TOPICAL MEDICATION EFFECTIVE IN RELIEVING SYMPTOMS OF KNEE OSTEOARTHRITIS

CHICAGO—Symptoms of primary osteoarthritis of the knee, including pain and stiffness, were significantly improved in patients who used a topical nonsteroidal anti-inflammatory drug (NSAID), according to an article in the October 11 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for treating symptoms of osteoarthritis (OA), a joint disease affecting an increasingly large percentage of the aging population. However, oral NSAIDs carry the common risk of adverse effects on the gastrointestinal (GI) tract, the liver, and the kidneys. Topical NSAIDs may offer an alternative oral medication with a reduction in adverse effects, especially on the GI tract, the article states.

Sanford H. Roth, M.D., of Arizona Research & Education, Phoenix, and colleagues tested the efficacy of a topical diclofenac sodium solution (an NSAID) in the treatment of knee OA. The trial was conducted from December 2000 to May 2001 and studied 228 men and women aged 40 to 85 years with primary OA in at least one knee. Patients were randomized to receive 40 drops of the diclofenac solution applied to the affected knees or a control solution four times daily during the 12-week study.

The researchers found that the topical diclofenac solution was significantly more effective than the control solution in improving symptoms of knee osteoarthritis. Patients who applied the diclofenac solution experienced a 45.7 percent reduction in their ratings of knee pain. Scores on scales rating physical function and stiffness also improved by 36.7 percent and 35.1 percent, respectively. Patients in the diclofenac group also experienced a 45 percent improvement in the score for pain with walking.

Most adverse effects related to using the diclofenac were skin reactions at the site of application. Sixty-eight people (41.5 percent) using the diclofenac solution experienced minor skin irritation. In both the diclofenac and control groups, dry skin and rash were most frequent, occurring in 60 of 164 of those using diclofenac, and 18 of 164 of people using the control solution.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 11, 2004
To contact Lars Frost, M.D., Ph.D., e-mail: lars.frost{at}aas.auh.dk.

ALCOHOL CONSUMPTION MAY BE ASSOCIATED WITH IRREGULAR HEART BEAT IN MEN

CHICAGO—Alcohol consumption may slightly increase the risk for developing a certain type of irregular heart beat, known as atrial fibrillation, or atrial flutter, according to an article in the October 11 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, evidence for a link between alcohol consumption and atrial fibrillation is conflicting.

Lars Frost, M.D., Ph.D., and Peter Vestergaard, M.D., Ph.D., from Aarhus University Hospital, Aarhus, Denmark, performed a follow-up study among 47,949 participants (average age, 56 years; 22,528 men; 25,421 women) in the Danish Diet, Cancer, and Health Study to investigate associations between alcohol consumption and atrial fibrillation. Patients were recruited for the Danish Diet, Cancer, and Health Study between December 1993 and May 1997. Participants were born in Denmark and had no history of cancer. Part of the study used questionnaires to assess alcohol consumption. Participants were asked what type of alcohol they drank (beer, wine or spirits) and how often.

The researchers found that the average consumption of alcohol per day was 28.2 grams for men and 13.9 grams for women. More than half of the women consumed less than one unit of alcohol per day, or less than 10 grams of alcohol. The percentage of men and women who were abstainers at the beginning of the study was 2.1 percent and 3.0 percent, respectively.

During the follow-up period (average of approximately 5.7 years), 556 participants developed atrial fibrillation (including 374 men [1.7 percent] and 182 women [0.7 percent]). There was a modest increase in risk of atrial fibrillation that corresponded with increasing alcohol consumption in men, but not among women. Compared to men who drank the least amount of alcohol (first quintile), men in the second, third, fourth and fifth quintiles (increasing alcohol consumption), had a 4 percent increase in risk, 44 percent increase in risk, 25 percent increase in risk and 46 percent increase in risk for atrial fibrillation, respectively. Compared to women in the lowest quintile of alcohol consumption, women in the second, third, fourth and fifth quintiles had a nine percent increase in risk, 27 percent increase in risk, 23 percent increase in risk and 14 percent increase in risk, respectively.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 11, 2004
To contact Nathaniel Hupert, M.D., M.P.H., call Jonathan Weil at 212/821-0560.

