Why Yoga Can Be Good for Rheumatoid Arthritis

By Kara Mayer Robinson
WebMD Feature

Regular exercise is a must when you have rheumatoid arthritis (RA). "It's important to keep muscles strong to support the joints, and movement is important to reduce stiffness," says Susan J. Bartlett, PhD, an associate professor of medicine at McGill University in Montreal.

Yoga can be a fun alternative to walking, swimming, biking, and other activities. Exercise, including yoga, helps you maintain a healthy weight and get fit, which in turn takes pressure off your joints. Plus it makes you less likely to get heart disease and diabetes, two conditions that have been linked to rheumatoid arthritis.

A program of yoga poses, breathing, and relaxation can make a big difference in joint tenderness and swelling, according to the Arthritis Foundation. And the better you feel, the better you'll be able to handle your RA.

Yoga is flexible -- literally. "Yoga can be modified in many different ways to help protect your joints and [be] adapted to the specific needs of most individuals," Bartlett says.

So if you're having problems with your wrists, you can make adjustments to protect them. And on those days when your body is telling you to pull back a little, yoga lets you do that.

Yoga has also been shown to boost energy, build positive feelings, and ease anxiety. For people who have an ongoing illness, particularly one that's painful and unpredictable, the mood-boosting impact of yoga is a great bonus. "It really helps with increased stress that goes hand-in-hand with living with a chronic disease," Bartlett says.

"We know that stress worsens RA symptoms and even the disease itself. So it's important to manage stress effectively and to listen to your body," Bartlett says. "When you practice yoga, you learn to listen to and respect your body as it is today, here and now. You learn to focus on yourself and on calming and quieting your body. By doing yoga, you're learning how to relax and let go of muscle tension."

To be sure it's safe and beneficial, it's important to choose a gentle type of yoga, such as hatha, anusara, or iyengar. If you're new to yoga, you should avoid power yoga, astanga, bikram or hot yoga, or kundalini.

"Talk with your doctor first to find out if you have any limitations or restrictions related to your joints," Bartlett says. If some joints are more damaged than others, your rheumatologist may want you to be extra careful about how you use them to avoid pain or stiffness.

Learning from an experienced, certified professional is critical. Bartlett recommends finding a yoga instructor with an advanced level of training and experience working with people who have arthritis. (Find one at the Yoga Alliance, yogaalliance.org.) It's not a good idea to do yoga by yourself with a video or the TV guiding you. Let your teacher know about any limitations you may have, before the class starts. They can often offer modifications if some poses are too challenging at first.

Take a gentle approach. If something hurts, don't do it. If you're experiencing an RA flare, listen to your body and adapt your poses, make your yoga session less intense and/or shorter, or wait for another day.

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Rheumatoid Arthritis Drugs Have Same Impact on Time Lost at Work: Study

Patients gained no more benefit from higher-priced biologic drug Remicade vs. cheaper medications

By Robert Preidt

HealthDay Reporter

MONDAY, July 1 (HealthDay News) -- Treatment with a pricey biological drug was no better than cheaper, conventional therapy in terms of reducing time off from work for people with rheumatoid arthritis, a new study finds.

Swedish researchers assessed lost work days among rheumatoid arthritis patients who had not responded to initial treatment with a standard medication, methotrexate.

The group of 204 patients were randomly given either the biological drug infliximab (Remicade) or conventional combination therapy with the non-biologics sulfasalazine plus hydroxychloroquine.

At the start of the study, the average amount of lost work time was 17 days per month for all patients. During the 21-month study, the patients receiving conventional therapy lost about six fewer days of work per month, compared with about five fewer days for those taking Remicade -- not a significant difference.

Regardless of the drugs used, early and aggressive treatment for patients who've failed to respond to methotrexate "not only stops the trend of increasing work loss days but partly reverses it," concluded researchers led by Jonas Eriksson of the Karolinska Institute in Stockholm.

However, the team say they "did not find any difference" in terms of work absentee rates depending on which drugs the patients took, even though Remicade did seem to provide "significantly improved disease control."

Experts not connected to the study said the relative price tags of these drugs is another key factor to consider.

