AMA President, Dr Andrew Pesce, said that the announcement of the Diabetes Advisory Group is another example of the Government announcing flawed policy before engaging in a proper process of consultation and negotiation with all the key players.

Dr Pesce said that failure to engage in genuine consultation with the AMA over its serious concerns with the proposed plan for care for people with diabetes is a snub to doctors and their patients with diabetes.

“The AMA was approached to be part of the Diabetes Advisory Group, but our participation was not possible when it was made clear that our inclusion was conditional on us changing our position,” Dr Pesce said.

“This is all about decision without consultation or negotiation.

“The Government has a fixed position on the fundamental elements of its plan, including capped funding for patient care and patient enrolment. Patients will also have to surrender their rights to a Medicare rebate if they enrol in the scheme.

“The AMA believes that these changes are not the best possible outcome for patients, and our concerns are shared by other peak groups and some diabetes organisations. We chose not to be part of a group that would not be able to openly discuss the glaring shortcomings in a flawed policy.

“The AMA has a credible alternative plan, which is a more comprehensive patient-centred plan for people with complex and chronic disease that recognises the importance of enhancing care for all people with chronic conditions, including diabetes. The AMA has asked that its plan be trialled against the Government’s model to establish which is better for patients, but this has been refused.

“The Government has followed the same path as it did with the implementation of the mining tax – there was no specific consultation with the profession before the Government announced its plans.

“We note that the Royal Australian College of General Practitioners has agreed to be part of the Advisory Group despite its stated opposition to the Government’s plan.

“The AMA believes that doctors and their patients will support our principled decision to stay outside a Group whose terms of reference will not allow proper consultation and negotiation to create a better plan to care for people with diabetes.

“The AMA will continue to work in other ways to achieve better use of what is otherwise welcome funding for diabetes care,” Dr Pesce said.

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Lorenzo Cohen, Ph.D., Director of the Integrative Medicine Program at The University of Texas M. D. Anderson Cancer Center is the recipient of the 2007 International Scientific and Technological Cooperation Award of Shanghai Municipality (ISTCASM) and the 2008 Magnolia Memorial Award for his contributions in furthering research into the use of traditional Chinese medicine in cancer therapies.

The prestigious awards, established by the Shanghai Municipality People’s Government, recognize individuals and international organizations that make outstanding contributions to the city. The ISTCASM award has been presented since 2006 to those who advance scientific and technological development in Shanghai. The Magnolia Memorial Award, named after the city’s official flower, was created by the municipal government in 1989 to show appreciation to expatriates who live in Shanghai and contribute to the city’s economic performance, international relations, business environment, management standards and community development. Cohen was selected based on the merit of his scientific collaboration with faculty from Fudan University Cancer Hospital in Shanghai.

Cohen and his M. D. Anderson colleagues have worked closely with researchers in the Department of Integrative Oncology at Fudan University Cancer Hospital over the past five years, and in 2005 the teams were awarded a $2.15 million grant from the National Cancer Institute to expand ongoing laboratory and clinical research studies of herbal and natural-based products as sources for new cancer therapies. M. D. Anderson and Fudan University Cancer Hospital signed a sister-institution agreement in 2003 that formalized a framework for educational, clinical and research exchange programs.

“I am extremely honored to accept these awards and extend my deep appreciation to my colleagues at Fudan University and the city of Shanghai for making this partnership possible,” said Cohen. “Together, we continue to make important strides in understanding traditional Chinese medicine and its potential to advance the science of cancer research and patient care.”

According to Luming Liu, M. D., chair and Zhiqiang Meng, deputy-chair of the Department of Integrative Medicine at Fudan University Cancer Hospital, the ongoing collaboration with Cohen and M. D. Anderson has opened multiple avenues for research training. Currently faculty and staff from both institutions are supporting the collaboration through work on several research projects.

Joint clinical studies currently underway include examining the ability of HuaChanSu (a form of dried toad venom) to treat advanced pancreatic, liver and lung cancer. Energy-based practices such as qigong are also being investigated as a way to promote relaxation among breast cancer patients undergoing radiation therapy.

“Dr. Cohen and the researchers in Shanghai have championed a 21st century research program dedicated to studying the mainstays of traditional Chinese medicine and its application to cancer,” said John Mendelsohn, M.D., president of M. D. Anderson. “Their continued work in this area exemplifies our commitment to the exchange of knowledge across continents to benefit cancer research and treatment.”

