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Showing posts with label Inflammation. Show all posts
Showing posts with label Inflammation. Show all posts

Monday, 27 March 2023

82% of patients with liver scarring experience pain - the three body parts often affected

An enlarged liver can throw the body into an inflammatory state, causing different types of pain.


Liver scarring can cause pain in a person's right shoulder (Image: Getty)

Liver cirrhosis is often described as "end stage" fatty liver disease because the organ can no longer function properly. This happens when healthy liver tissue becomes progressively replaced with scar tissue, a process that cannot be reversed. As the organ stops working properly, people start noticing pain in their neck, shoulders and joints.

Cleveland Clinic warns that cirrhosis can become increasingly painful as the condition worsens.

"Pain is reported by up to 82 percent of people who have cirrhosis and more than half of these individuals say their pain is long-lasting (chronic)," explains the health body.

Most people with the condition experience this pain in the upper right portion of their abdomen under their ribs.

The pain, however, can come both from the diseases that lead to cirrhosis and/or cirrhosis can make the pain from existing diseases worse.

READ MORE: Nation's favourite foods could raise your risk of liver disease

arthritis

Fatty liver disease can exacerbate pre-existing issues like arthritis (Image: Getty)

Because the disease throws the body into an inflammatory state it may also exacerbate pre-existing issues.

"Inflammation and your body's reaction to inflammation can cause general pain," explains Cleveland Clinic.

When in an inflammatory state, a person's osteoarthritis may become increasingly apparent.

Though pain is typically described in the abdomen, cirrhosis patients also complain of pain in the back, shoulders, and neck.


Cancer Research confirms that a swollen and enlarged liver can cause pain in a person's right shoulder.

"This is because the enlarged liver stimulates nerves that connect to nerves in the shoulders. This is called a referred pain," says the health body.

Joint pain, medically known as arthralgia, is another common problem that can present with or without arthritis.

In fact, there is a variety of different liver diseases that co-exist with arthralgia (joint pain) and arthritis.

READ MORE: Five warning signs of potentially 'life-threatening' liver scarring

Often, diffuse joint pain is described in patients suffering acute hepatitis that may mimic other rheumatic diseases.

"Approximately 50 percent of patients with hepatitis B and C have joint pain associated with cryoglobulinemia," explains the Rheumatology Advisor.

In one case report, the Liver Doctor described the case of a patient named Hana who experienced pain specifically in her right wrist.

"Hana initially thought it was due to all the computer work she does, but when both wrists became painful and swollen she decided to see her doctor," explained the Liver Doctor.

Liver

Liver scarring is an irreversible complication (Image: Getty)

How long does it take for fatty liver symptoms to appear?

Though fatty liver disease symptoms can appear in the short timeframe of five years, in most cases they'll emerge between 20 and 30 years after the condition has been diagnosed.

One can prevent these complications by adhering to certain dietary rules and reducing their body weight if they are overweight.

Additionally, a person should aim to do at least 30 minutes of exercise most days of the week to keep their liver in good health.

"If you're trying to lose weight, you might find that exercise is helpful," notes the Mayo Clinic.

https://www.express.co.uk/life-style/health/1751398/fatty-liver-disease-symptoms-pain

Wednesday, 21 April 2021

Fluvoxamin OCD drug spotlighted as potential COVID-19 treatment

 Despite a highlight story on 60 Minutes last month, fluvoxamine, a drug typically used to treat obsessive-compulsive disorder (OCD), is still just a brief mention in the "cytokine inhibitors" section in the New York Times' "Coronavirus Drug and Treatment Tracker."

https://www.cidrap.umn.edu/news-perspective/2021/04/ocd-drug-spotlighted-potential-covid-19-treatment



Wikimedia Commons

For now, it makes sense. Fluvoxamine, a serotonin reuptake inhibitor (SSRI), has shown promise in two smaller studies, but larger trials have not been published yet.

Even if the drug becomes a more mainstream treatment for COVID-19, one expert says any demand surge is not expected to result in shortages.

