A recently published study determined that women who make poor shoe choices early in life suffer with foot pain in later years. Research shows that men do not experience the same foot pain as women, due to type of shoes they wear. Details of this study appear in the October issue of Arthritis Care & Research, a journal published by WileyBlackwell on behalf of the American College of Rheumatology.

National data reveal that foot and toe symptoms are among the top 20 reasons patients ages 6574 visit their physician. In the U.S., foot pain is considered a very common musculoskeletal symptom and occurs in such conditions as rheumatoid arthritis, diabetes, and gout, or with sprains, muscle strains, bruises, and fractures. Previous studies have determined a correlation between improper footwear and foot pain, but this research focused on small patient samples or disease specific studies.

Researchers from Boston University School of Public Health and the Institute for Aging Research at Hebrew SeniorLife enrolled 3,372 participants in the Framingham Foot Study. Participants were derived from 2 large populationbased samples of residents from Framingham, Massachusetts. The first group was part of the Framingham Study Original Cohort (formed in 1948) and the Framingham Offspring Cohort (formed in 1972) that were originally studied for heart disease risk factors. The second group was a new population sample derived from census data and included subjects who were at least 50 years old and ambulatory who were added to increase participation by minority persons.

The Framingham Foot Study assessed 1,472 men and 1,900 women between 2002 and 2008. Subjects were asked if they experienced pain, aching, or stiffness in either or both feet. Data on specific areas of foot pain was identified in the nails, forefoot, hindfoot, heel, arch of the foot, and ball of the foot. Participants provided information on current and past shoewear across five age groups 2029 years, 3044 years, 4564 years, 6574 years, and 75+ years. Shoewear was classified as good (low risk shoes including athletic and casual sneakers), average (mid risk shoes such as hard or rubbersoled shoes, special shoes and work boots), and poor shoes (highrisk shoewear that lack support and sound structure, including highheeled shoes, sandals, and slippers).

According to the study 25% of participants reported generalized foot pain on most days with 19% of men and 29% of women falling into this subtype. “In women, we found an increased risk between hindfoot pain and shoewear,” said the authors. The study revealed that only a small percentage (< 2%) of men wore poor shoes, thus shoe type is not a major factor for developing foot pain in men. "While more research is needed, young women should make careful choices regarding their shoe type to avoid hindfoot pain later in life, or perform stretching exercises to alleviate the effect of high heels on foot pain," recommended researchers.

Citation
“Foot Pain Is Current or Past Shoewear a Factor?”
Alyssa B. Dufour, Kerry E. Broe, Anne H. Walker, Erin Kivell, UyenSa D.T. Nguyen, Marian T. Hannan, David R. Gagnon, Howard J. Hillstrom.
Arthritis Care & Research; Published Online September 29, 2009 (DOI 10.1002/art.24733); Print Issue Date October 2009.

Elsevier is pleased to announce that ten of its professional and scholarly books were honored at the annual BMA Medical Book Competition ceremony in London on September 8th 2009. An additional 19 Elsevier books were highly commended. In total, 684 books were entered to the BMAs competition with 126 prizes awarded with 26 first prizes, 91 highly commended prizes and 9 commended prizes.

Grays Anatomy for Students by Richard Drake, Wayne Vogl, and Adam Mitchell won first prize in the BMA Basic and Clinical Science category. This is the second edition of an anatomy textbook for medical students that has quickly become a favorite textbook around the world, translated into a dozen languages. It has captured a strong following because it explains complex anatomy with clear, understandable language, strong clinical correlations, and a stunning fullcolor artwork program. It is now part of an extensive family of Grays products including Grays Atlas of Anatomy, Grays Anatomy for Students Flashcards, Grays Anatomy Review, Dorland/Grays Pocket Atlas of Anatomy and, of course, Grays Anatomy, 40th Edition.

