nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Thursday, May 27, 2010

Study On Rheumatoid Arthritis Rising In Women, Causes Unclear

This is an interesting study and a classic for looking beyond the headlines.

Warning:  this is an article for Onion Peelers, who like to peel back the layers of what the media tells us about medical research.

The Mayo Clinic released a summary of their recent work on rheumatoid arthritis (RA).  Here's how the press puts together the results.  From the BBC (May 26):
Rhematoid arthritis 'on the rise in women.' Researchers from the Mayo Clinic in Minnesota say rheumatoid arthritis cases rose 2.5% between 1995 and 2007, after 40 years of decline, but fell among men in the same 12-year period.
No here's how the Mayo Clinic described their results (The Medical News, May 27),  from lead author Dr. Sherine Gabriel:
"We observed a modest increase of RA incidence in women during the study period, which followed a sharp decline in incidence during the previous 4 decades," said Dr. Gabriel. Results show that RA incidence in women increased by 2.5% per year from 1995 to 2007, while a decrease of 0.5% was noted for men. ... The overall age- and sex-adjusted prevalence of RA increased from 0.62% in 1995 to 0.72% in 2005.
First observation:  for those who feel stiff in the morning, "rheumatoid" arthritis is not "degenerative" arthritis, which is what almost all of us have.

Arthritis of the rheumatoid kind is a more serious problem, and one of the auto-immune diseases, where our own bodies begin to attack our this case, our joints.  As you can tell from the above, 62 cases per 10,000 makes it a very uncommon disease.

The decrease in men over 10 years is pretty minimal since a lot fewer men get it in the first place:  RA is more common in women by about a 3 to 1 ratio.  Note that the media tried to make the contrast in rates a more serious phenomenon than it is.

So why would the number of cases increase over the ten year period in women, when it was on the decline before?  The most likely culprits are "external."  That is, (1) environmental changes, (2) behavioral changes, or (3) chronically used drugs.

There's absolutely no data at this point to tell us the answer, but my bet is on hormonal replacement.  Environmental factors like air, food, water, and toxic exposures are all going to be hard to separate out.  Behavioral changes:  well, we know smokers are at higher risk for RA.  But smoking has been declining, more slowly in women than in men, but it's still going down.  That leaves drugs.

By coincidence, this reversal in RA cases began about the time the amount of estrogen in  hormone replacement pills was lowered.  At this point, it's all speculation, but this is where I would put my money if I had to bet.

The lesson we learn every day in medicine (both as patients and as doctors) is treatments are never completely benign, there are always consequences, side effects, and balancing influences to consider.

Doc D

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