ARTHRITIS WATCH

Children with Arthritis More Prone to FracturesA recent study conducted by the Children's Hospital ofPhiladelphia, Pa, showed that children who have arthritis aremore likely to experience bone fractures in childhood, adolescence,and possibly adulthood. The researchers suggest thatthese findings are proof that "we need to intervene to at leastpreserve and, more likely, to augment skeletal health duringchildhood and maximize peak bone mass accrual," they said.

The researchers studied 1939 children who were diagnosedwith arthritis between the ages of 1 and 9, as well as 207,072healthy children. They found that the percentage of fracturesreported in the arthritis group was significantly higher thanthat in the control group (6.7% vs 3.3%). Compared with thecontrols, the incident rate ratio for first fracture among thechildren with arthritis was 1.49 for ages 1 through 9, 3.13 forages 10 to 15, and 1.75 for ages 15 to 20.

Researchers insisted that these findings show that "weneed to make sure that children meet the dietary requirementsfor calcium intake and remain vitamin D-replete. Weneed to develop better clinical tools to diagnose and monitorchildren at risk for osteoporosis." The results of the study werepublished in the August 2006 issue of the Annals of theRheumatic Diseases.

No Raised Risk of Cancer withTNF Blocker Use in RA

According to pooled information from 3 major medicaldatabases, patients with rheumatoid arthritis (RA) who aretaking tumor necrosis factor (TNF)-alpha blockers do nothave an observable increased risk of lymphoma or solidcancers. Controversy surrounding the therapy has beensubstantial since the drugs were first approved by the FDAin the 1990s. Researchers found, however, that TNF-alphablockers may actually help stave off cancer in RA patientswho use them because of their anti-inflammatory properties.The findings appear in the September 2006 issue ofArthritis & Rheumatism.

Researchers at Harvard Medical School, Boston, Mass,evaluated 2 US Medicare databases and 1 from BritishColumbia, Canada. They analyzed data from 7830 patients,aged 65 and older, who were diagnosed with RA and hadbeen prescribed either methotrexate or one of the TNF-alphaantagonists (etanercept, infliximab, adalimumab, or anakinra).Their analyses showed that even though those who tookTNF-alpha blockers experienced more severe RA, cancerrates did not differ significantly between those who took theTNF-alpha blockers and those who took methotrexate.

Anti-RA Therapy May Reduce HeartAttack Risk

Research conducted at McGillUniversity in Montreal, Quebec,Canada, suggests that the use ofdisease-modifying antirheumaticdrugs (DMARDs) in patientswith rheumatoid arthritis (RA)could reduce their risk of developingcardiovascular diseaseassociated with RA. The findingswere based on data collectedfrom 107,908 RA patients whowere observed from 1999 to2003. During that time, 558acute myocardial infarctionsoccurred. According to researchers,however, the adjustedrate ratio was significantlylower in patients who were takingDMARDs.

The researchers found thatthe effect was consistent withthe use of all the traditionalDMARDs, such as methotrexateand leflunomide, but not biologicagents. They speculate that thecorrelation may be a result ofthe anti-inflammatory effects ofDMARDs, or perhaps "an indirectresult of the beneficial effect ofDMARDs on cardiac risk factors" in RA patients; for example, thedrugs improve physical activity,making the patients more ableto exercise, which, in turn, lowerstheir overall cardiovasculardisease risk. The researchersagree that "more data will benecessary to ascertain the cardiovasculareffects of" DMARDs.The findings were published inthe August 15, 2006, edition ofArthritis & Rheumatism.

Women Who Smoke at Greater Risk for RA

A US study shows that women whosmoke nearly double their risk of developingrheumatoid arthritis (RA) if they donot have a genetic risk factor for the disease.Researchers from the University ofCalifornia, San Francisco, looked at 115postmenopausal women who had RAand compared them with 466 womenwithout the disease. All the women weretaking part in the long-term IowaWomen's Health Study, which tracked thelifestyles of its participants, includingsmoking habits.

The researchers found that, in womenwho did not have the most well-establishedgenetic risk factor for RA, HLADRB1SE, smoking increased their risk ofdeveloping the disease by almost 2times. Researchers found no increasedrisk for RA in those women who didhave the risk factor, however. The findingssupport data which propose thatinteraction between genes and environmentalfactors is important in the developmentof complex autoimmune diseases,such as RA. The study was limitedto older Caucasian women, so furtherinvestigation would be needed to determinethe risk in women of other agegroups and ethnicities, the researcherssaid. The findings were published in theSeptember 2006 issue of the Annals ofthe Rheumatic Diseases.