Elseviers Rheumatoid Arthritis by Marc C. Hochberg, Alan J. Silman, Josef S. Smolen, Michael E. Weinblatt, and Michael H. Weisman was awarded first prize in the BMA Orthopaedics and Rheumatology category. A first edition in brilliant color, it provides the most current insights into the pathogenesis of rheumatoid arthritis, while also including comprehensive coverage of clinical features of the disease, as well as evidencebased options for treatment.

“We congratulate all of the winners and especially thank all of the authors, editors and Elsevier publishing staff who have worked on these prizewinning titles,” said Randy Charles, Managing Director Global Clinical Reference Group at Elsevier. “This is an amazing achievement and reflects our dedication to developing and delivering quality content.”

First prizes were awarded to Elsevier books in the following categories Anesthesia Andrew Bersten and Neil Soni Ohs Intensive Care Manual, 6th edition

Basic and Clinical Science Richard Drake, A. Wayne Vogl, and Adam WM Mitchell Grays Anatomy for Students, 2nd edition

Cardiology John Hampton The ECG in Practice, 5th edition

Haematology Stuart H. Orkin and others Nathan and Oskis Hematology of Infancy and Childhood, 7th edition

Health Care for the Elderly Hylton B. Menz Foot Problems in Older People

Medicine Mark Strachan, Surendra Sharma and John Hunter Davidsons Clinical Cases

Orthopaedics and Rheumatology Marc C. Hochberg and others Rheumatoid Arthritis

Primary Health Care Andrew Polmear EvidenceBased Diagnosis in Primary Care

Radiology Gerald de Lacey, Simon Morley and Laurence Berman The Chest XRay A Survival Guide

BMA Student Textbook Award Elspeth Brown and others Heart Sounds Made Easy with CDROM, 2nd edition Source
Anna Hogrebe

Thomas A. Medsger Jr., M.D., Gerald P. Rodnan Professor of Medicine, University of Pittsburgh School of Medicine, received the Scleroderma Foundations Lifetime Achievement Award in recognition of his service to the scleroderma community. The award is the foundations highest honor and is presented to individuals who have devoted a minimum of 20 years of service, either as a volunteer or professional, to the scleroderma community.

Scleroderma a disease that causes the tissue in the skin, joints and internal organs to thicken affects approximately 300,000 people in the United States. Dr. Medsger served as chief of the University of Pittsburghs Division of Rheumatology and Clinical Immunology, and director of the Scleroderma Research Program and UPMCs Scleroderma Clinic. His primary clinical and investigative interest is in scleroderma and other connective tissue diseases.

In 2001 and 2005, Dr. Medsger was the recipient of the Scleroderma Foundations Doctor of the Year award. He also has been designated as one of the Best Doctors in America by American Health Magazine for the past two decades and was the recipient of the American College of Rheumatologys Distinguished Rheumatologist Award. Recently, he had the title of “Master” conferred upon him by the American College of Rheumatology a title awarded to members of high professional competence, ethics and moral standing who have significantly furthered the science of rheumatology.

Dr. Medsger also received the Deans Master Educator Award from the University of Pittsburgh School of Medicine. Six of his former trainees have developed scleroderma research and patient care programs at other institutions.

Dr. Medsger currently serves as the Scleroderma Foundation Western Pennsylvania Chapters treasurer and interim president. He has written numerous articles for the Foundations Voice magazine and has published more than 300 journal articles about scleroderma and related diseases.

Dr. Medsger received his medical degree from the University of Pennsylvania. He completed an internship at Jackson Memorial Hospital in Miami, a residency at UPMC Presbyterian and postdoctoral fellowships at the University of Pittsburgh School of Medicine and Tennessee College of Medicine. He earned his undergraduate degree from Haverford College. Dr. Medsger joined the faculty at the University of Pittsburgh School of Medicine in 1971.

An existing osteoporosis drug is the first ever found to prevent cartilage loss from osteoarthritis following injury to a joint, and may also regenerate some cartilage that has been lost to osteoarthritis, according to an early study presented at the annual meeting of the American Society for Bone and Mineral Research in Denver. While the study was in mice, the model closely mimics human osteoarthritis that develops following knee injuries, according to the study authors.