Traditional Chinese medicine dates back up to 5,000 years ago and in China is accepted as standard of care. The majority of chemotherapies used today originated from natural plants and many popular drugs, such as morphine and aspirin were derived from plants, according to Cohen.

At M. D. Anderson, Cohen said that over 50 percent of patients report that they use ingestible complementary therapies. “Growing numbers of patients globally are integrating complementary therapies into their cancer care, especially cancer survivors who are looking to Eastern medicine to manage side effects and even prevent recurrence,” Cohen said. “It is important for medical teams to understand fully the potential benefits, risks and safety precautions associated with therapies such as traditional Chinese medicine, as we would any regimen.”

Director of the Shanghai Ministry of Science and Technology of Shanghai, Shou Ziqi, presented the awards to Cohen in an official ceremony in Shanghai last week. Dutch horticulturist Co Buschman was also honored for his work with Sino-Dutch agricultural projects in Shanghai since 1997.

Notes:

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 41 Comprehensive Cancer Centers designated by the National Cancer Institute. For four of the past six years, M. D. Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News and World Report.

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The Foundation for People with Learning Disabilities today welcomed the Government’s announcement to hold an independent inquiry into the deaths of six people with learning disabilities. The announcement comes after the publication of the report, ‘Death by indifference’, by the charity Mencap, which says the deaths occurred because of “institutional discrimination”.

Dr. Andrew McCulloch, Chief Executive of the Foundation for People with Learning Disabilities, said:

“We have recently learnt of the abuse experienced by people with learning disabilities in NHS settings in Cornwall and Sutton and Merton, so sadly Mencap’s findings come as no surprise. We know that neglect like this does exist in many parts of the country.

“The Department of Health’s decision to launch an inquiry into the standards of care for people with learning disabilities is a welcome one, but to what extent this will simply echo the Healthcare Commission’s current investigation and the Disability Rights Commission’s recent report is not clear. We need action to improve the care of people with learning disabilities, not continuous investigations.

“A particular priority is to improve the physical health care of people with learning disabilities by helping them to access good quality mainstream services.”

The Foundation for People with Learning Disabilities promotes the rights, quality of life and opportunities of people with learning disabilities and their families. We do this by working with people with learning disabilities, their families and those who support them to:

– Do research and develop projects that promote social inclusion and citizenship

– Support local communities and services to include people with learning disabilities

– Make practical improvements in services for people with learning disabilities

– Spread knowledge and information

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Cells have two different protection programs to safeguard them from getting out of control under stress and from dividing without stopping and developing cancer. Until now, researchers assumed that these protective systems were prompted separately from each other. Now for the first time, using an animal model for lymphoma, cancer researchers of the Max Delbruck Center (MDC) Berlin-Buch and the Charite – University Hospital Berlin in Germany have shown that these two protection programs work together through an interaction with normal immune cells to prevent tumors. The findings of Dr. Maurice Reimann and his colleagues in the research group led by Professor Clemens Schmitt may be of fundamental importance in the fight against cancer (Cancer Cell, Vol. 17, Issue 3, 16 March 2010, pp. 262-272; DOI 10.1016/j.ccr.2009.12.043)*.

Researchers have known for some time that – paradoxically – oncogenes themselves can activate these cell protection programs in an early developmental stage of the disease. This may explain why some tumors take decades to develop until the outbreak of the disease. The Myc oncogene triggers apoptosis (programmed cell death), inducing damaged cells to commit suicide in order to protect the organism as a whole. By means of chemotherapy, physicians activate this protection program to treat cancer.

The second protection program – not as well understood as apoptosis – is senescence (biological aging). This program is triggered by another oncogene, the ras gene. Senescence stops the cell cycle, and the cell can no longer divide. But in contrast to apoptosis the cell continues to live and is still metabolically active. Professor Schmitt, physician at Charit?© University Hospital and research group leader at the MDC, was able to show on an animal model for lymphoma that senescence can block the development of early-stage malignant tumors.

Myc oncogene triggers cascade to activate both protection programs

Now, for the first time, Dr. Reimann, Dr. Soyoung Lee, Dr. Christoph Loddenkemper, Dr. Jan R. D?¶rr, Dr. Vedrana Tabor and Professor Schmitt have provided evidence that the Myc oncogene plays a key role in the activation of both protection programs – without the presence of the ras oncogene. “What is remarkable about this finding is that an oncogene can first trigger apoptosis and interact with the tumor stroma – the tissue that surrounds the tumor which also contains healthy cells – and with the immune system and then is able to switch on signals which lead to tumor senescence,” Professor Schmitt said, summarizing how the interaction works.

