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Childhood arthritis is a disease that occurs in children under the age of 16. It causes pain, stiffness, and swelling in one or more of the joints. This pain, stiffness, and swelling are called inflammation. With childhood arthritis, the inflammation lasts longer than six weeks, and is not caused by an injury or other illness. Childhood arthritis is also called juvenile arthritis.

How common is childhood arthritis? It affects 1 in 1,000 US children under the age of 16.
Both boys and girls are affected by childhood arthritis. Arthritis is not just a disease of old people. In fact, approximately one in 1,000 children under the age of 16 suffers from arthritis. Juvenile arthritis is among the most common chronic childhood disorders.

What causes childhood arthritis?

The exact cause of childhood arthritis is unknown. Childhood arthritis does not usually run in families and cannot be passed from one person to another. The onset of childhood arthritis may follow an infection or injury, but these events do not cause the arthritis.
With childhood arthritis, the body’s immune system stops working properly. The immune system’s job is to fight off germs and disease. However, in a child with childhood arthritis the immune system attacks healthy tissues. What triggers this process is unknown.

What can you do about childhood arthritis? If your child has inflammation, in one or more joints for more than six weeks your doctor may perform a physical examination of your child and order tests, such as x-rays and blood tests to find out what is causing the inflammation. There is not just one single symptom, sign, or test that will give a diagnosis of childhood arthritis.

If your doctor thinks your child has childhood arthritis, he or she will usually refer your child to a rheumatologist (pronounced room-a-tol-o-jist). A rheumatologist is a doctor who has received special training in the diagnosis and treatment of problems involving inflammation of the joints, muscles and other parts of the body.

1Nutrition Physiology and Human Nutrition Unit, Institute of Food Science, Centre of Applied Chemistry, University of Hannover, Hannover, Germany.

Objective: Low antioxidant intake and status have been shown to be associated with an elevated risk for various diseases. Data on the status of antioxidant vitamins, selenium and coenzyme Q10 of younger female seniors are scarce. The aim of this study was to assess the status of these antioxidants, as well as influencing factors such as dietary intake, anthropometric data and educational level in female seniors (60-70 years) in Germany.

Design: Dietary intake of alpha-tocopherol, beta-carotene and ascorbic acid was determined by a 3-day diet record. Serum concentrations of alpha-tocopherol, beta-carotene, ascorbic acid, selenium and coenzyme Q10 were measured.

Anthropometric measures, socioeconomic and educational status were assessed.Setting:In total, 178 elderly women without severe diseases in the region of Hannover, Germany, were included in the study. The mean (+/-s.d.) age and BMI of the women was 63.2 (2.73) years and 25.6 (3.77) kg/m(2), respectively. The study participants were generally better educated than the overall German female population.

Results: Dietary intake of the ascorbic acid and alpha-tocopherol was below RDA in six and 75% of the women, respectively.

In comparison to estimated desirable serum concentrations of alpha-tocopherol, ascorbic acid, beta-carotene and selenium, lower concentrations were found in 23, 1, 6, and 39% of the women, respectively. Ascorbic acid (r=0.205, P=0.009) and beta-carotene (r=0.173, P=0.025) intake were significantly associated with serum concentrations. Beta-carotene concentrations were influenced by the type of diet, BMI, and school education (R (2)=0.128, P<0.001). Serum selenium was positively associated with alcohol intake (r=0.229, P=0.003).

Neither employment nor vocational training was predictive for the serum concentrations of antioxidant vitamins, selenium or coenzyme Q10.

Conclusions: Poor status of selenium and alpha-tocopherol is highly prevalent even among younger, well-educated female seniors, whereas ascorbic acid and beta-carotene status seems sufficient in most women.

Researchers from The University of Manchester’s Medical School have discovered that eating more brightly-coloured fruits and vegetables like oranges, carrots and sweetcorn may help reduce the risk of developing inflammatory disorders like rheumatoid arthritis.

Rheumatoid arthritis currently affects around 1% adults in the UK. Previous studies have suggested that vitamin C and the pigment beta-cryptoxanthin, both of which are found in brightly-coloured fruit and veg, may act as antioxidants, and protect the body against the oxidative damage which can cause inflammation.