Cartilage can become damaged by many kinds of injury and by mechanical stresses that come with age. Over time, damaged cartilage deteriorates to cause osteoarthritis (OA), with its attendant joint inflammation and pain. Currently available drugs like steroids or nonsteroidal antiinflammatory agents (e.g. Advil, Aleve) reduce pain but do not address the loss of cartilage behind the osteoarthritis, which is projected to afflict more than 50 million Americans by 2020.

Cartilage forms the spongelike, shockabsorbing layers that keep the impact of running and jumping and lifting from grinding bones against each other in joints. The cell type at the heart of osteoarthritis is the chondrocyte, the cartilageproducing cell responsible for maintaining the integrity of joint cartilage.

Outside of joints, chondrocytes undergo a normal maturation process that helps to form bone as part of fracture healing and bone growth in children. Disease processes and injury, however, cause chondrocytes in joint surface cartilage to become like those that help to heal bone elsewhere, but in a place where bone is not supposed to form. This mistaken maturation contributes to the gradual destruction of the joint seen in osteoarthritis.

Parathyroid hormone (PTH), known as teriparatide in drug form, has emerged as a major player in the maintenance and healing of bone, and the race is on to design new applications for it. Past studies have established that PTH prevents chondrocytes from undergoing maturation, and stimulates their proliferation, preserving larger pools of cartilage cells in the joint. Signaling molecules like PTH have their effect in the body by interacting with specifically shaped proteins on the cell surfaces called receptors. PTH docks into its receptors, like a ship coming into port, which changes the shape of the dock such that biochemical signals are sent.

The authors of the current study observed that chondrocytes within injured and degenerating cartilage have more PTH type 1 receptors on their surfaces. This makes them especially sensitive to the PTH signal that prevents harmful chondrocyte maturation into bone in the joint cartilage. Thus, PTH therapy should increase the cartilage supply exactly where cartilage loss is causing disease.

“Right now physicians have no way to bring back cartilage in patients who have lost it to osteoarthritis,” said Randy Rosier, M.D., Ph.D., professor within the Department of Orthopaedics and Rehabilitation at the University of Rochester Medical Center. “Our current results, at least in mice, show that we can inhibit cartilage degeneration and improve the volume of cartilage in diseased joints. Its remarkable enough that this compound delays the loss of cartilage, but these results show it also may be able to restore, at least to some extent, cartilage in already degraded joint surfaces.”

Researchers examined the impact of a daily dose of Forteo®/teriparatide, manufactured by Eli Lilly, and a generic version of teriparatide made by Sigma on the progress of OA following injury in study mice.

Experiments established a fivefold increase in PTH type 1 receptor expression in the articular cartilage of mice with injuryrelated osteoarthritis when compared to healthy cartilage. Injury triggers genetic mechanisms in an attempt to begin repairs, a repair response that may be responsible for the increase in PTH receptor in the joint. This in turn makes damaged cartilage particularly responsive to PTH.

In the current study, one group of mice with cartilage and ligament injuries was randomized to receive either saline as a control, Forteo® or generic PTH daily for 12 weeks. A second group of mice with joint injuries did not receive treatment until 8 weeks after injury. The delay was an attempt to determine the effect of treatment once the osteoarthritic process was already underway and some cartilage lost, a scenario that more closely mimics clinical reality. Patients do not visit their physician after an injury asking the doctor to prevent the onset of osteoarthritis 10 years in the future, Rosier said. They come in when an old injury and time have combined to degrade cartilage to the point where function is lost and pain felt.

Studies revealed that after 12 weeks of Forteo® or generic PTH treatment, there was approximately 27 percent more joint cartilage compared to salinetreated mice. Strikingly, delayed teriparatide treatment was even more effective in improving the amount of cartilage, with up to 35 percent more cartilage in Forteo® and PTHtreated groups than in the saline group, suggesting an ability to regenerate at least some of the lost cartilage.

