Canakinumab useful for treating Systemic Juvenile Idiopathic Arthritis

Canakinumab (ACZ885), a new interleukin-1 (IL-1)-beta blocking monoclonal antibody, recently showed efficacy besides being well tolerated in children suffering with systemic juvenile idiopathic arthritis (sJIA).

The finding was revealed by a new phase II study presented at PReS 2009, a joint congress with the 2009 Congress of the European League against Rheumatism (EULAR) in Copenhagen, Denmark.

From Sciencedaily.com:

* Systemic Juvenile Idiopathic Arthritis (sJIA) is one of the five major types of Juvenile Idiopathic Arthritis (JIA) (along with oligoarticular JIA, polyarticular JIA, enthesitis related arthritis and psoriatic arthritis). sJIA is characterised by arthritis, fever and a salmon-pink rash. Systemic JIA can be challenging to diagnose because the fever and rash come and go. It affects males and females equally, unlike the other two subtypes of JIA. It is the most difficult JIA subtype to be treated. Steroids are the only effective drugs but are associated with severe adverse events including growth failure and osteoporosis.

** The American College of Rheumatology (ACR) pediatric criteria assess patient response to a treatment and are adapted to include the addition of absence of fever. An ACR Pedi 30 response represents a >30% improvement in JIA signs and symptoms, such as the number of swollen joints with loss of motion, assessment of pain and level of disability. ACR Pedi 50 represents a >50% improvement, and ACR Pedi 70 represents a >70% improvement.

Dr Nicolino Ruperto, Senior Scientist of PRINTO (Paediatric Rheumatology International Trials Organization), an international not-for-profit research network managing trials of children with rheumatic diseases, remarked JIA (juvenile idiopathic arthritis) is the most common of all childhood chronic inflammatory disease that affects nearly one in 1,000 children, and sJIA is the most severe subtype.

Steroids do not show efficacy for treating tennis elbow

Steroid injections are not effective for treating tennis elbow, as per a new study in the BMJ. The study also suggested that a wait-and-watch approach is the best option before any medical advice or medication can be recommended.

The study findings suggested that tennis elbow is a self-limiting condition in most of the cases.

From Bio-Medicine.Org:

Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the 'wait and see' group.

However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group. The injection group also had the most reported recurrences, with 72% of participants' condition deteriorating after three or six weeks – which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow.

The research also found that the superior long-term effects of physiotherapy were replicated by the wait and see approach – at the end of the study participants in both the physiotherapy and wait and see group had either much improved or completely recovered.

The authors say that "the…poor overall performance of corticosteroid injections should be taken under consideration by both the patient and their doctor in management of tennis elbow."

It is believed that the finding would provide new insights to medical practitioners for treating individuals suffering from tennis elbow.

Target discovered for modified antibiotics

Researchers at the Technische Universität München (TUM) have been able to discover a promising target for a new class of antibiotics.

The finding is considered to offer insights on how to handle bacterial stems developing resistance to previously life-saving antibiotics.

Results of the work by involved researchers were presented in an issue of the chemistry journal Angewandte Chemie.

From Sciencedaily.com:

The cells of virtually all life forms synthesize essential natural substances belonging to the class of terpenes and steroids from the small isoprene building blocks dimethylallyl pyrophosphate (DMAPP) and isopentenyl pyrophosphate (IPP). Mammals and a large number of other organisms generate these essential metabolites via the so-called mevalonate pathway. But most human pathogens, including Plasmodium falciparum, have developed an alternate mechanism for producing these important substances. Now, this special pathway may spell doom for those bacteria. The TUM researchers have unraveled the structural basis of the terminal step in bacterial isoprene synthesis. The crucial enzyme has a most unusual structure, similar to a three-leaf clover, and may open a forceful line of attack for custom-tailored antibiotics.

Professor Michael Groll, Dr. Jörg Eppinger and Dr. Tobias Gräwert, biochemists at the Technische Universität München, and their team of researchers, described in detail about the structural basis for new reaction steps critical to microorganisms but playing no relevant role in humans.

Hay fever treatment possible with corticosteroid nasal spray

A corticosteroid nasal spray, fluticasone propionate (Flonase), can show its efficacy when it comes to controlling seasonal allergies when compared to a combination of popular anti-allergy drugs loratidine (Claritin) and montelukast (Singulair), according to researchers from the University of Chicago.

The study was presented at the 58th annual meeting of the American Academy of Allergy, Asthma and Immunology.

From News.Bio-Medicine.Org:

"Because of the effect on inflammation, we prefer fluticasone," he added, "but for patients, the choice may come down to cost and whether they would prefer a pill or a spray."
Since one out of five people in the United States suffers from seasonal allergies, such preferences have financial implications. Antihistamines are prescribed three times as often, even though intranasal corticosteroids are less expensive than the non-sedating antihistamines. Combining loratidine with montelukast increases the cost difference.
A daily dose of Claritin, the leading antihistamine, costs $2.92 at the University of Chicago Hospitals pharmacy. Singulair, which works by blocking leukotrienes -- substances that trigger inflammation -- costs $4 per day. Flonase, the leading prescription nasal spray, costs $2.21 per day.

Robert Naclerio, M.D., professor of surgery at the University of Chicago and director of the study, remarked that inflammation measures were improved for patients with hay fever and administered with fluticasone propionate. It was also remarked that fluticasone is an amicable option to treat seasonal allergic rhinitis because of its benefits and low cost.

Management of asthma among preschoolers

Asthma is the commonest of all chronic diseases in children and a major reason for admission to hospital still there is lack of asthma control in 26 to 45 percent of children, as per a review in CMAJ(Canadian Medical Association Journal.

The review provided invaluable insights for differentiating between transient asthma and chronic asthma in preschoolers and information on managing both types.

From Sciencedaily.com:

For children with intermittent asthma, using inhaled corticosteroids only during attacks does not appear to be effective. Regular therapy with inhaled steroids should be used for children with more severe intermittent or persistent symptoms. Treatment with leukotriene receptor antagonists during the viral season may help to reduce symptoms and visits to health care providers. The possibility of another condition should be considered if children do not respond to optimal therapy.

The study authors stated that more research is needed for examining the effectiveness of asthma treatment options among young children.