The Latest News in Rheumatology
9/6/2002
More Cases of Etanercept-Induced SLE Identified by FDA
Age at Disease Onset and Diagnosis Delay in HLA-B27
Negative vs. Positive Patients with Ankylosing Spondylitis
A
New Way to Look at Autoimmune Diseases
Study:
Exercise Reduces Inflammation
Chiropractors
and Nutrition
Rockville, MD--According to the FDA's Center for Biologics Evaluation
and Research (CBER), systemic lupus erythematosus (SLE) is "probably
associated with etanercept (Enbrel®) treatment."
Up to 16 cases of new-onset SLE have been reported during or soon after use
of etanercept from November 1998 to February 2002, as written in this week's Lancet.
According to the FDA, physicians and patients need to be aware that by taking
etanercept, it is possible to develop drug-induced SLE. In the
majority of the cases, "symptoms resolved completely within 1 to 4
months of withdrawal of etanercept, and one case showed incomplete
improvement," they note.
Other researchers doubt that etanercept has caused drug-induced SLE in the
aforementioned cases. They say that the majority of the patients' symptoms
did not fully fit the criteria for SLE.
Many people with AS find it often takes years for a correct diagnosis. It may
take even longer for patients who test negative for the HLA-B27 gene, which is
one of the genetic markers found in the majority of people with AS and other
spondyloarthropathies.
Muhammad Asim Khan, MD, and colleagues sought to investigate differences
between AS patients who test negative for the HLA-B27 gene and AS patients who
test positive for the gene.
Results: Out of the 1,080 AS patients taking part in the study, 10%
were HLA-B27 negative (90% HLA-B27 positive). This is the largest group of
HLA-B27 AS patients ever involved in a study. The researchers found the
following statistics:
Average age at disease onset-
- 27.7 years in HLA-B27 negative patients, and 24.8 years in HLA-B27
positive patients
- No difference between male (25.7 years) and female (24.2 years).
- No difference between patients with primary AS and AS associated
psoriasis, inflammatory bowel disease, or reactive arthritis.
- Percentage of late onset (age over 40 years) significantly greater among
HLA-B27 negative patients (13%) than among HLA-B27 positive patients (5%)
with AS
Average age at diagnosis-
- 39.1 years in HLA-B27 negative patients, and 33.2 years in HLA-B27
positive patients
- Average diagnosis delay 11.4 and 8.5 years, respectively.
They also found that acute uveitis was significantly less frequent in HLA-B27
negative patients (26%) than in HLA-B27 positive patients (41%) with AS.
In conclusion, these results confirm earlier reports indicating a
significantly older average age at disease onset and a less frequent prevalence
of acute uveitis in HLA-B27 negative patients than HLA-B27 positive patients.
The average delay between the first spondyloarthritis symptoms and diagnosis is
significantly longer in HLA-B27 negative than in HLA-B27 positive. Regardless of
HLA-B27 status, the frequency of juvenile disease onset (before age 16 years) is
nearly the same for both groups.
Instead of treating asthma, psoriasis or Crohn's disease separately, a
medical revolution may take place in the near future in which physicians will
deal with a newly conceived group of diseases called Immune-Mediated
Inflammatory Disorders (IMIDs).
IMIDs would include autoimmune diseases, as well as conditions like
transplant rejections, and various skin and upper airway/respiratory disorders.
The idea of IMIDs has come into sharper focus as doctors have seen seemingly
separate diseases respond to the same biological therapies within the last
couple of years.
For example, certain biotherapeutic drugs designed to treat rheumatoid
arthritis by enhancing the immune system may also treat a patient's psoriasis
and inflammatory bowel disease because the diseases share a common pathway of
immune mediation. Apparently, according to researchers, these
pharmaceuticals don't just suppress the immune system--they target very
specific parts of the immune system.
Members of the Federation of Clinical Immunology Societies (FOCIS) are
forming a national academic platform that will start working toward more
collaboration in the areas of diagnosis and treatment of disorders that deal
with the immune system. They will work across subspecialties, including
rheumatology, gastroenterology, oncology, dermatology, and neurology, to name
just a few.
These physicians ultimately hope to eliminate the underlying causes of the
disease, rather than simply treating symptoms with biotherapeutics.
But according to Dr. G. James Morgan, an associate professor of medicine at
Dartmouth Medical School and a member of FOCIS, "the earlier you can
control the disease, the more likely you can stop it, rather than always chasing
it."
Reporter Amanda Gardner's article can be found online at Health Talk (www.healthtalk.com/news/index.cfm?net=rain&sid=507721)
A recent study from the U.S. Centers for Disease Control and Prevention (CDC)
explains how exercise impacts inflammation. CDC medical officer Earl Ford found
a clear correlation between physical activity and decreased levels of c-reactive
protein (CRP) in the blood. The results were published in the September 2002
issue of the journal Epidemiology.
Based on previous studies, CRP levels appear to be reliable markers of
inflammation. Higher levels of CRP indicate there is inflammation (whether from
a temporary infection or a chronic condition) lurking somewhere in the body.
But Ford's study shows for the first time that CRP levels decline in people
who exercise.
By analyzing data from nearly 14,000 participants, there was a strong
correlation between self-reported physical activity and low levels of CRP in the
blood. While 21% of the sedentary participants in the study had elevated CRP,
only 13% of those who described themselves as moderately active had similar
levels. Among those who exercised vigorously, only 8% had elevated CRP.
Besides having potential positive effects for people with AS and other
rheumatic diseases that involve inflammation, these findings bring physicians
one step closer to understanding effects for the entire body, including the
heart.
According to an article titled "A Survey of Chiropractors' Use of
Nutrition in Private Practice" in the November 2001 issue of the Journal
of Chiropractic Humanities, 81% of the 74 chiropractors who responded to a
mail survey said they incorporated nutritional counseling, literature, or
supplementation into their practice.
The methods they used to "assess" their patients' nutrition needs
included:
- hair analysis (27%) - screening for nutritional deficiencies in the body
by analyzing hair samples
- kinesiology (39%) - the scientific study of movement of the human body or
its parts
- a "subluxation" pattern (46%) - incomplete or partial
"dislocation"
According to the study's authors, none of these controversial nutritional
practices are legitimate. They even found that 54% of the study's chiropractors
use nutrient combinations to treat specific diseases, an action they term
"somewhat alarming."
Generally speaking, SAA's Medical and Scientific Advisory Board does not
recommend chiropractic or any other form of spinal manipulation for people with
spondylitis because of the potential risks of doing harm.