IBS and Fibro — The Uncomfortable Truth
Aside from muscle pain and fatigue, one of the most common problems people with fibromyalgia face is irritable bowel syndrome (IBS), a condition in which abdominal pain is accompanied by diarrhea, constipation or alternating bouts of the two. A new study, however, suggests that IBS isn't necessarily more common in people with fibromyalgia — just more severe.
Researchers in Italy and the United Kingdom grouped 130 people with IBS according to their predominant symptoms (such as constipation, diarrhea or abdomimal pain). Then they further divided the groups based on IBS severity. Finally, they had all participants undergo a physical exam, using American College of Rheumatology (ACR) criteria, to diagnose cases of fibromyalgia and had the patients rate themselves on measures such as pain, mood and sleep disturbance, anxiety and fatigue.
Interestingly, the researchers found, people who were diagnosed with fibromyalgia also fell more commonly into the greatest severity group for IBS. But the researchers weren't surprised, given the commonalities of the two conditions: People with fibromyalgia and/or IBS are likely to have an increased sensitivity to bodily sensations and physical symptoms for which no physiologic cause can be found, say the study's authors.
Source: International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery, Vol. 16, No. 4
RHEUMATOID ARTHRITIS
Drug Therapy: Switch And Switch Again
For people whose rheumatoid arthritis (RA) doesn't respond well to the commonly used drug methotrexate, switching to the disease-modifying antirheumatic drug cyclosporine can often help get the disease under control. The problem is, for many people, cyclosporine leads to dangerous side effects, including high blood pressure and kidney problems. For those people, switching drugs as soon as cyclosporine gets the disease under control may maintain cyclosporine's benefits without its potentially dangerous side effects, a Korean study shows.
In the recent study, researchers at the Catholic University of Korea's School of Medicine in Seoul prescribed 24 weeks of cyclosporine for patients who had evidence of joint inflammation and disability despite taking maximum doses of methotrexate. They then prescribed an additional 16 weeks of hydroxychloroquine after the course of cyclosporine had ended. At the beginning of the study and through its full 40-week course, the participants were evaluated every four to eight weeks on a number of measures, including number of tender and swollen joints, blood tests to measure inflammation and the physicians' and patients' assessment of their disease.
The result: According to criteria set by the ACR, 56 percent of the participants experienced at least 20 percent improvement after 24 weeks on cyclosoporine. For 52 percent, improvement persisted 16 weeks after changing to hydroxychloroquine. What's more, side effects that were common with cyclosporine use disappeared in most people after switching the medications.
The researchers concluded that switching from methotrexate to cyclosporine and then switching again to hydroxychloroquine may be an effective strategy for people whose RA isn't controlled by methotrexate but who wish to avoid the long-term side effects of cyclosporine.
Source: Annals of the Rheumatic Diseases, Vol. 60, No. 5
LUPUS
Evaluating Estrogen Safety
Want to reduce your risk of back problems? Then you'd probably do well to follow your doctor's advice for preventing other common health problems: Don't smoke, and keep your cholesterol and blood pressure under control.
If you have lupus, can you safely take oral contraceptives? If birth control is no longer an issue, is it safe to use estrogen replacement therapy to reduce your risk of osteoporosis and heart disease after menopause? Answers to both questions can be found in investigations examining the safety of estrogen.
Because female hormones are suspected to play a role in lupus, many doctors hesitate to prescribe estrogen-containing medications for their lupus patients. Yet research by doctors at Tuen Mun Hospital and Queen Mary Hospital in Hong Kong suggests the benefits of estrogen for many women might outweigh the risks, and a major U.S. study should shed some more light on the subject soon.
In the Hong Kong study, researchers reviewed literature — human studies, clinical trials and epidemiologic surveys — published between 1970 and 2000 concerning the safety of using estrogens in women with lupus. Retrospective studies showed that manipulating estrogen — either by administering or blocking it — exacerbated lupus in some women, and that both oral contraceptives and hormone replacement therapy (HRT) slightly increased the risk of blood clots. Clotting risk was greater in women with antiphospholipid antibodies (a type of autoantibody common in people with lupus).
In general, HRT was well tolerated in postmenopausal women with lupus, and there were no prospective, or forward-looking, studies showing an adverse effect of estrogens on disease activity. Prospective studies, in which variables can be carefully controlled, are generally considered to be more reliable than retrospective studies.
