means further publicity on arthritis, in general, and PA in particular, in
the newspaper , in addition to the upcoming article I wrote for the magazine of
the AFA. Of course, the newspaper article will reach a wider segment of the
public than the magazine article.
I hope I handled myself well at the interview, but this is precisely the type of
situation envisaged when they flew me down to AFA headquarters for the media
training seminar. Not sure when it will be published as it is not major news,
but more human interest.
Regards, Gordon

Hey guys...Long time no chat...Well we moved...We are in Allen, Texas
now...About 45 minutes from Denton, Texas...I have been recouping from the pain
of moving...But all is doing well...Will fill you in with more later...Take care
my friends hope all is well...Love and hugs...Pam
P.S. Gillian, hope you are ok...Love ya

I am newly diagnosed with PA - after 6 years of off-and-on misery and being
in the land of the "unknown arthritis." I came off prednisone in March and
I was tapering off MTX when I erupted in psoriasis all over and my diagnosis
became obvious.
At the age of 50 - 6 years ago - I developed a rash on my shins that I now
realize was psoriasis. At the same time I developed morning fatigue, leg
and shoulder aches, stiffness after sitting, shortness of breath, and a very
sore knee. Later my sinuses and lungs became irritated, my voicebox was often
irritated and I developed bowel problems. When my regular doctor became
perplexed
I saw a series of specialists. A lung specialist treated my asthma but was
not at all surprised that I had developed it at age 50. A rheumatologist
diagnosed
me as having Polymyalgia Rheumatica, even though I was young for that disease.
After 3 years the rheumatologist decided I did not have PMR but did not have
an answer for my problems.
Meantime I found a very good ENT guy who agreed that something horrible was
happening with my sinuses. He removed the polyps and infections in my sinuses.
With lots of Nasonex and inhaled steroids my sinus, throat and lungs slowly
recovered.
Prednisone never really helped the arthritis and myalagias. After many
flare-ups,
the first rheumie tried methotrexate which helped a lot. I saw another rheumie
who told me I had polyarteritis nodosa. A third arthritis team told me they
were perplexed but would work with me to find out what it was. I started to
taper off my meds under their supervision. 6 weeks ago I developed a rash
on my backside and in fold areas. At first it was treated as fungal but it
continued to spread