Nancy Walsh

AMSTERDAM — Treatment with infliximab successfully controlled refractory ocular inflammation in two patients with sarcoidosis, Dr. Boris A. Cruz reported at the annual European Congress of Rheumatology.

Ocular involvement in this granulomatous multisystem disorder is a serious complication that is associated with significant visual loss. Tumor necrosis factor-α plays an important pathophysiologic role in granuloma formation; anti-TNF-α therapy is being considered in cases that are unresponsive to corticosteroids and immunosuppressants, Dr. Cruz said.

The first patient was an 18-year-old white male who had an 18-month history of pulmonary, cutaneous, and central nervous system necrotizing sarcoid granulomatosis, a variant form of sarcoidosis. He did not respond to first-line treatment with steroids, so methotrexate was added. This ameliorated the multiorgan involvement, but severe retinal vasculitis with typical candle-wax exudate developed in his right eye. Three 300-mg infusions of infliximab were given on days 0, 14, and 42, and the retinal lesions cleared. At 18 months, the patient remained in full remission and continued to get methotrexate plus quarterly infliximab infusions, Dr. Cruz wrote in a poster.

The second patient was a 64-year-old white woman with an 8-year history of pulmonary, cutaneous, and ocular sarcoidosis. Ophthalmologic evaluation confirmed the presence of bilateral retinal vasculitis with capillaritis, papillitis, peripheral multifocal choroiditis, and pathologic neovascularization. Her extraocular symptoms responded to steroids, but visual impairment progressed despite combined treatment with methotrexate plus intraocular steroid injections. She was given three 200-mg infusions of infliximab in the same schedule as the first patient, with clearance of all retinal inflammation and improvement of visual acuity. She too remains in clinical remission on a regimen of methotrexate and quarterly infusions of infliximab, according to Dr. Cruz of the department of rheumatology, Biocor Instituto, Nova Lima, Brazil.

AMSTERDAM — Treatment with infliximab successfully controlled refractory ocular inflammation in two patients with sarcoidosis, Dr. Boris A. Cruz reported at the annual European Congress of Rheumatology.

Ocular involvement in this granulomatous multisystem disorder is a serious complication that is associated with significant visual loss. Tumor necrosis factor-α plays an important pathophysiologic role in granuloma formation; anti-TNF-α therapy is being considered in cases that are unresponsive to corticosteroids and immunosuppressants, Dr. Cruz said.

The first patient was an 18-year-old white male who had an 18-month history of pulmonary, cutaneous, and central nervous system necrotizing sarcoid granulomatosis, a variant form of sarcoidosis. He did not respond to first-line treatment with steroids, so methotrexate was added. This ameliorated the multiorgan involvement, but severe retinal vasculitis with typical candle-wax exudate developed in his right eye. Three 300-mg infusions of infliximab were given on days 0, 14, and 42, and the retinal lesions cleared. At 18 months, the patient remained in full remission and continued to get methotrexate plus quarterly infliximab infusions, Dr. Cruz wrote in a poster.

The second patient was a 64-year-old white woman with an 8-year history of pulmonary, cutaneous, and ocular sarcoidosis. Ophthalmologic evaluation confirmed the presence of bilateral retinal vasculitis with capillaritis, papillitis, peripheral multifocal choroiditis, and pathologic neovascularization. Her extraocular symptoms responded to steroids, but visual impairment progressed despite combined treatment with methotrexate plus intraocular steroid injections. She was given three 200-mg infusions of infliximab in the same schedule as the first patient, with clearance of all retinal inflammation and improvement of visual acuity. She too remains in clinical remission on a regimen of methotrexate and quarterly infusions of infliximab, according to Dr. Cruz of the department of rheumatology, Biocor Instituto, Nova Lima, Brazil.

AMSTERDAM — Treatment with infliximab successfully controlled refractory ocular inflammation in two patients with sarcoidosis, Dr. Boris A. Cruz reported at the annual European Congress of Rheumatology.

Ocular involvement in this granulomatous multisystem disorder is a serious complication that is associated with significant visual loss. Tumor necrosis factor-α plays an important pathophysiologic role in granuloma formation; anti-TNF-α therapy is being considered in cases that are unresponsive to corticosteroids and immunosuppressants, Dr. Cruz said.

The first patient was an 18-year-old white male who had an 18-month history of pulmonary, cutaneous, and central nervous system necrotizing sarcoid granulomatosis, a variant form of sarcoidosis. He did not respond to first-line treatment with steroids, so methotrexate was added. This ameliorated the multiorgan involvement, but severe retinal vasculitis with typical candle-wax exudate developed in his right eye. Three 300-mg infusions of infliximab were given on days 0, 14, and 42, and the retinal lesions cleared. At 18 months, the patient remained in full remission and continued to get methotrexate plus quarterly infliximab infusions, Dr. Cruz wrote in a poster.

The second patient was a 64-year-old white woman with an 8-year history of pulmonary, cutaneous, and ocular sarcoidosis. Ophthalmologic evaluation confirmed the presence of bilateral retinal vasculitis with capillaritis, papillitis, peripheral multifocal choroiditis, and pathologic neovascularization. Her extraocular symptoms responded to steroids, but visual impairment progressed despite combined treatment with methotrexate plus intraocular steroid injections. She was given three 200-mg infusions of infliximab in the same schedule as the first patient, with clearance of all retinal inflammation and improvement of visual acuity. She too remains in clinical remission on a regimen of methotrexate and quarterly infusions of infliximab, according to Dr. Cruz of the department of rheumatology, Biocor Instituto, Nova Lima, Brazil.

AMSTERDAM — For the first time, rituximab has been shown to prevent the progression of joint damage—a critical therapeutic outcome—in patients with long-standing, intractable rheumatoid arthritis, Dr. Edward Keystone said at the annual European Congress of Rheumatology.

“This is the first time we've seen an agent that can inhibit radiographic progression after the failure of tumor necrosis factor blockade,” said Dr. Keystone. Some 25%–40% of patients do not respond to tumor necrosis factor-αinhibitors.

In a double-blind trial that included 517 patients whose mean disease duration was 12 years, the mean change in total Sharp score from baseline was 2.31 among patients randomized to placebo plus methotrexate (10–25 mg/week) after 1 year of follow-up.

In contrast, among those receiving two infusions of rituximab, 1 g 2 weeks apart, plus background methotrexate, the mean change in Sharp score was 1, said Dr. Keystone, a professor of medicine at the University of Toronto. Mean changes in erosion scores were 1.32 and 0.59 in the placebo and rituximab groups, respectively, while mean changes in joint space narrowing were 0.99 and 0.41.

These differences were statistically significant and represented a 50% reduction in radiographic progression, he said at the meeting, sponsored by the European League Against Rheumatism.

Of the patients receiving rituximab, 61% had no change in erosion score from baseline, as did 52% of those receiving only methotrexate.

Clinical efficacy also was maintained among patients receiving rituximab, with 51%, 27%, and 12% of patients achieving ACR 20, 50, and 70 responses, respectively, according to Dr. Keystone.

The average time to flare was 30 weeks.

Rituximab is a selective inhibitor of CD20+ B cells. Its administration results in depletion of this subset of B cells, possibly through cell-mediated and complement-dependent mechanisms.

AMSTERDAM — For the first time, rituximab has been shown to prevent the progression of joint damage—a critical therapeutic outcome—in patients with long-standing, intractable rheumatoid arthritis, Dr. Edward Keystone said at the annual European Congress of Rheumatology.

“This is the first time we've seen an agent that can inhibit radiographic progression after the failure of tumor necrosis factor blockade,” said Dr. Keystone. Some 25%–40% of patients do not respond to tumor necrosis factor-αinhibitors.

In a double-blind trial that included 517 patients whose mean disease duration was 12 years, the mean change in total Sharp score from baseline was 2.31 among patients randomized to placebo plus methotrexate (10–25 mg/week) after 1 year of follow-up.