"Currently, there are nine biologics FDA-approved for the treatment of rheumatoid arthritis," explained Dr. Steven Carsons, chief of the division of rheumatology, clinical immunology and allergy at Winthrop-University Hospital in Mineola, N.Y.

However, he said that biologics can cost between $15,000 to $20,000 per year, while the two non-biologics included in the Swedish study might cost only a tenth of that amount.

So, the new findings are "reassuring in terms of having effective, lower-cost alternatives with established safety profiles available for patients who do not have coverage for the more expensive biologics," Carsons said.

He added, however, that in the "real world" each patient responds differently to various rheumatoid arthritis medications, and many do fare much better on a biologic drug.

Another rheumatologist, Dr Diane Horowitz of North Shore University Hospital in Manhasset, N.Y., said the new study "brings into question the utility of choosing the more expensive [treatment] option" if ability to function well at work is a key consideration.

It's not clear, however, if the work-related benefits of a biologic would improve over a longer period of use. According to Horowitz, who is also a rheumatologist at Long Island Jewish Medical Center in New Hyde Park, N.Y., "further reseach needs to be done" to answer that question.

The study was published July 1 in the journal JAMA Internal Medicine.

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Knee Replacement Often Beneficial for Rheumatoid Arthritis: Study

Patients did as well as those with osteoarthritis, but same did not hold true for hip replacement

By Maureen Salamon

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- The common belief that rheumatoid arthritis patients don't benefit from knee replacement surgery as much as those with the more common osteoarthritis has been challenged by the findings from a pair of studies by New York City scientists.

Researchers from the Hospital for Special Surgery also found, however, that rheumatoid arthritis patients who underwent a total hip replacement didn't fare as well as those with osteoarthritis, though they did experience improvements in pain and function.

"One thing that we can clearly pull out of this research is that the levels of pain and function among those with rheumatoid arthritis were so much worse preoperatively at the point they approached joint replacement," explained rheumatologist Dr. Susan Goodman, the lead author of both studies. "They may be postponing or not getting to surgery until they're really in a much worse state. Perhaps that's one of the explanations for the results . . . perhaps it's their generalized disease. We really just don't know yet."

Goodman presented the research last week at the European League Against Rheumatism's annual meeting in Madrid, Spain. Research presented at scientific conferences has typically not been peer-reviewed or published and is considered preliminary.

Affecting one of every five adults, along with 300,000 children, arthritis is the leading cause of disability in the United States, according to the Arthritis Foundation. Osteoarthritis, the most prevalent form, progressively breaks down cartilage in the joints due to wear and tear, while rheumatoid arthritis is an autoimmune disease marked by inflammation of the membranes surrounding joints. Along with bringing chronic pain, both types can result in joint destruction.

Historically, rheumatoid arthritis patients have had worse outcomes after joint replacement surgeries than osteoarthritis patients, according to the study authors, but more effective drugs developed over the last two decades have helped them to better control their disease.

In the first study, Goodman and her team analyzed joint replacement registry data to identify 178 rheumatoid arthritis patients and more than 5,200 osteoarthritis patients who underwent knee replacement surgery. Though rheumatoid arthritis patients had worse pain and function before surgery, patients in both groups had similar satisfaction rates after surgery.

The second study compared outcomes of 202 rheumatoid arthritis patients and more than 5,800 osteoarthritis patients who underwent hip replacement, finding that those with rheumatoid arthritis started out with worse function before surgery and also had worse pain and function scores after surgery. However, rheumatoid arthritis patients were as likely as those with osteoarthritis to experience an overall improvement after hip replacement, though the gains didn't erase the disparity between the two groups.

"The advice to rheumatoid arthritis patients is, really, that you will have significant pain relief [from joint replacement surgery]," Goodman said. "It is an area that needs more study. We're looking forward to assessing more rheumatoid-specific factors."

The research, which looked at participants with active rheumatoid arthritis, is consistent with what Dr. Olivia Ghaw, an assistant professor of medicine in rheumatology at Mount Sinai Medical Center in New York City, sees in her practice.