With a new use patent application in place, the team will next seek to confirm the durability of the effect in further animal studies, and prepare to seek funding from the National Institutes of Health to begin pilot clinical studies of PTH treatment of osteoarthritis in humans, possibly in the later half of 2010.

Along with Rosier, the study was led by Erik Sampson, Todd OBrien, Di Chen, Susan Bukata, J. Edward Puzas, Regis OKeefe and Michael Zuscik within the Department of Orthopaedics and by Hani Awad in the Department of Biomedical Engineering at the University of Rochester Medical Center. The study was funded by the National Institutes of Health.

“These preclinical findings provide strong proofofconcept support for the potential use of teriparatide to slow joint cartilage degeneration in OA patients, and perhaps even reverse it,” Rosier said. “In the near future, we hope this serves as the foundation of new treatments that restore function to long injured joints, perhaps staving off joint replacement surgeries for some years.”

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Greg Williams

Patients receiving Enbrel® (etanercept) in combination with methotrexate for early Rheumatoid Arthritis (RA) are more likely to continue working, according to the COMET study published recently in Rheumatology.

One year results from the COMET study which compared the impact of methotrexate alone with methotrexate in combination with Enbrel on work productivity showed that active early RA patients receiving the Enbrelmethotrexate combination were nearly three times less likely to stop working compared to patients receiving methotrexate alone. Furthermore, work absenteeism was reduced by almost 50 per cent in the combination group.1

RA is a chronic and progressive disease that affects 2.9 million people across Europe.2 As the disease progresses, RA can cause permanent damage to the joints, resulting in deformity and loss of independence.

The prevention of work productivity loss represents benefit beyond the traditional measures of disease improvement. The economic impact of RA is significant, with an estimated €45 billion spent on the disease in Europe each year. Of this, 32 per cent of the total cost is likely due to work disability and decrease in work productivity.2 Results from previous studies suggest that even in the early stages of disease, RA can impact a persons ability to work.1 In the COMET study, half of the work stoppages observed occurred in the first three months of the trial.1

“Keeping a person gainfully employed represents a benefit to society, above and beyond, the clinical benefits of treatment” said Professor Aslam Anis, School of Population and Public Health, University of British Columbia and lead author of the paper. “The fact that half of the work stoppages occurred in the first three months of this trial, together with the fact that there were significantly fewer work stoppages in the Enbrelmethotrexate combination group, underscore the importance of early and aggressive treatment of RA.”

During the COMET (COmbination of Methotrexate and ETanercept) study, work absenteeism was recorded over 12 months amongst 205 patients with early active RA. Total absenteeism was defined as a composite of number of missed workdays, reduced working time and number of days patients were unemployed as a result of their RA.

At the end of one year1The number of missed workdays in the group receiving combination treatment of Enbrel and methotrexate (14.2 days) was approximately half that of patients receiving methotrexate monotherapy (31.9 days)

In total, the Enbrel combination group missed up to 37 fewer total days due to absenteeism than the methotrexate monotherapy group

24 per cent of patients in the monotherapy group had to stop work at least once during the year, compared to 8.6 per cent of patients in the combination therapy groupPreviously published data from the COMET trial showed that early treatment of RA can halt the joint damage seen as the disease progresses 80 per cent of patients in the combination group experienced no further joint damage as measured by xrays. Furthermore, 50 per cent of patients experienced a sustained reduction in disease activity as measured by the number of swollen joints (i.e. clinical remission) and 55 per cent achieved normal physical functioning, as measured by the Health Assessment Questionnaire.3

About COMET

The COMET (COmbination of Methotrexate and ETanercept in early rheumatoid arthritis) study was designed to compare the clinical efficacy and safety of Enbrel (ETN) and methotrexate (MTX) combination therapy with MTX alone on clinical disease activity and progressive joint damage in patients with active early rheumatoid arthritis. The work analysis was designed to compare the impact of ETN+MTX to MTX alone on work productivity among MTXnaïve patients with active early RA over 12 months.

