On May 1st, the [...] No related posts.]]> Etanercept, marketed under the name Enbrel, is a drug that belongs to the class of drugs known as tumor necrosis factor (TNF)-alpha blocker. It is used primarily to treat rheumatoid arthritis, but has also been approved for use in treating polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis.

On May 1st, the U.S. Food and Drug Administration (FDA) announced that it has required a warning label be added to Enbrel to increase the awareness of the risk of infections, particularly tuberculosis. The updated warning recommends screening for latent tuberculosis infection (LTBI) before beginning treatment with Enbrel.

It also warns that patients be monitored for possible antimicrobial treatment if the develop an infection and to stop taking Enbrel if a serious infection develops.

“Tuberculosis has been observed in patients receiving TNF-blocking agents, including Enbrel,” according to the warning. “Tuberculosis may be due to reactivation of latent tuberculosis infection or to new infection. Data from clinical trials and preclinical studies suggest that the risk of reactivation of latent tuberculosis infection is lower with Enbrel than with TNF-blocking monoclonal antibodies. Nonetheless, postmarketing cases of tuberculosis reactivation have been reported for TNF blockers, including Enbel.”

The warning’s section on adverse events now says, “In global clinical studies of 20,070 patients (28,308 patient-years of therapy), tuberculosis was observed in approximately 0.01% of patients. In 15,438 patients (23,524 patient-years of therapy) from clinical studies in the U.S. and Canada, tuberculosis was observed in approximately 0.007% of patients. These studies include reports of pulmonary and extra-pulmonary tuberculosis.”

The changes were distributed to clinicians in a letter from Amgen and Wyeth, which market the drug for the manufacturer, Immunex.

Originally posted 2008-05-03 21:47:03. Republished by Blog Post Promoter

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Since Chlamydia trachomatis or Chlamydia pneumoniae frequently cause reactive arthritis, a new study [...] No related posts.]]> Spondylarthritis (SpA) represents a group of arthritis diseases that have similar symptoms such as inflammatory back pain and inflammation at sites where tendons attach to bone. It includes ankylosing spondylitis, psoriatic arthritis, inflammatory bowel-disease-related arthritis, reactive arthritis and undifferentiated spondylarthritides (uSpA).

Since Chlamydia trachomatis or Chlamydia pneumoniae frequently cause reactive arthritis, a new study led by John D. Carter of the University of South Florida examined whether there was a connection between these two infections and uSpA.

The study involved analysis of blood and synovial tissue from 26 patients who had chronic uSpA or Chlamydia-induced reactive arthritis. Synovial tissue samples from 167 osteoarthritis patients were used as controls. Samples were analyzed to assess chlamydial DNA and the 26 subjects were asked if they had any known exposure to Chlamydia trachomatis or Chlamydia pneumoniae and if so, the infection was documented in relation to the onset of their uSpA. They also underwent a physical exam that included evaluation of swollen and tender joints and other symptoms of SpA. The results showed that the rate of Chlamydia infection was 62 percent in uSpA patients, significantly higher than the 12 percent seen in control subjects.

It is believed that as many as 150,000 cases of Chlamydia trachomatis-induced reactive arthritis may appear in the U.S. each year compared to about 125,000 new cases of rheumatoid arthritis. This is a low estimate since it does not include cases resulting from Chlamydia pneumoniae. “Thus, Chlamydia-induced reactive arthritis represents a considerable burden on the health care systems of the U.S. and other nations, and its impact on those systems may well be significantly underrecognized,” the authors state.

Most women with genital Chlamydia trachomatis infection have no symptoms at the time of the initial infection; this was also true of the patients in the study who had DNA evidence of Chlamydia. For Chlamydia pneumoniae, as many as 70 percent of acute infections are asymptomatic and, even when there are symptoms, definitive identification of the organism is rare. The authors point out that relying on identification of a symptomatic infection may therefore result in routine underdiagnosis or misdiagnosis of Chlamydia-induced reactive arthritis.

