Health
TNF Inhibitors Linked to Increased Multiple Sclerosis Risk
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Anti-tumor necrosis factor alpha (TNF-alpha) inhibitors are associated with an increased risk for multiple sclerosis (MS), especially among patients with rheumatic disease (RD), new research shows.
When investigators combed medical databases in four Canadian provinces for information on patients with RD and irritable bowel disease (IBD) taking anti-TNF-alpha agents alongside matched controls in a prospective cohort study, they found an increased risk for MS in the RD patients.
Dr Antonio Aviña-Zubieta
Physicians shouldn’t hesitate to prescribe anti-TNF-alpha therapy for patients if they believe their patients can benefit from it, study investigator Antonio Aviña-Zubieta, MD, PhD, senior scientist at Arthritis Research Canada in Vancouver, British Columbia, told Medscape Medical News.
“To better provide a context of the magnitude of the risk, we would need to treat 2268 individuals with anti-TNF-alpha therapy in order to get one additional case of MS. This is considered a rare side effect [of anti-TNF therapy],” he said, adding that MS still occurred even in people who did not receive anti-TNF therapy.
“Nevertheless, we do not recommend anti-TNF in patients with MS or those with a family history of MS. The decision to take anti-TNF is best taken together by patient and health care provider,” said Aviña-Zubieta.
The study was published online October 28 in the journal Neurology.
Potential MS Link Investigated
Anti-TNF-alpha agents are often prescribed to stop inflammation for chronic immune disorders such as rheumatoid arthritis, inflammatory bowel disease (IBD), psoriasis, and ankylosing spondylitis. Prior research has raised suspicions of an increased risk of MS with use of anti-TNF-alpha agents in small samples.
Investigators accessed population-linked databases in the Canadian provinces of British Columbia, Alberta, Saskatchewan, and Manitoba, which contain information about physician visits, hospitalizations, demographic data, and medication in those provinces.
They mined the databases for information about patients diagnosed with RD and IBD between January 2000 and March 2018 and then determined new incident cases of MS in the two disease cohorts with at least three outpatient records related to MS, hospitalizations, or prescription claims for MS. Investigators could only obtain information about RD from databases in BC and Manitoba.
The anti-TNF-alpha drugs were dispensed in the 2 years prior to MS onset, and included adalimumab, certolizumab, etanercept, infliximab, and golimumab.
Each case of MS was matched with up to five control subjects of similar ages who did not receive anti-TNF-alpha agents, had similar RD or IBD illness duration, and the same approximate place of residence.
Investigators identified nearly 300,000 patients with RD. During follow-up, 462 of them developed MS (80% female, mean age 47) and were matched with 2300 controls with RD (60% female, mean age 47). They found that 18 people with RD and MS took an anti-TNF-alpha, vs 42 of the 2296 patients who had RD but not MS.
After adjusting for variables that could influence the risk of developing MS, the investigators discovered that people with RD who took an anti-TNF-alpha agent had a 105% increased risk of developing MS compared to people with RD who didn’t take an anti-TNF-alpha agent.
Aviña-Zubieta said it would be ill-advised for people with RD who have a family history of MS to use the anti-TNF agents, as there are other medications that could also be helpful.
Investigators noted a smaller increased risk for MS in the group with IBD, but the findings did not reach statistical significance.
There are several theories about how anti-TNF therapy might risk MS in certain patients. Aviña-Zubieta speculated that the therapy may increase reactivity from immune cells to myelin leading to a loss and malfunction of the affected areas. Additionally, “TNF blockage by this therapy may affect myelin repair. The possibility of higher risk of infections that could be linked to MS is possible too, but not proven,” he noted.
Study limitations included smaller sample sizes from Saskatchewan and Manitoba. Investigators also noted that MS prodrome periods can occur as much as 5 years before onset, so patients exhibiting early MS symptoms or MS prodrome who have not yet been diagnosed might be misdiagnosed as controls.
Context Is Important
Commenting on the study for Medscape Medical News, Amy Kunchok, MD, a staff neurologist at the Cleveland Clinic’s Mellen Center for Multiple Sclerosis, Cleveland, Ohio said context is important when interpreting the findings.
