Jonathan Gardner

Women with early-stage breast cancer have higher levels of vitamin D and lower levels of parathyroid hormone in their bloodstream than women with advanced or metastatic breast cancer, according to an observational study published in the Journal of Clinical Pathology.

Past epidemiologic studies have suggested a link between higher vitamin D levels through exposure to sunlight and reduced prevalence of breast cancer. Previous research also has demonstrated that vitamin D levels are higher in healthy women, compared with those with primary breast cancer, and levels decrease with progression of bone metastases.

In the current study, researchers prospectively evaluated 279 white women with invasive breast cancer, including 204 with early-stage cancer and 75 with locally advanced or metastatic disease.

The investigators found significantly higher levels of 25 hydroxyvitamin D in the blood serum of women with early-stage breast cancer. The mean vitamin D level was 57 nmol/L in those women, compared with 46 nmol/L in the women with advanced breast cancer.

Parathyroid hormone levels also were significantly lower in the women with early-stage breast cancer: 3.91 pmol/L, compared with 5.06 pmol/L in the women with advanced or metastatic breast cancer.

The researchers, led by Dr. Carlo Palmieri of Imperial College in London, wrote that the study does not determine whether the reduced vitamin D levels helped contribute to advanced cancer or whether it is a consequence of “reduced dietary intake or altered synthesis in the skin due to reduced sun exposure” in those patients with more advanced disease.

“In summary, these findings lend support to the hypothesis that vitamin D has a role in the pathogenesis and progression of breast cancer,” the authors said (J. Clin. Pathol. 2006 Oct. 17 [Epub doi: 10.1136/jcp.2006.042747]).

Animal studies have shown that vitamin D can inhibit growth of breast cancer cell lines and development of carcinogen-induced mammary tumors, as well as by promotion of apoptosis, although the exact mechanisms are not clear, they noted.

Women with early-stage breast cancer have higher levels of vitamin D and lower levels of parathyroid hormone in their bloodstream than women with advanced or metastatic breast cancer, according to an observational study published in the Journal of Clinical Pathology.

Past epidemiologic studies have suggested a link between higher vitamin D levels through exposure to sunlight and reduced prevalence of breast cancer. Previous research also has demonstrated that vitamin D levels are higher in healthy women, compared with those with primary breast cancer, and levels decrease with progression of bone metastases.

In the current study, researchers prospectively evaluated 279 white women with invasive breast cancer, including 204 with early-stage cancer and 75 with locally advanced or metastatic disease.

The investigators found significantly higher levels of 25 hydroxyvitamin D in the blood serum of women with early-stage breast cancer. The mean vitamin D level was 57 nmol/L in those women, compared with 46 nmol/L in the women with advanced breast cancer.

Parathyroid hormone levels also were significantly lower in the women with early-stage breast cancer: 3.91 pmol/L, compared with 5.06 pmol/L in the women with advanced or metastatic breast cancer.

The researchers, led by Dr. Carlo Palmieri of Imperial College in London, wrote that the study does not determine whether the reduced vitamin D levels helped contribute to advanced cancer or whether it is a consequence of “reduced dietary intake or altered synthesis in the skin due to reduced sun exposure” in those patients with more advanced disease.

“In summary, these findings lend support to the hypothesis that vitamin D has a role in the pathogenesis and progression of breast cancer,” the authors said (J. Clin. Pathol. 2006 Oct. 17 [Epub doi: 10.1136/jcp.2006.042747]).

Animal studies have shown that vitamin D can inhibit growth of breast cancer cell lines and development of carcinogen-induced mammary tumors, as well as by promotion of apoptosis, although the exact mechanisms are not clear, they noted.

Women with early-stage breast cancer have higher levels of vitamin D and lower levels of parathyroid hormone in their bloodstream than women with advanced or metastatic breast cancer, according to an observational study published in the Journal of Clinical Pathology.

Past epidemiologic studies have suggested a link between higher vitamin D levels through exposure to sunlight and reduced prevalence of breast cancer. Previous research also has demonstrated that vitamin D levels are higher in healthy women, compared with those with primary breast cancer, and levels decrease with progression of bone metastases.

In the current study, researchers prospectively evaluated 279 white women with invasive breast cancer, including 204 with early-stage cancer and 75 with locally advanced or metastatic disease.

The investigators found significantly higher levels of 25 hydroxyvitamin D in the blood serum of women with early-stage breast cancer. The mean vitamin D level was 57 nmol/L in those women, compared with 46 nmol/L in the women with advanced breast cancer.

Parathyroid hormone levels also were significantly lower in the women with early-stage breast cancer: 3.91 pmol/L, compared with 5.06 pmol/L in the women with advanced or metastatic breast cancer.

The researchers, led by Dr. Carlo Palmieri of Imperial College in London, wrote that the study does not determine whether the reduced vitamin D levels helped contribute to advanced cancer or whether it is a consequence of “reduced dietary intake or altered synthesis in the skin due to reduced sun exposure” in those patients with more advanced disease.

“In summary, these findings lend support to the hypothesis that vitamin D has a role in the pathogenesis and progression of breast cancer,” the authors said (J. Clin. Pathol. 2006 Oct. 17 [Epub doi: 10.1136/jcp.2006.042747]).

Animal studies have shown that vitamin D can inhibit growth of breast cancer cell lines and development of carcinogen-induced mammary tumors, as well as by promotion of apoptosis, although the exact mechanisms are not clear, they noted.

Drug and lifestyle interventions reduce the risk of type 2 diabetes among patients with impaired glucose tolerance, and advice on diet and exercise is at least as effective as prescribing medication, Clare L. Gillies and associates reported.

The meta-analysis of 17 randomized controlled trials involving more than 8,000 patients with impaired glucose tolerance showed that pharmacologic and lifestyle (diet and exercise) interventions reduced the risk of progression to diabetes. Pooled hazard ratios were 0.44 for treatment with the antiobesity drug orlistat vs. placebo, 0.51 for lifestyle intervention vs. no intervention, and 0.70 for oral diabetes drugs vs. placebo.

“The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in the prevalence and incidence of type 2 diabetes,” wrote Ms. Gillies, a medical statistician at the University of Leicester (England), and colleagues. “Lifestyle interventions, which aim to reduce obesity and increase physical activity, help to directly address these risk factors.”

