Net Guide: Arthritis Pain

Pain Management, December 2010, Volume 3, Issue 8

A collection of links and resources from across the web focus on one specific condition. These resource range from useful websites to clinical trials.

//The Educated PatientTM

The Arthritis Foundation

One of the most in-depth sites for arthritis news, research, and advocacy, the Arthritis Foundation’s website is a must-see resource for any arthritis patient. The foundation’s goal is to help “people take control of arthritis by providing public health education; pursuing public policy and legislation; and conducting evidence-based programs to improve the quality of life for those living with arthritis.” Under the “Disease” tab, patients can visit the disease center (which contains information on various types of arthritis), the surgery center (which offers information on joint surgery), the pain center (which includes articles and resources to help visitors understand pain), and more.

Arthritis Pain: Do’s and Don’ts

Inform your patients about this helpful guide in managing arthritis pain on a day-to-day basis. The Mayo Clinic has put together this resource to offer tips on exercise and other common concerns. Under the “Basics” header, the article suggests that patients always speak to their doctors first about their symptoms, ask for clear definitions of the type of arthritis he or she has, and to find out the extent to which bones may already be damaged. In the “Everyday routines” section, the page suggests patients start off with gentle exercises in the morning. And during sedentary moments, the pages suggest that patients try to “adjust your position frequently” and periodically stretch. There is also a section on what to do with medications, and physician and emotional integration.

//Online CME

Rheumatoid Arthritis: What to Do about TNF Failures

Credits: 1.00

Fee: None

Expires: November 30, 2011

Multimedia: None

This activity explores “the therapeutic options with both conventional and biologic agents after failure of a TNF inhibitor” and “the factors influencing the choice of a biologic after failure of a TNF inhibitor.”

Headache in Patients with Rheumatic Disease: When to Worry

Credits: 0.50

Fee: None

Expires: February 25, 2011

Multimedia: Audio/Video/Slides

Complete this course for a review of “the frequency of headache disorders in patients with rheumatic diseases,” including a discussion of “unique headache disorders” and information on how to evaluate “a patient who has an underlying rheumatic disease and a headache.”


Increased Vascular Penetration and Nerve Growth in the Meniscus: A Potential Source of Pain in Osteoarthritis

Journal: Annals of the Rheumatic diseases (November 15)

Authors: Ashraf S, Wibberley H, Mapp P, et al.

Purpose: To describe “vascular penetration and nerve growth in human menisci, providing a potential mechanism for the genesis of pain in knee OA.”

Results: The team screened menisci that were obtained post mortem “on the basis of high or low macroscopic tibiofemoral chondropathy as a measure of the presence and degree of OA.” They selected 40 cases for the study, 20 per group, using image analysis to compare vascular and nerve densities between groups. The team concluded that “angiogenesis and associated sensory nerve growth in menisci may contribute to pain in knee OA.”

Pain and Ketoprofen: What Is its Role in Clinical Practice?

Journal: Rheumatismo (62:3; 2010)

Authors: Sarzi-Puttini P, Atzeni F, Lanata L, et al.

Purpose: To examine “the main available clinical evidence of ketoprofen in the treatment of acute and chronic pain, of both rheumatic and traumatic origin, as well as postoperative pain.”

Results: The authors concluded that “available data confirm that ketoprofen is effective and well tolerated, through different administration routes, for the treatment of various forms of rheumatic, traumatic and post-surgical pain, and may therefore be considered as a valid therapeutic option for these patients.”

Pain Sensitivity and Pain Reactivity in Osteoarthritis

Journal: Arthritis Care & Research (October 18, 2010; online ahead of print)

Authors: Lee Y, Lu B, Bathon J, et al.

Purpose: To assess “experimental pain sensitivity and compared the inflammatory response to pain in 26 OA patients and 33 age- and sex-matched controls from the general population.”

Results: “Participants underwent psychophysical pain testing to assess pain sensitivity in response to heat, cold and mechanical stimuli. Blood samples were taken at baseline and four time points after testing to determine the effect of acute pain on C-reactive protein (CRP), interleukin 6 (IL-6), interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α).” The team found that OS patients “are more sensitive to experiemtnal pain at multiple body sites;” RA patients demonstrate an altered stress response, as well as “increases in serum IL-6 after mental stress associated with anticipation of surgery, and increases in CRP after mental stress.”

