An arthritis drug may allow people to reduce use of steroids.
* THE QUESTION Steroids are the treatment of choice for the widespread muscle pain and stiffness associated with the inflammatory disorder known as polymyalgia rheumatica. Because most people need to take the drugs for two years or longer, side effects become a concern. Might methotrexate, a rheumatoid arthritis drug, help wean people from the steroids?
* THIS STUDY randomly assigned 72 people newly diagnosed with polymyalgia rheumatica to take a weekly dose of either methotrexate or a placebo, along with a daily dose of the steroid prednisone. The steroid doses were reduced after four weeks, with the aim of stopping them after 28 weeks unless symptoms recurred. After 18 months, 87 percent of the people who took methotrexate were free of steroids, compared with 53 percent in the placebo group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with polymyalgia rheumatica, which is thought to be linked to the aging process because it rarely occurs before age 50.
* CAVEATS Overall, side effects were about the same in both groups, but those taking methotrexate had mild gastrointestinal problems more often than the others. The study did not last long enough to detect possible steroid side effects, which often do not occur until after 18 months. All participants took high doses of folinic acid to replace that depleted by methotrexate; however, this may have altered the effectiveness or side effects of the drug.
* BOTTOM LINE People with polymyalgia rheumatica may want to talk with their doctor about methotrexate.
* FIND THIS STUDY October issue of Annals of Internal Medicine; abstract available online at www.annals.org.
* LEARN MORE ABOUT polymyalgia rheumatica at www.mayoclinic.com and at www.niams.nih.gov.
A topical painkiller appears to offer relief with few side effects.
* THE QUESTION When the cushioning in a joint breaks down, leaving bone to rub against bone, people suffering through the resulting aches and pains often turn to nonsteroidal anti-inflammatory drugs, or NSAIDs, for relief. But those pills can damage the gastrointestinal system. Might a topical NSAID treat the joint pain without this side effect?
* THIS STUDY randomly assigned 326 people with osteoarthritis in at least one knee to use either diclofenac drops or a placebo for 12 weeks. Those who used the drug reported 46 percent less knee pain, compared with 33 percent in the placebo group. With the medication, complaints of stiffness improved by 35 percent (24 percent for placebo), and overall physical functioning improved by 37 percent (24 percent for placebo). Twelve percent of those taking the medicine reported gastrointestinal effects, a rate similar to the 9 percent of those in the placebo group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with osteoarthritis of the knee, which strikes mostly after age 45, women more often than men.
* CAVEATS About 30 percent of the participants dropped out of the study. In the United States, the drug has been approved for a skin condition but not for osteoarthritis. The study was funded by Dimethaid Health Care, which markets topical diclofenac in Canada. One of the study's authors owns stock in Dimethaid.
* BOTTOM LINE People with knee osteoarthritis may want to ask their doctor about topical diclofenac.
* FIND THIS STUDY Oct. 11 issue of Archives of Internal Medicine; abstract available online at www.archinternmed.com.
* LEARN MORE ABOUT osteoarthritis at www.arthritis.org and www.niams.nih.gov.
The likelihood of stroke seems to increase slightly with tamoxifen.
* THE QUESTION Tamoxifen is commonly taken by women with breast cancer to prevent its recurrence and by women at high risk for the disease. Because the drug increases the risk of blood clots, does it make a stroke more likely?
* THIS STUDY reviewed randomized studies comparing tamoxifen to a placebo or another drug in nearly 40,000 women. Analysis showed that 1.06 percent of those taking tamoxifen had a stroke within about five years, compared with 0.76 percent of the others.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Women with breast cancer and those at elevated risk for the disease. An estimated 216,000 new cases of invasive breast cancer will be diagnosed in the United States this year.
* CAVEATS The studies did not identify whether participants had any risk factors for stroke. The reviewers stressed that the absolute risk of having a stroke in a given period from tamoxifen usage remained low.
* BOTTOM LINE Women considering tamoxifen may want to talk with a doctor about having cardiovascular checkups before and throughout their treatment.
* FIND THIS STUDY October issue of Neurology; abstract available online at www.neurology.org.
* LEARN MORE ABOUT tamoxifen at http://cis.nci.nih.gov and at www.cancer.org.
-- Linda Searing