PRESCRIPTIONS FOR ANTIBIOTICS TO PREVENT ANTHRAX UNCOMMON AFTER THE 2001 ANTHRAX ATTACKS

CHICAGO—Prescriptions for antibiotics that could be taken in advance to prevent against anthrax were uncommon among concerned patients after September 11, 2001 and the 2001 U.S. anthrax attacks, according to an article in the October 11 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, nationwide, more than 10,000 affected workers and others were given 3.75 million prophylactic antibiotic pills through official dispensing campaigns between October 2001 and January 2002. However, media reports suggest that even more prescriptions were given out by individual physicians.

Nathaniel Hupert, M.D., M.P.H., of the Weill Medical College of Cornell University, New York, N.Y., and colleagues reviewed the electronic medical records of outpatient telephone contacts and clinic visits at a large, primary care practice in New York City from September 11 to December 31, 2001 to identify factors associated with prescribing antibiotics to prevent anthrax.

There were 30,456 total patient visits (via phone or in person) between September 11 and December 21, 2001. Of these visits, 244 involved patient-initiated discussion about bioterrorism: 92 (0.6 percent) of 14,917 telephone contacts and 152 (1.0 percent) of 15,539 office visits. Average patient volume was higher from October to December in 2001 (221.2 patients per day) compared with the same time period in 2000 (199.1 patients per day).

Fifty patients (21 percent of the 244 who discussed bioterrorism with their physician) requested antibiotics or vaccines, and 52 patients (22 percent) received antibiotics: 39 received ciprofloxacin; 12 doxycycline; and 1 received both drugs.

"Despite widespread popular concern about bioterrorism and speculation about increased patient requests and physician prescribing of antibiotics for anthrax prophylaxis, only one in five patients who initiated discussion about anthrax or smallpox with physicians at this internal medicine practice in the wake of the 2001 terrorist attacks either requested antibiotics or received them," write the researchers.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 11, 2004
To contact Anat Achiron, M.D., Ph.D., e-mail: achiron{at}post.tau.ac.il.

IMMUNE THERAPY APPEARS TO REDUCE RISK OF SECOND ATTACK OF MULTIPLE SCLEROSIS SYMPTOMS

CHICAGO—Intravenous immunoglobulin therapy may reduce the risk of a second attack of symptoms related to multiple sclerosis, according to an article in the October issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to the article, multiple sclerosis (MS) is a chronic, inflammatory disease characterized by demyelinization of the brain and spinal cord. Myelin is a material that covers and insulates nerve cells, and allows signals to travel from cell to cell. The onset of MS is defined by having neurological impairment related to motor, sensory, cerebellar, visual, brainstem or cognitive functioning, as well as having symptoms of urinary tract dysfunction, the article states. Intravenous immunoglobulin (IVIg) has been reported to diminish the symptoms of MS in patients with relapsing-remitting MS (where symptoms flare up and then disappear later). The progression of MS is affected by the time to occurrence of the second neurological event, as well as the number of events within the first year.

Anat Achiron, M.D., Ph.D., of Sheba Medical Center, Tel-Hashomer, Israel, and colleagues assessed the effect of IVIg treatment in patients after the first neurological event suggestive of MS and evaluated the occurrence of a second attack.

Ninety-one patients (average age, 33.9 years) who experienced neurological symptoms indicative of MS for the first time enrolled in the study within six weeks of their symptoms. Patients were randomly assigned to receive IVIg treatment, or placebo, given once every six weeks for one year. Neurological and clinical assessments were performed every three months, and brain magnetic resonance imaging (MRI) was performed at the beginning and end of the study.

The researchers found that the probability of developing clinically definite multiple sclerosis was significantly lower in the IVIg treated group compared with patients in the placebo group. Patients in the IVIg group also had fewer brain lesions as seen on MRIs.