The Manchester team, based in the Arthritis Research Campaign’s Epidemiology Unit, worked with researchers from the Institute of Public Health at the University of Cambridge to analyse health questionnaires and diet diaries by over 25000 45-74 year-olds; completed as part of the EPIC (European Prospective Investigation of Cancer) Norfolk study of diet and chronic disease in the 1990s. They then followed-up the participants over a nine year period to identify new cases of inflammatory polyarthritis (IP), including rheumatoid arthritis.

Dr Dorothy Pattison, who led the research, said: “We found that the average daily beta-cryptoxanthin intake of the 88 patients who had developed inflammatory polyarthritis was 40% lower than those who hadn’t, and their intake of another carotenoid, zeaxanthin, was 20% lower.

“Those in the top third for beta-cryptoxanthin intake were only half as likely to develop IP as those in the lowest third, and vitamin C was also found to be an important factor.”

The findings appear to confirm previous evidence that a modest increase in fruit and vegetables containing beta-cryptoxanthin and vitamin C, equivalent to one glass of freshly-squeezed orange juice each day, might help to protect against developing inflammatory joint diseases.

Dr Pattison has previously published research which found that both low intakes of fruit and vegetables (in particular those high in vitamin C), and high levels of red meat consumption were associated with an increased risk of developing IP.

A full paper on the findings of the research appears in the August issue of The American Journal of Clinical Nutrition (http://www.ajcn.org/current.shtml).

The EPIC Norfolk study is funded by the Medical Research Council, Cancer Research UK and the British Heart Foundation.

The University of Manchester (www.manchester.ac.uk) was formed by the merger of The Victoria University of Manchester and UMIST in October 2004, and with 36 000 students expected in the coming academic year is the largest higher education institution in the country. Its Faculty of Medical & Human Sciences (www.mhs.manchester.ac.uk) is one of the largest faculties of clinical and health sciences in Europe, with a research income of over £37 million.

The School of Medicine (www.medicine.manchester.ac.uk) is the largest of the Faculty’s five Schools, with 1300 staff, almost 2000 undergraduates and a £32M research income. The School encompasses five teaching hospitals, and is closely linked to a range of general hospitals and community practices across the North West of England.

For further information please contact:

Jo Nightingale on 0161 275 8156/joanne.nightingale@manchester.ac.uk,
or Mikaela Sitford on 0161 275 2111/mikaela.sitford@manchester.ac.uk.
The Arthritis Research Campaign (arc) is the fourth largest medical research charity in the UK, funding research totalling £20 million annually. For more information please contact arc press officer Jane Tadman on 01246 541107 or visit www.arc.org.uk.

The University of Cambridge’s (www.cam.ac.uk) reputation for outstanding academic achievement is known worldwide and reflects the intellectual achievement of its students as well as the world-class original research carried out by the staff of the University and the Colleges.

As Cambridge approaches its 800th anniversary in 2009, it continues to change in response to the challenges it faces. The modern University is an international centre of teaching and research in a vast range of subjects: about half of the students study science or technology. Members of the University have won over 80 Nobel Prizes.

Plump, juicy Bing cherries, eaten fresh, may help people who suffer from the pain of gout or other forms of arthritic inflammation. That’s according to preliminary results from research at the Agricultural Research Service’s Western Human Nutrition Research Center in Davis, Calif.

The 10 healthy women, aged 22 to 40, who volunteered for the first phase of this research ate a special breakfast of 45 fresh, pitted Bing cherries.

ARS chemists Robert A. Jacob (now retired) and Darshan S. Kelley collaborated with university scientists in that preliminary study and, recently, in a more extensive follow-up investigation.

The experiments are among the first to track anti-inflammatory effects of fresh Bing cherries in carefully controlled tests with healthy volunteers. That’s in contrast to previous studies, conducted elsewhere, in which scientists analyzed extracts from sweet or tart cherries in the laboratory.