In contrast, among those receiving two infusions of rituximab, 1 g 2 weeks apart, plus background methotrexate, the mean change in Sharp score was 1, said Dr. Keystone, a professor of medicine at the University of Toronto. Mean changes in erosion scores were 1.32 and 0.59 in the placebo and rituximab groups, respectively, while mean changes in joint space narrowing were 0.99 and 0.41.

These differences were statistically significant and represented a 50% reduction in radiographic progression, he said at the meeting, sponsored by the European League Against Rheumatism.

Of the patients receiving rituximab, 61% had no change in erosion score from baseline, as did 52% of those receiving only methotrexate.

Clinical efficacy also was maintained among patients receiving rituximab, with 51%, 27%, and 12% of patients achieving ACR 20, 50, and 70 responses, respectively, according to Dr. Keystone.

The average time to flare was 30 weeks.

Rituximab is a selective inhibitor of CD20+ B cells. Its administration results in depletion of this subset of B cells, possibly through cell-mediated and complement-dependent mechanisms.

AMSTERDAM — For the first time, rituximab has been shown to prevent the progression of joint damage—a critical therapeutic outcome—in patients with long-standing, intractable rheumatoid arthritis, Dr. Edward Keystone said at the annual European Congress of Rheumatology.

“This is the first time we've seen an agent that can inhibit radiographic progression after the failure of tumor necrosis factor blockade,” said Dr. Keystone. Some 25%–40% of patients do not respond to tumor necrosis factor-αinhibitors.

In a double-blind trial that included 517 patients whose mean disease duration was 12 years, the mean change in total Sharp score from baseline was 2.31 among patients randomized to placebo plus methotrexate (10–25 mg/week) after 1 year of follow-up.

In contrast, among those receiving two infusions of rituximab, 1 g 2 weeks apart, plus background methotrexate, the mean change in Sharp score was 1, said Dr. Keystone, a professor of medicine at the University of Toronto. Mean changes in erosion scores were 1.32 and 0.59 in the placebo and rituximab groups, respectively, while mean changes in joint space narrowing were 0.99 and 0.41.

These differences were statistically significant and represented a 50% reduction in radiographic progression, he said at the meeting, sponsored by the European League Against Rheumatism.

Of the patients receiving rituximab, 61% had no change in erosion score from baseline, as did 52% of those receiving only methotrexate.

Clinical efficacy also was maintained among patients receiving rituximab, with 51%, 27%, and 12% of patients achieving ACR 20, 50, and 70 responses, respectively, according to Dr. Keystone.

The average time to flare was 30 weeks.

Rituximab is a selective inhibitor of CD20+ B cells. Its administration results in depletion of this subset of B cells, possibly through cell-mediated and complement-dependent mechanisms.

AMSTERDAM — The clinical response to repeat courses of rituximab equalled or surpassed the initial course in patients with rheumatoid arthritis who are participating in a long-term open-label study, Dr. Paul Emery said at the annual European Congress of Rheumatology.

Patients with rheumatoid arthritis (RA) unresponsive to traditional disease-modifying antirheumatic drugs but who achieved at least a 20% improvement in tender and swollen joint counts following a single course of rituximab were eligible to receive additional courses for residual disease.

To date, 145 patients have received at least two courses, and 24-week follow-up data are available for 99. Each treatment course consists of two separate infusions, 1,000 mg each, 2 weeks apart.

Baseline characteristics of the 99 patients were similar to those of the original larger study population, where the mean age was 54 years and disease duration was 10 years.

Mean tender and swollen joint counts at baseline were approximately 32 and 20, respectively, and mean disease activity score including a 28-joint count (DAS28) was 6.8 (N. Engl. J. Med. 2004; 350:2572–81).

A total of 58 (59%) of patients had achieved an ACR20 response 24 weeks after the first course of rituximab, while 72 (73%) reached this level of response 24 weeks after the second course, according to Dr. Emery, professor of rheumatology and clinical director of the Academic Unit of Musculoskeletal Disease at the Leeds (England) Teaching Hospitals Trust.

Maximal efficacy with rituximab generally is seen at 24 weeks.

Increased efficacy also was apparent on other measures. (See table.)

Repeat courses of the B-cell-depleting agent were well tolerated, and there was no evidence of increased overall incidence of adverse events, numbers of infections, or infusion reactions, he said.

ELSEVIER GLOBAL MEDICAL NEWS

AMSTERDAM — The clinical response to repeat courses of rituximab equalled or surpassed the initial course in patients with rheumatoid arthritis who are participating in a long-term open-label study, Dr. Paul Emery said at the annual European Congress of Rheumatology.

Patients with rheumatoid arthritis (RA) unresponsive to traditional disease-modifying antirheumatic drugs but who achieved at least a 20% improvement in tender and swollen joint counts following a single course of rituximab were eligible to receive additional courses for residual disease.

To date, 145 patients have received at least two courses, and 24-week follow-up data are available for 99. Each treatment course consists of two separate infusions, 1,000 mg each, 2 weeks apart.

Baseline characteristics of the 99 patients were similar to those of the original larger study population, where the mean age was 54 years and disease duration was 10 years.

Mean tender and swollen joint counts at baseline were approximately 32 and 20, respectively, and mean disease activity score including a 28-joint count (DAS28) was 6.8 (N. Engl. J. Med. 2004; 350:2572–81).

A total of 58 (59%) of patients had achieved an ACR20 response 24 weeks after the first course of rituximab, while 72 (73%) reached this level of response 24 weeks after the second course, according to Dr. Emery, professor of rheumatology and clinical director of the Academic Unit of Musculoskeletal Disease at the Leeds (England) Teaching Hospitals Trust.

Maximal efficacy with rituximab generally is seen at 24 weeks.

Increased efficacy also was apparent on other measures. (See table.)

Repeat courses of the B-cell-depleting agent were well tolerated, and there was no evidence of increased overall incidence of adverse events, numbers of infections, or infusion reactions, he said.

ELSEVIER GLOBAL MEDICAL NEWS

AMSTERDAM — The clinical response to repeat courses of rituximab equalled or surpassed the initial course in patients with rheumatoid arthritis who are participating in a long-term open-label study, Dr. Paul Emery said at the annual European Congress of Rheumatology.

Patients with rheumatoid arthritis (RA) unresponsive to traditional disease-modifying antirheumatic drugs but who achieved at least a 20% improvement in tender and swollen joint counts following a single course of rituximab were eligible to receive additional courses for residual disease.

To date, 145 patients have received at least two courses, and 24-week follow-up data are available for 99. Each treatment course consists of two separate infusions, 1,000 mg each, 2 weeks apart.

Baseline characteristics of the 99 patients were similar to those of the original larger study population, where the mean age was 54 years and disease duration was 10 years.

Mean tender and swollen joint counts at baseline were approximately 32 and 20, respectively, and mean disease activity score including a 28-joint count (DAS28) was 6.8 (N. Engl. J. Med. 2004; 350:2572–81).

A total of 58 (59%) of patients had achieved an ACR20 response 24 weeks after the first course of rituximab, while 72 (73%) reached this level of response 24 weeks after the second course, according to Dr. Emery, professor of rheumatology and clinical director of the Academic Unit of Musculoskeletal Disease at the Leeds (England) Teaching Hospitals Trust.

Maximal efficacy with rituximab generally is seen at 24 weeks.

Increased efficacy also was apparent on other measures. (See table.)

Repeat courses of the B-cell-depleting agent were well tolerated, and there was no evidence of increased overall incidence of adverse events, numbers of infections, or infusion reactions, he said.

ELSEVIER GLOBAL MEDICAL NEWS

GLASGOW, SCOTLAND — Successful stem cell transplantation in two patients with recalcitrant Still's disease suggests that this approach could offer a viable alternative for patients who do not respond to other therapies, according to Dr. Hanumantha V. Reddy.