But Ghaw said she felt the study's two-year follow-up period was perhaps not long enough to confirm if the joint replacement outcomes remained positive for rheumatoid arthritis patients.

"For some of my patients, if their joint is severely destructed, I still do recommend joint replacement," she said. "Ideally, we would love to get their underlying disease under better control. If we can bring their inflammation down, perhaps they can have better results with joint replacement."

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Rheumatoid Arthritis, Smoking, and Drinking Alcohol

The potential risks smoking and drinking pose to people with rheumatoid arthritis.By Stephanie Schupska
WebMD Feature

You already know that smoking is bad for you and that it's unhealthy to drink too much alcohol.

But do you know how tobacco and alcohol relate to rheumatoid arthritis -- your odds of developing RA, or, if you already have RA, your odds of making it worse?

Joint Stiffness and Rheumatoid Arthritis

Joint stiffness is a hallmark of rheumatoid arthritis (RA), a chronic disease that affects 1.3 million adult Americans. Resulting from an abnormal response of the immune system, rheumatoid arthritis inflames the soft tissue that lines the surface of joints (called the synovium). It is a systemic disease that not only makes joints stiff and painful, but can also affect other parts of your body, such as internal organs. By noting symptoms such as joint stiffness and seeking early treatment, you can...

Read the Joint Stiffness and Rheumatoid Arthritis article > >

Here's what the research shows.

Smoking may make people more likely to get RA. And, depending on their genes, it may make their RA worse. On top of that, smoking mixed with RA can lead to even greater problems, like heart disease.

“Very clear studies indicate that tobacco is highly associated [with] and probably causal in rheumatoid arthritis and is causal in the worst form of the disease,” says Susan Goodman, MD, an assistant attending rheumatologist and internist at the Hospital for Special Surgery and assistant professor of medicine at Weill Cornell Medical College.

Your genes may also matter. A Swedish study, published in December 2010, shows that the odds of developing RA was related not just to how much a person smokes, but also to their genetic makeup. People with a certain gene variation, called HLA-DRB1, who smoke are much more likely to get rheumatoid arthritis than someone who doesn’t smoke -- and to have severe RA.

“It turns out that people who smoke who bear this genetic factor are much more likely to develop rheumatoid arthritis and do develop more severe disease," Goodman says.

Smoking can also make dealing with the disease more difficult.

“In a lot of the studies on the course of rheumatoid arthritis, patients who smoke do less well, and they’re less likely to achieve remission,” Goodman says. “They’re more likely to have a worse outcome. Smoking gives them a worse prognosis.”

Smoking can increase painful rheumatoid nodules, which form in the joints, she says. It can also lead to heart disease, which -- even on its own -- is a big problem in people with RA. And smoking makes it worse.

“In the last 10 years, there have been studies that show the leading cause of death in patients with RA is cardiovascular disease,” says Walter Moore, MD, senior associate dean for graduate medical education and veteran affairs at Georgia Health Sciences University and chief of rheumatology at Charlie Norwood Department of Veterans Affairs Medical Center. “And smoking itself is clearly associated as a risk factor for cardiovascular disease.”

Stroke is another concern for RA patients.

“RA is an illness like diabetes. In and of itself, it’s a risk factor for heart attack and stroke,” says Andrew Ruthberg, MD, an assistant professor of medicine and an attending physician at Rush University Medical Center and director of Rush Rheumatoid Arthritis Clinic. “And those two things conspire to raise your risk for those other problems to a higher level.”

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Rheumatoid Arthritis (RA): Best and Worst Supplements and Herbs

WebMD explains which supplements and herbs may help relieve rheumatoid arthritis symptoms and which ones you should not take.By Karen Springen
WebMD Feature

At 35, Chicago flight attendant Michele Mason says her bones felt like “pins and needles” were in them, and her hands were so swollen that she found it difficult to put on her infant son’s socks. Her knees ached, too. “I couldn’t even get out of the bathtub by myself,” she says.

When her doctor suspected rheumatoid arthritis, Mason worried that traditional medicines might not be good for her breastfeeding baby. So with her doctor’s blessing, she took a very low-dose steroid and turned to herbs and supplements, including boswellia (Indian frankincense) and fish oil, to help relieve the pain and inflammation.