Jacob and Kelley found that levels of uric acid–a compound the body uses to form painful urate crystals during a gout attack–decreased significantly in volunteers’ blood (plasma) over the 5 hours after they ate the Bing-cherry breakfast.

And, levels of urate removed from their bodies in urine increased over those 5 hours.

The decrease in two key markers, or indicators, of inflammation–nitric oxide and C reactive protein–weren’t large enough to be statistically significant. However, this downward trend agreed with that noted earlier in other scientists’ test-tube studies of cherry extracts.

The cherry-breakfast study, reported last year in the Journal of Nutrition, paved the way for the California scientists’ longer, follow-up study of more markers in samples from more volunteers–18 women and two men, aged 22 to 40, who ate a total of 45 cherries throughout the day for several weeks.

Findings from this newer investigation should be available later this year. Read more about the research in Agricultural Research magazine.

Research could lead to future treatment advancements for rheumatoid arthritis and other autoimmune diseases

SAN DIEGO – (September 12, 2005) A major finding by researchers at the La Jolla Institute for Allergy & Immunology (LIAI) has identified a previously unknown cellular mechanism that acts as an off switch for immune system function. The discovery could lead to the future development of new treatments for autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and Crohn’s disease.

In autoimmune diseases, the immune system, which normally wards off invading viruses and bacteria, instead mistakenly attacks normal body tissues, leading to illness. “By understanding this cellular process for turning off immune system activity, we are hopeful this will lead to new treatments that will stop unwanted immune responses, such as those which occur in autoimmune diseases,” said LIAI scientist Carl Ware, Ph.D., who co-led the study with LIAI researcher Chris Benedict, Ph.D. The research team also involved scientists from Rush Medical Center and Northwestern University in Chicago and Washington University in St. Louis.

The findings will be published September 13 in the Proceedings of the National Academy of Sciences (PNAS) in a paper entitled, “Evolutionarily Divergent Herpesviruses Modulate T cell activation by Targeting the Herpesvirus Entry Mediator (HVEM) Cosignaling Pathway.”

Jennifer Gommerman, Ph.D., and Tania Watts, Ph.D., of the University of Toronto’s Department of Immunology, who co-wrote a PNAS commentary on the paper scheduled for online publication this week, called the findings a significant advancement. “This discovery underscores the importance of this pathway in immune regulation and advances our knowledge of how to develop effective treatments for certain illnesses.”

In the study, the team of scientists looked at two members of the herpes family of viruses, cytomegalovirus and herpes simplex virus, because of their ability to lay dormant in the immune system without causing disease. “These viruses teach us how to manipulate the immune system,” Dr. Ware said. “We found that these two very different viruses were attacking the same communication pathway in the immune system.” By disrupting that pathway, the viruses were keeping T lymphocytes - which are white blood cells that fight disease - from communicating with other cells in the immune system. “It’s kind of like jamming a phone system,” Dr. Ware explained. “If communication gets cut off, messages won’t get through and nothing is going to get done.”

Central in the viruses’ ability to manipulate immune system communication was a cellular protein called the Herpesvirus Entry Mediator (HVEM), which the scientists found effectively worked as an “off and on switch” for immune responses. Several cellular proteins — members of the tumor necrosis factor (TNF) family — interact with HVEM to enable this immune system communication switch. HVEM is part of a larger TNF family of molecules involved in a wide variety of important immune system functions. The finding is the latest from Dr. Ware’s laboratory involving TNF receptors, which he has been studying for more than 20 years. Drugs targeted at the TNF family are prominent treatments against some autoimmune diseases, including rheumatoid arthritis, psoriasis and Crohn’s disease.

Mitchell Kronenberg, Ph.D., LIAI President and Scientific Director, said the team’s findings are regarded as very exciting by the scientific community. “This research could one day lead to the development of drugs that mimic the action of HVEM,” he said. “That could give medical science a new method for reducing or even stopping the inflammation associated with rheumatoid arthritis and other autoimmune diseases.”