COVID-19 treatment potential

As 60 Minutes tells it, the first COVID-19–related fluvoxamine study began because Angela Reiersen, MD, MPE, was reflecting on potentially relevant medical studies when she herself was sick with COVID in March 2020. There was one that caught her attention: A 2019 Science Translational Medicine study that suggested fluvoxamine lowered inflammatory cytokine production and treated sepsis in mice.

"Mechanistically, we find that S1R [ER-resident protein sigma-1 receptor] restricts the endonuclease activity of the ER [endoplasmic reticulum] stress sensor IRE1 and cytokine expression but does not inhibit the classical inflammatory signaling pathways," write the researchers. "These findings could have substantial clinical implications, as we further find that fluvoxamine, an antidepressant therapeutic with high affinity for S1R, protects mice from lethal septic shock and dampens the inflammatory response in human blood leukocytes."

The same cytokine storm that is mentioned in this study is also an inflammation-causing symptom in COVID-19.

So, Reiersen mentioned it to her acquaintance Eric Lenze, MD, who became the lead author on a preliminary randomized clinical trial published in JAMA in November 2020, with Reiersen as senior author.

In that study, 80 participants with COVID-19 received 100 milligrams (mg) of fluvoxamine three times daily for 15 days, and 72 COVID-19 patients received a placebo. While 8.7% of the placebo group had to be hospitalized within 14 days because of worsening symptoms, none in the intervention group were.

In Lenze's study, he and his research team also discussed the S1R-IRE1 pathway, but in addition, they mentioned other possible mechanisms such as selective serotonin reuptake inhibition of platelet activation, the IRE1's effect on autophagy (cell self destruction as an immune response), and fluvoxamine's potential antiviral effects owing to its ability to enter cells' lysosomes.

The results of this study prompted another case study during a late 2020 COVID-19 outbreak at a horse racing track in California. Sixty-five track workers volunteered to receive 50 mg of fluvoxamine twice a day, and the 48 who declined were used as comparison. Similar to the first study, none who received fluvoxamine had clinical deterioration after 14 days; whereas, 12.5% of those who didn't receive fluvoxamine did and 60% still had symptoms, according to the results published in Open Forum Infectious Diseases.

As of yesterday, ClinicalTrials.gov shows that three studies are recruiting to assess fluvoxamine's effect on COVID-19. In one, researchers will randomize 880 to 1,100 Americans 30 and older who have mild COVID-19 and plans to follow them for 15 days, and another is designed to recruit 400 South Koreans with mild to moderate COVID-19 for a 10-day study.

The goal of the third study is to enroll about 2,700 Brazilians who have mild COVID-19 for a 1:1:1:1 ratio across fluvoxamine, metformin, and ivermectin, the latter of which recently had unpromising results for mild COVID results in JAMA.

Predicted resilience against demand surges

If the demand for fluvoxamine does increase, it is not expected to cause drug shortages in the US market.

In 1994, fluvoxamine became the US Food & Drug Administration's (FDA's) first approved SSRI, although it has been used internationally in clinical practice since 1983. Solvay was the first and exclusive manufacturer, selling fluvoxamine under the brand name Luvox.

Currently, the FDA reports seven companies that hold approved abbreviated new drug applications to manufacture fluvoxamine, and several other firms have entered and exited the market over the past decade. Unlike many other generic drugs that are made primarily in India, China, or other countries, much of the fluvoxamine is produced in US facilities.

There are at least five manufacturers in the United States who make the active pharmaceutical ingredient known as fluvoxamine, as well as companies in Canada and India, according to Stephen W. Schondelmeyer, PharmD, PhD, co-principal investigator of the Resilient Drug Supply Project at the University of Minnesota.

"Drug shortages are less likely to occur when there are multiple active ingredient manufacturers, when some of that production is based in the United States, and when there is continued strong demand for the drug," he adds.

Although the generic market is known to lower the price and profitability of a drug, demand for fluvoxamine continues to be substantial for OCD, as well as off-label for social anxiety disorder and other conditions. Drugs.com lists the cost for a bottle of 100 25-mg oral tablets around $79, but the US market demand was enough to pull in approximately $28 million in sales from September 2018 to September 2019, according to Upsher Smith, one of the drug's generic manufacturers.

https://www.cidrap.umn.edu/news-perspective/2021/04/ocd-drug-spotlighted-potential-covid-19-treatment

Fluvoxamine and COVID-19: Here’s How the OCD Drug Might Help Prevent COVID-19 Infections From Getting Worse

 The antidepressant may help dial back the body's immune response to COVID-19—which can actually be a good thing.