Treatment typically includes nonsteroidal anti-inflammatory drugs, high-dose corticosteroids, and intravenous immunoglobulin. Disease-modifying antirheumatic drugs (DMARDs) are sometimes used, although they tend to be more beneficial for the articular symptoms than for the systemic abnormalities, noted Dr. Reddy in a poster session at the annual meeting of the British Society for Rheumatology.

In the first case, explained by Dr. Reddy, a 34-year-old woman had intermittent fever, rash, arthritis that was significantly erosive, leukocytosis, anemia, and elevated inflammatory markers. She was steroid dependent and had not responded to DMARDs or biologic therapies.

She underwent autologous stem cell transplantation in early 2003 and responded well, soon entering remission with normalization of her inflammatory markers. In 2004, she had a successful pregnancy, and she remains in remission, Dr. Reddy reported.

The second stem cell transplantation involved a 24-year-old woman who had been diagnosed with Still's disease at age 14 and had frequent flares but no significant joint damage. She too was steroid dependent and had not responded to traditional DMARDs, biologic therapies, or intravenous immunoglobulin, according to Dr. Reddy of the rheumatology department, Royal Liverpool University Hospital, England.

The patient underwent autologous stem cell transplantation. The posttransplant period was complicated by 3 months of persistent fever, presumed to be viral in origin. She also experienced two episodes of severe autoimmune hemolysis characterized by frank hematuria and the presence of Kidd group antibodies. She recovered well, however, and is currently in remission, Dr. Reddy reported.

Stem cell transplantation risks were seen in a series of 34 children with juvenile idiopathic arthritis who underwent the procedure. Although 53% of patients in this series responded well and experienced drug-free remission, five died—two from disease relapse and three from infection-associated hemophagocytic syndrome (Ann. Rheum. Dis. 2004;63:1318–26).

GLASGOW, SCOTLAND — Successful stem cell transplantation in two patients with recalcitrant Still's disease suggests that this approach could offer a viable alternative for patients who do not respond to other therapies, according to Dr. Hanumantha V. Reddy.

Treatment typically includes nonsteroidal anti-inflammatory drugs, high-dose corticosteroids, and intravenous immunoglobulin. Disease-modifying antirheumatic drugs (DMARDs) are sometimes used, although they tend to be more beneficial for the articular symptoms than for the systemic abnormalities, noted Dr. Reddy in a poster session at the annual meeting of the British Society for Rheumatology.

In the first case, explained by Dr. Reddy, a 34-year-old woman had intermittent fever, rash, arthritis that was significantly erosive, leukocytosis, anemia, and elevated inflammatory markers. She was steroid dependent and had not responded to DMARDs or biologic therapies.

She underwent autologous stem cell transplantation in early 2003 and responded well, soon entering remission with normalization of her inflammatory markers. In 2004, she had a successful pregnancy, and she remains in remission, Dr. Reddy reported.

The second stem cell transplantation involved a 24-year-old woman who had been diagnosed with Still's disease at age 14 and had frequent flares but no significant joint damage. She too was steroid dependent and had not responded to traditional DMARDs, biologic therapies, or intravenous immunoglobulin, according to Dr. Reddy of the rheumatology department, Royal Liverpool University Hospital, England.

The patient underwent autologous stem cell transplantation. The posttransplant period was complicated by 3 months of persistent fever, presumed to be viral in origin. She also experienced two episodes of severe autoimmune hemolysis characterized by frank hematuria and the presence of Kidd group antibodies. She recovered well, however, and is currently in remission, Dr. Reddy reported.

Stem cell transplantation risks were seen in a series of 34 children with juvenile idiopathic arthritis who underwent the procedure. Although 53% of patients in this series responded well and experienced drug-free remission, five died—two from disease relapse and three from infection-associated hemophagocytic syndrome (Ann. Rheum. Dis. 2004;63:1318–26).

GLASGOW, SCOTLAND — Successful stem cell transplantation in two patients with recalcitrant Still's disease suggests that this approach could offer a viable alternative for patients who do not respond to other therapies, according to Dr. Hanumantha V. Reddy.

Treatment typically includes nonsteroidal anti-inflammatory drugs, high-dose corticosteroids, and intravenous immunoglobulin. Disease-modifying antirheumatic drugs (DMARDs) are sometimes used, although they tend to be more beneficial for the articular symptoms than for the systemic abnormalities, noted Dr. Reddy in a poster session at the annual meeting of the British Society for Rheumatology.

In the first case, explained by Dr. Reddy, a 34-year-old woman had intermittent fever, rash, arthritis that was significantly erosive, leukocytosis, anemia, and elevated inflammatory markers. She was steroid dependent and had not responded to DMARDs or biologic therapies.

She underwent autologous stem cell transplantation in early 2003 and responded well, soon entering remission with normalization of her inflammatory markers. In 2004, she had a successful pregnancy, and she remains in remission, Dr. Reddy reported.

The second stem cell transplantation involved a 24-year-old woman who had been diagnosed with Still's disease at age 14 and had frequent flares but no significant joint damage. She too was steroid dependent and had not responded to traditional DMARDs, biologic therapies, or intravenous immunoglobulin, according to Dr. Reddy of the rheumatology department, Royal Liverpool University Hospital, England.

The patient underwent autologous stem cell transplantation. The posttransplant period was complicated by 3 months of persistent fever, presumed to be viral in origin. She also experienced two episodes of severe autoimmune hemolysis characterized by frank hematuria and the presence of Kidd group antibodies. She recovered well, however, and is currently in remission, Dr. Reddy reported.

Stem cell transplantation risks were seen in a series of 34 children with juvenile idiopathic arthritis who underwent the procedure. Although 53% of patients in this series responded well and experienced drug-free remission, five died—two from disease relapse and three from infection-associated hemophagocytic syndrome (Ann. Rheum. Dis. 2004;63:1318–26).

GLASGOW, SCOTLAND — Sulfasalazine should be added to the list of drugs that can interfere with assays of urinary catecholamines and their metabolites, Dr. Clive Kelly reported at the annual meeting of the British Society for Rheumatology.

Several medications—including tricyclic antidepressants, antipsychotics, and levodopa—can cause false-positive results when assays for normetanephrine and metanephrine are undertaken to rule out pheochromocytoma. The effect of sulfasalazine on the results of urinary catecholamine assays has not thus far been reported in the literature or to the manufacturers, according to Dr. Kelly, who heads the department of rheumatology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, England.

In one such case of a false-positive pheochromocytoma result, a 48-year-old man with well-controlled rheumatoid arthritis was admitted with a blood pressure reading of 210/130 mm Hg. He had been taking sulfasalazine for 6 years and was then on 1 g/day. His other medications included Calcichew D3 (calcium carbonate plus vitamin D₃), cimetidine, and thyroxine. Initial investigations found nothing remarkable, Dr. Kelly said, but following a 24-hour urine collection, a high-performance liquid chromatography assay found significantly increased levels of normetanephrine at 60.8 μmol/day (the normal range is less than 3.2 μmol/day).

Three repeated analyses during the subsequent 5 months produced similar results, despite that neither MRI nor metaiodobenzylguanidine scintigraphy showed any evidence of a pheochromocytoma, Dr. Kelly wrote in a poster.

To further examine the influence of sulfasalazine on urine collections for fractionated metanephrines, he and his colleagues then prospectively recruited 10 rheumatoid arthritis patients on sulfasalazine who were not hypertensive and were not taking antihypertensive drugs, and 10 age- and sex-matched controls who also were not hypertensive but were not taking sulfasalazine. Both groups provided 24-hour urine collections, which were then analyzed using standard techniques.

The mean level of normetanephrine in the sulfasalazine group was 17.3 μmol/day, compared with 2.4 μmol/day in the control group. The pheochromocytoma false-positive rate was 80% in the sulfasalazine group and 20% in the control group, Dr. Kelly reported. Normetanephrine elevations were not dose dependent.

“We suspect that a metabolite of sulfasalazine forms a peak on the chromatogram close to the position of normetanephrine and is therefore easily misidentified,” he wrote. An alternative explanation is that sulfasalazine may increase endogenous loads of catecholamines or their metabolites.