“Fundamental significance”

According to the researchers’ findings, the cascade occurs as follows: First the Myc oncogene triggers apoptosis in the lymphoma cells. The dying, apoptotic cells attract macrophages of the immune system, which devour and dispose of the dead lymphoma cells. The thus activated macrophages in turn secrete messenger molecules (cytokines), including the cytokine TGF-beta. It can block the growth of cancer cells in the early stage of a tumor disease. The MDC and Charit?© researchers discovered that the cytokines in the tumor cells that had escaped apoptosis switch on the senescence program and suppress the cancer cells.

“Our findings promise to have fundamental significance for elucidating the pathogenesis not only of lymphoma cancers, but of cancer in general. Our results indicate that senescence triggered by the immune system’s messenger molecules may be a further important active principle, apart from apoptosis induced by chemotherapy.”

At present the researchers in Professor Schmitt’s group are focusing intensively on chemotherapy-mediated senescence. “If by inducing senescence we could obtain a sustained suppression of the cancer cells we can no longer destroy, this would mean exciting new possibilities for therapy,” Professor Schmitt said.

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Capricor Inc. announced today the results from preclinical
studies showing that its cardiosphere-derived stem cells (CDCs), when
transplanted into a well-established mouse model of myocardial
infarction (MI), protect the heart significantly better against
progressive degeneration following MI or heart attack than do highly
purified cardiac stem cells or heart derived mesenchymal like
progenitor cells.

Cardiac degeneration after a heart attack leads to progressive loss
of cardiac function ending in heart failure and death. This promising
study was conducted by Dr. Rachel Ruckdeschel Smith, Project Leader
Regenerative Medicine, at Capricor, will be presented today at the
American Heart Association’s 2008 Scientific Sessions. The
presentation will take place at the session entitled, Human
Progenitor Cells and Myocardial and Vascular Regeneration, located in
room 271-273, at the Ernest N. Morial Convention Center in New
Orleans.

“This study confirms our previously published preclinical work that
CDCs have a strong therapeutic effect when applied to animal models of
heart attack,” said Oliver Foellmer, President and CEO at Capricor.
“Preparations for a clinical trial testing CDCs in patients with
recent heart attack are already underway and we hope to file an IND
with the FDA by the end of this year to investigate the beneficial
impact that CDCs can have in patients.”

In this preclinical study, Dr. Ruckdeschel Smith and research
collaborators at Johns Hopkins Medical Center as well as the
University of Rome, compared transplantation of human CDCs, highly
purified human cardiac stem cells, and human heart derived
mesenchymal like progenitor cells into immunodeficient mice that had
induced myocardial infarcts. Many questions remain to be answered on
how various stem cells act when delivered into a damaged heart.
“Capricor’s CDCs represent a mixed population of multiple progenitor
lineages, acting synergistically to regrow heart muscle as well as
cardiac vasculature,” said Dr. Ruckdeschel Smith. “In contrast,
purified cardiac stem cells and mesenchymal like cells from the heart,
while maintaining an individual effect showed significantly less
benefit than the CDCs, which contain both these progenitor
populations.”

About Cardiosphere-derived Stem Cells

CPI-003, Capricor’s lead product candidate, is an autologous adult
stem cell product for the treatment of myocardial infarction. The
product contains multiple progenitor cells from the patient
themselves, and is derived from a small heart muscle biopsy in an
outpatient procedure. The cells are multiplied in the laboratory, and
then reintroduced to the patient. This elegant autologous therapy
represents the ultimate personalized medicine matching the patient
both genetically and immunologically. CDCs have an excellent safety
profile and clinical trials in cardiovascular indications are
expected to initiate in 2009.

About Capricor Inc.

Capricor Inc., headquartered in Los Angeles, California, is a leading
biotechnology company that specializes in discovering, developing,
and commercializing biotherapeutics for the treatment of heart
diseases. Capricor’s mission is to revolutionize the treatment of
cardiac disease by translating novel stem cell science into
therapeutics that halt and reverse the disease process for patients,
their families, and society in general. Further information can be
found at the company’s web site at capricor.