By Claire Gillespie 
March 08, 2021

The COVID-19 vaccine rollout has been the main focus of attention over the last few months—more than 90 million doses have been administered since distribution began on December 14, at a rate of more than 2.2 million shots per day. But at the same time, scientists have continued to work hard to find treatments for people who get infected.

One of them, the generic drug fluvoxamine, has shown huge potential. Developed 40 years ago as an antidepressant, fluvoxamine—sometimes known as Luvox—has been used mainly to treat obsessive-compulsive disorder (OCD), per the National Alliance on Mental Illness (NAMI). But now, researchers are taking a closer look at how the medication could be an important treatment to prevent patients who test positive for COVID-19 from getting seriously ill with the infection.

COVID-Fluvoxamine-Early-Treatment-For-COVID
CREDIT: GETTY IMAGES

In a new interview with 60 Minutes, Angela Reiersen, MD, a child psychiatrist at Washington University in St. Louis—and co-author of a November 2020 study published in the Journal of the American Medical Association (JAMA) regarding the use of fluvoxamine in COVID-19 patients—explained that she first got the idea that the drug could potentially treat COVID-19 after seeing research that fluvoxamine prevented sepsis in mice.

"I thought, well, I wonder if we could use fluvoxamine to treat COVID and prevent that clinical deterioration," Dr. Reiersen told 60 Minutes.

Dr. Reiersen and her colleagues—including Eric Lenze, MD, a fellow psychiatrist at Washington University who also specializes in finding new uses for drugs that are already approved by the Food and Drug Administration (FDA)—went on to conduct the small randomized clinical trial on fluvoxamine and COVID-19 patients.

The results of that JAMA study found that participants with symptomatic COVID-19 who were treated with fluvoxamine "had a lower likelihood of clinical deterioriation" than those who were given a placebo. "The results were really pretty incredible," Dr. Lenze told Alfonsi. "Out of the 80 people who received fluvoxamine, none, zero of them deteriorated versus 8% of the people who got [the] placebo."

Of course, since the study was only preliminary, researchers declared that more research was needed to determine "clinical efficacy" of the drug in COVID-19 patients. But that research sparked even more research on fluvoxamine's role in preventing serious disease in those with COVID-19 infections.

David Seftel, MD, a physician in Berkeley, California, opted to offer a 15-day prescription to his own COVID-19 patients, who fell victim to an outbreak in the Golden Gate Fields race track community. (FYI: His decision to use a prescription drug off-label is an accepted medical practice, provided the patient consents. "Off-label" simply means it hasn't been approved by the FDA for that particular condition.)

The results of Dr. Seftel's real world study, which were published in Open Forum Infectious Diseases, showed that, of 65 of those patients who chose to take fluvoxamine, none were hospitalized, while of the 48 who declined the prescription, 12.5% ended up hospitalized, and one died.

Experts believe fluvoxamine has shown to be effective against COVID-19 due to the medication's effects on the body's inflammatory response—specifically by tamping down that response in those with active COVID-19 infections.

Normally, when the body is trying to fight off an invader like SARS-CoV-2 (the virus that causes COVID-19), it releases cytokines, or biological chemicals that stimulate cell pathways and allow for communication between cells. Those cytokines signal to the body's immune system that it needs to start doing its job. In some cases, though, the the outpouring of cytokines becomes accelerated—known as a cytokine storm—creating high levels of inflammation in the body. "Normally, cytokines are meant to be helpful to us in moderation," Carl Fichtenbaum, MD, professor in the division of infectious diseases at the University of Cincinnati College of Medicine, previously told Health, "but when a certain pathway is engaged [too much] the immune system starts causing damage to the patient."

