Patients treated with methotrexate had a threefold increased risk of disease, report says 

From HealthDay

Rheumatoid arthritis (RA) patients treated with methotrexate have an increased incidence of melanoma and other cancers, an Australian study says.

Methotrexate (MTX) is a disease-modifying anti-rheumatic drug (DMARD) commonly prescribed to RA patients. A link between the drug and cancer has been suggested, and there are even concerns that the drug itself may be carcinogenic, but research examining this concern has proven inconclusive.

This new study included 459 RA patients (309 women, 150 men) who started treatment with MTX prior to June 1986. During a total of 4,273 person-years of follow up (an average of 9.3 years per patient), 87 cancers were identified.

The researchers found that the RA patients who received MTX were 50 percent more likely than people in the general population to develop cancer of any kind. In terms of specific cancers, the RA patients had more than a fivefold increased risk of non-Hodgkin lymphoma, a threefold increased risk of melanoma, and almost a threefold increased risk of lung cancer.

The increased risk levels for non-Hodgkin lymphoma and lung cancer were similar to the findings of studies in Europe and in the United States. However, the increased risk for melanoma identified in this study was new.

“This study is, to our knowledge, the first to report an increased risk of melanoma in patients with RA treated with MTX compared with the general population,” lead author Dr. Rachelle Buchbinder said in a prepared statement.

“Futher investigation is needed to determine whether this risk is unique to Australia and what role MTX, immunosuppression per se, and/or environmental factors such as exposure to UV radiation play in its development,” she said. “Our findings, taken together with other studies investigating the risk of skin cancer in patients with RA, may support a role for regular skin cancer screening for all patients with RA, particularly those receiving immunosuppressive therapy.”

The study was published in the June issue of the journal Arthritis Care & Research.

More than three drinks of alcohol a week can trim that risk by 50%, study says  

From HealthDay

People who drink alcohol regularly may cut their risk of developing rheumatoid arthritis, a new study finds.

Alcohol has been shown to reduce the risk of cardiovascular disease, and now this new study shows drinking may also reduce the risk of rheumatoid arthritis by up to 50 percent. This finding underscores the importance of lifestyle factors in the development of rheumatoid arthritis, the study authors said.

“Moderate alcohol consumption is not deleterious and may in some contexts be beneficial concerning risk for future onset of rheumatoid arthritis,” said lead researcher Henrik Kallberg, of the Institute of Environmental Medicine at the Karolinska Institute in Stockholm.

“In addition, our paper underlines that smoking may trigger development of rheumatoid arthritis,” Kallberg added.

The report was published in the June 4 online edition of the Annals of the Rheumatic Diseases.

For the research, Kallberg’s team collected data on 2,750 men and women who took part in two studies of rheumatoid arthritis. Among these people, 1,650 had rheumatoid arthritis.

All the people in the study were asked about their lifestyles, including how much they smoked and drank. In addition, their blood was analyzed to check for genetic risk factors for rheumatoid arthritis.

The researchers found that both men and women who drank regularly were less likely to develop rheumatoid arthritis. In fact, those who drank the most cut their risk for developing the disease by 50 percent, compared with those who drank the least.

“Drinking more than three drinks per week is associated with a 50 percent decrease for developing rheumatoid arthritis,” Kallberg said.

Moreover, in people with antibodies to a group of proteins involved in the development of rheumatoid arthritis, drinking alcohol also cut the risk of developing the disease. And in most smokers who had genetic risk factors for rheumatoid arthritis, drinking also reduced the risk of the disease. Smoking is a major risk factor for rheumatoid arthritis, and that risk is increased for those with a genetic susceptibility to disease, the researchers noted.

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system uses its own antibodies to attack joints, causing pain and swelling and loss of function in joints. The causes of the disease aren’t known, but researchers suspect there is a strong genetic component as well as lifestyle risks.

Dr. John Hardin, the chief science officer for the Arthritis Foundation, said he wasn’t surprised by the finding that alcohol could help prevent rheumatoid arthritis.

“This study brings attention to the fact that there are environmental factors that trigger rheumatoid arthritis,” he said.