The findings also have implications beyond autoimmune disease, including possible application in treatments for infectious diseases and cancer. “An important part of our findings is that HVEM can not only switch off immune system response but it can also switch it on,” Dr. Ware said. “This may be valuable in fighting infectious disease, where the body needs a stronger immune response. It also could aid in prompting immune cells to attack cancerous cells.”

In addition to Ware and Benedict, other researchers participating in the study from the La Jolla Institute for Allergy & Immunology were Timothy Cheung, Ian Humphreys, Karen Potter, Paula Norris, Heather Shumway, Bonnie Tran, Ginelle Patterson, Rochelle Jean-Jacques and Miri Yoon. In Chicago, researchers participating were Patricia Spear from Northwestern University and Nell Lurain from Rush Medical Center, and in St. Louis, Kenneth Murphy from Washington University. The research was supported in part by grants from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Pomegranate fruit extracts can block enzymes that contribute to osteoarthritis according to a Case Western Reserve University School of Medicine study published in the September 2005 issue of the Journal of Nutrition.

The study looked at the ability of an extract of pomegranate fruit against Interleukin-1b (IL-1b), a pro-inflammatory protein molecule that plays a key role in cartilage degradation in osteoarthritis. Current treatments for osteoarthritis – which affects 20 million people nationwide, according to the National Institutes of Health – offer limited effectiveness and do little to slow joint destruction and disease progression.

“This has generated considerable interest in the identification and development of new approaches and reagents to treat and inhibit, if not abolish, the progress of the disease,” said Tariq M. Haqqi, Ph.D., professor of medicine at Case.

“Arthritis is one of the foremost diseases for which patients seek herbal or traditional medicine treatments. However, all the extracts and herbs have not yet been scientifically evaluated for their efficacy and safety. Indeed, some of them may even interfere with the current treatments,” Haqqi said. “Therefore, careful use of supplements and herbal medicines during early stages of disease or treatment may be made to limit the disease progression.”

Plant-based flavonoids found in fruits, leaves and vegetables have attracted a lot of attention for their beneficial health effects in various diseases. Pomegranate, in particular, has been found to possess antioxidant and anti-inflammatory properties that have potential therapeutic benefits in a variety of diseases. The Case study demonstrated for the first time the ability of pomegranate fruit extracts to slow the deterioration of human cartilage.

“It has been revered through the ages for its medicinal properties,” said Haqqi. “Studies in animal models of cancer suggest that pomegranate fruit extract consumption may be anticarcinogenic, whereas studies in mice and humans indicate that it may also have a potential therapeutic and chemopreventive adjuvant effect in cardiovascular disorders.”

A bonus with the native Persian fruit is that its antioxidant constituents are rapidly absorbed by the body and are non-toxic. Using tissue samples of human cartilage affected by osteoarthritis, researchers added a water extract of pomegranate fruit to the culture using a well-established in vitro model. The findings showed a new activity for pomegranate fruit extract – namely cartilage protection – in addition to its previously discovered antioxidant and anti-inflammatory properties.

The IL-1b protein molecules create an overproduction of inflammatory molecules including matrix metalloproteases (MMP), which are tightly regulated enzymes necessary for tissue remodeling. When overproduced in a disease state, such as osteoarthritis, they degrade the cartilage resulting in joint damage and destruction.

The Case study results indicate that pomegranate fruit extracts inhibit the overproduction of MMP enzymes in human cartilage cells. “This suggests that consumption of pomegranate fruit extract may help in protecting cartilage from the effects of IL-1b by suppressing cartilage degradation in OA,” Haqqi said.

More studies are needed to determine the absorption rate of pomegranate fruit extracts in the joints. Future plans include animal model studies in osteoarthritis to determine whether the fruit extract promotes cartilage repair, and whether it can also be effective in treating rheumatoid arthritis.

Origin BioMedicinals Inc. announced today that it has received US FDA registration for its pain relief product Neuragen® PN. Neuragen® PN is a homeopathic blend of its popular Canadian product – Neuragen® RL. Neuragen® PN consists of a proprietary blend of botanical essential oil compounds, which was developed by two large US chronic pain centers in the early 1990’s.