GLASGOW, SCOTLAND — Sulfasalazine should be added to the list of drugs that can interfere with assays of urinary catecholamines and their metabolites, Dr. Clive Kelly reported at the annual meeting of the British Society for Rheumatology.

Several medications—including tricyclic antidepressants, antipsychotics, and levodopa—can cause false-positive results when assays for normetanephrine and metanephrine are undertaken to rule out pheochromocytoma. The effect of sulfasalazine on the results of urinary catecholamine assays has not thus far been reported in the literature or to the manufacturers, according to Dr. Kelly, who heads the department of rheumatology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, England.

In one such case of a false-positive pheochromocytoma result, a 48-year-old man with well-controlled rheumatoid arthritis was admitted with a blood pressure reading of 210/130 mm Hg. He had been taking sulfasalazine for 6 years and was then on 1 g/day. His other medications included Calcichew D3 (calcium carbonate plus vitamin D₃), cimetidine, and thyroxine. Initial investigations found nothing remarkable, Dr. Kelly said, but following a 24-hour urine collection, a high-performance liquid chromatography assay found significantly increased levels of normetanephrine at 60.8 μmol/day (the normal range is less than 3.2 μmol/day).

Three repeated analyses during the subsequent 5 months produced similar results, despite that neither MRI nor metaiodobenzylguanidine scintigraphy showed any evidence of a pheochromocytoma, Dr. Kelly wrote in a poster.

To further examine the influence of sulfasalazine on urine collections for fractionated metanephrines, he and his colleagues then prospectively recruited 10 rheumatoid arthritis patients on sulfasalazine who were not hypertensive and were not taking antihypertensive drugs, and 10 age- and sex-matched controls who also were not hypertensive but were not taking sulfasalazine. Both groups provided 24-hour urine collections, which were then analyzed using standard techniques.

The mean level of normetanephrine in the sulfasalazine group was 17.3 μmol/day, compared with 2.4 μmol/day in the control group. The pheochromocytoma false-positive rate was 80% in the sulfasalazine group and 20% in the control group, Dr. Kelly reported. Normetanephrine elevations were not dose dependent.

“We suspect that a metabolite of sulfasalazine forms a peak on the chromatogram close to the position of normetanephrine and is therefore easily misidentified,” he wrote. An alternative explanation is that sulfasalazine may increase endogenous loads of catecholamines or their metabolites.

GLASGOW, SCOTLAND — Sulfasalazine should be added to the list of drugs that can interfere with assays of urinary catecholamines and their metabolites, Dr. Clive Kelly reported at the annual meeting of the British Society for Rheumatology.

Several medications—including tricyclic antidepressants, antipsychotics, and levodopa—can cause false-positive results when assays for normetanephrine and metanephrine are undertaken to rule out pheochromocytoma. The effect of sulfasalazine on the results of urinary catecholamine assays has not thus far been reported in the literature or to the manufacturers, according to Dr. Kelly, who heads the department of rheumatology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, England.

In one such case of a false-positive pheochromocytoma result, a 48-year-old man with well-controlled rheumatoid arthritis was admitted with a blood pressure reading of 210/130 mm Hg. He had been taking sulfasalazine for 6 years and was then on 1 g/day. His other medications included Calcichew D3 (calcium carbonate plus vitamin D₃), cimetidine, and thyroxine. Initial investigations found nothing remarkable, Dr. Kelly said, but following a 24-hour urine collection, a high-performance liquid chromatography assay found significantly increased levels of normetanephrine at 60.8 μmol/day (the normal range is less than 3.2 μmol/day).

Three repeated analyses during the subsequent 5 months produced similar results, despite that neither MRI nor metaiodobenzylguanidine scintigraphy showed any evidence of a pheochromocytoma, Dr. Kelly wrote in a poster.

To further examine the influence of sulfasalazine on urine collections for fractionated metanephrines, he and his colleagues then prospectively recruited 10 rheumatoid arthritis patients on sulfasalazine who were not hypertensive and were not taking antihypertensive drugs, and 10 age- and sex-matched controls who also were not hypertensive but were not taking sulfasalazine. Both groups provided 24-hour urine collections, which were then analyzed using standard techniques.

The mean level of normetanephrine in the sulfasalazine group was 17.3 μmol/day, compared with 2.4 μmol/day in the control group. The pheochromocytoma false-positive rate was 80% in the sulfasalazine group and 20% in the control group, Dr. Kelly reported. Normetanephrine elevations were not dose dependent.

“We suspect that a metabolite of sulfasalazine forms a peak on the chromatogram close to the position of normetanephrine and is therefore easily misidentified,” he wrote. An alternative explanation is that sulfasalazine may increase endogenous loads of catecholamines or their metabolites.

SAN DIEGO — Participation in a program that incorporated mindfulness meditation and yoga resulted in a statistically significant reduction in psychological distress in a pilot study of patients with rheumatoid arthritis, Elizabeth Kimbrough Pradhan, Ph.D., reported at the annual meeting of the American College of Rheumatology.

A group of 63 adults with rheumatoid arthritis (RA) was randomized to either a 2.5-hour mindfulness-based stress reduction class once a week for 8 weeks or to a wait-list control group.

Mindfulness meditation involves the cultivation of moment-to-moment awareness and attention, against a backdrop of compassion for oneself and others, said Dr. Pradhan of the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore. Participants learned meditation techniques and hatha yoga postures, and were asked to practice at home for 45 minutes to an hour 6 days each week.

RA disease status was evaluated by Disease Activity Score (DAS) 28, while psychological distress was measured by the Symptom Checklist-90-Revised. Patients were predominantly female, educated, and of mid to high socioeconomic status. All were under the regular care of a rheumatologist, with 74% taking disease modifying antirheumatic drugs, 15.9% being prescribed biologic agents, 50.8% taking nonsteroidal anti-inflammatory drugs, and 31.8% using corticosteroids.

In the meditation group, there was a 30% reduction in psychological distress at 2 months, which was a statistically significant change, Dr. Pradhan said. The 10% decrease seen in the control group was not significant.

At 6 months, a statistically significant 33% reduction in psychological distress was seen in the meditation group, compared with a nonsignificant 2% decrease in the control group.

The mean DAS28 at baseline was 3.1 in the treatment group and 3.3 in the control group, indicating moderate disease activity. Mean erythrocyte sedimentation rate (ESR) was 22.1 in both groups.

There was no change in disease activity in either group by 2 months, but by 6 months there was an 11% decrease in the meditation group. This was statistically significant but would not be considered clinically significant by experts, Dr. Pradhan said. “Nonetheless, what was interesting was that of the four components in the DAS28, the one driving the change was ESR,” she said during a press briefing. There was a statistically significant 23% reduction in ESR from baseline to 2 months in the meditation group, and a statistically significant 33% decrease from baseline to 6 months. At both of these time points, there were slight increases in ESR in the control group. As to why the ESR would have decreased in response to meditation, Dr. Pradhan offered several possible explanations. One was that the meditation group may have modified lifestyle factors.

“If participants in the meditation group were feeling better as a result of being in the mindfulness-based stress reduction course, it is possible that they could have changed their diets to include more fruits and vegetables, reduced fried and sugary foods and so forth, which may have contributed to a decrease in general inflammation,” she explained.

Another possible explanation could be a proinflammatory response to stress, involving activation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system, she offered. Emotional responses to stress register in the hippocampus, causing the release of corticotropin-releasing hormone (CRH), which stimulates the HPA axis, ultimately resulting in the release of epinephrine and other hormones. CRH and norepinephrine are released peripherally through the response of the autonomic nervous system.

“A CRH receptor-dependent inflammatory response in RA synovial tissue has been observed, and CRH has been seen to up-regulate prostaglandin production in RA synovial tissue in a dose-response manner,” she said.