In the control arms of the studies, the cumulative incidence of diabetes over 5 years was 37.1%. Based on the risk reduction in the intervention groups, the absolute reduction in diabetes incidence was 18.4 percentage points with orlistat, 15.8 percentage points with lifestyle intervention, and 9.3 percentage points with oral diabetes drugs (BMJ 2007 Jan. 19 [Epub doi:10.1136/bmj.39063.689375.55]).

The number of patients needed to treat to avert or delay one case of diabetes was 5.4 for orlistat, 6.4 for lifestyle, and 10.8 for oral diabetes drugs.

The researchers acknowledged that the results for lifestyle interventions were affected by the baseline body mass index of patients in the trials. For every one unit of mean body mass index of the trial participants, the hazard ratio dropped by 7.3%, which increased the effective risk reduction of the intervention.

Adverse events ranged from 1.2% to 91% in the 10 studies that included pharmaceutical interventions, the researchers wrote.

“For pharmacological interventions, adverse effects need to be fully understood to enable potential harms and benefits to be assessed,” they wrote. “Also should what is fundamentally a lifestyle issue really be treated with a lifelong course of medication? As compliance is the key to the success of lifestyle interventions, strategies to assist compliance need to be carefully thought through and implemented.”

Drug and lifestyle interventions reduce the risk of type 2 diabetes among patients with impaired glucose tolerance, and advice on diet and exercise is at least as effective as prescribing medication, Clare L. Gillies and associates reported.

The meta-analysis of 17 randomized controlled trials involving more than 8,000 patients with impaired glucose tolerance showed that pharmacologic and lifestyle (diet and exercise) interventions reduced the risk of progression to diabetes. Pooled hazard ratios were 0.44 for treatment with the antiobesity drug orlistat vs. placebo, 0.51 for lifestyle intervention vs. no intervention, and 0.70 for oral diabetes drugs vs. placebo.

“The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in the prevalence and incidence of type 2 diabetes,” wrote Ms. Gillies, a medical statistician at the University of Leicester (England), and colleagues. “Lifestyle interventions, which aim to reduce obesity and increase physical activity, help to directly address these risk factors.”

In the control arms of the studies, the cumulative incidence of diabetes over 5 years was 37.1%. Based on the risk reduction in the intervention groups, the absolute reduction in diabetes incidence was 18.4 percentage points with orlistat, 15.8 percentage points with lifestyle intervention, and 9.3 percentage points with oral diabetes drugs (BMJ 2007 Jan. 19 [Epub doi:10.1136/bmj.39063.689375.55]).

The number of patients needed to treat to avert or delay one case of diabetes was 5.4 for orlistat, 6.4 for lifestyle, and 10.8 for oral diabetes drugs.

The researchers acknowledged that the results for lifestyle interventions were affected by the baseline body mass index of patients in the trials. For every one unit of mean body mass index of the trial participants, the hazard ratio dropped by 7.3%, which increased the effective risk reduction of the intervention.

Adverse events ranged from 1.2% to 91% in the 10 studies that included pharmaceutical interventions, the researchers wrote.

“For pharmacological interventions, adverse effects need to be fully understood to enable potential harms and benefits to be assessed,” they wrote. “Also should what is fundamentally a lifestyle issue really be treated with a lifelong course of medication? As compliance is the key to the success of lifestyle interventions, strategies to assist compliance need to be carefully thought through and implemented.”

Drug and lifestyle interventions reduce the risk of type 2 diabetes among patients with impaired glucose tolerance, and advice on diet and exercise is at least as effective as prescribing medication, Clare L. Gillies and associates reported.

The meta-analysis of 17 randomized controlled trials involving more than 8,000 patients with impaired glucose tolerance showed that pharmacologic and lifestyle (diet and exercise) interventions reduced the risk of progression to diabetes. Pooled hazard ratios were 0.44 for treatment with the antiobesity drug orlistat vs. placebo, 0.51 for lifestyle intervention vs. no intervention, and 0.70 for oral diabetes drugs vs. placebo.

“The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in the prevalence and incidence of type 2 diabetes,” wrote Ms. Gillies, a medical statistician at the University of Leicester (England), and colleagues. “Lifestyle interventions, which aim to reduce obesity and increase physical activity, help to directly address these risk factors.”

In the control arms of the studies, the cumulative incidence of diabetes over 5 years was 37.1%. Based on the risk reduction in the intervention groups, the absolute reduction in diabetes incidence was 18.4 percentage points with orlistat, 15.8 percentage points with lifestyle intervention, and 9.3 percentage points with oral diabetes drugs (BMJ 2007 Jan. 19 [Epub doi:10.1136/bmj.39063.689375.55]).

The number of patients needed to treat to avert or delay one case of diabetes was 5.4 for orlistat, 6.4 for lifestyle, and 10.8 for oral diabetes drugs.

The researchers acknowledged that the results for lifestyle interventions were affected by the baseline body mass index of patients in the trials. For every one unit of mean body mass index of the trial participants, the hazard ratio dropped by 7.3%, which increased the effective risk reduction of the intervention.

Adverse events ranged from 1.2% to 91% in the 10 studies that included pharmaceutical interventions, the researchers wrote.

“For pharmacological interventions, adverse effects need to be fully understood to enable potential harms and benefits to be assessed,” they wrote. “Also should what is fundamentally a lifestyle issue really be treated with a lifelong course of medication? As compliance is the key to the success of lifestyle interventions, strategies to assist compliance need to be carefully thought through and implemented.”

High doses of fish oil supplements in pregnant women improved eye and hand coordination in their babies at age 21/2 years, according to a randomized controlled trial published Dec. 21.

Researchers said their trial (Arch. Dis. Child. Fetal Neonatal Ed. 2006 Dec. 21 [Epub doi 10.1136/adc.2006.099085)] is the first to show improvements in eye-hand coordination with fish oil supplements, and said the results suggest that research into the beneficial effects of fish oil supplementation during pregnancy may require higher dosages.

“These preliminary data indicate that supplementation with a relatively high-dose fish oil during the last 20 weeks of pregnancy is not only safe but also seems to have potential beneficial effects that need to be explored further,” wrote the researchers, led by Jan Dunstan, research fellow with the University of Western Australia's school of pediatrics and child health. “Given the scarcity of data to support the efficacy of fish oil supplementation during pregnancy, our data have a potentially important role in informing on the effects of fish oil supplementation on early postnatal infant development.”

