Subcutaneous Methotrexate Delays Biologics

Delaying the use of biologics… one approach… next

Early Use Of Subcutaneous Methotrexate May Delay Need For Biologic Dmards

Reported in Healio, “In a large, Canadian cohort of early rheumatoid arthritis (RA) patients with moderate to high disease activity who were started on methotrexate, we found the use of subcutaneous methotrexate monotherapy was associated with a delayed start of biologics,” Stephanie K. Gottheil, MD, said at the EULAR Annual Congress. Gottheil and colleagues followed 1,189 patients until they started a biologic, were lost to follow-up or followed them until the end of the 36-month study. Researchers found patients treated with subcutaneous methotrexate monotherapy were half as likely to require biologics as patients who were treated with oral methotrexate monotherapy.

Comment: I don’t use a lot of subcutaneous methotrexate but this study my prompt me to use more.

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Anxiety Prior To Methotrexate Therapy May Result In Non-Response At 6 Months

One very important determinant of response to methotrexate…

Anxiety Prior To Methotrexate Therapy May Result In Non-Response At 6 Months

Reported in Healio… patients with rheumatoid arthritis who experience anxiety prior to the start of methotrexate therapy may have non-response at 6 months due to poor adherence, according to results presented at the EULAR Annual Congress.

“From a long list of lifestyle, clinical and psychosocial predictors at baseline, BMI, smoking and DAS28 score were each shown to significantly predict non-response 6 months after patients had started treatment with methotrexate,” Suzan Verstappen, of the Centre for Musculoskeletal Research at the University of Manchester, United Kingdom, said in a press release. “Of particular interest, however, is the role of participant anxiety on starting treatment with methotrexate in predicting response, which is likely to be the result of its negative effect on adherence.”

Comment: the mind is a powerful influence

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Fat Stem Cells for Knee Arthritis

More good news on the stem cell front… next

New Treatment Shows Promise for Crippling Knee Arthritis

Alan Mozes writing for Healthday reported on a small study that demonstrated that just one injection of stem cells can reduce pain and inflammation.

The idea is experimental: Extract stem cells from a patient’s own body fat — cells known for their ability to differentiate and perform any number of regenerative functions — and inject them directly into the damaged knee joint.

To explore the potential of stem cell therapy, the study authors focused on 18 French and German men and women, aged 50 to 75, all of whom had struggled with severe knee osteoarthritis for at least a year before joining the study.

Between April 2012 and December 2013, all of the patients first underwent liposuction to extract fat-derived samples of a specific type of stem cell. The researchers noted that these particular stem cells have been shown to have immune-boosting and anti-scarring properties, as well as the ability to protect against cell “stress” and death.

A third of the patients received a single “low-dose” injection of their own stem cells directly into their knee. Another third received a “medium-dose” injection, involving a little more than four times the amount of stem cells, while the remaining group received a “high-dose” injection packed with roughly five times as many stem cells as the medium-dose group.

After six months, the study team found that all three groups showed improvements in terms of pain, function and mobility.

However, only those in the low-dose group were determined to have “statistically significant” improvements in terms of both knee pain and function recovery.

Comment: this data is in keeping with other studies.

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Cell Phone Blindness

Having trouble seeing? It could be your smartphone… next

Cases of Smartphone ‘Blindness’ Reported

Reported in Healthday, a short-lived optical sensation can lead some smartphone users to mistakenly believe they’ve lost sight in one eye.

A letter in the New England Journal of Medicine cited two case studies: a 22-year-old woman who’d suffered recurring bouts of nighttime vision loss in her right eye for several months, and a 40-year-old woman who would wake up with a loss of vision in one eye that lasted as long as 15 minutes.

Both women underwent several tests, including magnetic resonance imaging and echocardiograms, before doctors realized that the transient “blindness” was due to an optical adaptation of the eyes caused by reading a smartphone in the dark while lying on their side in bed. When one eye was occluded by the pillow and they were viewing the phone with the other eye, the occluded eye adapted to the dark and the viewing eye adapted to the light. When both eyes were uncovered in the dark, the light-adapted eye was perceived to be “blind,” an effect lasting several minutes.

“I have seen a dozen or so similar cases,” study author Gordon Plant, M.D. an ophthalmologist with Moorfields Eye Hospital in London, told HealthDay. “The reason I wish to make this known is because it leads to anxiety and unnecessary investigation because the patients — and their doctors — think they have had a transient ischemic attack.”

Comment: so… how’s your eyesight doing?

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Obesity Reduces Remission Rates in Rheumatoid Arthritis

A huge barrier to obtaining remission in rheumatoid arthritis… pun intended

Obesity Halves Chance for RA Remission, Study Suggests

Janis Kelly writing in Medscape reported rheumatoid arthritis (RA) remission rates were significantly lower among patients who were obese compared with nonobese patients, according to a systematic review and meta-analysis reported in an article in Arthritis Care & Research. The authors also found that disease activity scores were significantly higher and call for studies to determine whether interventions to reduce body mass index (BMI) might also improve outcomes in RA.