This is where researchers think fluvoxamine comes into play. Though the drug typically works by increasing the amount of serotonin in the body, it also binds to and activates sigma-1 receptors, which may help reduce cytokine production in the body, according to a research article in Science Translational Medicine (this one, looking at patients with sepsis), and ultimately decrease the sometimes deadly inflammation that can occur in COVID-19 patients.

Though more research is still needed on the effects of fluvoxamine in COVID-19 patients—and yet another study led by Dr. Lenze is currently underway—when asked on if the positive results could have been a fluke, Dr. Seftel said, "I don't believe so. You cannot influence a virus that is as wily and as wicked as COVID with a fluke."

Francis Collins, MD, PhD, the director of the National Institutes of Health (NIH), told Alfonsi that "fluvoxamine could certainly be something you wanna put in the tool chest [because] it looks as if it has the promise to reduce the likelihood of severe illness."

Although the vaccine rollout is greatly reducing the number of people who get seriously ill and are hospitalized with COVID-19, no vaccine offers 100% protection, and new mutations of the virus are appearing all the time. So it's still important to find new treatments for the illness. With more research, we'll have a clearer idea of the part fluvoxamine may play.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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https://www.health.com/condition/infectious-diseases/coronavirus/fluvoxamine-covid-19

Friday, 12 February 2021

BBC - Covid: Arthritis drug tocilizumab cuts deaths

 Arthritis drug tocilizumab cuts deaths from Covid

By Michelle Roberts
Health editor, BBC News online

12 February 2021



A drug normally used to treat arthritis can be a life-saver for some of the sickest hospital patients with Covid, new research shows.

For every 25 patients treated with tocilizumab, along with a cheap steroid already routinely given, an additional life would be saved, the experts say.

Some hospitals are now doing this.

As well as improving survival and recovery time, it can avoid patients needing to be moved to intensive care, say the NHS doctors.

Wendy Coleman, 62, received the treatment last year when she was admitted to Chesterfield Royal Hospital with severe Covid-19.


Wendy Coleman volunteered to take part in the trial

"I was struggling to breathe quite badly and on the verge of being placed in an intensive care unit.

"After I was given tocilizumab, my condition stabilised and I didn't get any worse. Up until then, it was quite scary as I didn't know if I was going to make it or not," she said.

Tremendous result

Researchers say around half of people admitted to hospital with Covid could benefit from the treatment.

They have carried out a clinical trial with more than 4,000 volunteers, like Wendy, and say the results are "tremendous".

Half of these Covid patients were given tocilizumab, via a drip, alongside usual care with a life-saving cheap steroid drug called dexamethasone.

In that group, compared to another group that did not receive the new drug:

  • tocilizumab cut death risk - 596 (29%) of the patients in the tocilizumab group died within 28 days compared with 694 (33%) patients in the usual care group
  • and it reduced the chance of a patient needing to go on a ventilator or dying from 38% to 33%

Combined, tocilizumab and dexamethasone should cut death risk by about a third for patients on oxygen and halve it for those on a ventilator, the researchers say.

Prof Martin Landray, joint chief investigator of the RECOVERY trial and a medical expert at Oxford University, said: "Used in combination, the impact is substantial. This is good news for patients and good news for the health services that care for them in the UK and around the world."

Dr Charlotte Summers, an intensive care medic at Addenbrooke's Hospital in Cambridge, said: "These findings are a tremendous step forwards. This therapy looks like it keeps people out of the intensive care unit so they never need to see people like me which can only be a good thing."

The treatment isn't cheap, costing around £500 per patient on top of the £5 course of dexamethasone. But the advantage of using it is clear - and less than the cost per day of an intensive care bed of around £2,000.

The drugs dampen down inflammation, which can go into overdrive in Covid patients and cause damage to the lungs and other organs.

The preliminary trial results will soon be submitted to a peer-reviewed medical journal.

Health and Social Care Secretary Matt Hancock said: "We are working quickly and closely with colleagues across the health system and sector to ensure every NHS patient who needs this treatment should be able to access it - reducing further pressures on the NHS and potentially saving thousands of lives."

NHS national medical director Prof Stephen Powis said it was another breakthrough in the fight against coronavirus.

https://www.bbc.com/news/health-56024772