Tag: Micha Abeles


Recommendations Issued about Biosimilar Usage for Rheumatic Diseases

The treatment of choice for rheumatic diseases has traditionally been the use of biological agents called bio-originators. These agents are derived from microorganisms, animals or humans. The increasing cost of these agents has put effective treatment out of the reach of many disease sufferers.

A group of international rheumatologists, patient representatives and specialists in related fields conducted a scientific review to determine if the use of “biosimilars” can help give patients greater access to treatment. Biosimilars are substances that have been approved by the FDA because they are so similar to bio-originators that are already in use.

The task force addressed three questions. The first was the matter of cost. Biosimilars introduce more competition in the market and are expected to result in lower prices. It was predicted that the savings would be about 35 percent. In the United States, for a product with only one biosimilar available, the savings was only about 15 percent. The task force hopes that as more biosimilars become available, the cost savings will be more fully realized.

The second question was in regard to extrapolation. An example is the best way to explain extrapolation. If a bio-originator is used to treat conditions A, B and C, full extrapolation would mean that as soon as the FDA approves the biosimilar for condition A, it could also be used to treat conditions B and C. The task force was in agreement that the more cautious route of doing additional testing for each condition should be followed.

The third question investigated by the task force looked at the implications of having a patient switch from the bio-originator to a biosimilar. The data regarding biosimilars for rheumatic diseases strongly suggest that this switch is safe and produces no drop in effectiveness. The decision to switch from one to the other, however, should only be made by the doctor in consultation with the patient.

One topic that still requires further research is the question of interchangeability. Interchangeability means that the biosimilar is truly equivalent in every meaningful way to the bio-originator. This can only be determined if patients are switched from one to the other and back at least three times. If there are no differences found regarding safety, effectiveness, reaction of the immune system, or side effects between a group that undergoes the switching and a group that only uses the bio-originator, the two products can be called interchangeable.


A Boost for Lupus Research

On June 29, the U.S. House of Representatives passed the Fiscal Year 2018 Department of Defense (DoD) Appropriations bill, which funds the country’s military and medical activities. Within that legislation, $5 million in funding was allocated to the Lupus Research Program — in addition to the $5 million that Congress provided earlier this year for 2017! With a total of $10 million in funds, this will certainly provide a boost for lupus research.

First of all, what is lupus?

According to The National Resource Center on Lupus by the Lupus Foundation of America, lupus is a chronic autoimmune disease that affects your immune system. With lupus, your body can’t tell the difference between foreign bacteria or viruses and your body’s healthy tissues, therefore, your body can attack and destroy its own healthy tissue. This can cause inflammation, pain, and damage to all parts of your body — meaning skin, organs, and even joints can be affected.

How does this relate to rheumatology?

Because lupus is a disease that affects the joints, rheumatologists are commonly the doctors lupus patients see. Although people typically associate rheumatologists with arthritis, they also treat autoimmune diseases of the muscles and bones — such as osteoporosis and lupus. Throughout their schooling, rheumatologists are trained to spot signs and potential causes of joint inflammation, and can often diagnose a patient with lupus.

What were the driving forces behind getting this funding?

Conveniently, this funding was passed a few days after the Lupus Foundation of America’s National Policy Summit and advocacy day in Washington, D.C. With activists visiting over 200 Congressional offices, and thousands of others virtually participating, the U.S. government heard the message loud and clear: more funding needs to go towards lupus research.

What will the money be used for?

For years, research into this disease has been stagnant because the cause of lupus is so difficult to diagnose, and the true cause of it still remains unknown. However, this boost in funding will provide a plethora of new hypotheses to explore in terms of why and how people get lupus. For example, new and promising signs of potential breakthroughs in diagnostics, adult stem cells, environmental triggers, personalized treatments and more will be explored. In addition, clinical trials of medications will become more efficient and effective with new streamlined and modernized technologies that will developed.

With continued support from the community, government, and fellow rheumatologists, lupus can soon be defeated. This monetary boost will do wonders into research for the disease, and hopefully soon we will have a cause and appropriate treatments for lupus.


Smoke Exposure in Childhood Can Boost Chances of Getting RA

Each year The European League Against Rheumatism (EULAR), an organization that represents the patient, healthcare professional and professional societies of rheumatology in the European Union, holds the Annual European Congress of Rheumatology. Not only does this forum serve as a space where rheumatology professionals can connect with patient organizations from all across Europe, but is also helps rheumatologists engage with other professionals and learn about new findings in the field.

If you recall my previous blog, Medicines May Help to Prevent Arthritis, EULAR may sound familiar to you because this blog was based on a report from this forum as well. As a follow-up to my previous blog, I’d also like to talk about another interesting finding that was presented at the conference: secondhand smoke exposure from cigarettes in childhood can boost chances of getting rheumatoid arthritis (RA).

“This is the first demonstration of a rheumatoid arthritis risk associated with passive smoking,” explained Raphaèle Seror, M.D., a professor of rheumatology at the University of Paris–South and a practicing rheumatologist at the Hospital Bicetre Kremlin Bicetre, at the European Congress of Rheumatology.

The French rheumatologist and her team analyzed data collected from more than 70,000 French women, which followed their health for more than 20 years. Then, the team identified a cohort of women who had confirmed RA based on their self-report of having incident RA, which occurs after a health-depleting action such as excessive alcohol consumption or smoking, during a follow-up study.

This cohort of women who had confirmed incident RA totaled 389 women. Majority of those women had a history of smoking or being exposed to secondhand smoke. In fact, the analysis showed that women who had a history of second-hand smoke were exposed to it as children — and they were all exposed at an estimated more than an hour every day. These women actually showed to have a 43% higher rate of incident RA compared to women who never smoked or never had a history of secondhand smoke exposure.

