New research has identified four aspects of immune system disturbance which lead to the development of coeliac disease. Nearly 40 different inherited risk factors which predispose to the disease have now been identified. These latest findings could speed the way towards improved diagnostics and treatments for the autoimmune complaint that affects 1 in 100 of the population, and lead to insights into related conditions such as type 1 diabetes.

David van Heel, Professor of Gastrointestinal Genetics at Barts and The London School of Medicine and Dentistry has led an international team of researchers towards the discovery. Results of their research, funded by the Wellcome Trust, and supported by the patient charity Coeliac UK, are published online in Nature Genetics on 28 Feb 2010.

Professor van Heel, commenting on the latest findings said: “We can now shed light on some of the precise immune disturbances leading to coeliac disease. These include how T cells in the body react to toxic wheat proteins, how the thymus gland eliminates these T cells during infancy, and the body’s response to viral infections. We now understand that many of these genetic risk factors work by altering the amounts of these immune system genes that cells make. The data also suggests that coeliac disease is made up of hundreds of genetic risk factors, we can have a good guess at nearly half of the genetic risk at present.”

The study also shows that there is substantial evidence to indicate a shared risk between the gene associated with coeliac disease and many other common chronic immune mediated diseases. Previously Professor van Heel had identified an overlap between coeliac disease and type 1 diabetes risk regions, as well as coeliac disease and rheumatoid arthritis.

Coeliac disease is common in the West, affecting around one per cent of the population. It is an auto-immune disease triggered by an intolerance to gluten (a protein found in foods containing wheat, barley and rye) that prevents normal absorption of nutrients. If undetected it can lead to severe health problems including anaemia, poor bone health, fatigue and weight loss.

Researchers participating in the Multidimensional Intervention for Early Osteoarthritis of the Knee (Knee Study) determined that physically inactive, middle-aged people with symptomatic osteoarthritis benefitted equally from strength training regimens, self-management programs, or a combination of the two. Details of this study are available in the January 2010 issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

Osteoarthritis (OA) is the most common form of arthritis and the second leading cause of disability in the United States. Currently OA is the most prevalent chronic condition among women, afflicting 35-45% of women by the age of 65. A number of studies have compared strength training protocols with self-management programs in older patient populations, but few have examined the potential benefit of using both approaches in conjunction. “We hypothesized that combining the 2 treatments might enhance the outcomes,” said Patrick McKnight, lead author of the Knee Study.

The Knee Study, conducted at the University of Arizona Arthritis Center in Tucson, AZ, was a 24-month unblinded, randomized intervention trial to compare the effects of strength training programs, self-management programs, and a combination of both. The 273 study participants were between the ages of 35 and 65 years, reported pain and disability due to knee pain on most days in one or both knees for a period of no more than 5 years, and had Kellgren/Lawrence classification grade 2 radiographic evidence of knee OA in one or both knees.

Study participants were randomly assigned to 1 of 3 treatment groups. The strength training group engaged in a 9-month initial phase designed to improve the core areas of stretching and balance, range of motion and flexibility, and isotonic muscle strength. The second, 15-month phase of this group concentrated on developing independent, long-term exercise habits. The second study group participated in a 2-phase self-management program designed to educate participants and provide one-on-one treatment advice. The combined group participated in both the complete strength training and self-management programs. A total of 201 out of 273 participants completed the 2-year trial, with the self-management group achieving the highest compliance rates.

The study team set out to demonstrate that a combination of OA treatment programs would prove most effective, however, the study failed to uncover significant differences in results among the 3 study participant groups. All 3 groups demonstrated improvements in physical function tests and decreased self-reported pain and disability. “The logic behind the combined treatment was that the different factors addressed in physical and psychological treatments might produce an additive effect if administered together,” said Dr. McKnight. “These results suggest otherwise. Instead, the comparison of the 3 treatment arms showed no difference, suggesting similar benefits for all 3 over a 2-year period.”

Given the higher rate of compliance in the self-management group, the Knee Study researchers suggest that self-management may be a less intrusive and equally effective early treatment for knee OA. The CDC also recommends self-management activities to decrease pain, improve function, stay productive, and lower health care costs, including self-management education programs such as the Arthritis Foundation Self Help Program (AFSHP), or the Chronic Disease Self Management Program (CDSMP) to manage arthritis on a day-to-day basis.