There are a variety of environmental factors that can either promote the disease or help prevent it, Hardin said. “What this means to me is that things that cause an inflammatory state in the body are a hazard requiring rheumatoid arthritis,” he said.

“We know that smoking is one of the things associated with a systemic inflammatory response,” Hardin said. “We also know that alcohol is a mild anti-inflammatory.”

Hardin was cautious, however, about recommending drinking to stave off rheumatoid arthritis. “This study should not be construed as a license to go drink, because there are serious hazards associated with excess alcohol intake,” he said.

From UPI.com

Swedish researchers found women who breast feed more than 13 months were half as likely to get rheumatoid arthritis.Those who had breast fed for one to 12 months were 25 percent less likely to get the disease.The study, published online ahead of print in the Annals of the Rheumatic Diseases, also found taking oral contraceptives — suspected to protect against the disease because they contain hormones that are raised in pregnancy — did not have the same effect. Similarly, being pregnant — but not breast feeding — did not seem to have a protective effect either.

The authors said that it was difficult to say whether there was a connection between higher rates of breast feeding and a corresponding fall in the number of women affected by rheumatoid arthritis, but that the results of the study provided yet another reason why women should breast feed.

Study leader Dr. M. Pikwer of The Malmo University Hospital, in Sweden compared 136 women with rheumatoid arthritis with 544 women of a similar age without the disease.

From BrightSurf.com

Scientists at Duke University Medical Center may have solved the mystery surrounding the healing properties of gold - a discovery they say may renew interest in gold salts as a treatment for rheumatoid arthritis and other inflammatory diseases.

Physicians first used injections of gold salts in the early 1900s to ease the pain and swelling associated with arthritis. But treatment came at a high cost: The shots took months to take effect and side effects included rashes, mouth sores, kidney damage and occasionally, problems with the bone marrow’s ability to make new blood cells. Recently, new treatments like methotrexate and biologically engineered drugs have replaced gold as a preferred treatment, and gold salts, while remaining effective, are usually administered as a last resort.

But Dr. David Pisetsky, chief of the division of rheumatology and immunology in the department of medicine at Duke, says “we shouldn’t dismiss gold salts so quickly. We scientists have really never understood why gold works. Now that we have a better handle on its action, we may be able to use that mechanism to create new and better gold-like drugs to treat arthritis.”

Pisetsky had long been interested in a particular molecule, HMBG1, which provokes inflammation, the key process underlying the development of rheumatoid arthritis. HMBG1 is a dual-function molecule, which means that it behaves one way when it’s inside the nucleus of a cell, and quite another way when it’s released from the cell.

Pisetsky says that inside the nucleus, HMGB1 is a key player in transcription, the process that converts genetic information in DNA to its RNA equivalent. But when HMGB1 is released from the cell - either through normal processes or cell death - it becomes a stimulus to the immune system and enhances inflammation.

“Interestingly, HMGB1 is not produced evenly throughout the body,” says Pisetsky.

“There is an unusually high amount of it in the synovial tissue and fluid around the joints - where arthritis occurs.”

Pisetsky, working with colleagues at the University of Pittsburgh and the Karolinska Institute in Sweden, stimulated mouse and human immune system cells to secrete HMGB1, then treated them with gold salts. They found that the gold blocked the release of HMGB1 from the nucleus. That, in turn, should lessen the amount available to provoke the body’s immune system, weakening the inflammatory response.

“Basically, keeping HMGB1 corralled inside the nucleus is a good thing, when it comes to arthritis,” says Pisetsky.

Pisetsky says gold inhibits the release of HMGB1 by interfering with the activity of two helper molecules that ease HMGB1’s release from the cell, interferon beta and nitric oxide.

The study will appear in the January, 2008 issue of the Journal of Leukocyte Biology, but a preprint is already online at the journal’s website at: http://tinyurl.com/3cd957.

“Now that we have identified at least one of the ways gold can help arthritis sufferers, perhaps we can use that knowledge to build new and safer-acting, gold-based treatments,” says Pisetsky, a senior author of the study.

Pisetsky is encouraged by the results but says additional studies need to be done to find out if the same mechanism is active in animals and people and not just in laboratory studies.