The FDA ordered that the class of drugs known as Tumor Necrosis Factor alpha blockers, which are also referred to as TNF blockers or anti-TNF, carry a warning on the packaging that their use carries the risk of developing a potentially deadly fungal disease called histoplasmosis. These drugs are marketed under the names Cimzia, Enbrel, Humira, and Remicade.

The packaging already is required to warn about fungal infections in general, but the new warnings will have to specifically call out histoplasmosis. This is a result of the FDA receiving reports of 240 patients who were taking TNF blockers that developed histoplasmosis. Of those 240, 45 patients died, including at least 12 who had not been immediately been diagnosed with histoplasmosis leading to a delay in treatment. The ages of these patients ranged from 8 to 86 years, however, none of the deaths involved children.

Histoplasmosis starts in the lungs and can spread to other organs in the body. If not treated in time, it can lead to death. In healthy people the body’s immune system is able to control the histoplasmosis infection. The risk is to people that have compromised immune systems, such as patients with AIDS or taking immune system suppressing drugs, such as alpha blockers.

The fungus that causes histoplasmosis, histoplasma capsulatum, is found throughout the world. It grows in the ground and in material that is contaminated with bat or bird droppings. Concentrations can be especially high in bird roosts, caves where bats roost and poultry house litter. Histoplasmosis is also more common in the Mississippi and Ohio River Valleys.

Symptoms of histoplasmosis include shortness of breath, fatigue, cough and fever.

Anti-TNF drugs are used to treat rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, juvenile idiopathic arthritis, ankylosing spondylitis and Crohn’s disease.

The FDA published their directive on September 4th. You can read the actual release here

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Frankincense is an aromatic resin that has been used for perfume and incense for thousands of years. The most aromatic is the Arabian Frankincense that is obtained from the Boswellia sacra trees in Oman and Yemen. Indian Frankincense, which is considered to be an inferior aromatic compared to the Arabian form, comes from the Boswellia seratta tree found in Rajasthan and Madhya Pradesh. Indian Frankincense has been used for thousands of years in India in the Indian system of traditional medicine known as “Ayurveda”. Recent research has also found that Indian Frankincense can reduce the symptoms of osteoarthritis.

The research which was led by Siba Raychaudhuri, a faculty member at the University of California at Davis, specifically tested an extract which they called AKBA (3-O-acetyl-11-keto-beta-boswellic acid) from the Boswellia serrata tree. The randomized, double-blind, placebo-controlled study focused on 70 patients that had been diagnosed with knee osteoarthritis.

The participants were randomly given one of two doses of an enriched Indian frankincense extract, under the brand name of 5-Loxin, or a placebo on a daily basis. The groups that had been taking the 5-Loxin indicated that they noticed improvement in their symptoms within 7 days. After 3 months, the participants that had been given the frankincense extract reported reductions in pain and stiffness, as well as improvements in their mobility compared to the control group.

According to Raychaudhuri, “The high incidence of adverse affects associated with currently available medications has created great interest in the search for an effective and safe alternative treatment… AKBA has anti-inflammatory properties, and we have shown that B. serrata enriched with AKBA can be an effective treatment for osteoarthritis of the knee… In this study, the compound was shown to have no major adverse effects in our osteoarthritis patients. It is safe for human consumption and even for long-term use”.

The team’s findings were published in the July 31st edition of the online journal Arthritis Research & Therapy.

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I wrote last November about a clinical study on the effects of Pycnogenol®, an extract from the bark of the Maritime Pine Tree which grows on the southern coast of France. That study concluded that the participants, who had been diagnosed with osteoarthritis, that received the supplement experienced pain and physical function improvements after 60 and 90 days.

A recent study, conducted at Comenius University School of Medicine in Slovakia, and published in the August issue of the journal Phytotherapy, has confirmed that prior study.

The Slovakian study included 100 patients with stage I or II osteoarthritis. These patients were given either a daily 150 mg Pycnogenol® supplement or a placebo for a period of 3 months. The participants were allowed to continue with their current analgesic or nonsteroidal anti-inflammatory drugs (NSAID) treatments that were prescribed before the study, but they were required to record all pills that they took.

The patient’s osteoarthritis symptoms were based on the Western Ontario and McMaster Universities (WOMAC) pain and function subscales to measure joint stiffness & pain, and the extent to which the disease affected their daily activities. Their scores were calculated at the beginning, every 2 weeks during, and 2 weeks after the trial.

The overall scores for pain, stiffness and daily activities, for those receiving the supplement, showed an improvement of nearly 21%. This includes a pain index reduction of over 40% by the end of the trial. And the improvement continued after completion of the trial with the pain reduction at 2 weeks after the study at 36%. In addition, 38% of the Pycnogenol® group were able to reduce their intake of NSAIDs or analgesics.