CRH, norepinephrine, and epinephrine may also potentiate inflammation in RA by activating macrophages that release interleukin (IL)-1, IL-6, and tumor necrosis factor-α and through up-regulation of β-adrenoceptors for norepinephrine that results in increased IL-6 secretion, Dr. Pradhan added.

SAN DIEGO — Participation in a program that incorporated mindfulness meditation and yoga resulted in a statistically significant reduction in psychological distress in a pilot study of patients with rheumatoid arthritis, Elizabeth Kimbrough Pradhan, Ph.D., reported at the annual meeting of the American College of Rheumatology.

A group of 63 adults with rheumatoid arthritis (RA) was randomized to either a 2.5-hour mindfulness-based stress reduction class once a week for 8 weeks or to a wait-list control group.

Mindfulness meditation involves the cultivation of moment-to-moment awareness and attention, against a backdrop of compassion for oneself and others, said Dr. Pradhan of the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore. Participants learned meditation techniques and hatha yoga postures, and were asked to practice at home for 45 minutes to an hour 6 days each week.

RA disease status was evaluated by Disease Activity Score (DAS) 28, while psychological distress was measured by the Symptom Checklist-90-Revised. Patients were predominantly female, educated, and of mid to high socioeconomic status. All were under the regular care of a rheumatologist, with 74% taking disease modifying antirheumatic drugs, 15.9% being prescribed biologic agents, 50.8% taking nonsteroidal anti-inflammatory drugs, and 31.8% using corticosteroids.

In the meditation group, there was a 30% reduction in psychological distress at 2 months, which was a statistically significant change, Dr. Pradhan said. The 10% decrease seen in the control group was not significant.

At 6 months, a statistically significant 33% reduction in psychological distress was seen in the meditation group, compared with a nonsignificant 2% decrease in the control group.

The mean DAS28 at baseline was 3.1 in the treatment group and 3.3 in the control group, indicating moderate disease activity. Mean erythrocyte sedimentation rate (ESR) was 22.1 in both groups.

There was no change in disease activity in either group by 2 months, but by 6 months there was an 11% decrease in the meditation group. This was statistically significant but would not be considered clinically significant by experts, Dr. Pradhan said. “Nonetheless, what was interesting was that of the four components in the DAS28, the one driving the change was ESR,” she said during a press briefing. There was a statistically significant 23% reduction in ESR from baseline to 2 months in the meditation group, and a statistically significant 33% decrease from baseline to 6 months. At both of these time points, there were slight increases in ESR in the control group. As to why the ESR would have decreased in response to meditation, Dr. Pradhan offered several possible explanations. One was that the meditation group may have modified lifestyle factors.

“If participants in the meditation group were feeling better as a result of being in the mindfulness-based stress reduction course, it is possible that they could have changed their diets to include more fruits and vegetables, reduced fried and sugary foods and so forth, which may have contributed to a decrease in general inflammation,” she explained.

Another possible explanation could be a proinflammatory response to stress, involving activation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system, she offered. Emotional responses to stress register in the hippocampus, causing the release of corticotropin-releasing hormone (CRH), which stimulates the HPA axis, ultimately resulting in the release of epinephrine and other hormones. CRH and norepinephrine are released peripherally through the response of the autonomic nervous system.

“A CRH receptor-dependent inflammatory response in RA synovial tissue has been observed, and CRH has been seen to up-regulate prostaglandin production in RA synovial tissue in a dose-response manner,” she said.

CRH, norepinephrine, and epinephrine may also potentiate inflammation in RA by activating macrophages that release interleukin (IL)-1, IL-6, and tumor necrosis factor-α and through up-regulation of β-adrenoceptors for norepinephrine that results in increased IL-6 secretion, Dr. Pradhan added.

SAN DIEGO — Participation in a program that incorporated mindfulness meditation and yoga resulted in a statistically significant reduction in psychological distress in a pilot study of patients with rheumatoid arthritis, Elizabeth Kimbrough Pradhan, Ph.D., reported at the annual meeting of the American College of Rheumatology.

A group of 63 adults with rheumatoid arthritis (RA) was randomized to either a 2.5-hour mindfulness-based stress reduction class once a week for 8 weeks or to a wait-list control group.

Mindfulness meditation involves the cultivation of moment-to-moment awareness and attention, against a backdrop of compassion for oneself and others, said Dr. Pradhan of the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore. Participants learned meditation techniques and hatha yoga postures, and were asked to practice at home for 45 minutes to an hour 6 days each week.

RA disease status was evaluated by Disease Activity Score (DAS) 28, while psychological distress was measured by the Symptom Checklist-90-Revised. Patients were predominantly female, educated, and of mid to high socioeconomic status. All were under the regular care of a rheumatologist, with 74% taking disease modifying antirheumatic drugs, 15.9% being prescribed biologic agents, 50.8% taking nonsteroidal anti-inflammatory drugs, and 31.8% using corticosteroids.

In the meditation group, there was a 30% reduction in psychological distress at 2 months, which was a statistically significant change, Dr. Pradhan said. The 10% decrease seen in the control group was not significant.

At 6 months, a statistically significant 33% reduction in psychological distress was seen in the meditation group, compared with a nonsignificant 2% decrease in the control group.

The mean DAS28 at baseline was 3.1 in the treatment group and 3.3 in the control group, indicating moderate disease activity. Mean erythrocyte sedimentation rate (ESR) was 22.1 in both groups.

There was no change in disease activity in either group by 2 months, but by 6 months there was an 11% decrease in the meditation group. This was statistically significant but would not be considered clinically significant by experts, Dr. Pradhan said. “Nonetheless, what was interesting was that of the four components in the DAS28, the one driving the change was ESR,” she said during a press briefing. There was a statistically significant 23% reduction in ESR from baseline to 2 months in the meditation group, and a statistically significant 33% decrease from baseline to 6 months. At both of these time points, there were slight increases in ESR in the control group. As to why the ESR would have decreased in response to meditation, Dr. Pradhan offered several possible explanations. One was that the meditation group may have modified lifestyle factors.

“If participants in the meditation group were feeling better as a result of being in the mindfulness-based stress reduction course, it is possible that they could have changed their diets to include more fruits and vegetables, reduced fried and sugary foods and so forth, which may have contributed to a decrease in general inflammation,” she explained.

Another possible explanation could be a proinflammatory response to stress, involving activation of the hypothalamus-pituitary-adrenal (HPA) axis and the autonomic nervous system, she offered. Emotional responses to stress register in the hippocampus, causing the release of corticotropin-releasing hormone (CRH), which stimulates the HPA axis, ultimately resulting in the release of epinephrine and other hormones. CRH and norepinephrine are released peripherally through the response of the autonomic nervous system.

“A CRH receptor-dependent inflammatory response in RA synovial tissue has been observed, and CRH has been seen to up-regulate prostaglandin production in RA synovial tissue in a dose-response manner,” she said.

CRH, norepinephrine, and epinephrine may also potentiate inflammation in RA by activating macrophages that release interleukin (IL)-1, IL-6, and tumor necrosis factor-α and through up-regulation of β-adrenoceptors for norepinephrine that results in increased IL-6 secretion, Dr. Pradhan added.

GLASGOW, SCOTLAND — Shoulder involvement is often overlooked in ankylosing spondylitis, despite patients' reports that upper body pain interferes with their daily activities, Dr. Charlotte E. Page reported in a poster session at the annual meeting of the British Society for Rheumatology.

Among a group of 31 ankylosing spondylitis (AS) patients attending a 2-week physiotherapy program who responded to questionnaires about their symptoms, 12 reported current shoulder pain, while 10 patients reported experiencing shoulder pain in the past, reported Dr. Page of the rheumatology department of University Hospital of Wales, Cardiff. The patients, aged 17–62 years, had a mean AS duration of 19 years.

Among patients with current shoulder pain, four reported bilateral symptoms, and nine indicated that their daily activities were affected. Among those with previous pain, three study patients reported that their shoulder involvement continued to interfere with their daily activities, noted Dr. Page.

