Posted on Arthritis

How new therapies are revolutionizing the treatment of juvenile idiopathic arthritis

A groundbreaking study has found that children who exhibit neurodivergent traits, such as those associated with autism and ADHD, are twice as likely to experience chronic disabling fatigue by age 18.

The use of biologic and targeted therapies for children with juvenile idiopathic arthritis (JIA) surpassed more typical therapies in recent years, according to Rutgers Health researchers.

Their study examined more than 20 years of data from nearly 14,000 children with JIA throughout the nation.

Juvenile idiopathic arthritis (JIA) affects approximately 16 to 150 children per 100,000 in North America, according to the National Institutes of Health and prior research. This condition leads to chronic inflammation, resulting in persistent joint pain, swelling, and stiffness. The primary goals of JIA treatment are to alleviate symptoms, restore normal physical movement and growth, prevent long-term damage and vision loss, and enhance the overall quality of life. Researchers note that many studies on the use of antirheumatic drugs have focused more on adults with arthritis than on children with JIA.

“Juvenile Idiopathic Arthritis (JIA) can significantly impact the lives of affected children and their families,” stated Daniel Horton, a faculty member at the Rutgers Center for Pharmacoepidemiology and Treatment Science (PETS) and a senior author of the study. “Fortunately, the treatment options have greatly improved in recent years, offering people with JIA more potentially effective therapies.”

Researchers used data from privately insured people spanning the past two decades to describe trends throughout the significant expansion in the available treatments for JIA. Newer disease-modifying antirheumatic drugs, while often more expensive, are frequently more effective and better tolerated by patients than older conventional agents.

“Our study provides insight into the evolving real-world treatment practices for children with JIA,” said Priyanka Yalamanchili, lead author of the study, PETS trainee and a recent graduate of Rutgers School of Public Health’s master’s degree program in epidemiology with a pharmacoepidemiology concentration.

Initiations of conventional therapies declined by more than 45%, increasingly eclipsed by the use of newer biologic or targeted therapies. The use of adalimumab, one of the most popular biologics on the market today, has risen steadily since its initial approval for rheumatoid arthritis in 2002, representing nearly 80% of first-line biologic or targeted therapies started for JIA by 2022.

“This research sets the stage for future studies that will compare the effectiveness and safety of different therapies used to treat JIA,” said Horton, an associate professor at Rutgers Robert Wood Johnson Medical School and Rutgers School of Public Health and the faculty director of the Rutgers Institute for Health Survey/Data Core, which provided access to the data studied.

Posted on Diabetes, Diet

No ‘one size fits all’ treatment for Type 1 Diabetes, study finds

Researchers: "We have miscalculated for decades – half of an insulin dose may not work as expected"

A new study has found that factors beyond carbohydrates substantially influence blood glucose levels, meaning current automated insulin delivery systems miss vital information required for glucose regulation.

A team of researchers from the University of Bristol analysing automated insulin delivery data from people with Type 1 Diabetes (T1D) discovered that unexpected patterns in insulin needs are just as common as well-established ones.

The study, published today in JMIRx Med, aimed to identify patterns in insulin needs changes and analyse how frequently these occur in people with T1D who use OpenAPS, a state-of-the-art automated insulin delivery system (AID).

Lead author Isabella Degen from Bristol’s Faculty of Science and Engineering explained: “The results support our hypothesis that factors beyond carbohydrates play a substantial role in euglycemia – when blood glucose levels are within the standard range.

“However, without measurable information about these factors, AID systems are left to adjust insulin cautiously with the effect of blood glucose levels becoming too low or high.”

Type 1 Diabetes is a chronic condition in which the body produces too little insulin, a hormone that regulates blood glucose.

The principal treatment for T1D is insulin that is injected or pumped. The amount and timing of insulin must be skilfully matched to carbohydrate intake to avoid increased blood glucose levels. Beyond carbohydrates, other factors such as exercise, hormones, and stress impact insulin needs. However, how often these factors cause significant unexpected effects on blood glucose levels has been little explored, meaning that despite all advances, insulin dosing remains a complex task that can go wrong and result in blood glucose levels outside the range that protects people with T1D from adverse health effects.

The findings highlight the complexity of glucose regulation in T1D and demonstrate the heterogeneity in insulin needs among people with T1D, underlining the need for personalised treatment approaches.