The researchers randomized 52 pregnant women into a group supplementing their diets with 2.2 g of docosahexaenoic acid (DHA) and 1.1 g eicosapentaenoic acid (EPA) per day. A control group of 46 received olive oil supplements. Women were excluded from the study if their normal diet exceeded two meals of fish per week.

The researchers measured phospholipids in the red blood cells of the cord blood of the babies, and conducted tests measuring the babies' development at 21/2 years.

Of the 72 babies that made it to the follow-up at 21/2 years, all of the babies in the intervention group had significantly elevated DHA and EPA levels and significantly lower levels of arachidonic acid in their cord blood, compared with the control babies.

At 21/2 years (mean age of 34.7 months), researchers could not identify significantly higher scores for the 33 babies in the fish oil group in growth, development, receptive language, and behavior, except for the eye and hand subscale of the Griffiths Mental Development Scales. On the eye and hand subscale, the intervention group's mean score was 114, compared with 108 for the control group.

“Although the underlying mechanism is not understood, DHA is known to facilitate rapid phototransduction in the retinal membrane, and deficiencies are associated with reduced retinal function in infant primates,” the researchers write. “Furthermore, effects on visual evoked potential could indicate that DHA may also have an effect on the development of the visual cortex.”

The researchers said the small size of their sample is a weakness of the study. Although theirs could be a chance finding, they said they found no adverse effects of fish oil supplementation in any of the measures of development.

High doses of fish oil supplements in pregnant women improved eye and hand coordination in their babies at age 21/2 years, according to a randomized controlled trial published Dec. 21.

Researchers said their trial (Arch. Dis. Child. Fetal Neonatal Ed. 2006 Dec. 21 [Epub doi 10.1136/adc.2006.099085)] is the first to show improvements in eye-hand coordination with fish oil supplements, and said the results suggest that research into the beneficial effects of fish oil supplementation during pregnancy may require higher dosages.

“These preliminary data indicate that supplementation with a relatively high-dose fish oil during the last 20 weeks of pregnancy is not only safe but also seems to have potential beneficial effects that need to be explored further,” wrote the researchers, led by Jan Dunstan, research fellow with the University of Western Australia's school of pediatrics and child health. “Given the scarcity of data to support the efficacy of fish oil supplementation during pregnancy, our data have a potentially important role in informing on the effects of fish oil supplementation on early postnatal infant development.”

The researchers randomized 52 pregnant women into a group supplementing their diets with 2.2 g of docosahexaenoic acid (DHA) and 1.1 g eicosapentaenoic acid (EPA) per day. A control group of 46 received olive oil supplements. Women were excluded from the study if their normal diet exceeded two meals of fish per week.

The researchers measured phospholipids in the red blood cells of the cord blood of the babies, and conducted tests measuring the babies' development at 21/2 years.

Of the 72 babies that made it to the follow-up at 21/2 years, all of the babies in the intervention group had significantly elevated DHA and EPA levels and significantly lower levels of arachidonic acid in their cord blood, compared with the control babies.

At 21/2 years (mean age of 34.7 months), researchers could not identify significantly higher scores for the 33 babies in the fish oil group in growth, development, receptive language, and behavior, except for the eye and hand subscale of the Griffiths Mental Development Scales. On the eye and hand subscale, the intervention group's mean score was 114, compared with 108 for the control group.

“Although the underlying mechanism is not understood, DHA is known to facilitate rapid phototransduction in the retinal membrane, and deficiencies are associated with reduced retinal function in infant primates,” the researchers write. “Furthermore, effects on visual evoked potential could indicate that DHA may also have an effect on the development of the visual cortex.”

The researchers said the small size of their sample is a weakness of the study. Although theirs could be a chance finding, they said they found no adverse effects of fish oil supplementation in any of the measures of development.

High doses of fish oil supplements in pregnant women improved eye and hand coordination in their babies at age 21/2 years, according to a randomized controlled trial published Dec. 21.

Researchers said their trial (Arch. Dis. Child. Fetal Neonatal Ed. 2006 Dec. 21 [Epub doi 10.1136/adc.2006.099085)] is the first to show improvements in eye-hand coordination with fish oil supplements, and said the results suggest that research into the beneficial effects of fish oil supplementation during pregnancy may require higher dosages.

“These preliminary data indicate that supplementation with a relatively high-dose fish oil during the last 20 weeks of pregnancy is not only safe but also seems to have potential beneficial effects that need to be explored further,” wrote the researchers, led by Jan Dunstan, research fellow with the University of Western Australia's school of pediatrics and child health. “Given the scarcity of data to support the efficacy of fish oil supplementation during pregnancy, our data have a potentially important role in informing on the effects of fish oil supplementation on early postnatal infant development.”

The researchers randomized 52 pregnant women into a group supplementing their diets with 2.2 g of docosahexaenoic acid (DHA) and 1.1 g eicosapentaenoic acid (EPA) per day. A control group of 46 received olive oil supplements. Women were excluded from the study if their normal diet exceeded two meals of fish per week.

The researchers measured phospholipids in the red blood cells of the cord blood of the babies, and conducted tests measuring the babies' development at 21/2 years.

Of the 72 babies that made it to the follow-up at 21/2 years, all of the babies in the intervention group had significantly elevated DHA and EPA levels and significantly lower levels of arachidonic acid in their cord blood, compared with the control babies.

At 21/2 years (mean age of 34.7 months), researchers could not identify significantly higher scores for the 33 babies in the fish oil group in growth, development, receptive language, and behavior, except for the eye and hand subscale of the Griffiths Mental Development Scales. On the eye and hand subscale, the intervention group's mean score was 114, compared with 108 for the control group.

“Although the underlying mechanism is not understood, DHA is known to facilitate rapid phototransduction in the retinal membrane, and deficiencies are associated with reduced retinal function in infant primates,” the researchers write. “Furthermore, effects on visual evoked potential could indicate that DHA may also have an effect on the development of the visual cortex.”

The researchers said the small size of their sample is a weakness of the study. Although theirs could be a chance finding, they said they found no adverse effects of fish oil supplementation in any of the measures of development.

Long-term or heavy use of mobile phones does not increase the risk of developing one type of brain tumor, although exclusive long-term use on one side of the head appears to increase the risk slightly.

The case-control study examined mobile phone use among 1,521 glioma patients and 3,301 controls in Denmark, England, Finland, Norway, and Sweden. Mobile phones emit radio waves that some believe play a role in tumor development, although a carcinogenic link has not been established, wrote Anna Lahkola of the Finnish Radiation and Nuclear Safety Authority, Helsinki (Int. J. Cancer 2007 Jan. 17 [Epub doi:10.1002/ijc.22503]).