Coauthor Gilaad G. Kaplan, MD, MPH, told Medscape Medical News, “Obesity is a growing problem for society. Our work adds another negative stigma to the obesity epidemic…[O]bese patients who are diagnosed with [RA] are more likely to fare worse than nonobese individuals with [RA]. Because obesity is a modifiable risk factor, future studies are needed to determine whether adding weight loss to a treatment plan will improve outcomes for these patients.”

Comment: Obesity is a growing epidemic.  We need to inform patients with rheumatoid arthritis that they need to lose weight.


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Methotrexate Deaths In Australia

A workhorse drug for rheumatoid arthritis causing an excessive number of deaths in Australia

Eight Deaths Linked to Methotrexate in Australia

Dr. Jack Cush writing in Rheumnow reported methotrexate (MTX), a cornerstone drug used to treat rheumatoid arthritis (RA), has led to 90 hospitalizations and 8 deaths according to a recent report from the Medical Journal of Australia.

Many of these events were the result of inappropriate higher or more frequent doses than that prescribed. Such practices led to gastrointestinal tract ulceration, liver toxicity, bone marrow suppression, septicemia, and death.

In a nationwide search of MTX-related death rates, three datasets discovered that over 90 dosing error cases were reported from 2004 to 2015.

Twenty-two died from taking MTX, but only 7 deaths were directly attributed to overdosing. The United States Food and Drug Administration has noted 25 MTX deaths over a four-year timeframe.

The authors recommended changes in packaging and tablet appearance to reduce the incidence of these events.

Comment: Methotrexate is still the disease modifying drug of choice for rheumatoid arthritis. It has to be monitored though.

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Graphic Warnings for Cigarette Smoking

A picture is worth a 1,000 words… next

Graphic warnings may lead more smokers to try to quit

On its website, NBC News reported smokers are more likely to try quitting and more successful at quitting if they are given cigarette packs with graphic warnings compared to smokers given cigarette packs with only text warnings, according to a study published in JAMA Internal Medicine. The researchers found that 40% of smokers who got cigarette packs with graphic warnings tried to quit during the study period compared to 34% of smokers who got only text warnings on their packs.

Comment: I remember an old poster of a man who had lost his arms and legs because of cigarettes and he was still smoking through his tracheostomy.

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Patients Don’t Store Biologics Properly

A word of caution to patients who take biologics

Most Patients Do Not Store Their Biologic Drugs Within the Recommended Temperature Range

Dr. Kevin Deane writing in Medscape reported on a Dutch study which evaluated the temperatures at which patients with rheumatic diseases stored their biologic disease-modifying antirheumatic drugs (DMARDs). They did this by providing patients with an electronic temperature logger.

Of the 293 study participants given a temperature logger, 255 (87.0%) returned their logger to the pharmacy. Of these 255 participants, only 17 (6.7%) had stored their medication within the recommended temperature range. Of those who did not, 24.3% stored their medication for more than 2 hours outside of the recommended range.

The authors did not evaluate the effect of these storage conditions on the biologic activity of the medication but speculated that storing these medications outside of the recommended temperature range may adversely affect their efficacy.

Comment: It’s important to know what the temperature restrictions are for your medication.

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FDA Nixes Antacids With Aspirin

An over the counter preparation that could be life-threatening… next

FDA warns OTC antacids with aspirin can cause stomach or intestinal bleeding

Lydia Wheeler writing in The Hill reported that the Food and Drug Administration “is warning consumers to beware of over-the-counter drugs that contain both an antacid and aspirin.” According to the agency, these products “can cause stomach or intestinal bleeding.” Although rare, the FDA says it has identified eight cases of serious bleeding since 2009.

Comment: Not a big surprise here. In the old days when we used high doses of aspirin, people would get bleeding ulcers frequently.


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Barefoot Running Fewer Musculoskeletal Injuries

Are you a runner… the next item is for you…

Running Barefoot May Protect Against Some Musculoskeletal Injuries

Dr. Lara Pullen writing in enews rheum reported on a study published in the British Journal of Sports Medicine. “We aren’t seeing more musculoskeletal injuries in barefoot runners,” explains Dr. Altman-Singles, one of the authors, in an interview. “If anything, we are seeing fewer of certain types of musculoskeletal injuries.”

The researchers examined the differences in injuries between habitually barefoot and habitually shod runners. They categorized participants as barefoot runners if individuals spent at least 50% of their running time barefoot. Barefoot runners were allowed to run in minimalist footwear for the balance of their running time. In many cases, barefoot runners had experienced injuries, such as fasciitis and iliotibial band syndrome, prior to switching to barefoot running.

The researchers also noted that plantar fasciitis was more common in the shod group than the barefoot group. Additionally, shod runners experienced more patellofemoral pain syndrome and ITBS than did barefoot runners. Dr. Altman-Singles describes this difference as huge. Although barefoot running may have offered some protection against plantar fasciitis, barefoot runners had a greater number of Achilles or calf and posterior tibialis strains when compared with shod runners.

Comment: If you want to try this, be careful.

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