Patients who suffer from chronic rhinosinusitis (CRS) also tend to suffer from other chronic illnesses, like asthma, hypertension, and arthritis.

In a paper presented at the 2009 American Academy of Otolaryngology Head and Neck Surgery Foundation (AAOHNSF) Annual Meeting & OTO EXPO in San Diego, researchers studied the electronic records of 1,970,695 patients to determine whether there was a relationship between CRS and other chronic conditions. Chronic rhinosinusitis is an inflammatory condition involving one or more of the paranasal sinuses. The condition usually follows an allergic reaction or viral upper respiratory infection.

The analysis showed a higher incidence of CRS in trustedtablets.com patients with other chronic diseases, especially asthma patients, who are more likely to also have nasal polyps. Patients with other chronic diseases such as high blood pressure and arthritis also have higher incidence of chronic sinusitis but not nasal polyps.

The results of the study suggest that some of these chronic diseases may share common mechanisms of how they arise or progress.

Title CRS in the setting of other chronic illnesses
Presenters Rakesh Chandra, MD; David Conley, MD; Robert Kern, MD; Robert Schleimer, PhD; Sana Sweis, MD; David Lin

Source
Jessica Mikulski

Researchers at the University of Wisconsin School of Medicine and Public Health examined records of rheumatoid arthritis (RA) patients from the national Veterans Health Administration (VHA) system to determine the prevalence of rheumatoid vasculitis (RV) in this population. The study found a downward trend in the number of RA patients who go on to develop RV, with a significant drop of 53% among inpatients and 31% among outpatients between 2000 and 2001. Full details of the study are published in the September issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.

Rheumatoid Vasculitis is a complication of severe RA, an autoimmune disease that causes painful inflammation of the joints. Approximately 2%5% of RA patients develop RV, an extraarticular (occurring outside the joint) manifestation of rheumatoid arthritis, affecting small and mediumsize arteries in the body. RV can involve many body organs including the skin, eyes, heart, lungs, nerves to the hands and feet, as well as blood vessels in the fingers and toes.

In this crosssectional study, Christie Bartels, M.D., and colleagues from the University of Wisconsin School of Medicine analyzed data on patients admitted to VHA hospitals over a 22year period (19852006) or seen in outpatient settings over a 10year period (19972006). More than 37,000 patient records where a diagnosis of RA was noted qualified for the study and 92% of those being men with a mean age of 64.9 years. To determine a RV diagnosis, researchers included those patients who had one of the following arteritis, mononeuritis multiplex (damage to multiple individual nerve fibers), peripheral neuropathy due to connective tissue disease, gangrene, or chronic ulcers.

A past study of data from California hospitals also showed hospitalizations for RV declined between 1980 and 2001. But analysis of only inpatient data raises questions of whether RV cases escaped detection due to changing outpatient management of the disease. “Our study is the first to examine a national U.S. population for RV prevalence among both inpatients and outpatients,” stated Dr. Bartels. “We found the frequency of RV fell from 41 to 28 cases per 1,000 RA outpatients and from 32 to only 15 cases per 1000 RA inpatients.”

Researchers believe the decline in RV reported in the current study may be attributed to a decrease in the number of RV incidences, a disease cure in some patients, patients discontinuing VHA services or dying, or error. Treatment for rheumatoid arthritis improved throughout the 1990s and researchers speculate that the use of biologic agents and more aggressive combinations of antirheumatic drugs targeting severe RA may have diminished extraarticular disease, such as RV.

Additionally the authors noted that the VHA made systemwide efforts to decrease tobacco use among patients that may have impacted the rates of rheumatoid vasculitis prevalence. “Future studies should examine trends in smoking and pharmacotherapy in relation to RV, and ongoing monitoring is merited,” concluded the authors.