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Dr. Sanderson, DMD, announced that he is providing patients with Teeth in an Hour implants, making him the first dentist in Alabama to offer this service. Teeth in an Hour utilizes a new and innovative technology created by Nobel Biocare of Sweden, that allows patients to leave their dentist’s office with dental implants, permanent or temporary crowns and bridge replacements that same day, after a short and easy procedure.

Performed in April, 2007, Dr. Sanderson – with the help of Dr. Holt Gray, a licensed Prosthodontist in practice with Dr. Sanderson, and Dr. Kevin Sims, an accredited Periodontist – implanted a full bottom set of prosthetic teeth during a minimally invasive, 90-minute surgery. The patient had been plagued all her life with tooth problems – being without her top teeth for eight years and bottom teeth for three. She had worn dentures, but the bottom set didn’t work well and popped out easily, which is a common complaint. Teeth in an Hour procedures eliminated this problem.

The Teeth in an Hour procedure is available due to an evolving technology that uses digital images provided by CatScan 3 Dimensional Imaging, which are transferred to a computer. Using an I-Cat Cone Beam Scanner (limiting exposure to 20 seconds) 3-D images of the patient’s jaw are captured and thoroughly examined and analyzed so that the doctor can begin the pre-treatment planning process. After the imaging is complete, Nobel Biocare then creates the titanium arch for the prosthetic teeth and a surgical tool identical to the patient’s jaw to guide the placement of the implanted screws. The teeth are added onto the titanium bar in a laboratory. The procedure got approval from the U.S. Food and Drug Administration in 2004. Because the specialized software allows Dr. Sanderson the ability to do all treatment planning before surgery is even begun, the entire implant procedure can be done in about an hour. For more information about Teeth in an Hour, visit the Web site AlabamaTeethInAnHour

About Dr. James Sanderson and Dr. Gray Holt

Drs. Sanderson and Gray received Doctor of Dental Medicine degrees from The University of Alabama School of Dentistry in Birmingham. They have also received advanced training in cosmetic, comprehensive, and laser assisted dentistry from multiple locations across the U.S. and have affiliations with the Academy of Laser Dentistry, the LD Pankey Alumni Association, the American Academy of Cosmetic Dentistry, the American College of Prosthodontists, the Academy of Sports Dentistry, the Alabama Implant Study Group, and The Crown Council. Additionally, they have been fortunate to receive invitations to lecture and teach both locally and internationally. For more information about Drs. Sanderson and Gray’s practice, visit their Web site at SanDentistry
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Clopidogrel anticlotting prescription, in doubled dosages minimizes risk of cardiovascular deaths, heart attaches ad strokes by 14%. Intensified bleeding in patients did rise by 40%, but proved to show zero percent increase in coronary artery bypass graft surgery patients, intracranial bleeding or fatalities.

The study conducted by Dr. Shamir Mehta, Hamilton General Hospital and McMaster University, Hamilton, ON, Canada, concludes that double-dose clopidogrel regiment can be considered for all acute coronary cases. This technique is best utilized during PCI or precautionary coronary intervention.

In Mehta’s study, 8560 patients were assigned to double-dose and 8703 to single doses of clopidogrel, and 8624 to high-dose and 8639 to low-dose aspirin. Aspirin is often used in combination with clopidogrel for the best effect in patients. Aspirin has an antiplatelet effect by inhibiting the production of thromboxane, which under normal circumstances binds platelet molecules together to create a patch over damage of the walls within blood vessels. Because the platelet patch can become too large and also block blood flow, locally and downstream, aspirin is also used long-term, at low doses, to help prevent heart attacks, strokes, and blood clot formation in people at high risk for developing blood clots.

Increased doses reduced cardiovascular death, heart attack or stroke by 14% and definite stent thrombosis risk was reduced by 46%. High-dose and low-dose aspirin did not affect the outcome. Intensified bleeding was more common with double-dose than with standard-doses, but did not differ among high-dose and low-dose aspirin.

The authors of the Hamilton General Hospital and McMaster University study, explained:

In patients undergoing PCI for acute coronary syndromes, a 7-day double-dose regimen of clopidogrel was more effective than was the standard dose regimen in reduction of ischemic events and stent thrombosis. Daily high-dose aspirin did not significantly differ from low-dose aspirin. A double-dose regimen of clopidogrel can be considered for all patients with acute coronary syndromes treated with an early invasive strategy and intended PCI,

Dr Gregg Stone, Columbia University Medical Center and New York Presbyterian Hospital, NY, USA provides support by saying:

Presumably, any benefits from reduced ischemic complications in reducing mortality were offset by increased rates of major bleeding with double-dose clopidogrel. A reduction in major ischemic complications must be achieved without increasing overall bleeding, or vice versa, to further reduce mortality with antiplatelet and antithrombotic agents. The likelihood of achieving such a balance might be increased by considering individual patient’s risks for ischemia versus bleeding. Further study is needed to establish whether clinical decision making can be improved with point-of-care platelet-function testing, by assessing the genetic potential for drug metabolism, or both.

“Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial”
Shamir R Mehta, Jean-Francois Tanguay, John W Eikelboom, Sanjit S Jolly, Campbell D Joyner, Christopher B Granger, David P Faxon, Hans-Jurgen Rupprecht, Andrzej Budaj, Alvaro Avezum, Petr Widimsky, Philippe Gabriel Steg, Jean-Pierre Bassand, Gilles Montalescot, Carlos Macaya, Giuseppe Di Pasquale, Kari Niemela, Andrew E Ajani, Harvey D White, Susan Chrolavicius, Peggy Gao, Keith A A Fox, Salim Yusuf
The Lancet Published Online September 1, 2010. DOI:10.1016/S0140-6736(10)61088-4

Written by Sy Kraft (B.A. Bachelor of Arts – Journalism – University of California, Santa Barbara or California State University, Northridge)

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A post-hoc analysis from a Phase III clinical trial of AVONEX ® (interferon beta-1a) and post-randomization eight-year follow up shows that six-month sustained progression of disability at two years, using the Expanded Disability Status Scale (EDSS), is a significant predictor of long-term disability, as measured by EDSS milestones of 4.0, 5.0, 6.0 and 7.0 at eight years, in patients with relapsing-remitting multiple sclerosis (RRMS). The analysis suggests that patients taking AVONEX for two years were less likely to experience disability progression over time (eight years) when compared to placebo. These data were announced today at the 23 rd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) conference in Prague , Czech Republic.

The analysis involved 160 patients with RRMS who received at least two years of treatment (81 placebo, 79 interferon beta-1a), in the AVONEX Phase III trial and who were re-examined eight years post-randomization. 45 patients met the criteria for two-year disability progression sustained for six months (n=18 AVONEX, 27 placebo). The analysis revealed:

– Patients initially treated with AVONEX were less likely than patients initially receiving placebo to progress to EDSS scores of ?‰? 4.0 at eight years

– Six month sustained EDSS progression during the pivotal two-year trial was a significant predictor of disability progression eight years later

– Almost twice as many patients who had sustained progression in EDSS during the two-year trial progressed to an EDSS of ?‰? 4.0 than patients who did not progress (84% sustained, versus 44% unsustained)

– Almost three times as many progressed to an EDSS of ?‰?6.0 (67% sustained, versus 24% unsustained)

“This new analysis presents further evidence that patients who are treated for two years achieve long-term, clinically significant disability benefits,” said Dr. Richard Rudick, vice-chairman of Neurological Institute at the Cleveland Clinic Foundation. “For a person with RRMS, starting and staying with treatment slows disability progression, as measured by EDSS.”

EDSS is a common disability outcome measure that is used in multiple sclerosis clinical trials. EDSS ?‰? 4.0 signifies relatively severe disability, such as impacting physical coordination or the ability to walk without assistance.

AVONEX is the number one prescribed treatment for relapsing forms of multiple sclerosis (MS) worldwide, and is the only once-a-week MS therapy that is effective after the first attack. AVONEX is also proven to slow the progression of physical disability (as shown by 37% reduction over two years) and reduce the number of relapses. AVONEX has been proven effective in clinical trials for up to three years.

This study was funded by Biogen Idec.

About AVONEX

AVONEX is the number one most prescribed treatment for relapsing forms of MS worldwide, with more than 130,000 patients on therapy. It was launched in the U.S. in 1996 and later in Europe for the treatment of relapsing forms of MS to slow the progression of disability and reduce relapses. AVONEX has been proven effective in clinical trials for up to three years. AVONEX is marketed internationally in more than 90 countries. AVONEX was the first treatment approved for patients who have their first clinical MS attack and have a brain MRI scan consistent with MS; this use was approved in Europe in 2002 and in the U.S. in 2003.

The most common side effects associated with AVONEX multiple sclerosis treatment are flu-like symptoms, including myalgia, fever, fatigue, headache, chills, nausea, vomiting, pain and asthenia.

