Author: patienttalk

Posted on Rheumatoid arthritis

Reducing dementia in patients with rheumatoid arthritis

Vascular dementia.
Vascular dementia.


The incidence of dementia in patients with rheumatoid arthritis is lower in patients receiving biologic or targeted synthetic disease modifying antirheumatic drugs (DMARDs) than in patients who receive conventional synthetic DMARDs, according to a new study. The study was presented at the virtual annual meeting of the American College of Rheumatology.

“Being on a biologic or targeted synthetic DMARD actually decreased your risk of incidence of dementia by 17% compared to patients who were on a conventional synthetic DMARD only,” said lead study author Sebastian Sattui, MD, MS, a rheumatology fellow at Hospital for Special Surgery (HSS) in New York City. The study was done in collaboration with investigators from Weill Cornell Medicine and the University of Alabama at Birmingham.

Dr. Sattui said that the treatment in patients with rheumatoid arthritis has become more complex based on the understanding that rheumatoid arthritis has an impact well beyond what are thought of as the classical manifestations. Previous studies have suggested that inflammatory diseases such as rheumatoid arthritis can increase the risk for dementia and that TNF agents may have a role in preventing the incidence of dementia.

In the new study, researchers identified a cohort of patients with rheumatoid arthritis in Medicare claims data from 2006 to 2017. To be eligible, patients had to have continuous enrollment of at least 12 months in Medicare Part A, B and D, be at least 40 years of age and have no prior diagnosis of dementia.

In the sample of 141,326 eligible patients with rheumatoid arthritis, the crude incident rate of dementia was 2.0 per 100 person-years for patients on conventional synthetic DMARDs and 1.3 for patients on any biological DMARD. After adjusting for factors such as age, sex and other comorbidities, patients on biologic or targeted synthetic DMARDs had an adjusted 17% lower risk for dementia than patients on conventional synthetic DMARDs. No significant differences were observed between the different classes of biologic or targeted synthetic DMARDs, suggesting that decreased risk is possibly explained by the overall decrease in inflammation rather than a specific mechanism of action.

The researchers say clinicians should factor this new information into treatment decisions, but prospective studies are needed. “Our work shows yet another dimension in which treatment of rheumatoid arthritis can impact the overall health and quality of life of our patients,” said Dr. Sattui. “Rheumatoid arthritis is a systemic disease and it can have cognitive implications. However, these complications seem to share similar pathways to those of articular disease, and the medications that we use to treat rheumatoid arthritis could be effective in the prevention of dementia in patients with rheumatoid arthritis. Future studies need to assess the impact of the interventions, such as the treat-to-target strategy, on the incidence of dementia in patients with rheumatoid arthritis.”

Posted on Multiple Sclerosis

Diet shows major benefits for MS


Patients with relapsing-remitting multiple sclerosis (MS) who adopted a high-fat, low-carbohydrate ketogenic diet saw significant improvements in their MS – including reductions in neurologic disability, fatigue and depression and heightened overall quality of life, a new study finds.

The ketogenic diet – popular for weight loss and among the fitness community – was put to the test among 65 volunteers with relapsing-remitting MS, an inflammatory disorder in which the immune system attacks the natural insulation that protects the body’s nerves in the brain and spinal cord. MS symptoms vary widely, but patients often struggle with cognition, dexterity and mobility.

In the new study, more than 80% of participants on the keto diet adhered to it for the full six-month study period. Participants lost body fat and reported significant improvements in fatigue, depression and quality of life. In addition, their performance improved on physical endurance testing, such as the six-minute walk.

“The findings from the study are exciting and serve as a testament to the dedication of our study participants and the resilience of those living with MS,” said researcher J. Nicholas Brenton, MD, an expert on MS at UVA Health. “People living with MS are highly motivated toward research that studies the link between dietary intake and MS. Our study not only demonstrates the feasibility of dietary changes in MS patients but also the potential benefits that could arise from such interventions. Given the intriguing results of this study, our team is currently looking at how the ketogenic diet impacts the immune profile of MS patients.”

About the Ketogenic Diet

The ketogenic diet mimics the body’s fasting state. To do this, it cuts carbohydrates dramatically and replaces them with healthy fats and protein. As a result, the body relies on fat as a primary energy source (as opposed to carbs/sugars). A person on a ketogenic diet, for example, might eat a hamburger with no bun and a side of brussels sprouts with bacon. The traditional side of French fries would not be allowed – while fries are high in fat, they’re also loaded with carbohydrates, which are used as sugars by the body. Consuming excess carbs would defeat the point of keto, which is to minimize the body’s sugar reserves.

