A new wrinkle and some reassurance

I suppose I may have a new wrinkle from my brow being furrowed as I take in all the information here at ACR, but the new wrinkle I refer to in this post's title is using Botox for knee pain. At a press conference today, Dr. Maren Mahowald from the University of Minnesota presented results showing that injections of intra-articular botulinum toxin type A (otherwise known as Botox) into the knee disrupted the pain signals sent through the nervous system just enough to reduce persistent pain in those with severe knee OA. In the 35 patients, daytime pain decreased by 39 percent and nighttime pain decreased by 24 percent. Dr. Mahowald says she expects pain to continue to decrease over the next several months, as they continue to track patients in the study. No adverse effects were seen, and Dr. Mahowald and her group of researchers are now trying to determine how many shots are needed per year. (And she jokingly assured us that it would keep our knees from wrinkling. Dimpling is another issue, however.)

As I was writing the above paragraph, Dr. Eric Matteson from the Mayo Clinic stopped by the press room to review the final pages of Arthritis Today's 2007 Drug Guide, which goes to press this week (look for the finished version in the January-February issue). He and I were discussing the news about naproxen that he just heard presented this morning and that I just heard via the press conference at the National Press Club. The news is good: Nonprescription doses of naproxen (Aleve) have an antiplatelet effect similar to low-dose aspirin and the prescription form of naproxen (Naprosyn). The study confirms earlier studies indicating naproxen may be safer cardiovascularly than some other NSAIDs, but as Dr. Matteson points out, whether OTC naproxen helps prevent cardiovascular effects has not yet been studied. And Dr. Schiff, at the press conference, stressed that point also, saying the results do not mean that Aleve should replace baby aspirin for heart attack prevention. What the news does do, however, is give rheumatologists, patients and pharmacists some reassurance and may help everyone make treatment decisions rather than feeling that no NSAID is safe.

Well, off to another session -- more to come later!