In an article published in the Annals of the Rheumatic Diseases a study reports that researchers compared 136 women with rheumatoid arthritis with 544 women of a similar age without the disease. They found that those who had breast fed for longer were much less likely to get rheumatoid arthritis.

Women who had breastfed for 13 months or more were half as likely to get rheumatoid arthritis as those who had never breast fed. Those who had breast fed for one to 12 months were 25% less likely to get the disease.

The proportion of women breast feeding for more than six months has increased dramatically over the past 30 years. The authors concluded that it was difficult to say whether there was a connection between higher rates of breast feeding and a corresponding fall in the number of women affected by rheumatoid arthritis, but that the results of the study provided yet another reason why women should continue breast feeding.

Diabetes affects 7% of the American population–nearly a third unaware that they have the disease.

Patients with both arthritis and diabetes are caught in a conundrum. Physical activity is painful, yet their diabetes improves with physical activity. According to the Arthritis Foundation the good news is that safe and effective self-management programs are available. Individuals living with arthritis and diabetes can benefit from participating in a exercise of self-management programs the foundation offers (locate a local chapter at www.arthritis.org)

As Baby-Boomers age arthritis is expected to increase by 40% in the next 2 decades. However, arthritis research has declined steadily by $29 million over the past 6 years. The Arthritis Prevention, Control and Cure Act (S. 626/H.R. 1283) proposes to strengthen arthritis public health initiatives to ensure more people are diagnosed early, which will help avoid permanent disability and avoid pain.

Leigh Callahan, PhD, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, evaluated the basic 8-week Arthritis Foundation Exercise Program. The study showed:

• The exercise program is suitable for every fitness level–even inactive older individuals.
• Arthritis symptoms improved with exercise.
• Minor lifestyle changes–like a 10 minute walk 3 times a day–can reduce the impact of arthritis.
• Physical activity can reduce pain naturally.
• Physical activity can decrease dependence on pain medications.

Researchers believe that their research proves that it is a myth that exercise exacerbates arthritis symptoms.

Johan Frostegård, professor, Karolinska Institute, found that a gluten-free vegan diet reduces cardiovascular risk in people with rheumatoid arthritis. Participants in the year long study (sample size unknown) were assigned to one of two groups. One group ate a gluten-free vegan diet and the other group followed ordinary dietary advice.

The gluten-free vegan group, when compared to the control group, had reduced rheumatoid arthritis symptoms. Their blood levels of LDL and oxidised LDL-cholesterol (a risk factor for atherosclerosis) were lower in the gluten-free vegan group. The beneficial atheroprotective natural antibodies–against phosphorylcholine– was raised in rheumatoid arthritis patients.

Frostegård suggest that the study diet can have an effect on the immune system and natural protective antibodies can be increased.

In recent years new rheumatoid arthritis drugs have been shown to increase the chances for remission, halting of the progression of joint damage and improve, or prevent, disability. Access to these drugs in developed countries varies greatly, with Eastern Europe having the least access to the medications.

Approximately two-thirds of the costs for rheumatoid arthritis is carriend by the patient. Besides the patient’s out-of-pocket expenses there is also a loss of productivity. Early retirement due to the disease is frequent, with up to 50% of those living with rheumatoid arthritis forced to leave the workforce and apply for a disability within ten years of the onset of the disease.

Rheumatoid arthritis has one of the biggest impacts on the quality of life of the patient.

The full article can be found in The European Journal of Health Economics.

Betsy Sleath, University of North Carolina, Chapel Hill, studied 200 RA patients from 4 rheumatology clinics, seeing one of 8 participating physicians. The patient’s doctor visit was audio taped as well as being interviewed after the visit with a questionnaire to measure their mental status.

Approximately, 11% of the patients had moderately severe to severe signs of depression. Those with a greater restriction of normal activity showed increasing levels of depression. Of those patients that showed signs of depression only 20% discussed their concerns of depression with the attending physician.

Sleath feels that a chronic disease, like RA, can greatly impact a patient’s psychosocial well-being. However, the patient’s primary care physician typically does not initiated discussion about depression and if they do it is not addressed to any great degree. She notes that some physicians may not feel comfortable discussing depression with their patients, but they should consider having their office staff administer a brief depression screening before the patient’s visit. Furthermore, Sleath suggest that rheumatologist should be prepared to refer patients to a mental health profession or communicate with the patient’s primary care physician to coordinate a treatment plan.

