ALL GOOD THINGS COME TO AN END! 

After a decade of exciting research Tanezumab is dead. So are most of its siblings. Fasinumab is the lone survivor in this family of Nerve Growth Factor inhibitors. These drugs held a lot of promise and hope for people with advanced degenerative arthritis and chronic pain. But they were killed by the FDA reviewers because a few more people needed joint replacement surgery sooner than expected. 

There are many far dangerous and less beneficial drugs in the market, killing people by the thousands...

https://rheumnow.com/news/pfizerlilly-pull-tanezumab-development?utm_source=RheumNow+Newsletter&utm_campaign=8f8209a912-EMAIL_CAMPAIGN_2021_10_26_09_04&utm_medium=email&utm_term=0_11adbca03a-8f8209a912-243777661

Tanezumab 2012: FDA panel supports continued testing

http://www.reuters.com/article/2012/03/13/us-pain-drug-trial-idUSBRE82C0YB20120313

Tanezumab, and several other drugs in the family of drugs known as nerve growth factor inhibitors, are a potential breakthrough for treating osteoarthritis, back pain and other chronic pain conditions. The clinical trials for Tanezumab were halted by the FDA in 2010, because some patients were getting worse. The drug was just too good. Patients had never felt better. As a result, physical activity increased to the extent that some patients caused more damage to their joints and needed joint replacement surgery sooner than expected. Or at least that is what is believed must have happened. There was even some concern for Osteonecrosis, but that turned out to be a false alarm.

Now the drugs appear to be back on track, although the temporary halting of the trials has setback the time frame for FDA approval and then marketing. 

http://www.pfizer.com/news/press_releases/pfizer_press_release.jsp?guid=20120313005905en&source=rss_2011&page=1

And all good things come to an end :-(

https://rheumnow.com/news/pfizerlilly-pull-tanezumab-development?utm_source=RheumNow+Newsletter&utm_campaign=8f8209a912-EMAIL_CAMPAIGN_2021_10_26_09_04&utm_medium=email&utm_term=0_11adbca03a-8f8209a912-243777661

Genetic Profiling - what will we do when we get there?

http://www.arthritis.org/two-genes-linked-to-ra.php 

 

Breakthroughs in genetic research are rapidly bringing us closer to early diagnosis of mysterious illnesses and will soon improve our ability to target specific drugs towards individual patients. Our current approach of using 'randomized double-blinded placebo-controlled' clinical trials to prove efficacy and safety of new drugs will become obsolete due to genetic advances. No longer will I have to prescribe a drug to a patient because it worked for 60 out of 100 people in a clinical trial. The other 40 will soon have a voice - a genetic language - that we will be able to read.

 

Welcome to the era of 'personalized medicine'.   

 

When treating a patient with Rheumatoid Arthritis, I have about ten good drugs to choose from but there is no way to match the right drug with the right patient. So we just shoot in the dark and if it doesn't work we try again. Genetic research holds the promise to change all that and improve our accuracy.

 

It will however, undoubtedly also open the door for abuse and discrimination as well. If you don't like racial profiling, wait for the day when we have genetic profiling. Will insurers charge a higher premium for having "bad" genes? Will people stock pile a drug that they predictably will need tomorrow? Will your boy friend reject you because of your genes? Will your children sue you because you married each other while you knew that your future kids were going to be 'genetic disasters'? 

 

http://www.biopoliticaltimes.org/article.php?id=5599 

 

Let arthritis slow you down - what's the rush?

http://www.usaweekend.com/article/20110107/HEALTH01/101090303/Don-t-let-arthritis-slow-you-down

Researchers think Rheumatoid Arthritis is becoming more prevalent. That may or may not be true. The rise in numbers may just reflect increased awareness and improved diagnosis over the last decade. Osteoarthritis is definitely on the rise, and so is Gout and other types of arthritis as we are becoming an older fatter species.

Everything I needed to know about arthritis, I learned from my grandmother! (Just kidding). But she did live 85 healthy years, survived tuberculosis without treatment, and died without arthritis or diabetes or heart disease or cataracts or dentures. She was thin, she worked hard, she was a vegetarian, she fasted all the time and prayed all the time.

The author of the article referenced above asks you to diet and exercise and tai chi. Original isn't it? Grandma never followed a diet (other than being a vegetarian). In fact she would sneak in some butter when nobody was looking! She never exercised and had no clue where China is. Tai Chi to her would be Chai Tea misspelled. So what was her secret to good health? Well she lived a hard life. She ate hard foods. Slept on a hard bed. Never saw her on the couch. And she was constantly on the move. She walked slow but never stopped.

