Apr
01
2007

Disc Transplantation New For Herniated Disc

By | Orthopedics, Pain

Back problems can be a source of chronic pain and it is a significant reason for disability in the general population. Often the patient lives with the problem, and treatment with pain killers or over the counter remedies proves to be useless. Once the symptoms are becoming more severe and there is a feeling of numbness that extends into the leg or foot, even the most stoic back pain sufferer will seek out medical advice. Tests such as a CAT scan or MRI scan will reveal that the reason for the chronic pain is a herniated disk.

The only treatment that could be offered has been a discectomy which is performed by an orthopedic surgeon. So far fusion surgery has been the modality of choice, which has the unfortunate consequence of predisposing patients to degeneration in other levels of the spine as the wear and tear following fusion surgery is higher at the adjacent levels.

Dr. Dike Ruan from the Navy General Hospital in Beijing reports about a new treatment in the form of disc transplantation instead of fusion. Artificial materials have been tested and the results have been very variable. Contrary to organ transplantation it is possible to work with donor material from non-related persons as the inert disk material does not cause transplantation rejection. The herniated disc is removed including the adjacent end plate and a fresh-frozen composite disk with end plate is introduced. Five patients who underwent the procedure had improved neurological status after three months. Also the bony union at the end plate was nearly complete after three months. Long term follow up, which continued for at least five years, continued to show improvement.

Disc Transplantation New For Herniated Disc

Disc Transplantation New For Herniated Disc

Contrary to organ transplants in which anti-rejection drugs have to be used, the disk transplants caused no immunological reaction. Motion and stability remained excellent, and only minor degenerative changes were observed after five years.

With further refinements, such disc transplants will likely become an effective alternative treatment for degenerative disc disease.

More information about disc herniation treatment suggestions: http://nethealthbook.com/arthritis/lower-back-pain/treatment-low-back-pain-2/disc-herniation-treatment-suggestions/
Reference: The Lancet, 2007; 369-993 and p.999

Last edited November 2, 2014

Jul
01
2006

Benefits Of Arthritis Drug Outweigh Cancer Risk

By | Arthritis

Any medication that is very effective in one area may also have side effects.
An analysis of randomized trial has confirmed, that rheumatoid arthritis patients who are treated with anti- tumor necrosis (TNF) antibodies, are at an increased risk for cancer. A study from the Mayo Clinic and other studies from institutions in the U.K. showed that patients who are treated with the monoclonal antibodies infliximab (Remicade) and adalimumab (Humira) are at a higher risk for serious infections.
This may sound like a blow to any patient with rheumatoid arthritis. Treatment with Monoclonal antibodies and anti-Tumor necrosis antibodies has revolutionized the care of these patients. The medications are highly effective and have made a difference for many affected with rheumatoid arthritis.
Dr. Eric Matteson, a study co-author and professor of medicine in the division of rheumatology at the Mayo Clinic points out, that the concerns about infection and malignancy are not new. They are already mentioned in the drug labeling. The risk for cancer was statistically significant only in the high-dose groups. It was also impossible to draw any conclusions about whether any type of malignancy occurred more often than another. He also emphasized, that doctors and patients have to be alert to signs of infection, and age-appropriate cancer screening is of great importance for the patient who takes these particular medications.
Dr. John Esdaile from the University of British Columbia mentions some additional points. These medications are not handed out freely to any patient with R.A. The treatment cost of about $18,000 per year does not make this a standard medication for anybody with R.A. Patients with severe disease who have failed to get relief from any conventional medications would be the ones who are considered for this treatment. Most patients would likely be receiving doses in the lower range of the spectrum, and patients usually know within 3 months, whether the medication is helping them. The medications do not work in everyone, but for 50% of the patients the effect is dramatically positive. The patient, whose joints were being destroyed by rheumatoid arthritis, can go from a state of terrible pain and disability to being able to return to a good quality of life.

Benefits Of Arthritis Drug Outweigh Cancer Risk

Benefits Of Arthritis Drug Outweigh Cancer Risk

The key is close screening of patients regarding the suitability of the therapy. The possible increased risk for malignancies and infection must be discussed with candidates for anti-TNF therapy. Finally close monitoring for infection and cancer screening is necessary.

More information about rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/

Reference: The Medical Post, June 2, 2006, page 1 and 7.

Last edited Nov. 1, 2014

Jan
01
2006

Combination Of Drugs Helps Rheumatoid Arthritis

By | Arthritis

Several treatment options have become available to patients suffering from rheumatoid arthritis, but side effects can be a problem. Corticosteroids are still needed, and methotrexate has been added. While anti-tumor-necrosis factor therapy (TNF alpha antibody) is a very beneficial form of treatment, there are patients who fail to respond or have toxicity to these therapy forms.
Dr. Stanley Cohen, a clinical professor of internal medicine at the University of Texas Southwestern Medical School in Dallas investigated 520 patients who had not adequately responded to methotrexate and anti-TNF therapy. The patients received the genetically engineered monoclonal antibody, rituximab (Rituxan), which so far has been used to treat Hodgkin’s lymphoma. It was found to be highly effective for active rheumatoid arthritis when given with methorexate in patients who experienced an inadequate response to anti-TNF therapies.
The patients were randomly selected and received either a single dose of 1000mg rituximab or placebo on days one and fifteen. All patients received a corticosteroid prior to the infusion. They also took a short course of oral corticosteroids between the two injections. For the patients on rituxmab, the medication proved beneficial. It was also well tolerated. Statistically 51% of the patients on rituximab had at least a 20% improvement on the swollen and painful joints and at least 20% improvement in 3 to 5 other criteria, like general well being, disability or laboratory tests of C-reactive protein.
Only 18% of the placebo group showed any improvement. It was also noted that the effects of this one-time treatment could last up to 15 months.
As good as the current medication is, there are treatment failures. Dr. David Karp, chief of Rheumatic diseases at the same university but not involved with this study finds the development very valuable.

Combination Of Drugs Helps Rheumatoid Arthritis

Combination Of Drugs Helps Rheumatoid Arthritis

He concludes that it becomes important in this area to personalize the treatment plan. The future is to look at the patients’ blood or gene makeup and prescribe specific therapies directed at their particular problem.

More information regarding treatment of rheumatoid arthritis: http://nethealthbook.com/arthritis/rheumatoid-arthritis/treatment-rheumatoid-arthritis/

Reference: The Medical Post, December 20, 2005, page 33

Last edited October 30, 2014