Dietary changes are known to have effects on the body’s immune system. In particular, the ketogenic diet may have several benefits for immune-mediated disorders, so Brenton wanted to investigate how this diet could help patients with MS. 

He and his collaborators found that the diet had a wide array of benefits, as determined both by patient report and by laboratory and clinical tests. For example, patients on keto walked farther and faster in six minutes than they did prior to the diet. Other benefits included reductions in total body fat and enhanced fine motor speed, as well as improved fatigue, depression and quality of life scores and beneficial changes in inflammatory blood markers.

Based on the findings, the researchers conclude that the ketogenic diet is safe in the short-term and potentially effective in improving MS-related symptoms and overall quality of life.

“Our study provides evidence that a ketogenic diet is safe and beneficial, reducing some symptoms for people with MS, when used over a six-month period,” Brenton said. “Still, more research is needed as there are risks associated with these diets. It is important that people with MS consult with their healthcare provider before making any big changes to their diet, and that they be regularly monitored by a physician and registered dietitian if pursuing a true ketogenic diet.”

Posted on Fibromyalgia

Combining 2 drugs used to treat fibromyalgia safely improves patient outcomes

Fibromyalgia likely the result of autoimmune problems


Queen’s University researcher Ian Gilron has uncovered a more effective way of treating fibromyalgia, a medical condition characterized by chronic widespread pain typically accompanied by fatigue, as well as sleep, mood and memory problems.

The results of the trial suggest that combining pregabalin, an anti-seizure drug, with duloxetine, an antidepressant, can safely improve outcomes in fibromyalgia, including not only pain relief, but also physical function and overall quality of life. Until now, these drugs have been proven, individually, to treat fibromyalgia pain.

“Previous evidence supports added benefits with some drug combinations in fibromyalgia,” says, Dr. Gilron (Anesthesiology, Biomedical Sciences). “We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone.”

Fibromyalgia was initially thought to be a musculoskeletal disorder. Research now suggests it’s a disorder of the central nervous system – the brain and spinal cord. Researchers believe that fibromyalgia amplifies painful sensations by affecting the level and activity of brain chemicals responsible for processing pain signals.

“The condition affects about 1.5 to 5 per cent of Canadians – more than twice as many women as men. It can have a devastating on the lives of patients and their families,” explains Dr. Gilron. “Current treatments for fibromyalgia are either ineffective or intolerable for many patients.”

This study is the latest in a series of clinical trials – funded by the Canadian Institutes of Health Research (CIHR) – that Dr. Gilron and his colleagues have conducted on combination therapies for chronic pain conditions. By identifying and studying promising drug combinations, their research is showing how physicians can make the best use of current treatments available to patients.

“The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to health-care providers,” says Dr. Gilron.

This new research was published in the journal Pain.

Dr. Gilron and his research team at Queen’s are members of the SPOR Network on Chronic Pain. The national network, funded under Canada’s Strategy for Patient-Oriented Research, directs new research, trains researchers and clinicians, increases access to care for chronic pain sufferers, and speeds up the translation of the most recent research into practice.

Posted on Diabetes

A combination of drugs for obesity and Type 2 diabetes may be more effective than a single therapy

Combination of drugs for obesity and Type 2 diabetes may be more effective than a single therapy


Andrea Haqq (right) is bringing her clinical experience working with patients to an international collaboration aimed at identifying personalized drug combinations to better treat people with obesity and Type 2 diabetes. CREDIT Richard Siemens

Canadian and German researchers are teaming up to identify new drug combinations to treat people with obesity and Type 2 diabetes. 

The goal is to develop personalized prescriptions that are more effective than single drugs and that can potentially replace more invasive treatments such as bariatric surgery, especially for children. 

“As a pediatric endocrinologist, I can tell you we’re seeing more and more Type 2 diabetes in kids and adolescents, and it seems to be a more aggressive form than adult onset diabetes, so we do need better therapies to achieve even greater efficacy and degree of weight loss,” said Andrea Haqq, a professor in the University of Alberta’s Faculty of Medicine & Dentistry.

The researchers recently published a paper that examines the potential of several drugs that control incretins. These metabolic hormones stimulate the body to produce insulin and use it effectively. They also suppress appetite in order to control blood sugars and reduce weight. 

The researchers conclude that combining the drugs has several advantages, including higher effectiveness in at least some patients and fewer side-effects. 

Even a five per cent weight loss is considered clinically meaningful, and patients in some of the combination drug trials are achieving 10 or 15 per cent, said Haqq, who is a member of the Alberta Diabetes Institute and the Women and Children’s Health Research Institute. 