Researchers conducted interviews with all study participants to identify patterns of mobile phone use among glioma patients and controls. Of the cases, 58% said they had used a mobile phone regularly—at least once weekly for at least 6 months—in the year before diagnosis. A total of 59% of controls reported regular use. Regular mobile phone users had a lower risk of developing gliomas, compared with those who never or seldom used mobile phones (odds ratio 0.78).

Mobile customers who used the phone only on the same side of the head as the location of their tumor had a significantly increased risk of glioma if they started using the phone at least 10 years ago (OR 1.39).

Even among heavy and long-term users, the researchers found no link. “The most exposed group (the highest 10% based on the exposure distribution among controls) did not show an elevated risk of glioma,” they wrote. “Neither did the dose-response analyses reveal a clear trend in relation to the overall duration of mobile phone use, number of calls, or hours of use.” The authors acknowledge that “selection bias may have produced an apparent protective effect of mobile phone use.”

Long-term or heavy use of mobile phones does not increase the risk of developing one type of brain tumor, although exclusive long-term use on one side of the head appears to increase the risk slightly.

The case-control study examined mobile phone use among 1,521 glioma patients and 3,301 controls in Denmark, England, Finland, Norway, and Sweden. Mobile phones emit radio waves that some believe play a role in tumor development, although a carcinogenic link has not been established, wrote Anna Lahkola of the Finnish Radiation and Nuclear Safety Authority, Helsinki (Int. J. Cancer 2007 Jan. 17 [Epub doi:10.1002/ijc.22503]).

Researchers conducted interviews with all study participants to identify patterns of mobile phone use among glioma patients and controls. Of the cases, 58% said they had used a mobile phone regularly—at least once weekly for at least 6 months—in the year before diagnosis. A total of 59% of controls reported regular use. Regular mobile phone users had a lower risk of developing gliomas, compared with those who never or seldom used mobile phones (odds ratio 0.78).

Mobile customers who used the phone only on the same side of the head as the location of their tumor had a significantly increased risk of glioma if they started using the phone at least 10 years ago (OR 1.39).

Even among heavy and long-term users, the researchers found no link. “The most exposed group (the highest 10% based on the exposure distribution among controls) did not show an elevated risk of glioma,” they wrote. “Neither did the dose-response analyses reveal a clear trend in relation to the overall duration of mobile phone use, number of calls, or hours of use.” The authors acknowledge that “selection bias may have produced an apparent protective effect of mobile phone use.”

Long-term or heavy use of mobile phones does not increase the risk of developing one type of brain tumor, although exclusive long-term use on one side of the head appears to increase the risk slightly.

The case-control study examined mobile phone use among 1,521 glioma patients and 3,301 controls in Denmark, England, Finland, Norway, and Sweden. Mobile phones emit radio waves that some believe play a role in tumor development, although a carcinogenic link has not been established, wrote Anna Lahkola of the Finnish Radiation and Nuclear Safety Authority, Helsinki (Int. J. Cancer 2007 Jan. 17 [Epub doi:10.1002/ijc.22503]).

Researchers conducted interviews with all study participants to identify patterns of mobile phone use among glioma patients and controls. Of the cases, 58% said they had used a mobile phone regularly—at least once weekly for at least 6 months—in the year before diagnosis. A total of 59% of controls reported regular use. Regular mobile phone users had a lower risk of developing gliomas, compared with those who never or seldom used mobile phones (odds ratio 0.78).

Mobile customers who used the phone only on the same side of the head as the location of their tumor had a significantly increased risk of glioma if they started using the phone at least 10 years ago (OR 1.39).

Even among heavy and long-term users, the researchers found no link. “The most exposed group (the highest 10% based on the exposure distribution among controls) did not show an elevated risk of glioma,” they wrote. “Neither did the dose-response analyses reveal a clear trend in relation to the overall duration of mobile phone use, number of calls, or hours of use.” The authors acknowledge that “selection bias may have produced an apparent protective effect of mobile phone use.”

The tumor necrosis factor-α-inhibitor drugs adalimumab, etanercept, and infliximab should be used to treat rheumatoid arthritis patients only after 6-month trials of methotrexate and one other disease-modifying antirheumatic drug, the clinical effectiveness agency for England and Wales had ruled.

The TNF-α inhibitors should be prescribed only to those patients who have active rheumatoid arthritis as measured by a disease activity score greater than 5.1—or patients with about 8–10 swollen and tender joints—confirmed at least twice, measured 1 month apart, according to the National Institute for Health and Clinical Effectiveness' final appraisal document.

TNF-α-inhibitor therapy should be done in combination with methotrexate, unless contraindicated, according to NICE. In those instances, patients should receive either adalimumab or etanercept as monotherapy.

Physicians should stop treatment with TNF-α inhibitors after 6 months if the patient does not show an adequate response, defined as an improvement in disease activity score of at least 1.2 points.

Infliximab costs between $14,612 and $17,047 a year, while etanercept and adalimumab both cost $17,982 a year, according to the NICE committee examining the effectiveness of the three drugs.

The committee considered TNF-α-inhibitor medications as first-line or second-line therapy after failure of one disease-modifying antirheumatic drug (DMARD). However, the committee concluded, based on cost and efficacy data, that neither was an appropriate use of National Health Service resources.

For first-line therapy, clinical specialists told the appraisal committee that a large number of patients initially respond well to DMARDs, and both the British Society of Rheumatology and European League Against Rheumatism recommend a trial of at least one DMARD.

As a second-line treatment, the appraisal committee did not believe TNF-α inhibitors had demonstrated cost-effectiveness.

The tumor necrosis factor-α-inhibitor drugs adalimumab, etanercept, and infliximab should be used to treat rheumatoid arthritis patients only after 6-month trials of methotrexate and one other disease-modifying antirheumatic drug, the clinical effectiveness agency for England and Wales had ruled.

The TNF-α inhibitors should be prescribed only to those patients who have active rheumatoid arthritis as measured by a disease activity score greater than 5.1—or patients with about 8–10 swollen and tender joints—confirmed at least twice, measured 1 month apart, according to the National Institute for Health and Clinical Effectiveness' final appraisal document.

TNF-α-inhibitor therapy should be done in combination with methotrexate, unless contraindicated, according to NICE. In those instances, patients should receive either adalimumab or etanercept as monotherapy.

