The clot-inhibiting drug apixaban (trade name: Eliquis®) was approved in May 2011 for the prevention of thrombosis (blood clots) after operations to replace a hip or knee joint. In an early benefit assessment pursuant to the “Act on the Reform of the Market for Medicinal Products” (AMNOG), the German Institute for Quality and Efficiency in Health Care (IQWiG) examined the added benefit of apixaban.

IQWiG found proof of minor added benefit for adult patients who had undergone hip replacement: symptomatic clots in the deep veins of the leg occurred less frequently with apixaban treatment than with the comparator therapy.

Symptomatic clots in the deep leg veins also occurred less frequently with apixaban treatment in adults after knee replacement. However participants in the studies suffered clots in the lungs (pulmonary embolisms) more often under treatment with apixaban than the comparator group. From weighing up the benefits and harms (risk of side effects) on the basis of the data presented in the manufacturer’s dossier, IQWiG identified no proof of added benefit of apixaban over the appropriate comparator therapy in knee replacement operations.

Enoxaparin as comparator therapy

After the insertion of an artificial hip or knee, there is an increased risk of blood clots (thrombi) that are swept away in the bloodstream and can block a blood vessel in another part of the body. Clots that cause symptoms (symptomatic thromboembolism) may, for instance, occur in the lungs and deep veins of the legs.

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Rheumatoid arthritis alone is painful and disabling, but it also puts patients at higher risk of death. The greater susceptibility to infections that accompanies the autoimmune disorder is one reason. Assessing the danger of infection a particular patient faces so it can be addressed can prove challenging for physicians. A Mayo Clinic study finds that a risk score can be developed to predict a patient’s chances of having serious infections. The score uses information about how rheumatoid arthritis is affecting a patient, plus factors including age, corticosteroid use and the presence of other illnesses.

The findings are published online in the American College of Rheumatology journal Arthritis Rheumatism.

Using the National Institutes of Health-funded Rochester Epidemiology Project, researchers studied medical records of 584 rheumatoid arthritis patients diagnosed between 1955 and 1994 and followed up on until January 2000. Of those, 252, or nearly half, had more than one serious infection requiring hospitalization and/or intravenous antibiotic; those 252 collectively racked up 646 infections.

The Mayo team developed an infection risk score based on those and other rheumatoid arthritis patients they studied. Factors in the calculation include age; previous serious infections; corticosteroid use; a low white blood cell count; elevated results in a blood test used to detect signs of inflammation, called an erythrocyte sedimentation rate; signs of rheumatoid arthritis outside joints; and the presence of other serious conditions such as heart disease, heart failure, diabetes, lung disease, vascular disease and alcoholism. They confirmed the usefulness of the risk score in a second group of patients with rheumatoid arthritis from the same population.

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Main Category: Arthritis / Rheumatology
Article Date: 06 Sep 2012 – 0:00 PDT

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After Group Health Cooperative introduced video-based “decision aids” for people with knee and hip arthritis, rates of knee and hip replacement surgeries dropped sharply: by 38 and 26 percent, respectively, over six months. The cost of caring for those patients also declined: by 12 percent to 21 percent, according to an article in the September Health Affairs.

“Decision aids are balanced sources of information that clearly present the evidence-based pros and cons of treatment options for a health condition,” explained study leader David E. Arterburn, MD, MPH, a general internist and associate investigator at Group Health Research Institute.

This observational study of 9,515 Group Health patients compared six-month outcomes during two periods: before and after decision aids for knee and hip osteoarthritis started being distributed regularly to Group Health patients with these conditions who were considered candidates for joint replacement.

This is the first time anyone has explored how using decision aids in routine practice can affect health care and costs, Dr. Arterburn said. It is also the first major study of decision aids for knee and hip replacement.

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Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 05 Sep 2012 – 13:00 PDT

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Scientists have managed to predict when rheumatoid arthritis patients are most likely to suffer infections. Not only is rheumatoid arthritis crippling and agonizing, it also makes the patient more vulnerable to infections that coincide with the disorder, increasing their risk of death. However, physicians have had a difficult time assessing the potential danger of infection an individual might face.

According to a Mayo Clinic study, a person’s chances of having severe infections can be predicted by developing a risk score, which uses information regarding the impact the disease has on a patient, plus factors including age, corticosteroid use and if any other illnesses are present.

The findings, which were published in the American College of Rheumatology journal Arthritis Rheumatism, came from medical records in the National Institutes of Health-funded Rochester Epidemiology Project of 584 individuals struggling with rheumatoid arthritis. The subjects were diagnosed between 1955 and 1994 and were observed until January 2000.

Almost half (252) of those studied needed hospitalization and/or intravenous antibiotic because of more than one severe infection. Collectively, the subjects had a total of 646 infections.

An infection risk score, based on those participants and other patients they observed, was created by the Mayo experts. In order to get an accurate calculation, scientists focused on certain factors, including:

Main Category: Arthritis / Rheumatology
Also Included In: MRI / PET / Ultrasound;  Bones / Orthopedics
Article Date: 03 Sep 2012 – 1:00 PDT

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A study conducted by researchers at Boston University School of Medicine (BUSM) shows that magnetic resonance imaging (MRI) detected a high prevalence of abnormalities associated with knee osteoarthritis in middle-aged and elderly patients that had no evidence of knee osteoarthritis in X-ray images.

Ali Guermazi, MD, PhD, professor of radiology at BUSM and chief of Musculoskeletal Imaging at Boston Medical Center (BMC), led this study in collaboration with researchers from Lund University in Sweden, Brigham and Women’s Hospital in Boston and Klinikum Augsburg in Germany. The findings are published online in BMJ.

Osteoarthritis, the most common form of arthritis, is characterized by a degeneration of cartilage and the underlying bone and other soft tissues in the joints, leading to pain and stiffness. According to the Centers for Disease Control and Prevention, osteoarthritis is the leading cause of disability in the United States, affecting approximately 26.9 million Americans. It is responsible for a significant portion of primary care visit and hospitalizations and has a large financial impact on health care. With the aging population, it is anticipated that the prevalence of osteoarthritis will continue to increase.

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