A year later, her diagnosis of rheumatoid arthritis was confirmed. “I was happier to go with what I felt was a safer route with herbs,” she says. “While they didn’t make it go away, they did give me some relief."   

Like Mason, about 30% of patients surveyed from North Carolina with rheumatoid arthritis have tried supplements, according to a study in Preventing Chronic Disease . “And use is increasing,” says study co-author Leigh Callahan, PhD, associate professor of medicine, orthopaedics and social medicine at the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill.

So what are the best herbs and supplements for RA? And, are they safe? Here's what you need to know. 

First, know that herbs and supplements haven't been studied in the same way that prescription medicines for RA have. “There’s a tremendous disconnect between their widespread usage and people’s belief in their efficacy compared to what we’ve actually proven scientifically,” says Chaim Putterman, MD, chief of rheumatology at Montefiore Medical Center and Albert Einstein College of Medicine.

That is changing as the National Institutes of Health has a well-established center dedicated to studying complementary and alternative medicine . In the meantime, experts say that although some herbs and supplements may help relieve inflammation, they're best used in combination with RA medicines. “It’s not a good reason to throw out their disease-modifying anti-rheumatic drugs," says William St. Clair, interim chief of the division of rheumatology at Duke University Medical Center.”

Always talk to your doctor first, because herbs and supplements may interfere with other medicines you are taking. Remember, too, that since they are not regulated in the same way that drugs are, you cannot always be sure what you are buying, says St. Clair.

The National Center for Complementary and Alternative Medicine (NCCAM) recommends that women who are pregnant or nursing, or those considering CAM use in children use extra caution and consult their health care provider.

With that in mind, here are the herbs and supplements some experts suggest for RA.

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Standard Rheumatoid Arthritis Therapy as Good as Costlier Newcomer: Study

Biologic drug Enbrel wasn't better for patients who didn't respond to methotrexate alone

By Steven Reinberg

HealthDay Reporter

TUESDAY, June 11 (HealthDay News) -- Newer, costlier treatment for rheumatoid arthritis appears no better than an older, less-expensive regimen for people who don't respond to the first-line drug methotrexate, a new study suggests.

"Newer isn't always better," said researcher Dr. Ted Mikuls, an associate professor in the rheumatology division at the University of Nebraska Medical Center, in Omaha. "Some of the older medications can be effective."

Rheumatoid arthritis causes inflammation in the joints, resulting in swelling, stiffness, pain and reduced joint function. It can also affect other parts of the body.

"We compared two different ways of treating rheumatoid arthritis -- one that included a new biologic [medication] with an older, more conventional oral medication," Mikuls explained. "We basically showed that at the end of the day patients, regardless of what they got, looked very similar in terms of pretty much every outcome we looked at in the study."

Patients whose arthritis didn't respond to methotrexate alone who were then given a combination of methotrexate, sulfasalazine (Azulfidine) and hydroxychloroquine (Plaquenil) did as well as patients given methotrexate and the new biologic drug etanercept (Enbrel) -- which is given by injection -- the researchers said.

"The treatments are very different in terms of costs," Mikuls said. If a patient had to pay out of pocket for etanercept it could cost around $20,000 a year, while the out-of-pocket costs for the other drugs is a few hundred to a few thousand dollars, he said.

The out-of-pocket cost of etanercept varies by insurance provider, including those covering the Medicare drug benefit program, Mikuls added.

The report was published online June 11 in the New England Journal of Medicine to coincide with presentation of the study at the Annual European Congress of Rheumatology meeting in Madrid, Spain.

"This study addresses a real-life scenario for rheumatologists where patients are often on methotrexate and are not doing well and the question is what to do next," said Dr. Soumya Reddy, an assistant professor in the rheumatology division of the dermatology department at NYU Langone Medical Center, in New York City.

About 20 percent to 40 percent of patients don't respond methotrexate or can't take the drug either because of side effects or it is not indicated for them, said Reddy, who was not involved in the study.