Dr. Tracey M. Farragher, University of Manchester, wondered why other inflammatory diseases, like Crohn’s disease, do not share the same high risk of premature death from CVD. Her study focused on two genes associated with RA risk factors–HLA-DRB1 and PTPN22. The study involved 1,022 patients with inflammatory polyarthritis (IP) with a mean age of 54, at the onset of symptoms. By the completion of the study 24% of the patients had died. Of the patients who had died 31% had CVD listed as the cause of death.

Researchers found that individuals with the HLA-DRB1 combination had a 3-fold risk of death. Smokers were at a higher risk of death because of an interaction of smoking with certain genes. No evidence of any association between the PTPN22 gene and the risk of death was found.

This is the first study to link the HLA-DRB1 genotype with premature death from cardiovascular disease for those afflicted with any form of inflammatory arthritis. Farragher feels the study raises the possibility of a targeted strategy to prevent CVD in RA patients and reinforces the danger of smoking for anyone with arthritis.

Satpal Singh, PH.D., associate professor of pharmacology and toxicology, University of Buffalo School of Medicine and Biomedical Sciences, was conducting basic research on potassium channels. What surprised Singh was how the normal prescription level of the arthritis drug, Celebrex, inhibits the normal passage of potassium ions into and out of heart cells, which can create an irregular heart beat–or arrhythmia.

Singh, and his research team, have shown an important new effect of Celebrex through a totally different pathway, one that is unrelated to the drug’s effect as a pain reducer. The result is that Celebrex can have adverse side effects through an unexpected mechanism and result in an irregular heart beat.

The study appears in the January 18 edition of Journal of Biological Chemistry.

In the spinal column the messenger molecule amino butyric acid (GABA) is released to act as a kind of pain filter by activating chloride channels on neighboring cells, which then relay the pain signals to the brain.

Ulrich Zeilhofer, Professor at Institute of Pharmacology and Toxicology, University of Zürich had known that chronic inflammatory disease patients, such as rheumatoid arthritis or nerve damage patients, the GABA becomes compromised. As a result, pain signals are nearly unfiltered. Drugs known as benzodiazepines (i.e. Valium®) enhance the action of GABA when injected into the spinal canal. However, such injections are done in in very selected cases. More often benzodiazepines are administered with tablets, which means that it not only works on the spinal cord but also the brain. As a result there can be an undesired effect, like sedation, impaired memory, or addiction.  Over time their effectiveness can fade.

Benzodiazepines have at least 4 different subtypes of GABA receptors and have remained largely neglected as potential targets for pain treatment. The researchers used genetically altered mice with either a slight inflamed hind paw or an irritated sciatic nerve. Through the use of benzodiazepine injected into the spinal canal the researchers were able to identify 2 subtypes of GABA receptors which mediate spinal pain control.

Researchers feel drugs designed to target only the 2 GABA subtype receptors would be a big step forward in pain therapy. This approach would help those with chronic pain to be treated with medication that has fewer side effects.

Leigh F. Callahan, University of North Carolina, Chapel Hill, studied 346 people with self-reported arthritis, average age of 70-years. Participants were divided into 2 groups. In one group the participants followed the Arthritis Foundation Exercise Program (AFEP), which consists of basic and advanced range-of-motion and low-resistance exercises. They met for one hour, twice a week, for 8 weeks. The second group, the control group, did not perform exercises on a regular basis, but were offered the exercise program after the initial 8 weeks of the study.

Physical function changes were self-reporting as well as performance based measures such as lifting weights. The exercise group had significant improvements in pain relief, fatigue, and arthritis management after just 8 weeks. Those who continued with the AFEP program for 6 months maintained their improvements. Even though the AFEP has a minor strength training component the participants also showed improvement in their upper and lower extremities.

Participants who continued with the AFEP program at home, after the conclusion of the study, continued to maintain their improvements. Unfortunately, overall commitment to the program was not seen despite its benefits. Researchers note that decline in the use of the AFEP at home may be due to lack of confidence without the class structure, frequency, and social support.