Research Highlights from 2004

Using your answers to our questionnaires, the NDB reported many important findings to American College of Rheumatology (ACR) annual scientific meeting in October 2004. The ACR meeting is the most important gathering for US Rheumatologists. You can find these reports as “posters” and PowerPoint presentations on our web site (look in the physician’s section). The NDB presented more research than any other group in the world at this meeting. You can see it all on the web site. Here are some highlights.

Stroke reduced by Remicade

Working together with researchers in the stroke center at the National Institutes of Health (NIH), we found that people who took Remicade reduced the risk of stroke by 50 percent. This is an important finding, suggesting that control of inflammation by this treatment can alter the risk of cardiovascular problems. Zurab G. Nadareishvili and John Hallenbeck also authored this study.

Pneumonia, steroids, Remicade and Enbrel

We also reported that corticosteroids increased the risk of getting cataracts and pneumonia. They are also associated with increased risk of heart attack and stroke. Common names for corticosteroids are steroids, cortisone and prednisone. Like all drugs, there are benefits and risks that often balance each other. Corticosteroids help a great deal in reducing inflammation and may be responsible for other benefits. Things are not clearly black and white. In fact, we found an increased risk of pneumonia in people taking Remicade but not Enbrel. Dr. Liron Caplan was the primary author of this study. Statins reduce disability in RA. These drugs that reduce cholesterol also reduce inflammation.We found a modest beneficial effect among statin users. Dr. Eric J. Hochman and Dr. Hyon K. Choi contributed to this research.

RA does not increase the risk of sinus infections

However, among people taking Enbrel there was a suggestion of an increased risk of about 16 percent. This increase was not statistically significant, although users of Enbrel had higher rates of sinus infection than users of Remicade.

Joint Infection and Anti-TNF Therapy

Joint infection is a concern for RA patients who undergo total joint replacement surgery (TJR). Some recent research has shown that the risk of joint infection is much higher after TJR if the patient is taking anti-TNF therapy, such as Humira, Enbrel or Remicade. We decided to look at the risk of joint infection in RA patients in the NDB. Joint infections are very rare. If we look at “patient years,” or the number of years a person has RA, we found only 1.2 cases per 1,000 patient years among patients who’ve never had TJR. That means that on average, you would have to live 833 years with RA to get a joint infection. Patients who recently had TJR surgery have a greater risk, about 14 cases per 1,000 patient years. This makes sense, because any time the skin is broken, for surgery or just a scrape, the risk of infection goes up. Our skin is there to protect us, after all. How did anti-TNF therapy affect the results? We found that the risk of infection doubled, but that if you haven’t had recent TJR surgery your risk is still extremely small. You’d have to live about 500 years to have a joint infection. Thanks to your help and this research, doctors have better knowledge about infection risks with anti-TNF drugs, rather than having to guess about the risk. Other RA drugs did not increase the risk.

What does jaw pain mean?

Jaw pain can occur in Rheumatoid Arthritis (RA), Osteoarthritis (OA) and Fibromyalgia (FMS).We wanted to know what characteristics are common to people with jaw pain, and which form of arthritis they have.We found out that jaw pain is much more common in people with FMS, about 38 percent have it, whereas 18 percent of RA and OA patients have it. Does this mean that if you have jaw pain you probably have FMS? No. That determination can only be made by your doctor. It might indicate what we call a “general pain disorder” rather than a specific problem with your jaw joint. This means you, in general, might have more pain or decreased sensitivity to pain compared with people without jaw pain. Again, this information can be more useful to your doctor as he or she decides how to treat you. For doctors, as they see patients with jaw pain, this research means that they may want to give more thought to whether a person has above-average pain that needs specific attention. Dr. Robert S. Katz was the primary author of this study.

RA and non-melanoma skin cancer

Many studies have shown that RA patients have a higher risk of certain types of cancers. It is unknown whether this is because of the way RA affects the immune system, the way some RA drugs suppress the immune system, or both. In particular, European studies have shown that RA patients are at a higher risk of non-melanoma skin cancer (NMSC). Most NMSCs are found on parts of the body that get exposed to the sun, like the face and hands. They normally don’t affect other body areas. NMSC is almost always cured if detected early. We decided to calculate the risk of NMSC in RA patients by comparing them to OA patients. OA and OA drugs do not affect the immune system like RA. Indeed, there is a slightly increased risk for RA patients. Use of prednisone and use of combination TNF-inhibitor (etanercept, infliximab, adalimumab) and methotrexate were also associated with an increased risk for the development of NMSC. What does this mean for NDB patients? Probably not too much, because everybody (especially those with light-colored skin or previous skin problems) should always be alert to changes in the skin.You should tell your doctor any time you notice

  • Any change on the skin, especially in the size or color of a mole or other darkly pigmented growth or spot, or a new growth
  • Scaliness, oozing, bleeding, or change in the appearance of a bump or nodule
  • The spread of pigmentation beyond its border such as dark coloring that spreads past the edge of a mole or mark
  • A change in sensation, itchiness, tenderness, or pain
Dr. Eliza F. Chakravarty was the primary author of this study.

Low-dose aspirin and stomach problems

Those of you taking Cox-2 drugs, such as Celebrex, may have heard that these cause fewer stomach problems than pain-killers like acetaminophen and ibuprofen. We wondered whether people with RA or OA still had fewer problems if they took Cox-2s along with low-dose aspirin, which is commonly used by people with heart problems. It turns out that people taking both do not have an increase in heartburn, ulcers or general stomach discomfort. However, we did find a small increase in the risk of nausea. Dr. Elizabeth Benito Garcia was the primary author of this study.