For factors beyond carbohydrates to become more systematically included in clinical practice, scientists need to find a way to measure and quantify their impact and use this information in insulin dosing. This could also aid more accurate blood glucose forecasting, which the study showed is not consistently possible from information about insulin and carbohydrates alone.

Isabella added: “Our study highlights that managing Type 1 Diabetes is far more complex than counting carbs.

“The richness of insights that can be gained from studying automated insulin delivery data is worth the effort it takes to work with this type of real-life data.

“What surprised us most was the sheer variety of patterns we observed, even within our relatively small and homogenous group of participants.

“It’s clear that when it comes to diabetes management, one size doesn’t fit all.

“We hope our results inspire further research into lesser-explored factors that influence insulin needs to improve insulin dosing.”

The team is now advancing time series pattern-finding methods to handle real-life medical data’s diverse and complex nature, including irregular sampling and missing data. Their current focus is on developing innovative segmentation and clustering techniques for multivariate time series data tailored to uncover more granular patterns and handle the challenges AID data poses.

To support this future research, the team seeks long-term, open-access AID datasets that include a wide range of sensor measurements of possible factors and a diverse cohort of people with T1D. Additionally, they aim to collaborate with time series and machine learning experts to address technical challenges such as handling irregularly sampled data with varying intervals between variables and uncovering causalities behind observed patterns, ultimately driving innovations in personalised care.

Posted on A to Z of Medical Conditions, Cardiovascular disease, Exercise

Live well, think well: Research shows healthy habits tied to brain health

Type 2 diabetes and prediabetes are associated with accelerated brain ageing, according to a new study from Karolinska Institutet in Sweden published in the journal Diabetes Care. The good news is that this may be counteracted by a healthy lifestyle.

In middle-aged people, having risk factors like blood pressure, blood sugar and cholesterol that are not well-controlled, combined with not following certain healthy habits, including exercise, diet and sleep, are linked to a higher risk of stroke, dementia or depression later in life,. 

The eight cardiovascular and brain health factors, known as the American Heart Association’s Life’s Essential 8, are being active, eating better, maintaining a healthy weight, not smoking, maintaining healthy blood pressure, getting enough sleep, and controlling cholesterol and blood sugar levels.

“Brain health is paramount for the optimal well-being of every person, enabling us to function at our highest level and constantly adapt in the world,” said study author Santiago Clocchiatti-Tuozzo, MD, MHS, of Yale University in New Haven, Connecticut, and member of the American Academy of Neurology. “Our study found that making these healthy lifestyle choices in middle age can have meaningful impacts on brain health later in life.”

For the study, researchers evaluated data from 316,127 people, with an average age of 56, who were followed over five years.

Researchers analyzed participants’ scores across the eight essential cardiovascular health factors and organized them into three categories: optimal, intermediate, and poor.

Of the total group, 64,474 had optimal scores, 190,919 had intermediate scores, and 60,734 had poor scores.

Researchers then evaluated health records to identify who developed any of the following neurological conditions: stroke, dementia or late-life depression. Poor brain health was defined as developing these conditions during the follow-up years.

1.2% of participants met the definition for poor brain health, with 3,753 conditions. Of those with optimal Life’s Essential Eight scores, 0.7% met the definition of poor brain health, compared to 1.2% with intermediate scores and 1.8% with poor scores.

After adjusting for factors that could affect the risk of these three neurological conditions, such as age, sex, race and ethnicity, researchers found that people with poor scores on the healthy lifestyle factors were more than twice as likely to develop any of the three neurological conditions compared to those people with optimal scores. Researchers also found that people with an intermediate score had a 37% higher risk of having one of the three neurological conditions than those with an optimal score.

“Because the risk factors we looked at are all ones that people can work to improve, our findings highlight the potential benefits of using these eight cardiovascular and brain health factors to guide healthy lifestyle choices,” Clocchiatti-Tuozzo said. “More research is needed to understand this link between lifestyle habits and brain health, as well as how social factors like race and ethnicity can influence this connection.”

Posted on Children's health, Multiple Sclerosis

Are health care disparities tied to worse outcomes for kids with Multiple Sclerosis?

Happy Children

–People who develop multiple sclerosis (MS) as children and grow up in less advantaged neighbourhoods may have a larger volume of inflammation and brain tissue loss on imaging than those who grow up in more advantaged neighbourhoods.