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According to Dr. Peter Rohdewald, one of the study’s researchers, “The anti-inflammatory potency of Pycnogenol® explains the success in lowering joint pain and stiffness for arthritic joints. After three recent clinical studies on osteoarthritis, Pycnogenol® continues to demonstrate its effectiveness for osteoarthritis symptoms making it a viable, natural and safe alternative for individuals. This is the first study that investigated whether a relapse of symptoms occurs after taking Pycnogenol® is stopped. The results show a lasting effect after discontinuation which suggests the anti-inflammatory mechanisms of Pycnogenol® has allowed the joints to recover.”

There was another study earlier this year that showed that Pycnogenol® reduced osteoarthritis symptoms by 56% and patients were able to reduce their intake of analgesics and NSAIDs by 58%. The latter provided gastrointestinal relief as many of those drugs can have a negative impact on the digestive system.

Pycnogenol is widely available and is currently used on over 400 dietary supplements, multi-vitamins and health products. Here is an example:

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Osteoarthritis is the “wear and tear” form of arthritis. It results from a breakdown of cartilage that protects the ends of the bones. Osteoarthritis is most common in the hip and knee and is the most frequent reason for total knee and hip replacement surgery.

The current methods used to diagnose osteoarthritis are ineffective prior to an advanced stage where permanent joint damage has occurred. Being able to diagnose osteoarthritis at an earlier stage could provide an opportunity to reduce or prevent permanent damage. Early in the disease it may be possible to successfully treat it with dietary supplements and medications.

Now NYU researchers Alexej Jerschow, Ph.D. and Ravinder R. Regatte, Ph.D. have developed a new scan that may provide that hoped for early diagnosis.

This new test is based on a modified form of magnetic resonance imaging (MRI). This imaging identifies the concentration of glycosaminogycan (GAG), a polymer that holds water and gives cartilage its toughness and elasticity. According to Jerschow, a low concentration of GAG is known to correlate with the inception of osteoarthritis and other cartilage disorders.

“Our methods have the potential of providing early warning signs for cartilage disorders like osteoarthritis, thus potentially avoiding surgery and physical therapy later on,” states Jerschow. “Also, the effectiveness of early preventative drug therapies can be better assessed with these methods.”

The new imaging “tags” the hydrogen atoms that are attached to the GAGs to determine the concentration of GAG in the cartilage.

“Given the lack of knowledge about OA, I think any method that is noninvasive and relatively easy to apply will be quite valuable. Not only do you address diagnosis, but you address how we can understand OA’s mechanism,” says Jerschow.

The new test could also be used to determine the efficacy of the medications used to treat osteoarthritis. In fact, pharmaceutical companies have already requested information on using the new imaging to show that their drugs work.

According to Dr. Regatte, the time and cost for the GAG scan is essentially the same as a normal MRI. It is even possible to get a diagnosis on the same day.

Drs. Jerschow and Regatte presented their findings on August 21st at the 236th National Meeting of the American Chemical Society in Philadelphia.

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Researchers at the University of Southampton, led by Dr. Jo Adams, have concluded that wearing a specific type of silver ring splint is beneficial for alleviating symptoms of rheumatoid arthritis (RA). They found that this particular silver ring splint is effective in controlling hyperextension deformity in finger joints.

Hyperextension Deformity

Until now, people with arthritis in their hands had to use bulky plastic splints to get relief from the symptoms. The new silver splints have been found to be longer lasting, stronger and more comfortable. The purpose of the splints is to provide stability to the finger joints.

Cynthia Garris, an occupational therapist, was herself diagnosed with rheumatoid arthritis in 1974. She knew the benefit of using splints but was aware that the splints that existed at the time did not address long term use. So in 1985 she initially designed and manufactured a new series of silver splints. They are used by arthritis suferrers who find that they cannot use their hands to the extent that they were able before developing rheumatoid arthritis. The splints can be used for every day tasks or very specific or involved tasks.

Wessex Medical Research awarded a grant to fund the team’s research. The findings were published in a paper, ‘Three dimensional function motion analysis of silver ring splints in Rheumatoid Arthritis’.

Dr Jo Adams, who co-authored the report, was awarded the Arthritis Research Campaign Silver Medal at the British Society of Rheumatology’s annual meeting. The Arthritis Research Campaign prize in rheumatology is presented annually by medical research charity the Arthritis Research Campaign to five healthcare professionals working with people with arthritis in the fields of physiotherapy, occupational therapy, nursing, podiatry and other related areas.

The collaborative study was undertaken by technicians from Occupational Therapy at the Royal Hampshire County Hospital, Winchester, the School of Electronics & Computer Science and the School of Health Professions and Rehabilitation Sciences from Southampton University.

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