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Arthritic Fingers? Beware this Therapy!

Multiple Myeloma Signs and Symptoms
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Arthritic fingers can be painful. I’m simply asking you to learn the risks and benefits of the “exciting” bone therapy, denosumab, discussed below.

I’ve been living with my incurable blood cancer and the long-term side effects of my conventional therapies since my diagnosis in early 1994.

And in all that time the single most important thing I’ve learned about modern medicine is that each and every therapy comes with risks and benefits, pros and cons. While arthritic fingers certainly are a problem, denosumab can also cause problems. Understand the risks and benefits of this powerful therapy.

Full transparency- I live with a blood cancer called multiple myeloma. Bone strengthening therapies such as denosumab, are a component of the FDA standard-of-care treatment plan for multiple myeloma. As such, I have learned a lot about bone strengthening therapies such as denosumab.


What are the risks and benefits of Denosumab?

Benefits of Denosumab

  1. Increased Bone Density: Denosumab is effective in increasing bone mineral density (BMD) in patients with osteoporosis.
  2. Reduced Fracture Risk: It significantly reduces the risk of fractures, including vertebral, non-vertebral, and hip fractures.
  3. Cancer-Related Bone Conditions: In cancer patients, denosumab helps in preventing skeletal-related events (SREs) such as fractures and spinal cord compression.
  4. Convenient Administration: Denosumab is administered as a subcutaneous injection every six months, making it more convenient than some other treatments that require more frequent dosing.
  5. Alternative for Those Who Cannot Tolerate Bisphosphonates: It offers an alternative for patients who cannot take bisphosphonates due to gastrointestinal side effects or other contraindications.

Risks and Side Effects of Denosumab

  1. Hypocalcemia: Denosumab can cause low levels of calcium in the blood, which can be severe, especially in patients with pre-existing conditions that affect calcium or vitamin D metabolism.
  2. Infections: There is an increased risk of serious infections, including skin infections (cellulitis), particularly in patients with compromised immune systems.
  3. Osteonecrosis of the Jaw (ONJ): This rare but serious condition involves the death of bone tissue in the jaw and is more common in cancer patients receiving higher doses.
  4. Atypical Femoral Fractures: Long-term use of denosumab has been associated with an increased risk of atypical femoral fractures.
  5. Dermatologic Reactions: Some patients may experience skin reactions such as rashes or eczema.
  6. Muscle and Joint Pain: Denosumab can cause muscle, bone, or joint pain in some individuals.
  7. Rebound Effect: Discontinuation of denosumab can lead to a rapid loss of the bone density gained and an increased risk of fractures. Therefore, a transition to another osteoporosis treatment is often necessary if denosumab is stopped.

Considerations and Monitoring

  • Calcium and Vitamin D Levels: Patients should have adequate levels of calcium and vitamin D before starting treatment and may need supplements.
  • Dental Examination: A dental examination is recommended before starting denosumab, especially for cancer patients, to reduce the risk of ONJ.
  • Regular Monitoring: Periodic monitoring of calcium levels, renal function, and signs of infections or dermatologic reactions is important during treatment.

According to the study linked below, denosumab had little effect on pain and function of arthritic fingers. I could be wrong but it seems to me that all of the above listed risks are a lot to take for “radiologic changes.”

man hand holding his nutritional supplemets, healthy lifestyle background.

Your call. If you are interested in learning more about evidence-based non-conventional anti-inflammatory supplements email me at David.PeopleBeatingCancer@gmail.com

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Osteoporosis Medication Could Soothe Arthritic Fingers

“”These are exciting times in the field of finger polyarthritis, as there are new data that help us better understand and possibly treat arthritis in the hands…”

A promising approach for the erosive form of finger polyarthritis is treatment with an osteoporosis medication: The monoclonal antibody denosumab, which targets the receptor activator of nuclear factor-kappa B ligand…

Finger Polyarthritis Common 

Finger polyarthritis often takes a back seat to arthritis of the knees and hips, which is why Kloppenburg referred to it as a “forgotten disease.” It is not a rarity, however. “Up to 10%-25% of older women suffer from it.”

The term “hand arthritis” may be misleading. “It sounds so simple, as if it were just one joint,” said Kloppenburg. In fact, it is mostly a polyarticular disease that affects various finger joints, usually middle and end joints, and the thumb saddle joint.

Arthritis leads to deformities, painful movement restrictions, and sometimes erosive joint changes. “This is seen in around 10% of people with symptomatic, radiologically detectable finger polyarthritis, often accompanied by inflammation,” said Kloppenburg…

“What we really lack are medications that can stop, reverse, or prevent structural damage,” said Kloppenburg. In other words, disease-modifying osteoarthritis drugs are needed. The understanding that there are apparently different endotypes of arthritis helps in the search for potentially suitable agents. “The best known are synovitis-driven, cartilage-driven, and bone-driven endotypes.”

“We know that osteoclast and osteoblast activation play a role in arthritis, and that’s also what we see in erosive finger polyarthritis,” said Kloppenburg. Studies suggest that osteoclasts resorb the subchondral bone, leading to bone remodeling at the cartilage interface. MRI studies, such as a meta-analysis with data from nearly 2000 patients, support this observation. “There is an association between these subchondral bone lesions and local joint tenderness,” said Kloppenburg…

Can Denosumab Help?

Could osteoporosis medications help? That question was exactly what researchers from Belgium investigated in a randomized, placebo-controlled phase 2a study. They enrolled 101 patients with at least one erosive or pre-erosive interphalangeal joint, a soft swelling in at least one interphalangeal joint with ultrasound evidence of synovitis, and temporary inflammatory activations. Over 48 weeks, participants received subcutaneous denosumab or placebo every 12 weeks.

The primary endpoint was the change in the Ghent University Scoring System at week 24. The semiquantitative score developed specifically for finger polyarthritis combines radiologic signs of progressive erosion and repair. A significant improvement was achieved, which was even more pronounced after 48 weeks…

“This is a really exciting study,” said Kloppenburg, despite one disappointment. “Unfortunately, they could not demonstrate an improvement in pain and function.” The difference on the numerical rating scale from 0 to 10 was only 0.3 points in favor of denosumab at week 24, which was not significant. Kloppenburg attributed it to the study design and suggested new randomized controlled studies with pain as an outcome.

“It was only about radiologic changes,” said Lems, who also found the study “quite remarkable,” especially “in a disease where we do not have many treatment options.” ”

 

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