Dr Amy Kunchok
“Anti-TNF therapies are highly effective for many autoimmune disorders, as evidenced by numerous randomized controlled trials in rheumatological disorders and IBD,” said Kunchok, who was not involved in the study.
“As with any therapeutic decision, the physician needs to consider the medical needs of the patient and the risk–benefit scenario. In a patient with a preexisting MS diagnosis, we would generally not recommend these therapies, but instead suggest the treating specialist consider alternatives.
“However, in patients without prior inflammatory neurological disorders, these therapies may be safe and efficacious. There is more work needed to risk- stratify patients in terms of these rare inflammatory CNS events,” she added.
Neurology. Published online October 28, 2022. Abstract
The study was funded by the Canadian Institutes of Health Research. Aviña-Zubieta and Kunchok report no relevant financial relationships.
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Outbreak declared at local hospital
Seaforth Community Hospital Sign, Seaforth, ON. (Photo by Craig Power, © 2016).
January 30, 2023 5:41am
A COVID-19 Outbreak has been declared on the Inpatient Unit at Seaforth Community Hospital.
Quality, Patient Safety & Infection Control Manager Erica Jensen explains what an outbreak means.
“An outbreak refers to two or more COVID positive cases. So one of our control measures in response to outbreaks is that we restrict the family and caregiver presence on the unit to essential need only, so that is for palliative patients,” Jensen stated.
Jensen adds, the restrictions will be in place until, in collaboration with the local health unit, they can determine that no ongoing transmission is occurring within the outbreak unit.
“Definitely call ahead if you’re wanting to visit someone at the Seaforth Hospital. I know that the staff there are working diligently to contact family and caregivers who do have loved ones in the hospital right now,” Jensen added.
Jensen also points out, as much as COVID cases have gone down recently, testing is still quite limited, so it’s difficult to know exactly what the situation is and COVID is still present, so the outbreak wasn’t a complete surprise. She advises people to continue to take precautions like washing their hands, wearing a mask in public places and get vaccinated.
Apples are one of the oldest cultivated fruit, dating back at least 6,500 years, and have some of the greatest health benefits. There is truth behind the old adage “An apple a day keeps the doctor away.”
They are high in soluble fibre, low calorie, low on the glycemic index, and contain beneficial vitamins like Vitamin C, quercetin, pectin and potassium. They are a good antioxidant (especially the peel) and are the number one fruit to help prevent diabetes, cancer and heart disease. They help lower cholesterol as the soluble fibre in apples binds with saturated fat (preventing it from entering the bloodstream).
To aid weight loss, it is beneficial to eat an apple prior to a meal, as they curb your appetite. Apples encourage more saliva production, which protects your teeth. Some studies show mental health benefits of increased intellectual capabilities and a slowing down of mental aging and Parkinson’s (due to their antioxidant properties). The fibre and quercetin (a plant polyphenol) builds immunity to combat virus and bacteria, especially when one is stressed. The antioxidant properties help regulate ocular muscles and nerves, helping to preserve one’s eyesight.
Apples also speed up liver regeneration. The pectin in apples binds with heavy metals in the gut (aluminum and lead) and helps eliminate them. Heavy metal poisoning is one of the leading causes of Alzheimer’s disease. Apples are also proven to reduce anxiety when eaten regularly. The soluble fibre pectin aids IBS symptoms and ulcerative colitis.
Apple cider vinegar (fermented apple juice) has become a health rage and has its own set of health benefits including aiding digestion and weight loss, lowering inflammation and boosting energy.
Consuming it before a meal is said to help reduce blood sugar spikes afterward. It also helps with the absorption of the following nutrients: protein, calcium, iron, carbohydrates, fats, Vitamins A,B,C and E and magnesium. Apple cider vinegar is an antifungal, antibacterial and antiviral helps with absorption of calcium and other minerals. Even though it is acidic, once absorbed in the gut it is slightly alkaline. As it is acidic before digestion, it shouldn’t sit on the teeth as it may soften enamel. It is best to drink apple cider vinegar through a straw or rinse your mouth out afterwards with water.