Pain-specific Beliefs and Pain Experience in Children with Juvenile Idiopathic Arthritis: A Longitudinal Study

Journal: The Journal of Rheumatology (October 15, 2010; online ahead of print)

Authors: Thastum M, Herlin T

Purpose: The authors sought to “assess longitudinal associations between pain-specific health beliefs and pain in children with juvenile idiopathic arthritis (JIA), and to compare a selected group of patients with high pain and low disease activity (high-pain patients) with the remaining group.”

Results: The study included 47 children with JIA age 7-15 years who “completed the children’s version of the Survey of Pain Attitudes (SOPA-C) and a 3-week pain diary at study entry and in a followup study 2 years later (T2).” Based on the results, the authors concluded that “pain beliefs are influential on the longitudinal course of pain in children with JIA. Dysfunctional health beliefs in patients with high pain seem to be stable over time.”

//Clinical Trials

Role of Oral and Intestinal Microbiota in Rheumatoid Arthritis (RA)

Study Type: Interventional

Sponsor: New York University School of Medicine

Age/Gender Requirement: 18-70 years (male/female)

Purpose: To investigate “the hypothesis that bacteria living in a person's mouth and/or intestinal tract are responsible, at least in part, for the development of Rheumatoid Arthritis. The investigators believe that by killing those bacteria with antibiotics, they might be able to understand how the immune system works and, maybe, what causes RA.”

Self-Directed Exercise Program for Adults With Arthritis

Study Type: Interventional

Sponsor: University of South Carolina

Age/Gender Requirement: 18 years (male/female)

Purpose: The study is designed “to examine the effectiveness and safety of a self-directed physical activity program relative to a self-directed dietary program in adults with arthritis.”

Yoga for Arthritis

Study Type: Interventional

Sponsor: Johns Hopkins University

Age/Gender Requirement: 18-65 years (male/female)

Purpose: “The purpose of this study is to evaluate the impact of yoga on inflammatory arthritis and knee osteoarthritis.”

Living Well With Rheumatoid Arthritis

Study Type: Interventional

Sponsor: Bristol-Myers Squibb

Age/Gender Requirement: 18-70 years (male/female)

Purpose: The “Living Well with RA program” is designed “to evaluate the efficacy of an Internal Family Systems-based arthritis self-management program in improving Rheumatoid Arthritis subjects' disease activity, independence, and other health outcomes.”

Pharma Focus

Enbrel (Etanercept)

Clinical Trials

Golimumab in Rheumatoid Arthritis Patients with an Inadequate Response to Etanercept or Adalimumab

Study Type: Interventional

Sponsor: Centocor, Inc.

Age/Gender Requirements: 18 years (male/female)

Purpose: “The purpose of this study is to evaluate the efficacy and safety of switching rheumatoid arthritis (RA) patients who have an inadequate response to their current treatment with either etanercept methotrexate or adalimumab methotrexate to treatment with golimumab 50 mg subcutaneous injection every 4 weeks methotrexate to golimumab 2 mg/kg intravenous every 8 weeks methotrexate, for those who do not achieve a marked improvement of their RA at Week 16.”

Study Evaluating the Safety and Efficacy of Etanercept in Patients with Psoriatic Arthritis Treated by Rheumatologists

Study Type: Observational

Sponsor: Wyeth

Age/Gender Requirements: 18 years (male/female)

Purpose: “The purpose of this study is to evaluate the safety and effectiveness of etanercept under usual care settings in patients with PsA treated by rheumatologists.”

From the HCPLive Network

Addex Drug for Osteoarthritis Pain to Begin Clinical Trials

A drug being tested for osteoarthritis pain has proven effective in a model of OA pain. Manufactured by Addex Pharmaceuticals Ltd., ADX71943 modulates gamma-aminobutyric acid subtype B (GABA-B) receptors. These receptors are implicated in pain processing.

State of Mental Health Affects Osteoarthritis Pain

The mental health of an osteoarthritic patient may be just as important in treating for pain as the condition itself, according to a study published in the journal Osteoarthritis and Cartilage.

[American Journal of Managed Care logo]

Aggressive Treatment of Early Rheumatoid Arthritis: Recognizing the Window of Opportunityand Treating to Target Goals

The management of rheumatoid arthritis (RA) has undergone a paradigm shift in the past 15 to 20 years. Factors contributing to this include changes in treatment strategies and the development of antirheumatic biologic agents that down-regulate aspects of the host inflammatory response.