The reported prevalence of shoulder pain among the general population is approximately 12%, and estimates among those with AS range from 7% to 33%, she noted. “Our prevalence of 39% is slightly higher, probably reflecting the type of patients who attend intensive physiotherapy programs.”

Only 10 of the 22 patients who had either current or past shoulder pain had undergone one or more radiologic investigations. Eight had been evaluated with plain radiographs, three with ultrasound, and three with MRI arthrograms.

Among the eight patients who had received one or more corticosteroid injections to the shoulder region, five reported still having shoulder pain and six reported still experiencing symptoms that interfered with daily activities. Among the seven who had received physiotherapy directed at their shoulder symptoms, five continued to experience pain.

Specific physiotherapy and corticosteroid injections had therefore been given to only 32% and 36% of patients, respectively, and had not alleviated the symptoms in the majority, Dr. Page noted during her presentation.

Moreover, a total of 26 patients in the study reported peripheral joint involvement other than the shoulder.

Despite this, only six patients received disease-modifying antirheumatic drugs or anti-tumor necrosis factor-α therapy, which suggests an underappreciation of the extent of ankylosing spondylitis patients' peripheral joint pain, according to Dr. Page.

Much of the shoulder involvement was rotator cuff tendonitis, which can be imaged and treated, Dr. Page said in an interview. Patients should be asked specifically about this, she said.

“We all know about their hip pain but we seem to forget about the top half” of the body, she said.

GLASGOW, SCOTLAND — Shoulder involvement is often overlooked in ankylosing spondylitis, despite patients' reports that upper body pain interferes with their daily activities, Dr. Charlotte E. Page reported in a poster session at the annual meeting of the British Society for Rheumatology.

Among a group of 31 ankylosing spondylitis (AS) patients attending a 2-week physiotherapy program who responded to questionnaires about their symptoms, 12 reported current shoulder pain, while 10 patients reported experiencing shoulder pain in the past, reported Dr. Page of the rheumatology department of University Hospital of Wales, Cardiff. The patients, aged 17–62 years, had a mean AS duration of 19 years.

Among patients with current shoulder pain, four reported bilateral symptoms, and nine indicated that their daily activities were affected. Among those with previous pain, three study patients reported that their shoulder involvement continued to interfere with their daily activities, noted Dr. Page.

The reported prevalence of shoulder pain among the general population is approximately 12%, and estimates among those with AS range from 7% to 33%, she noted. “Our prevalence of 39% is slightly higher, probably reflecting the type of patients who attend intensive physiotherapy programs.”

Only 10 of the 22 patients who had either current or past shoulder pain had undergone one or more radiologic investigations. Eight had been evaluated with plain radiographs, three with ultrasound, and three with MRI arthrograms.

Among the eight patients who had received one or more corticosteroid injections to the shoulder region, five reported still having shoulder pain and six reported still experiencing symptoms that interfered with daily activities. Among the seven who had received physiotherapy directed at their shoulder symptoms, five continued to experience pain.

Specific physiotherapy and corticosteroid injections had therefore been given to only 32% and 36% of patients, respectively, and had not alleviated the symptoms in the majority, Dr. Page noted during her presentation.

Moreover, a total of 26 patients in the study reported peripheral joint involvement other than the shoulder.

Despite this, only six patients received disease-modifying antirheumatic drugs or anti-tumor necrosis factor-α therapy, which suggests an underappreciation of the extent of ankylosing spondylitis patients' peripheral joint pain, according to Dr. Page.

Much of the shoulder involvement was rotator cuff tendonitis, which can be imaged and treated, Dr. Page said in an interview. Patients should be asked specifically about this, she said.

“We all know about their hip pain but we seem to forget about the top half” of the body, she said.

GLASGOW, SCOTLAND — Shoulder involvement is often overlooked in ankylosing spondylitis, despite patients' reports that upper body pain interferes with their daily activities, Dr. Charlotte E. Page reported in a poster session at the annual meeting of the British Society for Rheumatology.

Among a group of 31 ankylosing spondylitis (AS) patients attending a 2-week physiotherapy program who responded to questionnaires about their symptoms, 12 reported current shoulder pain, while 10 patients reported experiencing shoulder pain in the past, reported Dr. Page of the rheumatology department of University Hospital of Wales, Cardiff. The patients, aged 17–62 years, had a mean AS duration of 19 years.

Among patients with current shoulder pain, four reported bilateral symptoms, and nine indicated that their daily activities were affected. Among those with previous pain, three study patients reported that their shoulder involvement continued to interfere with their daily activities, noted Dr. Page.

The reported prevalence of shoulder pain among the general population is approximately 12%, and estimates among those with AS range from 7% to 33%, she noted. “Our prevalence of 39% is slightly higher, probably reflecting the type of patients who attend intensive physiotherapy programs.”

Only 10 of the 22 patients who had either current or past shoulder pain had undergone one or more radiologic investigations. Eight had been evaluated with plain radiographs, three with ultrasound, and three with MRI arthrograms.

Among the eight patients who had received one or more corticosteroid injections to the shoulder region, five reported still having shoulder pain and six reported still experiencing symptoms that interfered with daily activities. Among the seven who had received physiotherapy directed at their shoulder symptoms, five continued to experience pain.

Specific physiotherapy and corticosteroid injections had therefore been given to only 32% and 36% of patients, respectively, and had not alleviated the symptoms in the majority, Dr. Page noted during her presentation.

Moreover, a total of 26 patients in the study reported peripheral joint involvement other than the shoulder.

Despite this, only six patients received disease-modifying antirheumatic drugs or anti-tumor necrosis factor-α therapy, which suggests an underappreciation of the extent of ankylosing spondylitis patients' peripheral joint pain, according to Dr. Page.

Much of the shoulder involvement was rotator cuff tendonitis, which can be imaged and treated, Dr. Page said in an interview. Patients should be asked specifically about this, she said.

“We all know about their hip pain but we seem to forget about the top half” of the body, she said.

GLASGOW, SCOTLAND — Chemo-therapy for lymphoma should be recognized as a risk factor for the development of osteoporosis, Dr. Bhaskar Dasgupta reported in a poster session at the annual meeting of the British Society for Rheumatology.

Patients with lymphoma have greatly improved survival rates because of advances in treatment, but their quality of life may be compromised by long-term complications of chemotherapy, reported Dr. Dasgupta, director of rheumatology, Southend Hospital NHS Trust, Westcliff on Sea, England. Osteoporosis is one such potential complication that can result from treatment with alkylating agents and the steroids that are often given with chemotherapy.

Height loss as a surrogate marker for vertebral osteoporosis was evaluated in a study of patients attending a lymphoma clinic. A total of 25 patients, 8 with Hodgkin's and 17 with non-Hodgkin's lymphoma, were enrolled. Mean age was 57.6 years, and 13 of the patients were female, reported Dr. Dasgupta. Exclusion criteria included a previous osteoporosis diagnosis, lymphoma with spinal involvement, and previous corticosteroid treatment.

When baseline height was compared with height 24 months or more after chemotherapy, the mean loss was found to be 22.8 mm, according to Dr. Dasgupta.

The degree of height loss increased with age—every 10-year increase in age was associated with a 5.2-mm decrease in height, he reported. No association was seen between height loss and gender, and none of the patients had other risk factors for osteoporosis.

No height loss association was found with either cumulative steroid dose or the type of chemotherapy received.

GLASGOW, SCOTLAND — Chemo-therapy for lymphoma should be recognized as a risk factor for the development of osteoporosis, Dr. Bhaskar Dasgupta reported in a poster session at the annual meeting of the British Society for Rheumatology.

Patients with lymphoma have greatly improved survival rates because of advances in treatment, but their quality of life may be compromised by long-term complications of chemotherapy, reported Dr. Dasgupta, director of rheumatology, Southend Hospital NHS Trust, Westcliff on Sea, England. Osteoporosis is one such potential complication that can result from treatment with alkylating agents and the steroids that are often given with chemotherapy.