These are some (proven and unproven) folk remedies using apple cider vinegar. Here are several but not all: removes age spots, as a soak for arthritic hands and feet or for athlete’s foot, soften foot corns, prevents asthma, heals bruises, fights cancer, helps prevent cataracts, eliminates cold sores, soothes a sore throat, eliminates cramping, treats dandruff, lowers blood sugars, kills diarrhea causing bacteria, soothes eczema and itching due to rashes, bites or stings, eliminates fatigue, increases stomach acid for those with gallbladder issues (associated with low stomach acid), aids hay fever, reduces headaches, dissolves the glue that holds nits (head lice eggs) onto the hair, treats hiccups, lowers blood pressure, aids osteoporosis by aiding calcium absorption, stops nose bleeds, aids absorption of all vitamins and minerals, treats smelly feet and warts.
As with any alternative remedy, it is important to talk to your naturopath and doctor beforehand to make sure there are no contra-indications with existing medicines, but there doesn’t seem to be any doubt that apples and apple cider vinegar contribute to healthy living. There are also many beauty aids but space prevents me from covering them in this article.
I personally use apple cider vinegar in a wonderful salad dressing with our Lemon-Honey Elixir, crushed garlic, avocado oil and a pinch of dried mustard.
Claire Nielsen is a health coach, author, public speaker and founder of www.elixirforlife.ca. The information provided in the above article is for educational purposes only and is not a substitute for professional health and medical advice. Please consult a doctor or healthcare provider if you’re seeking medical advice, diagnoses and/or treatment.
COVID-19 infections haven’t gone away on the North Shore.
But serious illnesses from respiratory diseases of all types are on the decline.
That’s the latest information this week that can be teased from statistics from both B.C.’s Centre for Disease Control and the Ministry of Health.
One of the biggest indicators of serious illness – hospitalizations – are thankfully on the decline.
Number of people in Lions Gate Hospital drops over 7%
Between Jan. 6, when Health Minister Adrian Dix first raised the alarm about high numbers of hospitalizations, the number of people in hospital at Lions Gate on the North Shore has fallen 7.2 per cent, according to the Ministry of Health. The number of people in hospital at Lions Gate went from 319 on Jan. 6 to 296 on Jan. 26.
A similar trend was seen at most major hospitals in B.C.
In Vancouver Coastal Health, hospitalizations fell 10.6 per cent in Richmond, 6.5 per cent at St. Paul’s and 4.2 per cent at Vancouver General. The only hospital where that didn’t happen was B.C. Children’s, where numbers remained stable.
As of Jan. 26, there were 42 people hospitalized who had tested positive for COVID-19 in VCH, two of those in critical care. There were also three new deaths in VCH among people who recently tested positive for COVID-19.
According to the B.C. Centre for Disease Control, flu – which peaked early in November – has now fallen to low levels. RSV infections – which have hit children hardest – remain high but have continued to decline. COVID cases have remained relatively stable.
North Shore sewage plant data shows small COVID uptick
According to recent data from wastewater sampling, levels of COVID-19 measured on the North Shore rose slightly from early January, although levels of virus being shed in sewage water were still not as high as they were over the Christmas period. Levels of the virus in most other Lower Mainland plants had declined as of Jan. 16.
Numbers of people vaccinated haven’t changed much on the North Shore. Between 92 and 95 per cent of adults 18 and over received at least two doses of the vaccine. But those numbers fell with each subsequent booster shot. Only 47 per cent of adults on the North Shore have received two boosters. There is also a relatively small uptake for children. Between 52 and 64 per cent of children age five to 11 have received two doses of vaccine, while under 20 per cent of the youngest children have received two doses.
Monday marks the third anniversary of the World Health Organization declaring COVID-19 as a global public health emergency.
On Friday, a committee of WHO voted on whether to maintain that designation. A final decision will be announced on Monday, but it isn’t expected to change anything in practical terms in Canada.
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