Glucocorticoid treatment may prevent long-term damage to joints


Joint injury can result in irreversible damage of cartilage which, despite treatment and surgery, often eventually leads to osteoarthritis (OA) in later life. New research published in BioMed Central's open access journal Arthritis Research & Therapy demonstrates that short term treatment of damaged cartilage with glucocorticoids can reduce long term degenerative changes and may provide hope for prevention of OA after injury.

Stopping arthritis before it starts


About 27 million Americans suffer from arthritis, and more than three million of those cases result from a joint injury, often in the knee, that provokes slow and steady cartilage deterioration.

A new study from MIT suggests that a steroid drug currently used to treatinflammatory diseases could also prevent osteoarthritis from ever developing in those people, if given soon after the injury.

“In essence, it’s repurposing an existing drug,” says Alan Grodzinsky, senior author of the study, a professor of biological, mechanical and electrical engineering, and the director of MIT’s Center for Biomedical Engineering.

Grodzinsky and his colleagues report their findings in the Sept. 2 issue of the journal Arthritis Research and Therapy. Other authors of the paper are Yihong Lu, a recent MIT biological engineering PhD recipient, and Christopher Evans, the Maurice Edmond Mueller Professor of Orthopedic Surgery at Harvard Medical School.

Severe joint injuries are more common in younger people, who are likelier to participate in sports such as basketball or skiing in which they are at a higher risk of tearing ligaments such as the anterior cruciate ligament (ACL). Military service and car accidents are also common sources of joint injuries in young people.

In most cases, the patient is treated with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to reduce pain and swelling. Weeks or months later, they might have surgery to stabilize the joint.

In about 50 percent of those cases, the patient’s cartilage steadily breaks down after the injury, eventually leading to arthritis, says Martin Lotz, professor of molecular and experimental medicine at the Scripps Research Institute, who was not involved in this study. Currently there is no way to prevent this cartilage degradation.

“There’s an opportunity here,” Lotz says of the MIT strategy of immediate intervention. “If you go in during this time, you would not only improve joint pain and swelling, you could actually reduce the risk of arthritis developing.” 

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In the new study, the MIT researchers tested the effects of glucocorticoids — steroids that can help reduce swelling and pain in arthritic joints. Doctors have been prescribing such drugs to treat chronic rheumatoid arthritis in the elderly for decades.

The researchers experimented on human and bovine cartilage tissue. First they damaged the tissue, then flooded it with inflammatory proteins called cytokines, which are typically released after a joint injury. Cytokines hasten cartilage breakdown.

In damaged tissue treated immediately with the glucocorticoid dexamethasone, cartilage breakdown was halted. The drug also worked when given a day or two after the injury, which is important because people who suffer joint injuries might not get to see a doctor right away, Grodzinsky says.

The researchers don’t yet know if dexamethasone could reverse cartilage damage that has already occurred, but plan to test that in future studies. They are also planning animal studies to determine how many joint treatments are necessary to maintain the protective effect. If those animal studies yield positive results, the findings could be rapidly translated to human treatments, Grodzinsky says, because the drug is already approved for human use.

The research team also investigated how dexamethasone exerts its protective effects. Though the process is not yet fully understood, they found some evidence that it blocks the degradation of aggrecan, a protein-carbohydrate complex that is a major structural and biomechanically functional component of cartilage. Appropriate drug delivery localized to joint cartilage is also under study.

Chondroitin sulfate improves hand function, relieves morning stiffness caused by osteoarthritis


New research shows that chondroitin sulfate significantly decreased pain and improved hand function in patients with osteoarthritis (OA) of the hand compared with those in the placebo group. Results of the clinical trial available today in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR), also report that chondroitin sulfate improves grip strength and relieves morning stiffness.

The ACR estimates that OA—the most common form of arthritis—affects more than 27 million adults in the U.S., causing joint pain and stiffness. Approximately 10% of the world population, 60 years and older, have symptomatic osteoarthritis according to the Global Burden of Disease 2000 report from the World Health Organization (WHO). Prior studies have found that 20% to 30% of adults have OA of the hand, with the prevalence rising to more than 50% after 60 years of age.