Researchers in the US who compared the effects on hip, knee and ankle joints of running barefoot versus running in modern running shoes, concluded that running in shoes exerted more stress on these joints compared to running barefoot or even walking in high-heeled shoes.

The study was the work of lead author Dr D Casey Kerrigan, of JKM Technologies LLC, in Charlottesville, Virginia and colleagues from the University of Colorado and the University of Virginia, and was published in the December 2009 issue of PM&R: The journal of injury, function and rehabilitation.

Knee osteoarthritis (OA) accounts for more disability in the elderly than any other disease, and although running has been shown to benefit health in many ways, including cardiovascular health, it can stress the joints in the leg, such as the hip, knee, and ankle.

For the study, Kerrigan and colleagues recruited from the general population, 68 healthy young adults (37 women, 31 men) with no history of musculoskeletal injury and who regularly ran at least 15 miles a week in running shoes that are typically available in the shops.

They gave each of the participants a pair of running shoes that was typical of most running footwear, but bore no particular design characteristics and appeared neutral. They then observed the participants running with these shoes on, and also barefoot, on a treadmill, with a motion analysis system. The data was collected after a warm up period and while the runners were running at a pace that was comfortable to them individually.

They observed that, compared with barefoot running, running with running shoes resulted in:

* Increased joint torques at the hip, knee and ankle.

* Disproportionately large increases in the hip internal rotation torque and in the knee flexion and knee varus torques.

* On average these torque increases were: 54 per cent in hip internal rotational, 36 per cent in knee flexion, and 38 per cent in knee varus.

(Joint torque is a measure of the amount of twisting about an axis that goes on at that joint. There are several kinds of torque measure, depending on the joint, which axis is the centre of rotation, and the types of movement through which the attached limbs travel.)

The researchers concluded that while typical running shoes support and protect feet quite well, they increase stress on the hips, knees and ankles, and this is likely to be caused by an elevated heel and extra material under the medial arch.

They also remarked that the 36 to 38 per cent ncreased torque on knee joints observed in the running shoes is even greater than that observed in earlier research on walking in high heeled shoes, which showed a 20 to 26 per increased torque on knee joints.

“Considering that lower extremity joint loading is of a significantly greater magnitude during running than is experienced during walking, the current findings indeed represent substantial biomechanical changes,” said Kerrigan in a press statement, adding that the goal of new footwear design should be to reduce joint torque so it is on a par with barefoot running, while not compromising other functions.

Psoriasis, a chronic disease that causes red, raised patches of skin, is increasingly seen as a systemic disease with links to arthritis and cardiovascular disease. The December issue of Mayo Clinic Women’s HealthSource provides an overview of this sometimes embarrassing condition, what’s known about it and how it’s treated. Highlights of the overview include:

– Symptoms: Patches of thick, red skin covered with silvery, flaky scales commonly appear on the elbows and knees, but can appear anywhere on the body. They result from skin cells on overdrive, reproducing much faster than normal. Doctors aren’t sure why this overproduction occurs, although genetic and environmental factors likely play roles. Psoriasis symptoms come and go and flare in response to triggers that can include infections, some medications, alcohol, smoking, stress, sunburn, skin irritation or injury.

– A systemic illness: Doctors are finding that psoriasis is more than a skin disorder. About one in four people with psoriasis develop a form of arthritis called psoriatic arthritis that can cause pain, stiffness and swelling in the joints. Studies have shown that people with psoriasis face a higher risk of heart attack, stroke and other cardiovascular problems. The underlying link may be chronic inflammation, which plays a role in psoriasis and heart disease.

– Treatment: While psoriasis can’t be cured, a variety of topical and systemic treatment options can help control the condition. For mild-to-moderate psoriasis, topical treatments often are effective. Options include corticosteroids or retinoids to reduce inflammation; vitamin D analogs to slow skin growth; and tar, to reduce scaling, itching and inflammation. Calcineurin inhibitors (tacrolimus and pimecrolimus) can help reduce inflammation and skin cell buildup.

In addition, ultraviolet light slows the rapid growth of skin cells. Ultraviolet light therapy may be used alone or in combination with other treatments. Several systemic medications are used for severe forms of psoriasis, though these options pose the risk of serious side effects.