AVONEX should be used with caution in patients with depression or other mood disorders and in patients with seizure disorders. AVONEX should not be used by pregnant women. Patients with cardiac disease should be closely monitored. Patients should also be monitored for signs of hepatic injury. Routine periodic blood chemistry and hematology tests are recommended during treatment with AVONEX. Rare cases of anaphylaxis have been reported. Please see complete prescribing information available at AVONEX.

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Babies whose mothers do not get enough essential B vitamins around the time of conception could be more at risk of Type 2 diabetes.

A study of female sheep showed that reducing their intake of B12 and folate (a form of vitamin B9) before pregnancy produced major physical effects in their offspring.

At only two years of age, the sheep showed signs of insulin resistance and were 25 per cent fatter than normal with higher blood pressure.

Scientists say there is a greater chance of these sheep developing Type 2 diabetes and becoming obese, and they are more at risk of heart disease.

The findings were published in the Proceedings of the National Academy of Sciences.

“This is an interesting new study but it is very early days yet, as it has only been undertaken with animals,” said Caroline Butler, Care Advisor at Diabetes UK.

“Much more research is required before we can see if the results would be replicated in humans.”

Vitamin B12 is essential for the synthesis of red blood cells and the maintenance of a healthy nervous system. It can be found in red meat, eggs and dairy products.

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The incidence of rheumatoid arthritis (RA) in women has risen during the period of 1995 to 2007, according to a newly published study by researchers from the Mayo Clinic. This rise in RA follows a 4-decade period of decline and study authors speculate environmental factors such as cigarette smoking, vitamin D deficiency, and lower dose synthetic estrogens in oral contraceptives may be the source of the increase. Details of the study which includes more than 50 years of RA epidemiology data appear in the June issue of Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

Between 1 and 2 million Americans suffer the effects of RA, a chronic inflammatory disease that targets joints and which contributes to work-related disability, increased morbidity, and shortened survival. Up to one-half of all RA patients become unable to work within 10-20 years of follow-up and those with the disease have a 60% to 70% higher mortality risk than those in the general population. Furthermore, studies show that RA treatments alone account for $9 billion in excess health care costs with direct and indirect costs expected to exceed $39 billion annually.

The current study, led by Sherine Gabriel, M.D., M.Sc., expanded on prior research (1955-1994) from the Mayo Clinic team, by determining RA incidence and prevalence between 1995 and 2007. Researchers screened medical record of 1,761 Olmsted County, Minnesota residents 18 years and older who had received 1 or more diagnoses of arthritis (excluding degenerative arthritis or osteoarthritis). After thorough review of all medical records, a diagnosis of RA was made in 466 patients whose mean age at RA incidence was 55.6 years, with 321 females (69%) in the study cohort.

“We observed a modest increase of RA incidence in women during the study period, which followed a sharp decline in incidence during the previous 4 decades,” said Dr. Gabriel. Results show that RA incidence in women increased by 2.5% per year from 1995 to 2007, while a decrease of 0.5% was noted for men. Researchers did not find a disproportionate increase in RA incidence in any particular age group over the study period. “As expected we found an increase in RA prevalence during the same time period,” added Dr. Gabriel. The overall age- and sex-adjusted prevalence of RA increased from 0.62% in 1995 to 0.72% in 2005.

Prior studies have clearly demonstrated that cigarette smoking is associated with a greater risk for RA development in both sexes. While smoking rates in the U.S. are declining, the rate is significantly slower in women than men, which researchers believe may, in part, explain the modest increase of RA incidence in women. Researchers also note that lower doses of estrogens found in modern oral contraceptives offer less protection against RA development then at the previously higher doses found in older medications, which they suspect may contribute to the increased RA incidence among women. Furthermore, several studies have shown vitamin D deficiency to be associated with RA development and coupled with evidence that this deficiency, particularly in women, has risen over the past decades the Mayo team considered it a possible contributor to the upward trend in RA.

In an editorial also published in this month’s issue of Arthritis & Rheumatism, Dr. Ted Mikuls of the University of Nebraska Medical Center remarked, “Public health measures are already under way to address many of the environmental risk factors that have been implicated in RA risk, including interventions that encourage smoking cessation and efforts focused at optimizing levels of physical activity, vitamin D intake, and oral hygiene.”

Dr. Gabriel concluded, “Reasons for the increase in incidence we found are unknown, but environmental factors likely play a role and should be further explored.”

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