Origin BioMedicinals’ product is used today by health practitioners for the treatment of diabetic peripheral neuropathy, post-shingles pain, fibromyalgia, spinal compression pain and other chronic nerve pain. Neuragen® is a topical oil that can be used only as needed for these painful conditions, providing greater ease of use and less side effects than prescription drugs. Neuragen® PN now contains St. John’s Wort (Hypericum) as a homeopathic ingredient for added effectiveness.

Two previous trials were conducted for Neuragen®. The first trial was for diabetic peripheral neuropathy, where 70% of 29 patients noted improvement in pain, usually within minutes of applying Neuragen® topically. Of these, most patients noted a remarkable 50-100% improvement in pain. Efficacy was measured by reduction in pain intensity over the first six hours.

This rate of efficacy is comparable or better than the prescribed pharmaceutical drugs for neuropathic pain, but without any side effects. Reported quality of life benefits during the study also included improved joint flexibility, decreased cramping and improved balance, as well as improvement in sleep, work ability, social life, energy and less depression. A second multi-center trial for post-shingles pain, similar results were reported where 68% of 30 patients experienced substantial pain relief ranging from 2-10 hours, and occurring within 5-15 minutes.

HALIFAX, Nova Scotia, Canada (September 7, 2005) – Origin BioMedicinals Inc. announced today that it has received US FDA registration for its pain relief product NEURAGEN® PN. NEURAGEN® PN is a homeopathic blend of its popular Canadian product – NEURAGEN® RL. Neuragen® PN consists of a proprietary blend of botanical essential oil compounds, which was developed by two large US chronic pain centers in the early 1990’s.

Origin BioMedicinals’ product is used today by health practitioners for the treatment of diabetic peripheral neuropathy, post-shingles pain, fibromyalgia, spinal compression pain and other chronic nerve pain. NEURAGEN® is a topical oil that can be used only as needed for these painful conditions, providing greater ease of use and less side effects than prescription drugs. NEURAGEN® PN now contains St. John’s Wort (Hypericum) as a homeopathic ingredient for added effectiveness.

Two previous trials were conducted for NEURAGEN®. The first trial was for diabetic peripheral neuropathy, where 70% of 29 patients noted improvement in pain, usually within minutes of applying NEURAGEN® topically. Of these, most patients noted a remarkable 50-100% improvement in pain. Efficacy was measured by reduction in pain intensity over the first six hours.

This rate of efficacy is comparable or better than the prescribed pharmaceutical drugs for neuropathic pain, but without any side effects. Reported quality of life benefits during the study also included improved joint flexibility, decreased cramping and improved balance, as well as improvement in sleep, work ability, social life, energy and less depression. A second multi-center trial for post-shingles pain, similar results were reported where 68% of 30 patients experienced substantial pain relief ranging from 2-10 hours, and occurring within 5-15 minutes.

People who exercise regularly experience 25% less muscle and joint pain in their old age than people who are less active. Research published in Arthritis Research & Therapy reveals that people who regularly participate in brisk aerobic exercise, such as running, experience less pain than non-runners even though they are more likely to suffer from pain from injuries.

Bonnie Bruce and colleagues from Stanford University, USA, compared the level of pain in a group of runners and a group of community-based individuals who acted as controls. Participants were followed for 14 years, and were on average in their mid-sixties when the study started. Each year, they completed a questionnaire about their health status, exercise habits and history of injuries. In total, the study included 866 subjects: 492 Runners’ Association members and 374 controls.

Bruce et al.’s results show that the greater majority of physically active participants did, on average, between 355 and 2,119 minutes of exercise per week over the course of the study, while controls exercised significantly less. After adjusting for confounding factors such as gender, age, weight and health status the results show that pain increased in both groups over time. But members of the Runners’ Association experienced 25% less musculoskeletal pain than controls. This reduction persisted throughout the study period, until the subjects reached an age of 62 to 76 years.

“Exercise was associated with a substantial and significant reduction in pain even […] despite the fact that fractures, a significant predictor of pain, were slightly more common among runners”, conclude the authors.