Researchers conclude that oral contraceptives may be considered for patients with lupus, provided they don't have antiphospholipid antibodies. “The slight increase in [blood clot] risk should not be the chief deterrent to the use of HRT in postmenopausal [lupus] patients considering its various health benefits,” they write.
A major multi-center prospective study supported by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) seeks evidence that will give doctors more definitive advice concerning estrogen use — both in oral contraceptives and estrogen replacement therapy — in lupus patients. The study, which has been ongoing since 1996, is still seeking participants at 13 sites across the country.
If you have lupus, have not used estrogen-containing drugs since your diagnosis and think you might be interested in participating, check out the National Institutes of Health's clinical trials Web site at www.clinicaltrials.gov (enter the acronym SELENA in the search box) for more information.
Source: Seminars in Arthritis and Rheumatism, Vol. 30, No. 6; NIH
RHEUMATOID ARTHRITIS
Dangers of Experimental Treatment Discovered
If you had a treatment called total lymphoid irradiation (TLI) for rheumatoid arthritis between the late '70s and mid-'80s, it's important that you maintain regular doctor visits now — even if your arthritis is under control. The reason: The procedure, doctors have since discovered, increases the risk of cancers of the lymph nodes.
Researchers at Stanford University Medical Center in Palo Alto, Calif., identified 53 people who had been treated with TLI in 1979 and after. They compared those 53 to a group of 106 controls who received treatment with disease-modifying antirheumatic drugs only. The two groups were similar in terms of age, sex and duration and severity of RA.
After an average follow-up of 9.2 years, 45 members of the control group (approximately 42 percent) had died. For the TLI group, mortality was slightly lower during the first decade after follow-up; however, for those who died, the cause was different. Three died of lymphoma and two died of myelodysplastic syndrome (a condition in which the blood stops producing white blood cells), while none of the control group died of those causes.
Despite the increased cancer risk, the researchers say the TLI — which involved applying radiation to the spleen and lymph nodes in the chest in an effort to destroy self-destructive immune cells — was no more risky, overall, than other treatments used during the same time frame. Nevertheless, people who underwent the procedure should be followed long-term for the development of cancers.
Source: Arthritis & Rheumatism, Vol. 44, No. 7
LOW BACK PAIN
Preserve Back Health Early in Life
Because having back pain in adolescence has been shown to increase your risk of having it as an adult, taking steps to help your child reduce the risk of back pain during teen years may make a difference in lifelong back health.
To find out what factors are associated with back pain in teens, researchers at McGill University in Montreal went to local high schools. They randomly selected 502 students to take part in a series of three medical evaluations to be conducted at six-month intervals. The goal: to determine both the incidence and causes of back pain.
They discovered that, initially, 125 students had experienced low back pain for at least one week during the previous six months. Over the course of the evaluations, 65 additional students developed low back pain. Factors associated with the new cases, the researchers discovered, included high growth (more than average height growth during the six-month period), smoking, tight quadriceps and hamstrings, and working during the school year.
Although you can't change your child's rate of growth, the study suggests that there are many things your child can do — such as exercising to improve leg flexibility, limiting afterschool jobs and not smoking — that will make a difference for years to come.
Source: American Journal of Epidemiology, Vol. 154, No. 1
POST-TRAUMATIC ARTHRITIS
Procedure Improves Hip Replacement
Despite the overall success rate of total hip replacement in recent years, studies show that people with osteoarthritis (OA) that developed as the result of joint injury haven't fared as well as others when it comes to this procedure. Orthopaedic surgeons at Rush-Presbyterian-St. Luke's Medical Center in Chicago found that one particular type of hip implant might work better in people with that kind of arthritis.
The surgeons performed 30 total hip replacements in people with post-traumatic OA. The procedures all used an implant with a cementless acetabular component — the portion that fits into the pelvis. (A cementless component has a porous mesh surface into which the patient's own bone grows to hold the component in place, whereas traditional implants are cemented in place.) They then followed the patients an average of 63 months and compared both the short-term and longer-term results to those of 204 patients who had had the same procedure for other forms of arthritis.
Their findings: While the procedure itself was associated with more complications (including longer surgery time and greater blood loss) in people with post-traumatic arthritis, the results at follow-up differed little. Twenty-seven patients (90 percent) had a good or excellent result — a finding comparable to that of the 204 with other forms of arthritis. Furthermore, none of the patients experienced dislocations or deep infections — two possible complications of joint replacement surgery.
Source: Journal of Bone and Joint Surgery, American Volume, Vol. 83, No. 6
Research Spotlight compiled and written by Mary Anne Dunkin
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