Physicians should stop treatment with TNF-α inhibitors after 6 months if the patient does not show an adequate response, defined as an improvement in disease activity score of at least 1.2 points.

Infliximab costs between $14,612 and $17,047 a year, while etanercept and adalimumab both cost $17,982 a year, according to the NICE committee examining the effectiveness of the three drugs.

The committee considered TNF-α-inhibitor medications as first-line or second-line therapy after failure of one disease-modifying antirheumatic drug (DMARD). However, the committee concluded, based on cost and efficacy data, that neither was an appropriate use of National Health Service resources.

For first-line therapy, clinical specialists told the appraisal committee that a large number of patients initially respond well to DMARDs, and both the British Society of Rheumatology and European League Against Rheumatism recommend a trial of at least one DMARD.

As a second-line treatment, the appraisal committee did not believe TNF-α inhibitors had demonstrated cost-effectiveness.

The tumor necrosis factor-α-inhibitor drugs adalimumab, etanercept, and infliximab should be used to treat rheumatoid arthritis patients only after 6-month trials of methotrexate and one other disease-modifying antirheumatic drug, the clinical effectiveness agency for England and Wales had ruled.

The TNF-α inhibitors should be prescribed only to those patients who have active rheumatoid arthritis as measured by a disease activity score greater than 5.1—or patients with about 8–10 swollen and tender joints—confirmed at least twice, measured 1 month apart, according to the National Institute for Health and Clinical Effectiveness' final appraisal document.

TNF-α-inhibitor therapy should be done in combination with methotrexate, unless contraindicated, according to NICE. In those instances, patients should receive either adalimumab or etanercept as monotherapy.

Physicians should stop treatment with TNF-α inhibitors after 6 months if the patient does not show an adequate response, defined as an improvement in disease activity score of at least 1.2 points.

Infliximab costs between $14,612 and $17,047 a year, while etanercept and adalimumab both cost $17,982 a year, according to the NICE committee examining the effectiveness of the three drugs.

The committee considered TNF-α-inhibitor medications as first-line or second-line therapy after failure of one disease-modifying antirheumatic drug (DMARD). However, the committee concluded, based on cost and efficacy data, that neither was an appropriate use of National Health Service resources.

For first-line therapy, clinical specialists told the appraisal committee that a large number of patients initially respond well to DMARDs, and both the British Society of Rheumatology and European League Against Rheumatism recommend a trial of at least one DMARD.

As a second-line treatment, the appraisal committee did not believe TNF-α inhibitors had demonstrated cost-effectiveness.

Both physiotherapy and a wait-and-see approach to treating tennis elbow outperformed corticosteroid injections over the course of a year, even though patients receiving the injections were experiencing less pain at 6 weeks, according to study findings.

Leanne Bisset, a PhD candidate at the School of Health and Rehabilitation Sciences at the University of Queensland, St. Lucia, Australia, and associates studied 198 adults with a history of tennis elbow for a minimum of 6 weeks; none of the patients had been treated for the condition in the previous 6 months. The patients were randomized into groups treated with one steroid injection followed by a second in 2 weeks if needed, physiotherapy (treatments of 30 minutes over 6 weeks, plus home exercises and elbow manipulation), or a “watch and wait” strategy that included modification of daily activities and treatment with analgesics, heat, cold, or braces (BMJ 2006; 333:939).

After 6 weeks, the average pain-free grip ratio of the unaffected arm to the affected arm was highest in the injection group at 84%. But at 12 weeks, it dropped to 64%, before rising again to 85% at 52 weeks. In the wait-and-see group, the pain-free grip ratio rose steadily from 52% at 6 weeks to 96% at 52 weeks.

In the physiotherapy group, it rose steadily also, from 70% at 6 weeks to 101% at 52 weeks. The steroid group had the most recurrences; 72% deteriorated after 3 or 6 weeks. Recurrence rates were 8% in the physiotherapy group and 9% in the wait-and-see group.

Both physiotherapy and a wait-and-see approach to treating tennis elbow outperformed corticosteroid injections over the course of a year, even though patients receiving the injections were experiencing less pain at 6 weeks, according to study findings.

Leanne Bisset, a PhD candidate at the School of Health and Rehabilitation Sciences at the University of Queensland, St. Lucia, Australia, and associates studied 198 adults with a history of tennis elbow for a minimum of 6 weeks; none of the patients had been treated for the condition in the previous 6 months. The patients were randomized into groups treated with one steroid injection followed by a second in 2 weeks if needed, physiotherapy (treatments of 30 minutes over 6 weeks, plus home exercises and elbow manipulation), or a “watch and wait” strategy that included modification of daily activities and treatment with analgesics, heat, cold, or braces (BMJ 2006; 333:939).

After 6 weeks, the average pain-free grip ratio of the unaffected arm to the affected arm was highest in the injection group at 84%. But at 12 weeks, it dropped to 64%, before rising again to 85% at 52 weeks. In the wait-and-see group, the pain-free grip ratio rose steadily from 52% at 6 weeks to 96% at 52 weeks.

In the physiotherapy group, it rose steadily also, from 70% at 6 weeks to 101% at 52 weeks. The steroid group had the most recurrences; 72% deteriorated after 3 or 6 weeks. Recurrence rates were 8% in the physiotherapy group and 9% in the wait-and-see group.

Both physiotherapy and a wait-and-see approach to treating tennis elbow outperformed corticosteroid injections over the course of a year, even though patients receiving the injections were experiencing less pain at 6 weeks, according to study findings.

Leanne Bisset, a PhD candidate at the School of Health and Rehabilitation Sciences at the University of Queensland, St. Lucia, Australia, and associates studied 198 adults with a history of tennis elbow for a minimum of 6 weeks; none of the patients had been treated for the condition in the previous 6 months. The patients were randomized into groups treated with one steroid injection followed by a second in 2 weeks if needed, physiotherapy (treatments of 30 minutes over 6 weeks, plus home exercises and elbow manipulation), or a “watch and wait” strategy that included modification of daily activities and treatment with analgesics, heat, cold, or braces (BMJ 2006; 333:939).

After 6 weeks, the average pain-free grip ratio of the unaffected arm to the affected arm was highest in the injection group at 84%. But at 12 weeks, it dropped to 64%, before rising again to 85% at 52 weeks. In the wait-and-see group, the pain-free grip ratio rose steadily from 52% at 6 weeks to 96% at 52 weeks.

