Bulletin Board Highlighting the latest news and research in rheumatology Bulletin Board Bulletin Board Cognitive behavioral therapy in the news... Lead story: improves sleep and pain in people Cognitive behavioral therapy improves sleep and pain in people with osteoarthritis with osteoarthritis pg 503 In brief… pg 504 IRF-8 protein thought to be involved Results published in the Journal of Clinical The CBT-I regime were made up of 8 in causing gum disease, osteoporosis Sleep Medicine revealed that a successful weekly 2 hour classes, which were spread and arthritis pg 504 treatment for older patients with osteoar- throughout the calendar year in an academic thritis and comorbid insomnia is behavioral medical center. Sleep and pain were reviewed Number of US veterans to develop therapy for insomnia (CBT-I). through self-report at the beginning of the rheumatoid vasculitis drops Cognitive behavioral therapy is a form of treatment and at the end of one year. significantlypg 505 psychotherapy that emphasizes the impor- Initially sleep latency dropped by 16.9 Rheumatism video discloses center of tant role of thinking in how we feel and minutes and a year after treatment it was inflammation at an early stagepg 505 what we do. Patients with osteo arthritis found to have decreased by 11 minutes. and comorbid insomnia were reported to Wake after sleep onset was initially reduced have responded well to the therapy and by 37 minutes, which also dropped to Vitello believes that CBT-I could be both their immediate and self-reported 19.9 minutes a year after treatment. Pain incorporated into behavioral interventions sleep appeared to without directly address- improved by 9.7 points initially and 4.7 for pain management in osteoarthritis. He ing pain control. Patients demonstrated points a year later and sleep efficiency concluded by explaining that the treat- significant decreases in sleep latency and increased by 13 and 8% a year on. These ment of sleep disturbance could ultimately wake after sleep onset; reduced pain was sustained improvements were observed in improve the quality of life for patients with observed and sleep efficiency rose. 19 out of 23 patients that received CBT-I. chronic pain conditions. The study was carried out using a com- The study described sleep quality as a parative method involving 23 patients central concern for patients suffering from with an average age of 69 who were treated osteoarthritis and indicated that 60% of Source: Vitiello MV, Rybarczyk B, von Korff M, by CBT-I and 28 patients, with a mean age people suffering from the disease experi- Stepanski EJ: Cognitive behavioral therapy for of 66.5 years, were treated through stress enced sleep disturbance during the night insomnia improves sleep and decreases pain in older management and wellness control group. due to chronic pain. This in turn caused adults with co-morbid insomnia and osteoarthritis. All patients were required to be over 55, prolonged sleep disturbance as the insom- JCSM 5(4), 355–362 (2009). demonstrate insomnia symptoms and nia maintained the feeling of pain. http://www.nacbt.org/whatiscbt.htm have been diagnosed with osteoarthritis. The control group was reported to have no significant improvements. Michael Vitiello, leading author and a professor at the University of Seattle, WA, USA, claims that insomnia and osteo- arthritis are coexisting diseases as opposed to the common perspective that insomnia is a symptom of osteoarthritis. He explained that if you improve sleep, this will have a knock-on-effect and improve osteoarthri- tis. Insomnia, at least in adults, generally does not exist on its own and rather coex- ists with other illnesses and depression. For this reason, if patients are able to improve their sleep this will have a long last effect on their illness. Vitiello added “study after study has shown that the improvement persists for a year or more.” 10.2217/IJR.09.48 © 2009 Future Medicine Int. J. Clin. Rheumatol. (2009) 4(5), 503–505 ISSN 1758-4272 503 Bulletin Board Bulletin Board IRF-8 protein thought to be in brief… Adverse events and factors associated with involved in causing gum disease, toxicity in patients with early rheumatoid arthritis treated with methotrexate tight control therapy (the CAMERA study). osteoporosis and arthritis Verstappen SM, Bakker MF, Heurkens AH et al. Ann. Rheum. Dis. (2009) (Epub ahead of print). Assesses toxicity profiles in rheumatoid arthritis The interferon regulatory factor-8 receptor activator of nuclear factor-kB patients treated with methotrexate (MTX) in (IRF-8) gene has been found to be ligand (RANKL), which is encoded by an intensive or a conventional strategy. The involved in diseases including peri- the Tnfsf11 gene.’ study also looks at factors associated with MTX- odontitis (gum disease), rheumatoid The scientists used microarray tech- related toxicity. Results from a previous study arthritis and osteoporosis. Scientists at nology to identify the downregulation were used where intensive MTX treatment strat- the Hospital for Special Surgery, New of the IRF-8 gene. IRF-8 expression was