ARTHRITIS WATCH

Published Online: Sunday, October 1, 2006

Children with Arthritis More Prone to Fractures A recent study conducted by the Children's Hospital of Philadelphia, Pa, showed that children who have arthritis are more likely to experience bone fractures in childhood, adolescence, and possibly adulthood. The researchers suggest that these findings are proof that "we need to intervene to at least preserve and, more likely, to augment skeletal health during childhood and maximize peak bone mass accrual," they said.

The researchers studied 1939 children who were diagnosed with arthritis between the ages of 1 and 9, as well as 207,072 healthy children. They found that the percentage of fractures reported in the arthritis group was significantly higher than that in the control group (6.7% vs 3.3%). Compared with the controls, the incident rate ratio for first fracture among the children with arthritis was 1.49 for ages 1 through 9, 3.13 for ages 10 to 15, and 1.75 for ages 15 to 20.

Researchers insisted that these findings show that "we need to make sure that children meet the dietary requirements for calcium intake and remain vitamin D-replete. We need to develop better clinical tools to diagnose and monitor children at risk for osteoporosis." The results of the study were published in the August 2006 issue of the Annals of the Rheumatic Diseases.

No Raised Risk of Cancer with TNF Blocker Use in RA

According to pooled information from 3 major medical databases, patients with rheumatoid arthritis (RA) who are taking tumor necrosis factor (TNF)-alpha blockers do not have an observable increased risk of lymphoma or solid cancers. Controversy surrounding the therapy has been substantial since the drugs were first approved by the FDA in the 1990s. Researchers found, however, that TNF-alpha blockers may actually help stave off cancer in RA patients who use them because of their anti-inflammatory properties. The findings appear in the September 2006 issue of Arthritis & Rheumatism.

Researchers at Harvard Medical School, Boston, Mass, evaluated 2 US Medicare databases and 1 from British Columbia, Canada. They analyzed data from 7830 patients, aged 65 and older, who were diagnosed with RA and had been prescribed either methotrexate or one of the TNF-alpha antagonists (etanercept, infliximab, adalimumab, or anakinra). Their analyses showed that even though those who took TNF-alpha blockers experienced more severe RA, cancer rates did not differ significantly between those who took the TNF-alpha blockers and those who took methotrexate.

Anti-RA Therapy May Reduce Heart Attack Risk

Research conducted at McGill University in Montreal, Quebec, Canada, suggests that the use of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) could reduce their risk of developing cardiovascular disease associated with RA. The findings were based on data collected from 107,908 RA patients who were observed from 1999 to 2003. During that time, 558 acute myocardial infarctions occurred. According to researchers, however, the adjusted rate ratio was significantly lower in patients who were taking DMARDs.

The researchers found that the effect was consistent with the use of all the traditional DMARDs, such as methotrexate and leflunomide, but not biologic agents. They speculate that the correlation may be a result of the anti-inflammatory effects of DMARDs, or perhaps "an indirect result of the beneficial effect of DMARDs on cardiac risk factors" in RA patients; for example, the drugs improve physical activity, making the patients more able to exercise, which, in turn, lowers their overall cardiovascular disease risk. The researchers agree that "more data will be necessary to ascertain the cardiovascular effects of" DMARDs. The findings were published in the August 15, 2006, edition of Arthritis & Rheumatism.

Women Who Smoke at Greater Risk for RA

A US study shows that women who smoke nearly double their risk of developing rheumatoid arthritis (RA) if they do not have a genetic risk factor for the disease. Researchers from the University of California, San Francisco, looked at 115 postmenopausal women who had RA and compared them with 466 women without the disease. All the women were taking part in the long-term Iowa Women's Health Study, which tracked the lifestyles of its participants, including smoking habits.

The researchers found that, in women who did not have the most well-established genetic risk factor for RA, HLADRB1 SE, smoking increased their risk of developing the disease by almost 2 times. Researchers found no increased risk for RA in those women who did have the risk factor, however. The findings support data which propose that interaction between genes and environmental factors is important in the development of complex autoimmune diseases, such as RA. The study was limited to older Caucasian women, so further investigation would be needed to determine the risk in women of other age groups and ethnicities, the researchers said. The findings were published in the September 2006 issue of the Annals of the Rheumatic Diseases.




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