In the physiotherapy group, it rose steadily also, from 70% at 6 weeks to 101% at 52 weeks. The steroid group had the most recurrences; 72% deteriorated after 3 or 6 weeks. Recurrence rates were 8% in the physiotherapy group and 9% in the wait-and-see group.

People older than 95 are nearly 20 times as likely to die with dementia as those who die between the ages of 65 and 69, according to a population-based study in England and Wales.

The study demonstrates that the prevalence of dementia increases with age and that those who reach the age of 80 without mental impairment can still become demented as they continue to age, suggesting that with increasing life expectancy the number of people with dementia also will increase, the investigators reported. Based on the results of the study, the researchers estimated that the number of people who die each year with dementia is 114,000 in England and Wales and 487,000 in the United States; these numbers will increase in 20 years to 138,000 andd 528,000, respectively.

The investigators analyzed patients in the Medical Research Council Cognitive Function and Aging Study, which enrolled 13,004 patients at centers in Liverpool, Newcastle, Nottingham, Oxford, and Cambridgeshire in England and Gwynedd in north Wales (PLoS Med 2006 Oct. 31 [Epub doi10.1371/journal.pmed.0030397]).

The study followed 2,558 patients who were classified as having severe cognitive impairment and 2,577 who were classified as having moderate/severe cognitive impairment as measured by the Geriatric Mental State interview.

Of the 768 people who had died within 1 year of their last interview, 30% were suffering from dementia. Of those ages 65–69 years, just 6% had dementia, but of those age 95 years and older, 58% were suffering from dementia, according to the study.

Led by Dr. Carol Brayne, professor of public health medicine at University of Cambridge, the researchers wrote that the prevalence of dementia demonstrated in their study suggests that prevention may have a negligible effect in an aging society.

“It may be that, although there will be a preventable component to dementia giving us a small and important absolute reduction in expectation of dementia at given ages, there is also a component that is not amenable to such types of prevention,” the authors said. “Researchers may be doing those who are aging now and themselves a disservice in the future if they assume, and project to the public, that dementia and cognitive impairment can be prevented altogether during increasingly long lives.

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People older than 95 are nearly 20 times as likely to die with dementia as those who die between the ages of 65 and 69, according to a population-based study in England and Wales.

The study demonstrates that the prevalence of dementia increases with age and that those who reach the age of 80 without mental impairment can still become demented as they continue to age, suggesting that with increasing life expectancy the number of people with dementia also will increase, the investigators reported. Based on the results of the study, the researchers estimated that the number of people who die each year with dementia is 114,000 in England and Wales and 487,000 in the United States; these numbers will increase in 20 years to 138,000 andd 528,000, respectively.

The investigators analyzed patients in the Medical Research Council Cognitive Function and Aging Study, which enrolled 13,004 patients at centers in Liverpool, Newcastle, Nottingham, Oxford, and Cambridgeshire in England and Gwynedd in north Wales (PLoS Med 2006 Oct. 31 [Epub doi10.1371/journal.pmed.0030397]).

The study followed 2,558 patients who were classified as having severe cognitive impairment and 2,577 who were classified as having moderate/severe cognitive impairment as measured by the Geriatric Mental State interview.

Of the 768 people who had died within 1 year of their last interview, 30% were suffering from dementia. Of those ages 65–69 years, just 6% had dementia, but of those age 95 years and older, 58% were suffering from dementia, according to the study.

Led by Dr. Carol Brayne, professor of public health medicine at University of Cambridge, the researchers wrote that the prevalence of dementia demonstrated in their study suggests that prevention may have a negligible effect in an aging society.

“It may be that, although there will be a preventable component to dementia giving us a small and important absolute reduction in expectation of dementia at given ages, there is also a component that is not amenable to such types of prevention,” the authors said. “Researchers may be doing those who are aging now and themselves a disservice in the future if they assume, and project to the public, that dementia and cognitive impairment can be prevented altogether during increasingly long lives.

ELSEVIER GLOBAL MEDICAL NEWS

People older than 95 are nearly 20 times as likely to die with dementia as those who die between the ages of 65 and 69, according to a population-based study in England and Wales.

The study demonstrates that the prevalence of dementia increases with age and that those who reach the age of 80 without mental impairment can still become demented as they continue to age, suggesting that with increasing life expectancy the number of people with dementia also will increase, the investigators reported. Based on the results of the study, the researchers estimated that the number of people who die each year with dementia is 114,000 in England and Wales and 487,000 in the United States; these numbers will increase in 20 years to 138,000 andd 528,000, respectively.

The investigators analyzed patients in the Medical Research Council Cognitive Function and Aging Study, which enrolled 13,004 patients at centers in Liverpool, Newcastle, Nottingham, Oxford, and Cambridgeshire in England and Gwynedd in north Wales (PLoS Med 2006 Oct. 31 [Epub doi10.1371/journal.pmed.0030397]).

The study followed 2,558 patients who were classified as having severe cognitive impairment and 2,577 who were classified as having moderate/severe cognitive impairment as measured by the Geriatric Mental State interview.

Of the 768 people who had died within 1 year of their last interview, 30% were suffering from dementia. Of those ages 65–69 years, just 6% had dementia, but of those age 95 years and older, 58% were suffering from dementia, according to the study.

Led by Dr. Carol Brayne, professor of public health medicine at University of Cambridge, the researchers wrote that the prevalence of dementia demonstrated in their study suggests that prevention may have a negligible effect in an aging society.

“It may be that, although there will be a preventable component to dementia giving us a small and important absolute reduction in expectation of dementia at given ages, there is also a component that is not amenable to such types of prevention,” the authors said. “Researchers may be doing those who are aging now and themselves a disservice in the future if they assume, and project to the public, that dementia and cognitive impairment can be prevented altogether during increasingly long lives.

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Memory assessment services at a specialized clinic or by community mental health teams should be the single point of referral for all British patients with a possible diagnosis of dementia, according to a new guideline published Nov. 22 by the clinical effectiveness agency for England and Wales.

The guideline from the National Institute for Health and Clinical Effectiveness (NICE) and the Social Care Institute for Excellence also calls for magnetic resonance imaging or computerized tomography to be used to determine subtype diagnoses and exclude other cerebral conditions that could be causing a suspected case of dementia.

Health care and social care providers need to coordinate and integrate care for dementia patients, including jointly agreeing to written policies and procedures, under the NICE guideline.