This study included a greater number of men who were older than average RA patients and whose use of tobacco was likely higher than most RA cohorts. These demographics may limit the ability to apply the results to the general RA population. “Previous reports have described increased rates of extraarticular manifestations among men, smokers, and persons who were older at the time of RA onset, so perhaps the characteristics of our study sample facilitated detection of changes among the most atrisk population,” Dr. Bartels surmised. “As RA treatment evolves, it will be important to continue following trends in rheumatoid vasculitis prevalence using samples with a sex ratio that more closely reflects the general population,” she added.

Article
“Decline in Rheumatoid Vasculitis Prevalence Among US Veterans,” Christie Bartels, Carolyn Bell, Ann Rosenthal, Kazuhiko Shinki, and Alan Bridges. Arthritis & Rheumatism; Published Online August 27, 2009 (DOI 10.1002/art.24775); Print Issue September 2009.

Source
Dawn Peters

The U.S. Food and Drug Administration is requiring stronger warnings in the prescribing information for a class of drugs known as TNF blockers. The warnings, which include an updated boxed warning, highlight the increased risk of cancer in children and adolescents who receive these drugs to treat juvenile rheumatoid arthritis, the inflammatory bowel disorder, Crohns disease, and other inflammatory diseases.

In addition, the FDA is working with manufacturers to explore new ways to further define the risk of cancer in children and adolescents who use these drugs.

TNF blockers target and neutralize tumor necrosis factoralpha (TNFα), a protein that, when overproduced in the body due to chronic inflammatory diseases, can cause inflammation and damage to bones, cartilage and tissue. The drugs in this class include Remicade (infliximab), Enbrel (etancercept), Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab).

Todays action is based on the completion of an investigation first announced by the FDA in June 2008. An analysis of U.S. reports of cancer in children and adolescents treated with TNFblockers showed an increased risk of cancer, occurring after 30 months of treatment on average. About half of the cancers were lymphomas, a type of cancer involving cells of the immune system. Some of the reported cancers were fatal.

Additional required updates to the prescribing information include incorporation of reports of psoriasis associated with the use of TNF blockers.

For more information see

Update to June 2008 Early Communication about an Ongoing Safety Review of TNF Blockers
Information for Healthcare Professionals

The Arthritis Foundation supports health care reform, which provides universal and affordable health care for the 46 million Americans living with arthritis.

American families, both insured and uninsured, are struggling with rising health care costs and the number of uninsured is rising. Due to the nature of chronic disease, people with arthritis struggle to pay for physician visits and for the increasing costs of multiple medications and other care that is necessary to properly manage their disease.

“Arthritis is the nations most common cause of disability, though many people are not aware that it is a very serious, painful and lifealtering disease,” said Amy Melnick, chief public policy officer for the Arthritis Foundation. “The burden of medical debt excessively falls on patients with chronic diseases, and studies show that outofpocket costs are rising faster for arthritis than for many other chronic conditions.”

In 2007, 28 percent of workingage adults with chronic conditions such as arthritis reported that their families had trouble paying medical bills. Of those, one in four went without needed care, half delayed needed care and 56 percent failed to get prescription medications, because of cost concerns. Prescription costs are hitting harder than ever due to reduced coverage, preexisting conditions and higher copays. These unmet needs put people with arthritis at greater risk for complications and permanent disability.

The Arthritis Foundation applauds the current proposals in Congress for the many provisions that would benefit all Americans, and particularly those affected by a chronic disease or disability, like arthritis. The provisions included for affordability; preventive services; the prohibitions of discrimination based on health status; the elimination of the annual or lifetime limits on coverage; requiring coverage of dependents up to 26 years of age; and the strategy to develop national quality and efficiency standards mirror the principles of the Arthritis Foundation and will greatly improve the American health care system. We support these goals and principles as outlined in the current proposed legislation.

“In our nation, the costs for individual health insurance premiums have risen nearly eight times faster than average incomes. With 45 million uninsured citizens, it is now more important than ever to find ways to make health care affordable and ensure greater access to care for all,” said Melnick.