The findings are "reassuring," in that when a biologic is not an option, due to cost or other reasons, the older regimen is effective, she said.

Which regimen is best really needs to be tailored to each patient, Reddy said.

For the study, researchers randomly assigned 353 patients to methotrexate, sulfasalazine and hydroxychloroquine or to methotrexate and etanercept for 48 weeks. Some patients switched from one regimen to another midway through the study.

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Low Testosterone Linked to Later Arthritis in Study

Hormonal changes could influence disease severity, researchers say

By Robert Preidt

HealthDay Reporter

WEDNESDAY, April 3 (HealthDay News) -- Men with low levels of the hormone testosterone may be at greater risk for rheumatoid arthritis, according to a new study.

Both men and women with rheumatoid arthritis have lower levels of testosterone in their blood than people without the disease. But it has not been known whether low testosterone levels are a cause or effect of rheumatoid arthritis.

Rheumatoid arthritis causes pain, swelling, stiffness and loss of joint function. Severe cases can last a lifetime.

In this study, Swedish researchers analyzed blood samples collected from 104 men who were later diagnosed with rheumatoid arthritis and 174 men of the same age who did not develop the disease. The average time between collection of the blood sample and a diagnosis of rheumatoid arthritis was just less than 13 years, but ranged from 1 to 28 years.

After taking into account known rheumatoid arthritis risk factors such as smoking and weight, the researchers found that men with lower testosterone levels were more likely to develop rheumatoid arthritis. They did not, however, prove a cause-and-effect link between the two.

These men also had significantly higher levels of follicle stimulating hormone -- a chemical involved in sexual maturity and reproduction -- before they were diagnosed with rheumatoid arthritis, according to the study, which was published online April 3 in the journal Annals of the Rheumatic Diseases.

The findings suggest that hormonal changes occur before rheumatoid arthritis develops and could influence disease severity, the researchers said in a journal news release.

Rheumatoid arthritis results from the immune system attacking the body's own tissues. Previous research suggests that testosterone may dampen the immune system, the researchers said.

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Cartilage Gives Early Warning of Arthritis, Study Finds

Damage to the tissue that cushions joints occurs even before people feel pain, research shows

By Robert Preidt

HealthDay Reporter

TUESDAY, April 2 (HealthDay News) -- Exercise-related damage in cartilage can help identify people with the earliest stages of osteoarthritis, a new study reveals.

The findings could improve early detection of the painful joint disease and could also be used to improve methods of repairing damaged cartilage, said study senior author Alan Grodzinsky, of the Massachusetts Institute of Technology, and colleagues.

For the study, the researchers developed a method that identifies osteoarthritis-related changes that occur in cartilage in response to high-load activities such as running and jumping.

Cartilage is firm, rubbery tissue that cushions bones and keeps them from rubbing together. When osteoarthritis begins to develop, the ability of cartilage to resist physical-activity-related impact is reduced. This is now known to be due to the loss of molecules called glycosaminoglycans (GAGs).

Using their new system, the researchers found that GAG-depleted cartilage loses its ability to stiffen under the forces of high-load activities. GAG loss also caused an increase in the depletion of fluids from the cartilage, which likely reduces protection against the impact of high-load activities.

The findings show how GAG loss at the earliest disease stages reduces the ability of this tissue to withstand high-load activities, according to the study, which was published in the April 2 issue of the Biophysical Journal.

"This finding suggests that people with early degradation of cartilage, even before such changes would be felt as pain, should be careful of dynamic activities such as running or jumping," Grodzinsky said in a journal news release.

Osteoarthritis affects about one-third of older adults and is the most common type of joint disorder.

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Certain Lifestyle Factors Linked to Arthritis in Study Patients

Title: Certain Lifestyle Factors Linked to Arthritis in Study Patients
Category: Health News
Created: 3/25/2013 2:35:00 PM
Last Editorial Review: 3/26/2013 12:00:00 AM

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Health Tip: Is Arthritis Affecting Your Hands?

