Managing aches & pains

Managing aches & pains
S. Indra Sathiabalan
The Sun

OSTEOARTHRITIS (OA) is the most common form of arthritis and it affects millions around the world. It is caused by the breakdown and eventual loss of the cartilage of the joints. Cartilage is a protein-like substance that functions as a cushion between the bones of the joints.

OA is also known as degenerative arthritis and commonly occurs in the hands, feet, spine, and large weight-bearing joints, such as the hips and knees.

One of the world’s leading bone health experts gave a talk on this disease at the World Health Medicine Conference 2009 held at Putra World Trade Centre, Kuala Lumpur, recently.

Prof Yves Henrotin, the director of the Bone and Cartilage Research Unit at the University of Liége, Belgium, has published over 100 scientific articles on bone health and was the co-editor of Osteoarthritis: Clinical and Experimental Aspects.

He is also a respected authority in the management of cartilage and osteoarthritis and is one of only 12 members of the prestigious Osteoarthritis Research Society International and the International Cartilage Repair Society.

In an email interview, Henrotin said OA is characterised by “a combination of joint pain and stiffness with associated functional problems, which can have a substantial effect on quality of life”.

He said the main causes of osteoarthritis are joint overuse, ageing, obesity, trauma and joint malalignment, adding that the main joints affected are the hip, knees and hands. “Individuals with OA may report some difficulty with occupational as well as certain leisure activities, depending upon the site and severity of their arthritis.”

Henrotin said that although OA is often characterised in its later stages by cartilage degradation, in reality, all the components of the joint are affected.

He said as the average life expectancy increases, OA will become a bigger public health problem – not only because it is a manifestation of ageing but because it usually takes many years to reach clinical relevance.

“OA is already one of the 10 most disabling diseases in industrialised countries. It is rare in people under 40 but becomes more common with age – most people over 65 years of age show some radiographic evidence of OA in at least one or more joints.”

He added that OA is the most frequent cause of physical disability among older adults globally with more than eight million people in the UK and over 20 million Americans estimated to be affected by it.

It is also anticipated that by the year 2030, 20% of adults will have developed OA in Western Europe and North America.

“OA is not only a common problem among the elderly population, but is also becoming more widespread among younger people. In the United States alone, rheumatoid arthritis (RA) and OA combined affect as many as 46 million people.”

So, what are the signs of OA?

Henrotin said: “The first sign is pain during joint function, but that stops when the person rests. Other signs are joint deformation, crepitus (sound heard when joints rub against each other) and stiffness.”

There is no cure for OA and treatment is mainly to help alleviate some of the symptoms.

“Current recommendations for the management of OA include a combination of non-pharmacological and pharmacological modalities,” said Henrotin.

“Until now, the pharmacological management of OA is dominated by non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics (mainly paracetamol).

“Non-pharmacological modalities of treatment are information and education, regular contact by phone, regular aerobic, muscle-strengthening and range of motion exercises, weight loss, walking aids, knee brace and thermal modalities including heat and cold therapy.”

He pointed out that the acute pain and inflammatory flare can be managed by fast-acting drugs including analgesic and non-steroidal inflammatory drugs.

“However, the intake of these drugs is associated with some severe adverse effects. For this reason, these drugs must be used at the lower efficient dose during a short period.

“Alternatives are natural or physical agents with no known adverse effects, like curcumin-based products and cold therapy.”

To those who are also suffering from OA, Henrotin advises them to stay active.

“To take drugs is not enough to manage joint pain. The patient must be involved in its treatment and to be aware that losing weight and physical activity help to fight chronic pain.”

 

Aggressive breast cancer meets its match

Aggressive breast cancer meets its match
Joseph Masilamany

Dr.Martin… new hope for breast cancer patients.

AN aggressive form of breast cancer, known in medical circles as HER2-positive metastatic tumour can now be stopped in its tracks – and its progression delayed or even “starved”, say researchers.

Studies have established that HER2-positive (HER2-P) breast cancer, which is usually treated with the hormonal therapy, letrozole, can now be better contained when administered together with lapatinib – a drug that specifically targets HER2-P cancer cells.

In the study, participated by 200 women with metastatic HER2-P (that had not been previously treated), the results were more than promising, with some tumours seen to have shrunk to stage 1 settings.

There are four stages in cancer with stage four being terminal.

In the study, revealed at the San Antonio Breast Cancer Symposium in Texas last year – half of the women were treated with letrozole alone – while the other half received a combo-therapy of both, letrozole and lapatinib.

About 38% of the HER2-P patients treated with the combo-cocktail had a partial or complete response to treatment, compared to 15% of the cancers treated with a single dosing of letrozole.

It was also noted, that in the combo-cocktail group, the cancers had stopped growing 29% longer
– while 50% of the tumours treated with the lapatinib-letrozole combination were stable (no change in tumour size and pathology) as compared to 30% of those treated with letrozole only.

HER2-P spreads insidiously and it accounts for one in four of all breast cancers reported worldwide.

Speaking to theSun recently, clinical oncologist, Dr Martin Melor, of the  Subang Jaya Sime Darby Medical Centre, said that HER2-P breast cancers have too many copies of the HER2/neu gene which over expresses the HER2 protein.

Martin, who attended the San Antonio symposium, issued an upbeat note on this new area of research. He said with further “positive findings” on this potential combo-therapy, oncologists may be able to better manage and treat their patients afflicted with the HER2-P type of breast cancer.

Lapatinib, which is available in the country, is developed by pharmaceutical giant, Glaxosmithkline.

It has been approved by the US Food and Drug Administration to be used in combination with the chemotherapy drug, capacitabine.