Haqq’s laboratory is collaborating with that of Timo Müller, director of the Institute for Diabetes and Obesity at the Helmholtz Diabetes Center and a researcher with the German Center for Diabetes Research in Münich, Germany.

As part of the collaboration with the Müller team, first author Qiming Tan, a PhD candidate in the U of A Faculty of Medicine & Dentistry, will study for a term in Germany and a German student will join Haqq’s lab here.

Haqq and Tan recommend further research to identify why some individuals respond differently to the drugs. Some racial and ethnic groups bear a disproportionate burden of obesity and Type 2 diabetes, they said, so more participants from these groups are needed in trials. Further studies should also focus on how differences in biological sex affect drug efficacy and safety. 

In addition to drug combinations, the researchers are looking for non-pharmacological solutions, such as how adding fibre to a person’s diet can slow weight gain and improve the effectiveness of existing diabetes medications.

Posted on Autism

Autistic adults report high rates of COVID-19 vaccination

Infographic for Autistic Individuals and COVID-19 Vaccine


Researchers from the A.J. Drexel Autism Institute found more autistic adults had received the first dose of the COVID-19 vaccine compared to the general population in Pennsylvania, as of April 21, 2021. CREDIT Policy Impact Project at the A.J. Drexel Autism Institute

As reported in 2021, autistic adults, adults with intellectual disability and adults with mental health diagnoses have multiple risk factors for COVID-19 infection, and more severe disease if contracted. Public health messaging has strongly urged everyone eligible to get vaccinated for COVID-19, as it reduces the risk of contracting, decreases the severity and limits the spread of the virus. Researchers from Drexel University’s A.J. Drexel Autism Institute recently published a study identifying the differences between autistic adults who reported COVID-19 vaccination acceptance and those who were vaccination hesitant.

Identifying health promotion strategies based on self-reported, lived experiences with COVID-19 among vulnerable groups, including autistic individuals, is important for public health, as it can inform strategies to increase vaccination rates — which, in turn, supports public health by decreasing the potential for disease transmission.

The report, published in Vaccine, described COVID-19 vaccination status, self-reported preferences among autistic adults and additional to related factors.

“Vaccine accepters were more likely to report increased loneliness during COVID-19, live in more populated counties and in counties won by President Biden in the 2020 U.S. presidential election,” said Kaitlin Koffer Miller, director of Policy Impact at the Policy and Analytics Center (PAC) at the Autism Institute and co-author of the report. “Positive relationships were found between wanting to protect others from COVID-19, concern about getting COVID-19 and trusting the safety of the vaccines.”

The report also found concern about vaccine safety was common among the vaccine hesitant, but a lack of concern of COVID-19 overall was not commonly reported among this group.

Autistic adults, who had previously participated in the 2018 Pennsylvania Autism Needs Assessment and agreed to be contacted for future research, were asked to respond to a survey which aimed to learn about community participation experiences of autistic adults in Pennsylvania. The survey included 17 questions specifically related to COVID-19 experiences, including vaccination acceptance, hesitancy and status of vaccination. It was distributed to 431 autistic adults via an online survey platform, with data being collected between March-August 2021.

Researchers found 78.3% of survey respondents reported that they had received or intended to get a COVID-19 vaccine, with 55.4% reporting that they had received at least one dose. In comparison, 42% of overall adults in Pennsylvania received at least one dose of a COVID-19 vaccine as of April 2, 2021, which was the median response date for the survey sample.

“Reaching this group effectively in public health messaging about vaccination is critical,” said Koffer Miller. “By understanding reasons for vaccine hesitancy — for example, concerns about vaccine safety — or vaccine acceptance, such as feelings of increased loneliness, amongst autistic adult respondents can help drive more effective public health messaging and vaccine outreach to this population.”

The report provides concrete suggestions and examples for how public health professionals can most effectively reach autistic adults in their outreach, such as using visual tools like social stories, which are a powerful tool for conveying information and have been shown to be an effective means of communicating with autistic individuals.

The authors noted the importance of using this tailored and accessible messaging will become increasingly paramount as fourth doses become more widely available and recommended, and regular vaccination against COVID-19 becomes part of the public health dialogue.

“It was very important to be able to highlight practical, usable resources from organizations like the Autism, Services, Education, Resources, and Training Collaborative (ASERT) alongside the research findings to provide a direct translation and link to actionable ways to address what was identified as needed action in the study,” said Koffer Miller, who is also regional manager of the ASERT Collaborative Eastern Region.