Two hundred and five patients [MTX (n=100) VS ETN+MTX (n=1050], who were working full time or part time at the start of the trial and had at least one followup observation, were included in the analysis. Compared with the MTX group, the ETN+MTX group had a maximum of 37 fewer missed workdays or at minimum 22 fewer missed workdays.

About ENBREL

ENBREL is a fully human soluble tumour necrosis factor (TNF) receptor antagonist. ENBREL was first approved in 1998 for moderate to rheumatoid arthritis and has since been used in 505,000 patients worldwide across indications.

ENBREL is approved for the following indications

Rheumatoid arthritis
ENBREL in combination with methotrexate is indicated for the treatment of moderate to severe active rheumatoid arthritis in adults when the response to diseasemodifying antirheumatic drugs, including methotrexate (unless contraindicated), has been inadequate. ENBREL can be given as monotherapy in case of intolerance to methotrexate or when continued treatment with methotrexate is inappropriate. ENBREL is also indicated in the treatment of severe, active and progressive rheumatoid arthritis in adults not previously treated with methotrexate. ENBREL, alone or in combination with methotrexate, has been shown to reduce the rate of progression of joint damage as measured by Xray and to improve physical function.

Polyarticular juvenile idiopathic arthritis
Treatment of active polyarticular juvenile idiopathic arthritis in children and adolescents aged 4 to 17 years who have had an inadequate response to, or who have proved intolerant of, methotrexate. ENBREL has not been studied in children aged less than 4 years.

Psoriatic arthritis
Treatment of active and progressive psoriatic arthritis in adults when the response to previous diseasemodifying antirheumatic drug therapy has been inadequate. ENBREL has been shown to improve physical function in patients with psoriatic arthritis, and to reduce the rate of progression of peripheral joint damage as measured by Xray in patients with polyarticular symmetrical subtypes of the disease.

Ankylosing spondylitis
Treatment of adults with severe active ankylosing spondylitis who have had an inadequate response to conventional therapy.

Plaque psoriasis
Treatment of adults with moderate to severe plaque psoriasis who failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapy including cyclosporine, methotrexate or PUVA. ENBREL is also licensed in the European Union for treatment of chronic severe plaque psoriasis in children and adolescents from the age of 8 years who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies.

About Wyeth

Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of womens health care, infectious disease, gastrointestinal health, central nervous system, inflammation, transplantation, haemophilia, oncology, vaccines and nutritional products.

Wyeth is one of the worlds largest researchdriven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products, nutritionals and nonprescription medicines that improve the quality of life for people worldwide. The Companys major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.

References

1. Anis A et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis results from the COMET study. Rheumatology doi10.1093/rheumatology/kep239. EPub, 18 August 2009

2. Lundkvistet al. The burden of rheumatoid arthritis and access to treatment health burden and costs. Eur J Health Econ 2008;8 (Suppl.2)S4960

3. Emery P et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET) a randomised, doubleblind, parallel treatment trial. Lancet. 2008;372375382

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It is Tammy HautDonahue s quest to rid the world of osteoarthritis, which afflicts 20 million Americans. Some suffer from injury; others from the wear and tear of age.

The condition results from the degeneration of the cartilage in joints, the most troublesome being the knee. When cartilage is worn away, a painful rubbing of bone on bone occurs.

HautDonahue, a mechanical engineer at Michigan Technological University, believes the cure for osteoarthritis will begin with the meniscus, a littleunderstood buffer between the two major leg bones the femur and the tibia that meet in the knee. She endeavors to unravel its mysteries.

Artificial replacements for damaged tissue are not effective. Neither is the removal of damaged tissue. Rather, she investigates tissue engineering so the meniscus can be repaired or replaced following damage.

The science isnt there yet. “To repair the meniscus, we have to understand how the old one works.”