And that is my message from her to you: Let the arthritis slow you down. What's the rush? But don't stop, keep moving. A lot is happening in arthritis research. there is lots to look forward to. Stay tuned.

Solid Marriage Eases RA Pain!

http://www.webmd.com/rheumatoid-arthritis/news/20101029/solid-marriage-may-ease-ra-pain?src=RSS_PUBLIC

"This study suggests that the association between marital status and health status depends on the quality of the marriage..."
Isn't that a 'no-brainer'? Your grand mother could have told you that before these Johns Hopkins researchers! Although I do wonder if they are jumping to conclusions. It may just be that RA patients who are in better health have better marriages...In fact I am sure, healthy people have healthier marriages.

UK Scientists Developing Stem Cell Treatment To End Need For Hip, Knee Replacements

http://www.dailymail.co.uk/health/article-1321434/Stem-cell-jab-end-need-hip-replacements-repairing-damaged-joints.html

This maybe a major breakthrough for a potential treatment of Osteoarthritis. If successful, we will be able to treat Osteoarthritis with an injection of stem cells instead of joint replacement surgery.

There have been ongoing attempts to regenerate cartilage but it is difficult to recreate the natural structure of cartilage in the lab. Hopefully, embryonic stem cells will make that possible.

Meanwhile there are some voo-doo remedies sold by some famous 'arthritis experts'...and I quote one here - "At our center, we are using autologous  (a patient’s own stem cells) stem cell concentrates to regionally treat osteoarthritis of the knee and hip.  So far, our data looks promising." Beware of these claims. They are not standardized, not approved and not paid for by insurance. And they don't work.

Arthritis: It's Only Going to Get Worse

http://www.hcplive.com/articles/Arthritis-Its-Only-Going-to-Get-Worse?utm_source=Listrak&utm_medium=Email&utm_term=http%3a%2f%2fwww.hcplive.com%2farticles%2fArthritis-Its-Only-Going-to-Get-Worse&utm_campaign=Rheumatology+eDigest%3a+Arthritis+-+It%27s+Only+Going+to+Get+Worse

There won't be enough Rheumatologists to take care of these patients. But if we listened to our mothers, most of the modifiable risk factors for Osteoarthritis would be taken care of: don't smoke, don't skip school, don't be lazy and don't get fat.
It is remarkable that these four life-style changes can significantly reduce the risk of the four most prevalent diseases - arthritis, diabetes, high blood pressure and coronary artery disease. It is even more remarkable that a person's level of formal education  is a strong determinant of the risk of developing many diseases, including: Rheumatoid Arthritis, Osteoarthritis, Back problems, High blood pressure, Heart attack, Stroke, Diabetes, Kidney diseases and certain Cancers. Studies have shown that high school graduates have a 2-4 fold decrease in risk of having these diseases compared to those with less than 8 years of education.
One large study from the UK found that the risk of dying from a heart attack more than triples, in men with a certain type of arrhythmia, depending on their education level:
http://www.nejm.org/doi/pdf/10.1056/NEJM197807132990202

Eating Broccoli Could Guard Against Arthritis

http://www.sciencedaily.com/releases/2010/09/100915084504.htm

I hope this one works! My mother will not take Glucosamine/Chondroitin because she is a vegetarian.
There are many other vegetarian items that are claimed to be good for prevention/treatment of arthritic pain.
Here is a short list:

Oranges, Blueberries, Kiwis, Apples, Cherries, Parsley, Prunes, Carrots, Beans, Tomatoes, Ginger, Turmeric.

FDA says NO to Colchicine and Tanezumab

The implications of the FDA's two far reaching actions last week can impact every doctor and patient in the world.

First, clinical trials of a drug were halted because it was "too good".  A potential drug for Osteoarthritis - Tanezumab, was stopped from development because patients were doing better than expected and as a result hurting their joints with increased activity. I can tell from my own patient's experiences that it worked well. And it is not even a narcotic.

http://www.bloomberg.com/news/2010-09-29/pfizer-arthritis-drug-cut-pain-too-well-leading-to-joint-damage-in-study.html

Second, in truly spinning the wheel backwards, FDA is removing generic colchicine from the shelves to make room for branded colchicine (Colcrys). The difference in price is 10 cents per pill vs $5 per pill. Colchicine has been around for more than a few decades, in fact more than a century in some form or another. Now a drug company decides to manufacture it as a branded drug and go through FDA's approval process. How does that make the old generic drug any more dangerous? I am asking my patients to stock up on the generic while it is still around...and I am determined not prescribe Colcrys ever.

http://www.federalregister.gov/articles/2010/10/01/2010-24684/singleingredient-oral-colchicine-products-enforcement-action-dates

I am baffled by these two announcements. What are they trying to do? Will the FDA now remove ALL pain killers - such as Morphine for being too good , and ALL unapproved old drugs - such as Aspirin for being dangerous?  