Indeed, unwieldy medical bills contributed to 62 percent of all bankruptcies in 2007, according to a recent study (PDF) published in the American Journal of Medicine, and to half of all home foreclosures as revealed in a similar 2008 Harvard study.

The Arthritis Foundation wants health care reform this year that will improve the lives of people with arthritis and other chronic diseases. We strongly believe that legislative action is necessary to guarantee quality, affordable, essential health care for all Americans.

According to a new study from researchers at Duke University, total knee arthroplasty (TKA) procedures performed in older patients with osteoarthritis of the knee result in longterm, significant improvement of physical functioning and motor skills when compared to patients who do not receive TKA.

Published in the July 2009 issue of Medical Care, the study examined physical functioning and gauged outcomes in a national sample of Americans aged 65 and older for up to four yearsa longer period than previous TKA studies. Relative to the untreated comparison group, recipients of total knee replacements experienced significant improvement in function, including a 17.5% increase in mobility, a 39.3% improvement in motor skills; and a 46.9% decrease in limitations in activities of daily living such as bathing and dressing oneself.

The number of total knee replacements performed in the United States has increased dramatically since 1990; currently 581,000 such procedures are performed every year. This number is expected to increase markedly as Baby Boomers age.

“In this era of costcutting, policymakers have underscored the importance of evaluating treatments in terms of effectiveness and benefits to patients,” says lead author Frank Sloan, Ph.D., McMahon professor of health policy and management and professor of economics at Duke University. “Our findings show that knee replacements are effective in treating patients with advanced osteoarthritis, contributing to reduced disability and improved quality of life for these individuals. Such findings are extremely important for the broader context of discussions about healthcare reform, costcontainment, device quality, and patient safety.”

For the study, Duke researchers identified 2272 patients diagnosed with osteoarthritis of the lower leg using data from the Health and Retirement Study (HRS) linked to Medicare claims from 1994 through 2006. Of that group, 516 underwent TKA procedures and 1756 did not. Researchers used propensity score matching to generate 515 pairs of treated and untreated individuals who were matched on relevant, measurable factors such as baseline functional status, other health conditions, socioeconomic characteristics, and time before TKA or diagnosis.

Among the patients who underwent TKA, baseline physical functioning measures were taken at an interview before and closest to surgery. For the comparison group, these measures were taken from an interview preceding and closest in time to the year of their first diagnosis with osteoarthritis of the lower leg. Each pair was followed for up to four years, and their resulting physical abilities were compared.

The studys mobility, gross motor skills, large muscle activities, and limitations in activities of daily living indices accounted for a wide breadth of physical activities, including getting in and out of bed; the ability to bathe and dress oneself; sitting for two hours; getting up from a chair; stooping, kneeling, and crouching; walking across the room, one block, and several blocks; climbing one flight and several flights of stairs; and pushing and pulling a large object.

The study comes at a time when Congress and the nations healthcare agencies are looking for ways to identify diagnostics and therapies that offer the greatest value to patients and the healthcare system. Representatives Bill Pascrell Jr. (DNJ) and Lloyd Doggett (DTX) have introduced legislation to establish a federallyfunded registry of patients who have received artificial hips or knees, providing researchers and policymakers with an ongoing source of data about patient outcomes with such devices and related surgical procedures.

According to Sloan, total knee replacement has repeatedly been shown to offer clinical benefits for patients with osteoarthritis, a major risk factor for disability in the United States. Recently, a team at Brigham and Womens Hospital and the Boston University School of Public Health confirmed that, for older adults with advanced osteoarthritis, total knee replacement also appears to be a costeffective procedure across all patient risk groups.

“We know that the inability to perform activities of daily living is highly predictive of nursing home admittance, as patients can no longer care for themselves,” says Sloan. “TKA offers the potential for extending independence and therefore delays the need for assisted living.”

The Duke University research was supported by a grant from the Institute for Health Technology Studies (InHealth). The coauthors of this study are David Ruiz Jr., MA, and Alyssa Platt, MA.

Source
Robyn Stein