Her inquiry, which ranges from computer modeling to working with animals, could revolutionize medicine. Most of the research in the US, she says, addresses what happens to bone and cartilage in the absence of meniscus; she wants to protect the cartilage. “Then you wont have the arthritis problem in the first place.”

Michigan Technological University is a leading public research university, conducting research, developing new technologies and preparing students to create the future for a prosperous and sustainable world. Michigan Tech offers more than 130 undergraduate and graduate degree programs in engineering, forestry and environmental sciences, computing, technology, business and economics, natural and physical sciences, arts, humanities and social sciences.

GlaxoSmithKline (GSK) and Genmab A/S (OMX GEN) announced preliminary topline results from a Phase III study of ofatumumab administered intravenously for the treatment of rheumatoid arthritis (RA) in patients who had an inadequate response to methotrexate. The study met the primary endpoint, ACR20 at 24 weeks, which indicates a 20 percent or greater improvement in the number of swollen and tender joints, as well as improvements in other diseaseactivity measures.

In the study, 260 patients were treated and included in the analysis. At week 24, the ACR20 response rate was significantly greater for RA patients on ofatumumab (n=129) than on placebo (n=131) with a 50 percent response rate in the patients receiving ofatumumab, compared to 27 percent for patients on placebo (pvalue less than 0.001). All key secondary endpoints were significant (pvalue less than or equal to 0.001)

There were no unexpected safety findings. The most common adverse events in the ofatumumab treated patients (greater than 5 percent) were rash, urticaria, nasopharyngitis, pruritus, throat irritation and hypersensitivity. Other than nasopharyngitis, these events generally occurred within 24 hours of the first infusion. One death, judged by the investigator as unrelated to ofatumumab, was reported in the study during the 24week study period.

“We have always believed in ofatumumabs potential to make a difference in patients lives. We are pleased with the results of this study, supporting the further investigation of this antibodys promise in the treatment of RA” said Lisa N. Drakeman, Ph.D., Chief Executive Officer of Genmab.

“RA can be a highly debilitating disease. It is encouraging to see the reduction in disease symptoms achieved with intravenous ofatumumab, and we look forward to presenting the full study results, ” said Carlo Russo, M.D., Senior Vice President, Biopharm Development, GSK.

About the study

In this 24 week doubleblind study, patients with active RA were randomized to receive two 700 mg doses of intravenous ofatumumab or placebo two weeks apart in addition to background methotrexate. Disease status was measured every 4 weeks. Patients for this nonIND study were recruited from Europe, South America and Australia.

The primary objective of the study was to determine the efficacy of intravenous ofatumumab in reducing the clinical signs and symptoms in RA patients after two 700 mg doses of ofatumumab compared to placebo. The primary endpoint of the study was ACR20 at 24 weeks. Other key secondary objectives included safety, patient reported outcomes, biomarkers and ACR 50 and ACR 70.

ACR Response

The ACR 20 response is defined as a 20 percent or greater improvement from baseline in tender and swollen joint counts, and 20 percent or greater improvement in 3 of the 5 following assessments patient and physician global assessments, pain, disability, and an acute phase reactant (ESR or CRP).

About ofatumumab

Ofatumumab is a novel, investigational, fully human monoclonal antibody that targets a membraneproximal (close to the cell surface) small loop epitope (a portion of a molecule to which an antibody binds) on the CD20 molecule of Bcells. This epitope is different from the binding sites targeted by other CD20 antibodies currently available.

Ofatumumab is being developed for other indications under a codevelopment and commercialization agreement between Genmab and GlaxoSmithKline. It is not yet approved in any country.

About GlaxoSmithKline (GSK)

GlaxoSmithKline one of the worlds leading researchbased pharmaceutical and healthcare companies is committed to improving the quality of human life by enabling people to do more, feel better, and live longer.

GSKs BioPharm R&D division has a rich early pipeline based on cutting edge molecular biology and genetic technology and a mature latestage portfolio that will provide important medicines to oncology.