To further confirm the suspicions of the link between smoking and RA incidence, 37% of women with a history of smoking without childhood exposure had the likelihood of developing RA, and 73% of women who had both secondhand smoke exposure as children and smoked into adulthood were likely to develop RA.

Although this study only analyzed women, it can be evident that we can say the same for men as well. Regardless, “secondhand smoke exposure to children was about as potent a trigger for future rheumatoid arthritis as active smoking by an adult,” says a report from Rheumatology News.

Were you frequently exposed to secondhand smoke as a child? Do you smoke today? It’s probably a good idea to make an appointment with your local rheumatologist to get yourself checked for RA.


Foods that Alleviate Arthritis Pain

Although arthritis doesn’t have a cure, there are certain things you can do to alleviate the pain. Some of these include participating in activities like yoga, acupuncture, or taking medication. However, there is a natural way to alleviate arthritis pain: eating certain foods that have the power to fight inflammation.

Cruciferous Vegetables

Our bodies naturally produce energy and other metabolic processes — which in turn produces harmful byproducts called free radicals. These little atoms can assist with the development of arthritis since they attack joints and can leave them inflamed. Eating cruciferous vegetables can block the inflammatory side effects, and even slow down cartilage damage in joints because these vegetables are full sulforaphane, which is a free-radical fighting compound.

To incorporate more cruciferous vegetables into your diet, try adding brussels sprouts, cabbage, kale, bok choy, swiss chard, cauliflower, or broccoli to your salad or stir-fry. It’s also relatively easy to add broccoli as a side dish to your meal or to incorporate it into a pasta dish. In addition, these days it’s become quite popular to substitute cauliflower for carbohydrates, so you may want to try some of these recipes.


The human body can make most of the types of fats it needs, however, it doesn’t make omega-3 fatty acids. These essential fats can reduce inflammation and may help lower risk of arthritis, says the University of Maryland Medical Center.

To incorporate more omega-3 fatty acids into your diet, try incorporating more fish into your meals. Salmon, trout, sardines and mackerel can easily be the main course for your dinners. You can also eat more tuna by making tuna fish sandwiches or tuna noodle casserole. If you’re not a fan of fish, flaxseeds, chia seeds and walnuts can make excellent snacks during the workday or can easily be incorporated into smoothies.

Allium Vegetables

You’ve probably never heard of the word allium, but you’ve certainly heard of the vegetables that are in this category. Onions, garlic, leeks, scallions, chives and shallots not only add rich flavor to your foods, but they provide a compound called diallyl disulfide, which can fight arthritis. “This compound may have some effect in limiting cartilage-damaging enzymes,” which can cause the inflammation that’s commonly associated with arthritis, says rheumatologist Scott Zashin, MD, clinical professor at the University of Texas Southwestern Medical School in Dallas.

Olive Oil

Olive oil has been shown to reduce pain and stiffness in patients with rheumatoid arthritis because of its anti-inflammatory antioxidants. Diets that are rich in olive oil, like the Mediterranean diet, is an easy way to incorporate more of the product into your diet. Not only that, but the healthy fats found in olive oil can provide you with a similar satisfaction to using full-fat dairy products like butter. Feel free to swap out buttered rolls for bread dipped in olive oil and other spices or add extra flavor to your vegetables by tossing them in olive oil!


Why Millennials are Already Showing Signs of Arthritis

According to a recent report cited in the Washington Post, the Centers for Disease Control and Prevention determined that one in four adults in the United States suffers from arthritis. To put this into a better perspective, 54 million adults have this condition, and not all of them are elderly as you would typically imagine. And to break it down even further, about 8 million millennials have been diagnosed with arthritis.

So what’s the cause? It’s a combination of technology usage and excessive workouts like CrossFit that put too much use on their joints.

The Case for Technology

Think about how today’s technology is used. We all frequently type on a keyboard whether it’s in front of a computer screen or directly on your smartphone. As for millennials, they’ve grown up in a world full of technology easily accessible at their fingertips. From computers, cell phones, and controllers for video games, it’s become a habit for many millennials to be tapping away at something in their hands.

All of these technological advances require heavy usage of fingers and thumbs. And with 27 bones in each hand, developing finger and thumb arthritis is quite common! In fact, researchers believe that arthritis in wrists and fingers could be an increasing problem since many adults text frequently and have spent too much time playing video games as kids. The repetitive motion of texting and hitting buttons on a controller puts a lot of stress on joints, which can cause arthritic over time.

The Case for Excessive Workouts

James Francisco, a 29-year old former college football player, has been playing sports his entire life. However, every time he finished his workouts, he had a dull pain in his knees that would last two to three hours. After seeing a physical therapist, Francisco was diagnosed with early onset arthritis. “You wouldn’t think you would hear those words in your 20s,” said Francisco.

Francisco has a point, because many millennials would never fathom having arthritis this early in their lifetime. But his physical therapist, Dr. Karena Wu, says she’s seen an increasing number of millennials with arthritis or joint inflammation at an early age. Why? Parents have been enrolling children in competitive sports like football and soccer at a younger age. As these children grow up, they’ve been inclined to participate in intensive workouts like CrossFit or competitions like the Tough Mudder.  

“They are doing more intense activities, they’re spending a longer time participating in sports, and they’re doing so many sports that they don’t take a break,” says Wu. “Their muscles are getting a lot more use than we would have gotten growing up as a kid and playing in the backyard.” All of that muscle usage is certainly taking a toll on millennial’s joints, causing pain in places like the knees, shoulders and wrists.

If you’re a millennial, have you noticed any pain on your joints? Let me know in the comments below.

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