Title: Health Tip: Is Arthritis Affecting Your Hands?
Category: Health News
Created: 3/21/2013 8:35:00 AM
Last Editorial Review: 3/21/2013 12:00:00 AM

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Exercise is good, not bad, for arthritis

Posted May 08, 2013, 2:38 pm

When pain strikes, it’s human nature to avoid doing things that aggravate it. That’s certainly the case for people with arthritis, many of whom tend to avoid exercise when a hip, knee, ankle or other joint hurts. Although that strategy seems to make sense, it may harm more than help.

Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body.

A national survey conducted by the federal Centers for Disease Control and Prevention showed that more than half of people with arthritis (53%) didn’t walk at all for exercise, and 66% stepped out for less than 90 minutes a week. Only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Delaware had the highest percentage of regular walkers (31%) while Louisiana had the lowest (16%). When the CDC tallied walking for less than 90 minutes a week, Tennessee led the list, with 76% not walking that much per week, compared to 59% in the  District of Columbia.

This map shows the percentage of adults with arthritis in each state who walked less than 90 minutes per week during 2011.

The findings were published in the journal Morbidity and Mortality Weekly Report, one of its contributions to Arthritis Awareness Month.

Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function. “Swimming or bicycling tend to be better tolerated than other types of exercise among individuals with arthritis in the hips or knees,” says rheumatologist Dr. Robert H. Shmerling, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

Exercise programs aim to help people with arthritis:

increase the range of motion in the affected jointstrengthen musclesbuild enduranceimprove balance

You can create an exercise program of your own, with help from a trusted doctor, nurse, or physical therapist. Or you can try one that’s been developed by arthritis experts. Examples include the Fit and Strong! program from the University of Illinois at Chicago, or one of several programs developed by the Arthritis Foundation: its Exercise Program, Walk with Ease program, or Aquatics program.

The fatigue, pain, and stiffness caused by many types of arthritis present a barrier to exercise—but these are the same symptoms that tend to improve with regular exercise.

If you have arthritis and don’t currently exercise, start slow. Take a five-minute stroll around your block, swim, or workout on an exercise bicycle. Do it every day, and then gradually increase the time spent exercising or how hard you exercise, but not both at once. If you have heart disease or other health issues, check with your doctor before embarking on an exercise program.

“If exercise was a newly developed medicine, it would be a blockbuster,” says Dr. Shmerling. “It has an excellent safety profile, and enormous benefits for people with arthritis, heart disease, and a long and growing list of other health problems.”

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Newer Rheumatoid Arthritis Drugs Don't Seem to Increase Risk of Shingles

By Serena Gordon

HealthDay Reporter

TUESDAY, March 5 (HealthDay News) -- The newest medications used to treat autoimmune diseases such as rheumatoid arthritis don't appear to raise the risk of developing shingles, new research indicates.

There has been concern that these medications, called anti-tumor necrosis factor (anti-TNF) drugs, might increase the chances of a shingles infection (also known as herpes zoster) because they work by suppressing a part of the immune system that causes the autoimmune attack.

"These are commonly used drugs for people with rheumatoid arthritis and other autoimmune diseases, and the issue was whether or not they increased the risk of [shingles]. We found there is no increased risk when using these drugs, which was reassuring," said study author Dr. Kevin Winthrop, associate professor of infectious disease and public health and preventive medicine at Oregon Health and Science University in Portland.

Results of the study are published in the March 6 issue of the Journal of the American Medical Association.

Shingles is a major concern for people with autoimmune conditions, particularly people who are older and more at risk for developing shingles in general. Shingles is caused when the same virus that causes chickenpox is reactivated.

The symptoms of shingles, however, are often far more serious than chickenpox. It typically starts with a burning or tingling pain, which is followed by the appearance of fluid-filled blisters, according to the U.S. National Institutes of Neurological Disorders and Stroke. Shingles pain can vary from mild to so severe that even the lightest touch causes intense pain.

People who have rheumatoid arthritis already have an increased risk of shingles, although Winthrop said it's not exactly clear why. It may be due to older age, or it may have something to do with the disease itself.

Rheumatoid arthritis and other autoimmune conditions are treated with many different medications that help dampen the immune system and, hopefully, the autoimmune attack. Corticosteroids such as prednisone often are the first line of treatment, but because these drugs have many side effects, the goal is to be on the lowest dose possible or off them altogether.

