For the first time, French researchers have isolated and grown a bacterial strain that causes Whipple's disease, a rare intestinal disorder that prevents the body from absorbing nutrients from food.
This success opens the door for diagnosing Whipple's disease with a simple blood test, rather than with the current method of removing a sample of intestinal tissue, according to the researchers. A team led by Dr. Didier Raoult, of the Universite de la Mediterranee in Marseilles, reports the findings in the March 2nd issue of The New England Journal of Medicine. Although Whipple's disease was first identified in 1907 and linked to bacterial infection about 40 years ago, researchers have been unable to grow the bacterium in the lab -- a crucial, basic step in studying an infectious disease. Whipple's disease usually strikes the small intestine, causing irregular breakdown of fats and carbohydrates and an inability to absorb nutrients. Patients -- mostly middle-aged men -- suffer symptoms such as weight loss, cramps, diarrhea, and arthritis. Antibiotics and nutritional supplements often quell the symptoms, but many patients relapse and need life-long treatment. To isolate the Whipple's bacterium, the French doctors removed a tissue sample from a patient with inflammation in the heart and heart valves, one of the less-common complications of Whipple's disease. Using the heart tissue sample, the investigators were able to get the bacteria to grow in cultured cells. Further tests showed that 7 out of 9 Whipple's patients had antibodies in their blood that recognized the bacteria, compared with 3 out of 40 people without the disease. In another test, all the Whipple's patients had another type of antibody that recognized the bacteria, but 73% of healthy people also had such antibodies. The findings suggest that Whipple's bacterial infection is common, but rarely causes illness, according to an editorial by Dr. Morton N. Swartz of Massachusetts General Hospital in Boston. The French researchers' blood test, however, is not ready for use in diagnosing Whipple's, Swartz notes. A more specific test is needed to diagnose the disease, he concludes.
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Life expectancy for Americans has gone up over the past four decades, but a recent study suggests that people with rheumatoid arthritis are not sharing in this positive trend. Researchers at the Mayo Clinic in Minnesota report that life expectancy for this group has not improved at all.
"Patients with rheumatoid arthritis may be functioning better than in the past," said study leader Dr. Sherine Gabriel in a statement. "But they are not living longer. We need to better understand why that is." Gabriel and colleagues looked at the medical records of all patients living in Olmsted County (where the Mayo Clinic is located) who had rheumatoid arthritis (RA). Three groups were compared: those who had RA and were at least 35 years old in 1965, 1975, or 1985. The researchers also looked at new cases of RA between 1955 and 1985. A total of 425 new cases of RA were diagnosed between 1955 and 1985, of whom 26.6% were men and 73.4% women. Average age at diagnosis was 60.2 years. In addition to these new cases, there were 163 existing cases in 1965, 235 in 1975, and 272 in 1985. When the researchers compared the survival of patients with RA to that of people from the community without RA, patients with RA had significantly worse survival in all three groups. The survival rate among those newly diagnosed with RA during the study period were also worse. "We found that the risk of mortality in RA is roughly 38% greater than in the general population," the team note. "This risk was more pronounced in women with RA, who had a 55% increased risk, compared to women in the general population." For example, write Gabriel and colleagues, the life expectancy for an average 50 year old woman in Minnesota is 34 years, while that for a 50 year old women with RA is four years less at 30 years. For men, the differences were less: an average 50 year old could expect to live 27 years, while a man with RA could expect 26 additional years of life. The researchers also note that while life expectancy in Olmsted County has improved over the past decades, life expectancy for people with RA has not, and in fact seems to have got worse in the more recent decades. "People with RA have not enjoyed the survival benefits that would be expected for people of the same age and sex from the same community over the past 3 decades," the researchers conclude in their report, published in a recent issue of the Journal of Rheumatology. Gabriel and colleagues note that the population of Olmsted County is 96% white, so their findings cannot be applied to non-white populations. They also note that the study findings back up the results of previous studies from various countries, including the UK, France and Finland. SOURCE: The Journal of Rheumatology |
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