A randomized, double-blind, placebo-controlled study assessing chromium picolinate supplementation in 113 people with atypical depression found that a subset of patients who reported the highest levels of carbohydrate cravings demonstrated significantly greater reductions than the placebo group on four items on the Hamilton Depression Rating Scale (HAM-D-29): carbohydrate craving, appetite increase, increased eating, and diurnal variation of feeling (mood variation throughout the day).

The study, published today in the Journal of Psychiatric Practice, found that 65 percent of the chromium picolinate patients with high carbohydrate craving versus 33 percent of those receiving placebo had significantly greater improvements on total HAM-D-29 scores (p < 0.05). HAM-D-29 is a standard tool commonly used in assessing severity of symptoms in depressed patients.

Carbohydrate cravings, weight gain and unexplained fatigue are characteristic symptoms of atypical depression, a common but frequently undiagnosed depressive disorder affecting up to 42 percent of the 19 million Americans diagnosed with depression. “These results suggest that the use of chromium picolinate may be beneficial for patients with atypical depression who also have severe carbohydrate craving,” said the study’s lead investigator, John P. Docherty, M.D., president and CEO of Comprehensive NeuroScience Inc, and adjunct professor of psychiatry at Weill Medical College of Cornell University. “For years, the link between depression, insulin sensitivity, and the value of dietary chromium picolinate has been hinted at in small studies and this trial may bring us closer to understanding the connection.”

Study Design The study, “A Double-Blind, Placebo-Controlled, Exploratory Trial of Chromium Picolinate in Atypical Depression: Effect of Carbohydrate Craving” was an 8 week, multi-center trial of 113 randomized adult outpatients with atypical depression. Patients ranged from age 18-65 years of age.

The 110 patients constituting the intent-to-treat (ITT) population received 600 mcg/day of elemental chromium, as Chromax? chromium picolinate (n = 70) or placebo (n = 40).

This ITT group was defined as patients who received at least one dose of study medication and completed at least one study evaluation, while the evaluable population was the subset of 75 patients (n=50 chromium picolinate and 25 placebo) who took at least 80 percent of the study product with no significant protocol deviations. Primary efficacy measures were the 29-item Hamilton Depression Rating Scale and the Clinical Global Impressions Improvement Scale (CGI-I). Nutrition 21 (NASDAQ: NXXI) supplied Chromax chromium picolinate for the clinical trial.

Investigators found no significant difference between the chromium picolinate and placebo groups on overall improvement on the primary efficacy measures (both the placebo and treatment groups significantly improved from baseline). However, the chromium picolinate group in the evaluable populations showed significantly greater improvements in four HAM-D-29 items: carbohydrate craving, appetite increase, increased eating, and diurnal variation of feeling. In addition, the chromium picolinate group reporting the highest levels of carbohydrate craving showed significantly greater improvements than the placebo group on overall HAM-D-29 scores. These results held true for both the ITT group (65% chromium picolinate versus 33% placebo) and the evaluable group (80% chromium picolinate versus 38% placebo).

The high carbohydrate cravers in the ITT population treated with chromium picolinate also showed significant improvement compared with placebo on three of the same HAM-D-29 items: carbohydrate craving, appetite increase and increased eating. Chromium picolinate was well tolerated throughout the study and treatment-associated adverse events were minimal and not statistically or clinically different from those seen in the placebo group.

“These findings also suggest that physicians and mental health professionals should be alert to patients who report carbohydrate craving as it may signal the possible presence of a more serious underlying medical condition, such as atypical depression,” Dr. Docherty said. “The use of antidepressants, mood stabilizers, and antipsychotics that are commonly prescribed to treat depression can often worsen carbohydrate cravings. A treatment that effectively reduces carbohydrate cravings and has a favorable tolerability and side-effect profile would be a very useful contribution to improve overall health outcomes.”

Chromium is an essential trace mineral whose main function is to work with insulin to metabolize carbohydrates, fats and proteins. When chromium is bound to picolinic acid to create chromium picolinate, absorption in the body is significantly improved. Recently the U.S. Food and Drug Administration recognized chromium picolinate as a safe nutritional supplement.