Source GlaxoSmithKline

Arthritis Care, the UKs largest support charity for people with arthritis, welcomes the National Audit Office report into rheumatoid arthritis services and urges health chiefs to implement its recommendations as swiftly as possible.

The audit highlights minimal GP training in rheumatoid arthritis (RA) and poorly coordinated services, which the charity says means thousands of people with this devastating disease are failed by the system.

The NAO report echoes what people with RA have been telling Arthritis Care for years that it takes too long to get diagnosed. Early diagnosis and referral for suitable treatment is crucial as it can literally stop this debilitating condition in its tracks. We applaud the audits recommendations that the Department of Health and Primary Care Trusts (PCTs) replace their often scattergun delivery with joinedup services. If actioned, the recommendations in this report should dramatically improve life for people with RA as well as save the country millions of pounds, said Neil Betteridge, Arthritis Cares chief executive.

44 yearold Elizabeth Ogg from West Sussex developed rheumatoid arthritis 6 years ago after the birth of her son. Elizabeth, who used to work as a management consultant, said “It was terrifying when I started getting unbearable pains in my arms and legs. My mother urged me to see my doctor straight away my father had RA and she recognised the potential symptoms immediately. Even with the private health care I had through my job, it still took over 6 months to get the correct diagnosis and start treatment.

After I was diagnosed, it became very clear that my GP at the time had very little understanding of RA, how severe it was or the medication that I would need to use. I didnt have any guidance or support and I was never referred to any specialist services, not even a physiotherapist it was a disaster. Thankfully, I recently moved to West Sussex and since then I cannot praise the support Ive had enough. My GP is wonderful she has a special interest in rheumatology and I see a specialist nurse regularly as well as a physiotherapist and podiatrist. Im finally getting the support I need to live with my condition. I cant believe the difference in service Ive experienced it just shouldnt be this way.”

Arthritis Care believes that the key to addressing the majority of the problems identified by the NAO lies in the proper implementation of the Department of Healths Musculoskeletal Services Framework. The framework, launched in 2006 is a strategy for the delivery of integrated musculoskeletal services for England.

The Musculoskeletal Services Framework was devised to improve services but any implementation has been intermittent and halfhearted. As the audit says, 73% of PCTs have not even undertaken any assessment to establish the number of people with RA in their areas. Arthritis Care is calling on the government and Strategic Health Authorities, plus every PCT, to respond to the audit by prioritising proper implementation of the framework. We also want to see a National Clinical Director for musculoskeletal services appointed to drive through improvements in services, just in the same way as one exists in the areas of mental health, diabetes and heart disease, says Betteridge.

According to the CDC, 46 million Americans were told by a doctor they have arthritis, the leading cause of disability in the United States. Flexcin International, Inc., a natural supplement company offering the only joint pain remedy products with CM8™, offers arthritis and bursitis treatment for anyone suffering from painrelated disease and injuries.

The CDC also reports that the most commonly identified limitations among adults reporting a disability include walking three blocks and climbing a flight of stairs. Given the aging of “baby boomers,” the number of adults with joint pain and arthritis is likely to increase dramatically over the next 15 years. Flexcin with CM8 works as an arthritis remedy for hip pain, hand or foot pain, and muscle pain. The patented formula of CM8 is clinically proven to promote optimal joint health by helping to stimulate the lubricating fluid in the joints, support stronger cartilage and increase total mobility.

“Arthritis and joint pain can be extremely uncomfortable for people at any age and, worse, can disrupt our lives in many unfortunate ways,” said Tamer Elsafy, CEO and founder of Flexcin. “Flexcin with CM8 helps remove this harsh pain from your life without any unwanted or dangerous side affects. We invite anyone in search of an arthritis remedy to take the Flexcin challenge so we can show them what life is like pain free.”

People living with arthritis and joint pain can take the Flexcin challenge, a threemonth supply of Flexcin with CM8 that comes with a moneyback guarantee.

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