MS rarely develops in children. About 5% of people with MS are diagnosed before age 18.

In addition to neighbourhood location, worse brain imaging outcomes were also seen among people who self-identified as Black or Latino, those from families where the parents had lower education levels, and those who had public health insurance, which is used as a marker of low household income.  

“Our findings suggest that social disadvantage in childhood can have lasting effects on MS severity,” said study author Kimberly A. O’Neill, MD, of New York University Grossman School of Medicine. “Childhood is a critical time for exposure to environmental factors associated with increased susceptibility to MS, such as passive smoke, pollution and low sunlight exposure. More studies are needed to understand which and how factors in disadvantaged neighbourhoods increase the risk for MS severity in young people.”

The study involved 138 people with an average age of 20 who were diagnosed with MS before age 18, known as pediatric-onset MS. They had been diagnosed with MS for an average of four years.

All had brain scans to measure areas of brain inflammation and injury due to MS and brain volume loss. Researchers collected information on social factors that may impact a person’s health, including self-reported race and ethnicity, type of health insurance, parents’ education level, and the degree of neighbourhood advantage or disadvantage.

Social factors associated with disadvantage correlated with greater volume of inflammatory lesions in the brain’s white matter and greater black hole volume, which is a sign of irreversible loss of brain tissue. The identified social factors accounted for 26% of the difference in white matter lesion volume and 23% in black hole volume among participants.

Once all factors were taken into account, having public health insurance was the strongest predictor of greater inflammation and tissue loss. People with public health insurance had an average white matter lesion volume larger than people with private insurance. They also had average black hole volumes larger than those with private insurance.

The researchers found that the differences were not explained by how soon a neurologist saw children, how quickly they were started on medication for MS or how compelling their medications were at slowing their disease progress.

“This suggests that access to health care does not explain the more severe disease burden shown in the brain scans of people in disadvantaged groups in our study,” O’Neill said. “While these are associations and not causes, many of these groups have historically been underrepresented in MS research, and our work here is just beginning.”  

Posted on Pain Management

Electrical nerve stimulation eases pain and fatigue for some conditions

Wearable TENS system “offered immediate, on-demand relief,” say researchers

Transcutaneous Electrical Nerve Stimulation (TENS) device

Transcutaneous Electrical Nerve Stimulation (TENS) device Credit Bijan Najafi Research Team

 Wearable electrical nerve stimulation devices can relieve people experiencing the persistent pain and fatigue linked to long COVID, a study co-led by UCLA and Baylor College of Medicine researchers suggests.

Long-COVID, a complex and lingering condition following COVID-19 recovery, affects approximately 1 in 13 adults in the U.S. Symptoms such as widespread pain, fatigue, and muscle weakness often continue to disrupt daily activities, including walking and basic tasks.

The study focused on a wearable Transcutaneous Electrical Nerve Stimulation (TENS) device, which uses low-voltage electrical currents to reduce pain, fatigue, and mobility issues associated with long-COVID.

However, the device could have broader applications.

 “While this study focused on managing pain and fatigue caused by long COVID, it may also have potential applications for addressing similar symptoms in individuals with other respiratory diseases, those who have experienced extended ICU stays and developed post-hospitalization weaknesses, and conditions involving chronic fatigue and pain, such as fibromyalgia or chemotherapy-related side effects,” Najafi said. “But further studies are needed to confirm these potential uses.”

In the study, 25 participants with chronic musculoskeletal pain, fatigue, and gait difficulties were assigned either a high-dose (active) TENS device or a low-dose (placebo) device. Both groups used the TENS device for three to five hours daily over four weeks.

Researchers measured participants’ pain levels, fatigue, and walking performance before and after the therapy period. Findings indicated that the high-dose TENS group experienced notable improvements in pain relief (26.1% more relief than placebo) and walking ability (8% during fast walking), suggesting that wearable TENS therapy may help reduce long-COVID’s impact on daily life.

The high-dose TENS group also reported a slightly higher perceived benefit (71.2%) than the low-dose group (61.4%), underscoring the potential of wearable TENS technology to support long-term COVID recovery.

Najafi said one factor in the study’s success was likely the high rate of daily device usage. The wearable nature of the TENS device allowed participants to use it seamlessly throughout the day without disrupting their routines.

“This wearable TENS system offered immediate, on-demand relief from pain and fatigue, making it easy to integrate into daily activities,” Najafi said.