Perhaps they could have approved Tanezumab with the same warning as they have on cigarettes - "Taking Tanezumab can be injurious to your health"....

Bisphosphonates: All good things come to an end

EU agency starts safety probe of common bone drugs
Novartis Hid Bone Drug's Risks, Lawyer Tells Jury

It was too good to last. When Merck came out with Fosamax in 1995, I had just finished my training and taken up my first real job in Dallas. I remember reading the ground breaking article published  in the New England Journal of Medicine in November of 1995 [N Engl J Med 1995; 333:1437-1444] and my reaction was - "this will change everything". It was the first real treatment for Osteoporosis. Osteoporosis, Bone Density Testing, Fosamax, Actonel, Boniva...have become familiar words over the last decade, thanks to the massive educational and marketing effort that followed. Osteoporosis is now a billion dollar industry, not just a 'silent epidemic'. But, drugs that make huge profits cannot last long in this market. So now more new drugs are entering the market. And they have to destroy the older generic drugs to make room for themselves. Suddenly, the bisphosphonates are not safe anymore! They are causing the "jaw-rotting disease"!!, they are causing more hip fractures!!! All non-sense. You wish that the lay press would stop exaggerating these reports.

No, the bisphosphonates will not make your jaw bone melt away. Osteonecrosis of the jaw bone is a rare complication seen predominantly in cancer patients after a tooth extraction. These are people on chemotherapy getting massive doses of bisphophonates to protect their bones from the spreading cancer. You are more likely to be hit by a UFO...

And NO, bisphosphonates do not increase the risk of hip fractures. They DECREASE the risk of hip fractures, even after long term use. The one report that was highlighted in the media was about a small series of patients who had taken Alendronate for more than 5 years, and experienced an uncommon variety of hip fracture more frequently than what is expected in the normal population. What the media failed to report was another report of a larger series of patients showing no such increase in the risk of this uncommon variety of hip fracture. And what they really failed to tell us was that these drugs clearly protect us from the common type of hip fracture.

Moral of the story: Don't get your medical information from the news man. Ask me.

Glucosamine and Chondroitin have no effect ? Again?

Researchers Claim Arthritis Supplements Have No Effect

Another article trashing Glucosamine and Chondroitin. This time from Switzerland - the motherland of Cheese, Chocolates and Banks.

"Health authorities and health insurers should not cover the costs for these preparations, and new prescriptions to patients who have not received treatment should be discouraged," Peter Juni of the University of Bern, whose study was published in the British Medical Journal on Friday, told Reuters [BMJ 2010; 341:c4675 doi: 10.1136/bmj.c4675 (Published 16 September 2010)].

Yes, that is true and has been said before, but...ask the people who take it and benefit from it. It has changed their lives. And no side effects.

Q: So where is the disconnect?
A: When a scientific article claims something is ineffective, it is like saying - "Most humans cannot fit into a size 7 shoe" . Yes, that is true, but what they fail to elaborate is that the average human shoe size is 7 and there are plenty of people who can wear a size 7 shoe perfectly well. They may well be in the minority because majority of humans may have feet bigger or smaller than size 7. So shall we stop making size 7 shoes? That is exactly what the Swiss researchers in the article above are suggesting.

Glucosamine and Chondroitin, like many other remedies, work amazingly well for some folks and do nothing for others. All you can do is try. Take it for 2 months. If it works, keep taking it. If it doesn't work, move on.
 
By the way, there is one other industry that Switzerland tops the world markets in - world's two biggest pharmaceutical giants, that just happen to be Swiss also - Novartis and Roche - both very active in making arthritis drugs. Wonder if the $2 billion market of Glucosamine/Chondroitin is hurting their bottom line!

Krystexxa (pegloticase) Approved For Treatment Of Gout

Your joints may be hot, but Gout is cool! Finally, the drug industry has made inroads into the Gout market. Of all the ailments we see in Rheumatology, Gout is the easiest to treat and unfortunately the easiest to screw up. It is good to have another new drug for Gout, but don't go running to your doctor asking for this one just yet. Very very few patients will truly need Pegloticase. The rest will be over-diagnosed and over-treated, as usual. And the ones who truly need it will not, as usual.

Welcome!

When it comes to Arthritis and associated conditions there is more noise and less information on the web. And then there is the "ask your doctor" disclaimer on everything. Well here is the no noise, facts only, blog - answers from your arthritis doctor. Stay tuned...and ask me. What's on your mind? Sorry, So what's in your 'joints'?