"Although hand OA is highly prevalent among adults and can significantly impact the quality of life for suffers, therapeutic options are still limited," said Cem Gabay, M.D., with University Hospitals of Geneva in Switzerland and lead investigation of the Finger osteoArthritis Chondroitin Treatment Study (FACTS). "There are few trials examining therapeutic approaches specific to hand OA and much of the available evidence has been extrapolated from studies investigating other forms of OA."

The single-center, placebo-controlled FACTS trial included 162 patients with radiographic hand OA who met inclusion criteria—spontaneous hand pain on the visual analogue scale (VAS) of 40 mm (scale 0-100) or more and Functional Index for Hand OA (FIHOA) level of 6 (scale 0-30). Participants received either 800 mg of chondroitin sulfate (80 patients) or placebo (82 patients) once daily for 6 months.

Results showed that patients in the chondroitin sulfate group had significant decrease in global hand pain compared with the placebo group, reflecting an 8.7 decrease on the VAS. Hand function also improved significantly for those taking chondroitin sulfate, decreasing more than 2 points on the FIHOA. Researchers also reported significantly improved hand function and reduction in morning stiffness for participants taking chondroitin sulfate versus placebo.

"Our findings show chondroitin sulfate is a safe and effective treatment for patients with hand OA," concluded Dr. Gabay. "Alternative therapies, such as nonsteroidal anti-inflammatory drugs (NSAIDs), provide similar pain reducing effects, but with considerably more long-term toxicities." Chondroitin sulfate is a naturally occurring molecule and a main component of joint cartilage. The chondroitin sulfate agent used in this study (Chondrosulf®) is licensed as a drug in Europe and not as a nutripharmaceutical; in the U.S. chondroitin sulfate is sold as a supplement and often paired with glucosamine.

More information: Symptomatic Effect of Chondroitin Sulfate 4&6 in Hand Osteoarthritis: The Finger osteoArthritis Chondroitin Treatment Study (FACTS): A Randomized Double-Blind Placebo Controlled Clinical Trial." Cem Gabay, Carole Medinger-Sadowski, Danielle Gascon, Frank Kolo, Axel Finckh. Arthritis & Rheumatism; Published Online: September 6, 2011. DOI:10.1002/art.30574

Provided by Wiley (news : web)

Killer Hospital Bug

A fungus that has become a major threat to hospital patients may have a hidden weakness, according to research published on Monday that highlights the bug's ability to bind to human tissue.

Candida albicans is widespread among humans, but normally does not affect health other than as vaginal or oral yeast infections, also called thrush.

But in medical settings, C. albans is a peril for sick people or individuals whose immune system has been compromised by cancer, HIV or organ transplant.

It accounts for one in every four hospital-acquired infections, often through plastic surfaces implanted in the body such as catheters, prosthetic joints or heart devices.

In the severest cases, nearly half of those infected die.

Adding to the problem is that C. albicans is a stealthy foe, able to change the structure of its cell wall to outsmart new drugs.

The latest research, published in a PNAS journal on Monday, highlights a promising target: the mechanism that the yeast uses to latch on to human cells and colonise them, thanks to a tiny part of a protein call Als adhesin.

"Als adhesin proteins give the yeast an ability to thrive throughout the human body, which is what makes it such a dangerous infections," said Ernesto Cota, a medical biologist at Imperial College London.

Cota's team used hi-tech scanners to probe the structure of the elusive protein.

The next step is to test experimental compounds on lab-dish samples of the fungus to see whether this will block the binding action.

The study appears in Proceedings of the National Academy of Sciences (PNAS).

(c) 2011 AFP

Research indicates certain probiotics may influence brain functioning


(Medical Xpress) -- It was just last year that a certain company selling a special probiotic enhanced yogurt was ordered by a U.S. court to stop suggesting in its advertisements that it's product had health benefits that went beyond the norm. Now, new evidence by Javier Bravo and colleagues at University College Cork, suggests the company may have been on to something. In their paper, published in the Proceedings of the National Academy of Science, the team describes how mice given the prbiotic Lactobacillus rhamnosus, showed signs of being less anxious and depressed and even had lowered levels of stress hormones.