– Self-help measures: Home-care measures can help prevent or manage symptoms. A daily bath removes scales and calms inflamed skin. Adding bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts can offer additional relief. After bathing, applying a thick moisturizing cream or ointment, such as petroleum jelly, can be helpful. During cold, dry weather, it’s beneficial to apply moisturizer several times a day. Short sessions in sunlight three or more times a week can improve psoriasis, as can avoiding known triggers.

Heart attacks and other heart conditions tend to be more common in the winter. Cold lowers the heart’s supply of blood, while exertion raises the demand for it. This imbalance between supply and demand can also cause attacks of chest pain.

When your body gets cold, blood vessels constrict. “If you already have plaque built up in your arteries, that constriction can decrease blood flow to the heart, leading to symptoms and a heart attack,” says Jennifer Mieres, director of cardiology at the New York University School of Medicine. If you have risk factors for heart disease, such as high blood pressure and high cholesterol levels Mieres suggest people take extra care to stay warm.

A decade-long study of 66,346 hip fractures in New York City found that, at least in that city, hip fracture rates were highest in winter, especially on the coldest and windiest days. “In cold weather, people venture out less, so theoretically, that could be a protective factor,” says Joseph Zuckerman, an orthopedic surgeon who helped conduct that study and is president of the American Academy of Orthopedic Surgeons. “But when people do go out, there are greater risks, including ice patches.”

It is thought that winter inactivity weakens muscles, making falls more likely. “It’s wise to practice defensive walking,” Zuckerman says, “Watch where you are going. If you need a walker or cane, use it. Inside, get rid of loose rugs and other clutter and install a night light.”

Winter is a time when we not only catch colds and flu but when chronic ailments are exacerbated by the cold, wind and damp. People with arthritis may experience their condition worsening in the winter months with even achier bones and joints.

“Some studies have shown that about 70 percent of people with arthritis are weather sensitive,” notes Dave Terlizzi, director of the new Kimball Institute for Rehabilitative and Occupational Health Services. “Women and those with osteoarthritis may be slightly more affected by weather changes than men and people with other types of arthritis.”

“That’s why it is essential for people who have arthritis, and those who could potentially acquire the disease, to exercise and avoid becoming a couch potato during the winter months,” Terlizzi states.

Cold and damp weather can cause tendons, ligaments and muscles surrounding joints to contract, and cavities in joints can be affected by atmospheric pressure. It is still unknown why some people are affected by weather and others are not.

Middle-aged men and women who engage in high levels of physical activity may be unknowingly causing damage to their knees and increasing their risk for osteoarthritis, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

“Our data suggest that people with higher physical activity levels may be at greater risk for developing knee abnormalities and, thus, at higher risk for developing osteoarthritis,” said Christoph Stehling, M.D., research fellow in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF) and radiology resident in the Department of Clinical Radiology, University of Muenster, Germany.

Osteoarthritis is a degenerative joint disease that causes pain, swelling and stiffness. According to the Centers for Disease Control and Prevention, osteoarthritis is the most common form of arthritis and affects an estimated 27 million American adults.

The UCSF study involved 236 asymptomatic participants who had not reported previous knee pain and were enrolled in the National Institutes of Health Osteoarthritis Initiative. Study participants included 136 women and 100 men, age 45 to 55, within a healthy weight range. The participants were separated into low-, middle-, and high-activity groups based on their responses to the Physical Activity Scale for the Elderly (PASE) questionnaire. PASE is a standard test that scores an older individual’s physical activity level, based on the type of activity and the time spent doing it. Several factors contribute to the final PASE score, but a person whose activity level is classified as high typically might engage in several hours of walking, sports or other types of exercise per week, as well as yard work and other household chores.

Subsequent MRI analysis by two musculoskeletal radiologists indicated a relationship between physical activity levels and frequency and severity of knee damage. Specific knee abnormalities identified included meniscal lesions, cartilage lesions, bone marrow edema and ligament lesions. Abnormalities were associated solely with activity levels and were not age or gender specific.

“The prevalence of the knee abnormalities increased with the level of physical activity,” Dr. Stehling said. “In addition, cartilage defects diagnosed in active people were more severe.”