Dementia patients who develop noncognitive behavioral issues should be assessed to determine the cause of the behavior, including undetected pain, depression, and drug side effects, the guideline says.

The guideline also makes final a NICE drug assessment published earlier this year that restricts use of the acetylcholinesterase inhibitors donepezil, galantamine, and rivastigmine only for those Alzheimer's disease patients who are diagnosed as suffering from moderately severe dementia. Patient groups objected to that decision, but their appeal was rejected in October.

Memory assessment services at a specialized clinic or by community mental health teams should be the single point of referral for all British patients with a possible diagnosis of dementia, according to a new guideline published Nov. 22 by the clinical effectiveness agency for England and Wales.

The guideline from the National Institute for Health and Clinical Effectiveness (NICE) and the Social Care Institute for Excellence also calls for magnetic resonance imaging or computerized tomography to be used to determine subtype diagnoses and exclude other cerebral conditions that could be causing a suspected case of dementia.

Health care and social care providers need to coordinate and integrate care for dementia patients, including jointly agreeing to written policies and procedures, under the NICE guideline.

Dementia patients who develop noncognitive behavioral issues should be assessed to determine the cause of the behavior, including undetected pain, depression, and drug side effects, the guideline says.

The guideline also makes final a NICE drug assessment published earlier this year that restricts use of the acetylcholinesterase inhibitors donepezil, galantamine, and rivastigmine only for those Alzheimer's disease patients who are diagnosed as suffering from moderately severe dementia. Patient groups objected to that decision, but their appeal was rejected in October.

Memory assessment services at a specialized clinic or by community mental health teams should be the single point of referral for all British patients with a possible diagnosis of dementia, according to a new guideline published Nov. 22 by the clinical effectiveness agency for England and Wales.

The guideline from the National Institute for Health and Clinical Effectiveness (NICE) and the Social Care Institute for Excellence also calls for magnetic resonance imaging or computerized tomography to be used to determine subtype diagnoses and exclude other cerebral conditions that could be causing a suspected case of dementia.

Health care and social care providers need to coordinate and integrate care for dementia patients, including jointly agreeing to written policies and procedures, under the NICE guideline.

Dementia patients who develop noncognitive behavioral issues should be assessed to determine the cause of the behavior, including undetected pain, depression, and drug side effects, the guideline says.

The guideline also makes final a NICE drug assessment published earlier this year that restricts use of the acetylcholinesterase inhibitors donepezil, galantamine, and rivastigmine only for those Alzheimer's disease patients who are diagnosed as suffering from moderately severe dementia. Patient groups objected to that decision, but their appeal was rejected in October.

Calcium supplementation has little effect on bone mineral density in children and is unlikely to prevent fractures in childhood or adulthood, reported Tania Wizenberg and her fellow investigators.

The metaanalysis of 19 randomized controlled trials (BMJ 2006 [Epub doi:10.1136/bmj. 38950.561400.55]), which included 2,859 children, found that children who take calcium supplementation did not have significantly greater bone mineral density (BMD) at the femoral neck or at the lumbar spine at the end of trials or after supplementation. The studies had a treatment period of at least 3 months, and bone outcomes were measured after at least 6 months of follow-up, according to Ms. Wizenberg and of the Menzies Research Institue, Hobart, Australia, and her fellow researchers.

At the upper limb, the metaanalysis showed a difference of 6.38 mg/cm

A single study that evaluated total bone density showed no persistent effect, they reported.

“This small increase in upper limb bone mineral density is unlikely to result in a clinically important decrease in the risk of fracture,” they wrote. “Importantly, we found no effects at other sites where fracture is common.” Based on studies showing lower BMD among children who suffer upper limb fractures, the authors forecasted a 0.2% decrease a year in absolute risk of fractures among boys, and 0.1% in girls. “The public health impact of this is likely to be small,” they said.

Calcium supplementation has little effect on bone mineral density in children and is unlikely to prevent fractures in childhood or adulthood, reported Tania Wizenberg and her fellow investigators.

The metaanalysis of 19 randomized controlled trials (BMJ 2006 [Epub doi:10.1136/bmj. 38950.561400.55]), which included 2,859 children, found that children who take calcium supplementation did not have significantly greater bone mineral density (BMD) at the femoral neck or at the lumbar spine at the end of trials or after supplementation. The studies had a treatment period of at least 3 months, and bone outcomes were measured after at least 6 months of follow-up, according to Ms. Wizenberg and of the Menzies Research Institue, Hobart, Australia, and her fellow researchers.

At the upper limb, the metaanalysis showed a difference of 6.38 mg/cm

A single study that evaluated total bone density showed no persistent effect, they reported.

“This small increase in upper limb bone mineral density is unlikely to result in a clinically important decrease in the risk of fracture,” they wrote. “Importantly, we found no effects at other sites where fracture is common.” Based on studies showing lower BMD among children who suffer upper limb fractures, the authors forecasted a 0.2% decrease a year in absolute risk of fractures among boys, and 0.1% in girls. “The public health impact of this is likely to be small,” they said.

Calcium supplementation has little effect on bone mineral density in children and is unlikely to prevent fractures in childhood or adulthood, reported Tania Wizenberg and her fellow investigators.

The metaanalysis of 19 randomized controlled trials (BMJ 2006 [Epub doi:10.1136/bmj. 38950.561400.55]), which included 2,859 children, found that children who take calcium supplementation did not have significantly greater bone mineral density (BMD) at the femoral neck or at the lumbar spine at the end of trials or after supplementation. The studies had a treatment period of at least 3 months, and bone outcomes were measured after at least 6 months of follow-up, according to Ms. Wizenberg and of the Menzies Research Institue, Hobart, Australia, and her fellow researchers.

At the upper limb, the metaanalysis showed a difference of 6.38 mg/cm

A single study that evaluated total bone density showed no persistent effect, they reported.

“This small increase in upper limb bone mineral density is unlikely to result in a clinically important decrease in the risk of fracture,” they wrote. “Importantly, we found no effects at other sites where fracture is common.” Based on studies showing lower BMD among children who suffer upper limb fractures, the authors forecasted a 0.2% decrease a year in absolute risk of fractures among boys, and 0.1% in girls. “The public health impact of this is likely to be small,” they said.

Pharmaceutic management or physical therapy for older adult knee-pain patients yielded significantly greater short-term pain reduction than written and oral advice on coping with knee pain, according to a randomized clinical trial.