Height loss as a surrogate marker for vertebral osteoporosis was evaluated in a study of patients attending a lymphoma clinic. A total of 25 patients, 8 with Hodgkin's and 17 with non-Hodgkin's lymphoma, were enrolled. Mean age was 57.6 years, and 13 of the patients were female, reported Dr. Dasgupta. Exclusion criteria included a previous osteoporosis diagnosis, lymphoma with spinal involvement, and previous corticosteroid treatment.

When baseline height was compared with height 24 months or more after chemotherapy, the mean loss was found to be 22.8 mm, according to Dr. Dasgupta.

The degree of height loss increased with age—every 10-year increase in age was associated with a 5.2-mm decrease in height, he reported. No association was seen between height loss and gender, and none of the patients had other risk factors for osteoporosis.

No height loss association was found with either cumulative steroid dose or the type of chemotherapy received.

GLASGOW, SCOTLAND — Chemo-therapy for lymphoma should be recognized as a risk factor for the development of osteoporosis, Dr. Bhaskar Dasgupta reported in a poster session at the annual meeting of the British Society for Rheumatology.

Patients with lymphoma have greatly improved survival rates because of advances in treatment, but their quality of life may be compromised by long-term complications of chemotherapy, reported Dr. Dasgupta, director of rheumatology, Southend Hospital NHS Trust, Westcliff on Sea, England. Osteoporosis is one such potential complication that can result from treatment with alkylating agents and the steroids that are often given with chemotherapy.

Height loss as a surrogate marker for vertebral osteoporosis was evaluated in a study of patients attending a lymphoma clinic. A total of 25 patients, 8 with Hodgkin's and 17 with non-Hodgkin's lymphoma, were enrolled. Mean age was 57.6 years, and 13 of the patients were female, reported Dr. Dasgupta. Exclusion criteria included a previous osteoporosis diagnosis, lymphoma with spinal involvement, and previous corticosteroid treatment.

When baseline height was compared with height 24 months or more after chemotherapy, the mean loss was found to be 22.8 mm, according to Dr. Dasgupta.

The degree of height loss increased with age—every 10-year increase in age was associated with a 5.2-mm decrease in height, he reported. No association was seen between height loss and gender, and none of the patients had other risk factors for osteoporosis.

No height loss association was found with either cumulative steroid dose or the type of chemotherapy received.

TORONTO — A single intravenous dose of zoledronic acid reduced markers of bone resorption in postmenopausal women more rapidly and to a greater extent than did weekly oral alendronate, Dr. Kenneth Saag reported in a poster session at a world congress on osteoporosis.

Zoledronic acid is the most powerful of the available bisphosphonates, and its long duration of effect now has been shown in a multicenter double-blind trial that randomized 118 women aged 45–79 years to a single infusion of 5 mg zoledronic acid or 70 mg weekly oral alendronate for 24 weeks. Patients receiving IV zoledronic acid also received oral placebo, and those receiving oral alendronate also received IV placebo.

In the zoledronic acid group, mean urine cross-linked N-telopeptide of type I collagen (NTx) fell from 46.1 to 15.2 nmol bone collagen equivalent (BCE)/mmol creatinine at 1 week, while the level of this marker of bone turnover fell from 45.8 to 35.5 nmol BCE/mmol creatinine in the alendronate group at 1 week. The greater reduction in urine NTx with zoledronic acid was significant and persisted throughout the 24 weeks of the study, according to Dr. Saag of the division of rheumatology, University of Alabama, Birmingham.

Levels of bone-specific alkaline phosphatase (BSAP) also decreased from baseline through week 24 in both groups. While reductions in BSAP levels were significantly greater in the zoledronic acid group at week 12, levels in both groups were within the premenopausal range of 6.2–12.8 ng/mL.

Overall, 91% of patients in the zoledronic acid group and 86% of those in the alendronate group experienced an adverse event. During the first 3 days after drug initiation, flulike symptoms led to a greater frequency of adverse events in the zoledronic acid group than in the alendronate group (64% vs. 37%), but after 3 days the adverse event rates were similar in the two groups, Dr. Saag said.

Serious adverse events were reported by two patients in the zoledronic acid group (one report of osteoarthritis and one of chest pain) and by three patients in the alendronate group (one report of patella fracture and two of osteoarthritis). None of the reports was considered to be related to the treatment.

Patient preferences for the treatments also were analyzed, with study participants expressing a “strong preference” for the single infusion compared with the weekly regimen (66% vs. 20%), Dr. Robert Lindsay noted in another poster session at the meeting, which was sponsored by the International Osteoporosis Foundation.

Even among patients who experienced adverse events during the 3 days after the infusion, 74% expressed an overall preference for the single-dose treatment, according to Dr. Lindsay of the clinical research center, Helen Hayes Hospital, West Haverstraw, N.Y.

The study was funded by Novartis Pharma AG, Basel, Switzerland.

TORONTO — A single intravenous dose of zoledronic acid reduced markers of bone resorption in postmenopausal women more rapidly and to a greater extent than did weekly oral alendronate, Dr. Kenneth Saag reported in a poster session at a world congress on osteoporosis.

Zoledronic acid is the most powerful of the available bisphosphonates, and its long duration of effect now has been shown in a multicenter double-blind trial that randomized 118 women aged 45–79 years to a single infusion of 5 mg zoledronic acid or 70 mg weekly oral alendronate for 24 weeks. Patients receiving IV zoledronic acid also received oral placebo, and those receiving oral alendronate also received IV placebo.

In the zoledronic acid group, mean urine cross-linked N-telopeptide of type I collagen (NTx) fell from 46.1 to 15.2 nmol bone collagen equivalent (BCE)/mmol creatinine at 1 week, while the level of this marker of bone turnover fell from 45.8 to 35.5 nmol BCE/mmol creatinine in the alendronate group at 1 week. The greater reduction in urine NTx with zoledronic acid was significant and persisted throughout the 24 weeks of the study, according to Dr. Saag of the division of rheumatology, University of Alabama, Birmingham.

Levels of bone-specific alkaline phosphatase (BSAP) also decreased from baseline through week 24 in both groups. While reductions in BSAP levels were significantly greater in the zoledronic acid group at week 12, levels in both groups were within the premenopausal range of 6.2–12.8 ng/mL.

Overall, 91% of patients in the zoledronic acid group and 86% of those in the alendronate group experienced an adverse event. During the first 3 days after drug initiation, flulike symptoms led to a greater frequency of adverse events in the zoledronic acid group than in the alendronate group (64% vs. 37%), but after 3 days the adverse event rates were similar in the two groups, Dr. Saag said.

Serious adverse events were reported by two patients in the zoledronic acid group (one report of osteoarthritis and one of chest pain) and by three patients in the alendronate group (one report of patella fracture and two of osteoarthritis). None of the reports was considered to be related to the treatment.

Patient preferences for the treatments also were analyzed, with study participants expressing a “strong preference” for the single infusion compared with the weekly regimen (66% vs. 20%), Dr. Robert Lindsay noted in another poster session at the meeting, which was sponsored by the International Osteoporosis Foundation.

Even among patients who experienced adverse events during the 3 days after the infusion, 74% expressed an overall preference for the single-dose treatment, according to Dr. Lindsay of the clinical research center, Helen Hayes Hospital, West Haverstraw, N.Y.

The study was funded by Novartis Pharma AG, Basel, Switzerland.

TORONTO — A single intravenous dose of zoledronic acid reduced markers of bone resorption in postmenopausal women more rapidly and to a greater extent than did weekly oral alendronate, Dr. Kenneth Saag reported in a poster session at a world congress on osteoporosis.

Zoledronic acid is the most powerful of the available bisphosphonates, and its long duration of effect now has been shown in a multicenter double-blind trial that randomized 118 women aged 45–79 years to a single infusion of 5 mg zoledronic acid or 70 mg weekly oral alendronate for 24 weeks. Patients receiving IV zoledronic acid also received oral placebo, and those receiving oral alendronate also received IV placebo.