The findings also indicated that some activities carry a greater risk of knee damage over time.

“This study and previous studies by our group suggest that high-impact, weight-bearing physical activity, such as running and jumping, may be worse for cartilage health,” Dr. Stehling said. “Conversely, low-impact activities, such as swimming and cycling, may protect diseased cartilage and prevent healthy cartilage from developing disease.”

A new study by radiologists found that middle-aged men and women who do lots of exercise, and particularly high impact activities like running and jumping, may be unknowingly causing damage to their knees and putting themselves at greater risk of developing osteoarthritis. By implication, low impact activities like swimming and cycling may protect damaged and healthy joints they said, although further research is needed to confirm this.

The study was the work of Christoph Stehling and colleagues, and is being presented Monday at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), taking place from Nov 29 to Dec 4, in Chicago.

Stehling is a research fellow in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF) and a resident in radiology with the Department of Clinical Radiology at the University of Muenster in Germany.

Osteoarthritis, the most common form of arthritis, affects some 27 million American adults, estimates the US Centers for Disease Control and Prevention (CDC). The disease is degenerative and affects the joints, causing pain, swelling and stiffness.

Osteoarthritis has three features: damaged cartilage (the strong, smooth lining that allows joints to move easily without friction), bony growths around the edge of joints, and mild inflammation (synovitis) of the tissue surrounding the affected joint.

Stehling told the media that:

“Our data suggest that people with higher physical activity levels may be at greater risk for developing knee abnormalities and, thus, at higher risk for developing osteoarthritis.”

For the study, Stehling and colleagues analysed data of 100 men and 136 women aged 45 to 55 taking part in the National Institutes of Health Osteoarthritis Initiative (which they referred to as the “OAI incidence cohort”).

None of the participants reported experiencing knee pain before enrollment and their weight was in the healthy range.

The researchers categorized the participants into low, middle and high activity, depending on their responses to a questionnaire that assessed their physical activity according to the Physical Activity Scale for the Elderly (PASE). PASE yields a score based on activity type and time spent doing it.

The participants were thus put in one of three groups: low activity (PASE score 27 to 155), middle activity level (PASE 156 to 230) and high activity (PASE 231 to 409).

A middle-aged person who spends several hours a week walking, doing sport and other exercises, plus yard work, heavy gardening and household chores would have a high PASE score.

Two of the researchers, who are experts in musculoskeletal radiology, analyzed MRI images of the participants to assess severity of any cartilage, meniscal and ligament damage, or other abnormalities, in the right knee.

The results showed that:

* 47 per cent of the participants had meniscal lesions.

* 74.6 per cent had cartilage lesions.

* 40.3 per cent had bone marrow edema.

* 17 per cent had ligament lesions.

* Incidence of abnormalities went up in line with PASE activity level (low, medium, high).

* Grade of cartilage lesions also went up with PASE activity level.

* Presence of other knee abnormalities was also significantly linked to presence of cartilage defects.

* Abnormalities were linked solely with activity levels and were not age or gender specific.

The researchers concluded that:

“Middle-aged non-symptomatic individuals from the OAI incidence cohort had a high prevalence of knee abnormalities including cartilage and meniscus lesions. Individuals with higher PASE showed a significantly higher number and grade of knee abnormalities.”

“These results suggest that subjects with higher physical activity levels may be at greater risk for cartilage and meniscal abnormalities and thus higher risk for developing Osteoarthritis (OA),” they added.

Stehling said that knee abnormalities went up in line with level of physical activity, and “in addition, cartilage defects diagnosed in active people were more severe”.

He said the findings also showed that some activities carry a greater risk of knee damage over time.

“This study and previous studies by our group suggest that high-impact, weight-bearing physical activity, such as running and jumping, may be worse for cartilage health”, said Stehling.

“Conversely, low-impact activities, such as swimming and cycling, may protect diseased cartilage and prevent healthy cartilage from developing disease,” he added, suggesting more studies were now needed to compare the effect of low and high impact activity on disease progression.

“Subjects with Higher Physical Activity Levels Have More Severe Focal Knee Lesions Diagnosed with 3T MRI: Analysis of the Non Symptomatic Incidence Cohort of the Osteoarthritis Initiative.”