The trial (BMJ 2006 Oct. 20 [Epub doi:10.1136/bmj.38977.590752.0B]) randomized 325 knee-pain patients 55 years of age and older from North Staffordshire (England), into equal-sized groups—one received up to six 20-minute sessions of physical therapy over 10 weeks with additional home exercises, another received advice from a community pharmacist in up to six 20-minute meetings, and a control group received a booklet and a telephone call from a rheumatology nurse.

Researchers, led by Dr. Elaine Hay, a professor in community rheumatology at the Primary Care Musculoskeletal Research Centre, Keele University, chiefly measured improvements on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

At 3 months, the researchers found that the intervention groups both had shown a significantly greater improvement than the control group on the 20-point WOMAC pain scale.

The pharmacy group had improved by a mean of 1.59 points to 7.49, the physiotherapy group by a mean 1.56 to 7.36, compared with the control group's improvement of 0.41 to 8.99.

By 6 months, neither intervention group was showing a significant improvement over the control group.

On the 68-point WOMAC physical function scale, the physiotherapy group improved by a mean score of 4.79 points to 24.27 at 3 months, significantly better than the control group's improvement of 0.80 to 30.18, the trial found. The difference was not sustained to 6 or 12 months.

The researchers added, however, that the physical therapy group consulted general practitioners less frequently, and the pharmacy and physical therapy groups took fewer NSAIDs than the control group. The pharmacy group did take significantly more analgesics, however.

“Interventions by pharmacists have been shown to favorably influence prescribing to reduce adverse drug reactions, improve the appropriateness of drug use, reduce drug costs, and improve compliance in a range of conditions,” the authors wrote.

“Our trial adds to this evidence by showing that evidence-based care for adults over 55 with knee pain, delivered by primary care pharmacists and physiotherapists, results in short-term improvements in health outcome, reduction in use of nonsteroidal anti-inflammatory drugs, and high patient satisfaction,” the investigators continued.

The researchers cited as a potential weakness of the trial their “lack of information about patients' adherence to treatment, which is likely to be an important determinant of clinical outcome.”

Pharmaceutic management or physical therapy for older adult knee-pain patients yielded significantly greater short-term pain reduction than written and oral advice on coping with knee pain, according to a randomized clinical trial.

The trial (BMJ 2006 Oct. 20 [Epub doi:10.1136/bmj.38977.590752.0B]) randomized 325 knee-pain patients 55 years of age and older from North Staffordshire (England), into equal-sized groups—one received up to six 20-minute sessions of physical therapy over 10 weeks with additional home exercises, another received advice from a community pharmacist in up to six 20-minute meetings, and a control group received a booklet and a telephone call from a rheumatology nurse.

Researchers, led by Dr. Elaine Hay, a professor in community rheumatology at the Primary Care Musculoskeletal Research Centre, Keele University, chiefly measured improvements on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

At 3 months, the researchers found that the intervention groups both had shown a significantly greater improvement than the control group on the 20-point WOMAC pain scale.

The pharmacy group had improved by a mean of 1.59 points to 7.49, the physiotherapy group by a mean 1.56 to 7.36, compared with the control group's improvement of 0.41 to 8.99.

By 6 months, neither intervention group was showing a significant improvement over the control group.

On the 68-point WOMAC physical function scale, the physiotherapy group improved by a mean score of 4.79 points to 24.27 at 3 months, significantly better than the control group's improvement of 0.80 to 30.18, the trial found. The difference was not sustained to 6 or 12 months.

The researchers added, however, that the physical therapy group consulted general practitioners less frequently, and the pharmacy and physical therapy groups took fewer NSAIDs than the control group. The pharmacy group did take significantly more analgesics, however.

“Interventions by pharmacists have been shown to favorably influence prescribing to reduce adverse drug reactions, improve the appropriateness of drug use, reduce drug costs, and improve compliance in a range of conditions,” the authors wrote.

“Our trial adds to this evidence by showing that evidence-based care for adults over 55 with knee pain, delivered by primary care pharmacists and physiotherapists, results in short-term improvements in health outcome, reduction in use of nonsteroidal anti-inflammatory drugs, and high patient satisfaction,” the investigators continued.

The researchers cited as a potential weakness of the trial their “lack of information about patients' adherence to treatment, which is likely to be an important determinant of clinical outcome.”

Pharmaceutic management or physical therapy for older adult knee-pain patients yielded significantly greater short-term pain reduction than written and oral advice on coping with knee pain, according to a randomized clinical trial.

The trial (BMJ 2006 Oct. 20 [Epub doi:10.1136/bmj.38977.590752.0B]) randomized 325 knee-pain patients 55 years of age and older from North Staffordshire (England), into equal-sized groups—one received up to six 20-minute sessions of physical therapy over 10 weeks with additional home exercises, another received advice from a community pharmacist in up to six 20-minute meetings, and a control group received a booklet and a telephone call from a rheumatology nurse.

Researchers, led by Dr. Elaine Hay, a professor in community rheumatology at the Primary Care Musculoskeletal Research Centre, Keele University, chiefly measured improvements on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months.

At 3 months, the researchers found that the intervention groups both had shown a significantly greater improvement than the control group on the 20-point WOMAC pain scale.

The pharmacy group had improved by a mean of 1.59 points to 7.49, the physiotherapy group by a mean 1.56 to 7.36, compared with the control group's improvement of 0.41 to 8.99.

By 6 months, neither intervention group was showing a significant improvement over the control group.

On the 68-point WOMAC physical function scale, the physiotherapy group improved by a mean score of 4.79 points to 24.27 at 3 months, significantly better than the control group's improvement of 0.80 to 30.18, the trial found. The difference was not sustained to 6 or 12 months.

The researchers added, however, that the physical therapy group consulted general practitioners less frequently, and the pharmacy and physical therapy groups took fewer NSAIDs than the control group. The pharmacy group did take significantly more analgesics, however.

“Interventions by pharmacists have been shown to favorably influence prescribing to reduce adverse drug reactions, improve the appropriateness of drug use, reduce drug costs, and improve compliance in a range of conditions,” the authors wrote.

“Our trial adds to this evidence by showing that evidence-based care for adults over 55 with knee pain, delivered by primary care pharmacists and physiotherapists, results in short-term improvements in health outcome, reduction in use of nonsteroidal anti-inflammatory drugs, and high patient satisfaction,” the investigators continued.

The researchers cited as a potential weakness of the trial their “lack of information about patients' adherence to treatment, which is likely to be an important determinant of clinical outcome.”