They add that because reactive arthritis is a type of SpA and patients with reactive arthritis do not have the classic combination of symptoms of arthritis, conjunctivitis/iritis and urethritis, it is reasonable to believe that Chlamydia trachomatis plays a role in causing uSpA, which may in fact be reactive arthritis. They conclude that although there is no diagnostic test for Chlamydia-induced reactive arthritis, testing for chlamydial DNA in the synovial tissue of patients thought to have reactive arthritis may be the most accurate way of diagnosing the condition.

Originally posted 2009-05-01 13:41:26. Republished by Blog Post Promoter

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AS is a form of [...] No related posts.]]> A global team of researchers, led by Professor Matthew Brown, from the University of Queensland’s Diamantina Institute for Cancer, Immunology and Metabolic Medicine, has discovered that there is a genetic relationship between ankylosing spondylitis (AS) and Crohn’s disease. The study was published in the current issue of Nature Genetics.

AS is a form of arthritis that causes inflammation in the joint of the vertebrae. This leads to pain and stiffness in the back and potentially bone erosion and fusion of bones in the spine. It can also damage other joints, the eyes and the heart.

The approach of the study was to determine if the genetic markers that are associated with AS could be treated by drugs that are already in development. The team of researchers scanned over 14 thousand genetic variants in the DNA of 2500 healthy and affected people. They found two genes, called ARTS1 and IL23R. In addition to the gene HLA-B27, which was identified 37 years ago to have a responsibility for the development of the disease, the ability exists to account for 70 percent of the overall cause of ankylosing spondylitis. This will enable doctors in the early identification of individuals that are at risk for development of the disease.

The report also states that at the current rate all of the genes that play a part in the development of ankylosing spondylitis should be identified in the next twelve months.

Another study has linked the IR23R gene to the development of Crohn’s disease, a debilitating inflammatory bowel disease. Discovery of the gene could explain why people with inflammatory bowel disease have tend to have a higher probability of developing AS. There are human trials already being conducted for treatment of Crohn’s disease that inhibits the activity of IL23R. The researchers stated in their report that the Crohn’s treatment looks very promising as a potential treatment for ankylosing spondylitis. They also expect that new therapies will be developed with clinical trials in the next couple years.

Originally posted 2007-10-23 20:26:53. Republished by Blog Post Promoter

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HLA-B27

The first gene, HLA-B27, was determined in the 1960’s to have a link with spondyloarthropathies, which are a group of [...] No related posts.]]> I have posted in the past about the links discovered between various forms of arthritis and genetics. Here are a couple more genes that have been identified with an increased risk in arthritis.

HLA-B27

The first gene, HLA-B27, was determined in the 1960’s to have a link with spondyloarthropathies, which are a group of diseases that affect the spine and other joints. It was found that 90% of people with ankylosing spondylitis had the HLA-B27 gene but that only 7% of the general population has that specific gene. HLA-B27 has more recently been linked to psoriatic arthritis.

In the ten years following the discovery of the link to the HLA-B27 gene, researchers found a link between people with HLA-DR genes and an increased risk of rheumatoid arthritis (RA). The scientists believed that HLA-DR is a contributor to autoimmune disease.

HLA-DR4

The HLA-DR4 gene has been associated with a number of diseases such as Lyme disease and RA. Lyme disease is caused by at least three different species of bacteria which can be transmitted to humans via deer ticks. The symptoms of Lyme disease include:

• Inflammation
• Joint Pain
• Arthritis

People who have a more severe disease symptoms and do not respond well to treatments with antibiotics are more often found to have the HLA-DR4 gene. The theory is that once the bacteria moves to the joints, the immune response against it cross reacts with the person’s own joint tissue in people who have the HLA-DR4 gene, leading to an autoimmune reaction.

Other genes also are suspected of being major factors in the evolution of rheumatoid arthritis. In support of the effort to find additional genetic links to arthritis, the North American Rheumatoid Arthritis Consortium, consisting of 12 medical centers across the country, has been analyzing clinical findings and genetic material from 1,000 pairs of siblings who both have rheumatoid arthritis. By testing 400 different genetic regions, researchers hope to identify specific genes associated with the rheumatoid arthritis.

Originally posted 2009-03-16 12:00:50. Republished by Blog Post Promoter

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