egy was more advantageous along with new York, USA, collaborating with research- reduced by 75% in the primary stage of data of adverse events compared between ers from other institutions, published osteoclast formation. each treatment group. Factors causing MTX their findings inNature Medicine. The researchers demonstrated this withdrawal or liver toxicity at follow-up were Dr Baohong Zhao, the lead author using IRF-8 deficient mice; when examined with Logistic regression analyses. of the study, explained that the discov- analyzed, the mice were found to The research showed a higher proportion of ery “…doesn’t have immediate thera- have decreased bone mass and severe patients in the intensive group experienced peutic applications, but it does open a osteoporosis. While there was no MTX-related adverse events but in every case new avenue of research that could help decrease in osteoblast numbers, there the effects were milder. Higher BMI and a identify novel therapeutic approaches or was seen to be a significant decrease in correlation with creatinine clearance were interventions to treat diseases’. osteoclast numbers. discovered in MTX withdrawal. An immediate It was demonstrated that by down- Enhanced levels of oesteoclasts were increase in serum liver enzymes was associ- regulating the gene, which codes for also observed in humans when IRF-8 ated with liver toxicity. The study concluded the IRF-8 protein there was an increase mRNA in human osteoclast precursors in favor of intensive treatment strategy when in proliferation of cells called osteo- was silenced. Moreover, in the absence studying toxicity profiles. clasts. Osteoclasts are cells respon- of IRF-8, NFATc1, a protein that inter- Disease activity and damage are not asso- sible for breaking down bone and acts with IRF-8, appeared to lose its ciated with increased levels of fatigue in sys- osteoblasts for the formation of bone. function and no longer be expressed. temic lupus erythematosus patients from a These two types of cell work closely “We hope that the understanding multiethnic cohort: LXVII to remodel and fortify bone tissue. of this gene can contribute to under- Burgos PI, Alarcón GS, McGwin G Jr, Crews KQ, Consequently, if there is an increase standing the regulatory network of Reveille JD, Vilá LM. Arthritis Rheum. 61(9), in osteoclast development, canals and osteoclastogenesis and lead to new 1179–1186 (2009). cavities can form causing diseases therapeutic approaches in the future” Establishes factors relating to enhanced such as periodontitis, osteoporosis and Zhao concluded. fatigue in systemic lupus erythematosus (SLE) rheumatoid arthritis. patients from Lupus in minorities: nature ver- Reserachers demonstrated that IRF-8 Source: Zhao B, Takami M, Yamada A et al.: sus nurture, a longitudinal multiethnic cohort. expression in osteoclast precursors was Interferon regulatory factor-8 regulates bone The study included patients of Hispanic, downregulated during the initial phase metabolism by suppressing osteoclastogenesis. African–American and Caucasian ethnic- of osteoclast differentiation induced by Nat Med. 15(9), 1066–1071 (2009). ity who, when the study began, had an SLE disease duration of less than 5 years and were aged 16 or more. By means of gener- About the Bulletin Board alized estimating equations the association The Bulletin Board highlights some of the most important events and between a variety of different factors and research in the field of rheumatology. characteristics for fatigue were examined. If you have newsworthy information, please contact: A significant majority of the 515 patients Christine Forder, Commissioning Editor, were female with the highest percentage being Puerto Rican–Hispanic and the lowest International Journal of Clinical Rheumatology, Future Medicine Ltd, Hispanic. Variables such as ethnicity, weight Unitec House, 2 Albert Place, London N3 1QB, UK loss, fever, pain levels and abnormal behavior Tel.: +44 (0)20 8371 6090; were found to be associated with increased Fax: +44 (0)20 8343 2313; fatigue. Conversely, disease activity and dam- [email protected] age related to SLE were not. 504 Int. J. Clin. Rheumatol. (2009) 4(5) future science group Bulletin Board Bulletin Board Number of US veterans to develop rheumatoid vasculitis drops significantly Researchers at the University of to determine the prevalence of RV there may have been RV cases that went Wisconsin School of Medicine and in this population (as defined by the undetected owing to changing outpatient Public Health (WI, USA) have discov- International Classification of Diseases). management of the disease. ered that there has been a substantial Over 90% of the patients were men with The treatment for RA improved decline in the prevalence of rheumatoid a mean age of 64.9 years. Commenting throughout the 1990s and researchers vasculitis (RV) in US patients at the on the study, lead author Christie Bartel suggest this as one possible explanation national Veterans Health Administration remarked: “Our study is the first to exam- for the decline in the number of RV cases.