Two other classes of drugs -- the "biologic" anti-TNF drugs and a group of medications called non-biologic disease-modifying anti-rheumatic drugs (DMARDs) -- are newer medications that can be used to treat rheumatoid arthritis and other autoimmune conditions. Examples of biologics are adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade). A commonly used DMARD is methotrexate.

Winthrop and his colleagues reviewed data from almost 60,000 people with various autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis and ankylosing spondylitis. More than 33,000 were taking biologic anti-TNF drugs, and almost 26,000 were on DMARDs. The study period ran from 1998 through 2008.

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Salty Diet Might Help Trigger MS, Rheumatoid Arthritis

By Barbara Bronson Gray

HealthDay Reporter

WEDNESDAY, March 6 (HealthDay News) -- Eating lots of foods loaded with salt may do more than raise your blood pressure: Researchers report that it could also contribute to the development of autoimmune diseases, where the body's immune system mistakenly mounts an attack upon some part of the body.

Three new studies suggest salt may be a prime suspect in a wide range of autoimmune diseases, including multiple sclerosis (MS), psoriasis, rheumatoid arthritis and ankylosing spondylitis (arthritis of the spine).

A significant increase in the incidence of autoimmune diseases, especially multiple sclerosis and type 1 diabetes, suggests that environmental factors, and not genetics, may explain the trend, the researchers noted.

"The diet does affect the autoimmune system in ways that have not been previously recognized," said senior study author Dr. David Hafler, a professor of neurology and immunobiology at the Yale School of Medicine, in New Haven, Conn.

It was an accidental discovery that triggered the researchers' interest in salt; they stumbled upon the fact that people who ate at fast food restaurants seemed to have higher levels of inflammatory cells than others, Hafler explained.

In the study, Hafler and his team found that giving mice a high-salt diet caused the rodents to produce a type of infection-fighting cell that is closely associated with autoimmune diseases. The mice on salt diets developed a severe form of multiple sclerosis, called autoimmune encephalomyelitis. Findings from animal studies are not always mirrored in human trials, however.

Inflammatory cells are normally used by the immune system to protect people from bacterial, viral, fungal and parasitic infections. But, in the case of autoimmune diseases, they attack healthy tissue.

Hafler's study is one of three papers, published in the March 6 issue of the journal Nature, that show how salt may overstimulate the immune system. In addition to Hafler's research, scientists from the Broad Institute in Boston explored how genes regulate the immune response, and researchers from Harvard Medical School and Brigham and Women's Hospital in Boston zeroed in on how autoimmunity is controlled by a network of genes.

All three studies help explain, each from a different angle, how "helper" T-cells can drive autoimmune diseases by creating inflammation. Salt seems to cause enzymes to stimulate the creation of the helper T-cells, escalating the immune response.

"We think of helper T-cells as sort of the orchestra leaders, helping the immune system know what the cells should be doing in response to different microbial pathogens," explained Dr. John O'Shea, director of intramural research at the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases, in Bethesda, Md. "The strength of these papers is that they have found another factor that drives [helper T-cell] differentiation -- salt."

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Chemicals in Cookware, Carpets May Raise Arthritis Risk in Women

By Alan Mozes

HealthDay Reporter

THURSDAY, Feb. 14 (HealthDay News) -- In what researchers are calling a first, a new analysis suggests that the greater a woman's exposure to a type of common chemical compound called PFCs, the greater her risk for developing osteoarthritis.

Researchers did not find a similar risk among men regarding these chemicals, which are now found in everything from nonstick cookware to take-out containers and carpeting.

Osteoarthritis, the most common type of arthritis, causes pain and stiffness and involves degeneration of the cartilage in the joints.

And the study authors stressed that while their investigation identified a robust link between osteoarthritis and exposure to two specific PFC chemicals -- known as PFOA and PFOS -- for now the finding can only be described as an association, rather than a cause-and-effect relationship.