In the zoledronic acid group, mean urine cross-linked N-telopeptide of type I collagen (NTx) fell from 46.1 to 15.2 nmol bone collagen equivalent (BCE)/mmol creatinine at 1 week, while the level of this marker of bone turnover fell from 45.8 to 35.5 nmol BCE/mmol creatinine in the alendronate group at 1 week. The greater reduction in urine NTx with zoledronic acid was significant and persisted throughout the 24 weeks of the study, according to Dr. Saag of the division of rheumatology, University of Alabama, Birmingham.

Levels of bone-specific alkaline phosphatase (BSAP) also decreased from baseline through week 24 in both groups. While reductions in BSAP levels were significantly greater in the zoledronic acid group at week 12, levels in both groups were within the premenopausal range of 6.2–12.8 ng/mL.

Overall, 91% of patients in the zoledronic acid group and 86% of those in the alendronate group experienced an adverse event. During the first 3 days after drug initiation, flulike symptoms led to a greater frequency of adverse events in the zoledronic acid group than in the alendronate group (64% vs. 37%), but after 3 days the adverse event rates were similar in the two groups, Dr. Saag said.

Serious adverse events were reported by two patients in the zoledronic acid group (one report of osteoarthritis and one of chest pain) and by three patients in the alendronate group (one report of patella fracture and two of osteoarthritis). None of the reports was considered to be related to the treatment.

Patient preferences for the treatments also were analyzed, with study participants expressing a “strong preference” for the single infusion compared with the weekly regimen (66% vs. 20%), Dr. Robert Lindsay noted in another poster session at the meeting, which was sponsored by the International Osteoporosis Foundation.

Even among patients who experienced adverse events during the 3 days after the infusion, 74% expressed an overall preference for the single-dose treatment, according to Dr. Lindsay of the clinical research center, Helen Hayes Hospital, West Haverstraw, N.Y.

The study was funded by Novartis Pharma AG, Basel, Switzerland.

GLASGOW, SCOTLAND — Involvement of the distal interphalangeal joint is a common feature of both psoriatic arthritis and osteoarthritis, but a new study using high-resolution magnetic resonance imaging has shown that the local microanatomical environment in psoriatic arthritis is quite distinct, according to Dr. Ai Lyn Tan.

The study included 10 patients with psoriatic arthritis (PsA), 10 with osteoarthritis (OA), and 10 normal controls. The distal interphalangeal joint structures, including ligaments, tendons, and entheses, were imaged using a 1.5-T MRI scanner with a 23-mm diameter microscopy coil and producing T-weighted spin-echo images, Dr. Tan wrote in a poster session at the annual meeting of the British Society for Rheumatology.

PsA was characterized by significant inflammation of ligaments and tendons, along with involvement of the corresponding entheseal insertions. Extracapsular enhancement and nail bed changes were striking, as was diffuse bone edema, particularly of the distal phalanx, she reported.

This condition was present in 80% of the PsA patients, often without cartilage damage.

“It appears that the ligament and extensor tendon entheses are the epicenter of the inflammatory response in PsA, with diffuse involvement of adjacent structures,” observed Dr. Tan of the Academic Unit of Musculoskeletal Disease, University of Leeds (England).

Findings among patients with OA also included more ligament and entheseal changes than among the normal controls, but there was significantly less contrast enhancement, compared with PsA. The OA joints were characterized by less soft-tissue swelling, and with degenerative changes such as loss of cartilage, usually at the volar aspect, she noted.

Osteophytes also were present in some OA joints, along with focal bone edema at the tendon entheses.

These observations suggest that, while in PsA inflammatory changes are prominent in ligaments, tendons, and adjacent bone, changes in the entheseal insertions appear to be primary, Dr. Tan suggested. Similar changes are present in OA, but they are much less marked.

“This study in patients with PsA adds further weight to the argument that enthesitis is the unifying concept in patients with true PsA,” Dr. Tan also wrote (Arthritis Rheum. 2006;54:1328–33).

GLASGOW, SCOTLAND — Involvement of the distal interphalangeal joint is a common feature of both psoriatic arthritis and osteoarthritis, but a new study using high-resolution magnetic resonance imaging has shown that the local microanatomical environment in psoriatic arthritis is quite distinct, according to Dr. Ai Lyn Tan.

The study included 10 patients with psoriatic arthritis (PsA), 10 with osteoarthritis (OA), and 10 normal controls. The distal interphalangeal joint structures, including ligaments, tendons, and entheses, were imaged using a 1.5-T MRI scanner with a 23-mm diameter microscopy coil and producing T-weighted spin-echo images, Dr. Tan wrote in a poster session at the annual meeting of the British Society for Rheumatology.

PsA was characterized by significant inflammation of ligaments and tendons, along with involvement of the corresponding entheseal insertions. Extracapsular enhancement and nail bed changes were striking, as was diffuse bone edema, particularly of the distal phalanx, she reported.

This condition was present in 80% of the PsA patients, often without cartilage damage.

“It appears that the ligament and extensor tendon entheses are the epicenter of the inflammatory response in PsA, with diffuse involvement of adjacent structures,” observed Dr. Tan of the Academic Unit of Musculoskeletal Disease, University of Leeds (England).

Findings among patients with OA also included more ligament and entheseal changes than among the normal controls, but there was significantly less contrast enhancement, compared with PsA. The OA joints were characterized by less soft-tissue swelling, and with degenerative changes such as loss of cartilage, usually at the volar aspect, she noted.

Osteophytes also were present in some OA joints, along with focal bone edema at the tendon entheses.

These observations suggest that, while in PsA inflammatory changes are prominent in ligaments, tendons, and adjacent bone, changes in the entheseal insertions appear to be primary, Dr. Tan suggested. Similar changes are present in OA, but they are much less marked.

“This study in patients with PsA adds further weight to the argument that enthesitis is the unifying concept in patients with true PsA,” Dr. Tan also wrote (Arthritis Rheum. 2006;54:1328–33).

GLASGOW, SCOTLAND — Involvement of the distal interphalangeal joint is a common feature of both psoriatic arthritis and osteoarthritis, but a new study using high-resolution magnetic resonance imaging has shown that the local microanatomical environment in psoriatic arthritis is quite distinct, according to Dr. Ai Lyn Tan.

The study included 10 patients with psoriatic arthritis (PsA), 10 with osteoarthritis (OA), and 10 normal controls. The distal interphalangeal joint structures, including ligaments, tendons, and entheses, were imaged using a 1.5-T MRI scanner with a 23-mm diameter microscopy coil and producing T-weighted spin-echo images, Dr. Tan wrote in a poster session at the annual meeting of the British Society for Rheumatology.

PsA was characterized by significant inflammation of ligaments and tendons, along with involvement of the corresponding entheseal insertions. Extracapsular enhancement and nail bed changes were striking, as was diffuse bone edema, particularly of the distal phalanx, she reported.

This condition was present in 80% of the PsA patients, often without cartilage damage.

“It appears that the ligament and extensor tendon entheses are the epicenter of the inflammatory response in PsA, with diffuse involvement of adjacent structures,” observed Dr. Tan of the Academic Unit of Musculoskeletal Disease, University of Leeds (England).

Findings among patients with OA also included more ligament and entheseal changes than among the normal controls, but there was significantly less contrast enhancement, compared with PsA. The OA joints were characterized by less soft-tissue swelling, and with degenerative changes such as loss of cartilage, usually at the volar aspect, she noted.

Osteophytes also were present in some OA joints, along with focal bone edema at the tendon entheses.

These observations suggest that, while in PsA inflammatory changes are prominent in ligaments, tendons, and adjacent bone, changes in the entheseal insertions appear to be primary, Dr. Tan suggested. Similar changes are present in OA, but they are much less marked.

“This study in patients with PsA adds further weight to the argument that enthesitis is the unifying concept in patients with true PsA,” Dr. Tan also wrote (Arthritis Rheum. 2006;54:1328–33).