"But we did find a clear and strong association between exposure to [these] compounds and osteoarthritis, which is a very painful chronic disease," said study lead author Sarah Uhl, who conducted the study while working as a researcher at the Yale School of Forestry and Environmental Studies in New Haven, Conn.

"This adds to the body of information that we have suggesting that these highly persistent synthetic chemicals are of concern when it comes to the public health," she said.

The new study appears in the Feb. 14 online issue of Environmental Health Perspectives.

Uhl noted that exposure to PFCs is nearly universal, given their inclusion in a vast array of products to enable (among other things) the grease-proofing of food packaging, waterproofing of rain gear, and textile stain protection.

Previous research has linked PFC exposure to a higher risk for the premature onset of menopause in women, higher levels of "bad" LDL cholesterol in men and women, and reduced effectiveness of routine vaccinations among children.

To explore a potential PFC-osteoarthritis connection, the authors looked at PFOA and PFOS exposure data collected between 2003 and 2008 by the U.S. National Health and Nutrition Examination Survey.

The analysis covered more than 4,000 men and women between the ages of 20 and 84 for whom osteoarthritis status information was available.

The team found "significant associations" between osteoarthritis incidence and exposure to PFOA or PFOS among women but not men.

Women exposed to the highest levels of either chemical seemed to face up to nearly double the risk for developing osteoarthritis, compared to women exposed to the lowest levels.

The osteoarthritis-PFC connection also appeared to be stronger among younger women (between 20 and 49) than among older women (between 50 and 84). But the team said more follow-up research is needed to confirm the observation.

While the biological reason behind the potential connection remains unclear, the team suggested that the chemicals may have a particularly profound impact on hormonal balances for women.

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Chemicals in Cookware, Carpets May Raise Arthritis Risk in Women

Title: Chemicals in Cookware, Carpets May Raise Arthritis Risk in Women
Category: Health News
Created: 2/14/2013 10:35:00 AM
Last Editorial Review: 2/14/2013 12:00:00 AM

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Sunshine Linked to Lower Rheumatoid Arthritis Risk: Study

By Robert Preidt

HealthDay Reporter

TUESDAY, Feb. 5 (HealthDay News) -- Older women who've had regular exposure to sunlight may be less likely to develop rheumatoid arthritis, new findings indicate.

This beneficial effect -- which is believed to be due to ultraviolet B (UV-B) in sunlight -- was only evident in older women. This may be because younger women are more aware of the skin-related hazards of sunlight and take more steps to limit their exposure, the researchers said.

For the study, the investigators looked at about 235,000 participants who took part in two phases of the U.S. Nurses' Health Study. The first phase began in 1976 with nurses aged 30 to 55 and continued until 2008. The second phase began in 1989 with nurses aged 25 to 42 and continued until 2009.

By the end of the two phases, 1,314 of the women had developed rheumatoid arthritis, according to the study published in the current online edition of the journal Annals of the Rheumatic Diseases.

The nurses' UV-B exposure was estimated based on data from the states where they lived while taking part in the study. Likely estimates of their UV-B exposure at birth and by age 15 were also included.

Among women in the first phase of the Nurses' Health Study, those with the highest estimated levels of UV-B exposure were 21 percent less likely to develop rheumatoid arthritis than those with the lowest levels.

However, no such association between UV-B exposure and rheumatoid arthritis risk was seen among women in the second phase. These women were younger than those in the first phase and may have been more aware about the dangers of too much sun exposure and avoided it, the study authors suggested.

"Our study adds to the growing evidence that exposure to UV-B light is associated with decreased risk of rheumatoid arthritis," concluded Dr. Elizabeth Arkema, of the department of epidemiology at Harvard School of Public Health, and colleagues.

But even though the researchers found an association between greater estimated exposure to UV-B light and lower risk of rheumatoid arthritis in the women in the first phase of the Nurses' Health Study, the finding did not prove that there was a cause-and-effect relationship.

It's not known how UV-B exposure might reduce the risk of rheumatoid arthritis, but it could be due to the skin's production of vitamin D in response to sunlight, the study authors suggested in a journal news release.

More information

The American Academy of Family Physicians has more about rheumatoid arthritis.

View the original article here