January 2015 Round-Up of MS News and Research

• 3-Year results from HALT-MS trial shows clinical efficacy in RRMS

• Almost half of MS patients experience tremors, according to patient reports

• MS panel recommends expanding No Evidence of Disease Activity (NEDA) to include neuropsychological measures

• Cinnamon holds potential as an economical and effective treatment for MS

• Fecal microbiota transplantation (FMT) may improve MS symptoms

• Other Studies of Interest

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Hot Topics and MS Research News for January 2015

Folic Acid and RA

In the world of rheumatoid arthritis, the subject of folic acid is forever tied to methotrexate. A discussion of one is incomplete without the other. In searching the medical literature for articles related to ‘rheumatoid arthritis and folate (folic acid)’, I discovered that most of the titles of the articles include mention of methotrexate.

Are folic acid and folinic acid effective against methotrexate side effects in RA patients?

Yes, according to the Cochrane Review updated in 2013 that included six randomized controlled trials involving 624 RA patients taking MTX (≤ 25 mg/week), of whom 385 also took low-dose folic acid (≤ 7 mg/week). Studies using higher doses of folic acid were excluded because the high dose is no longer recommended or used in clinical practice.

For patients supplemented with either folic or folinic acid while receiving MTX therapy for RA, a 26% relative (9% absolute) risk reduction was seen for the incidence of gastrointestinal side effects such as nausea, vomiting, or abdominal pain. Folic and folinic acid also appear to be protective against abnormal serum transaminase (liver enzyme) elevation caused by MTX, with a 76.9% relative (16% absolute) risk reduction, as well as reducing patient withdrawal from MTX for any reason by 60.8% relative (15.2% absolute) risk reduction.

Importantly, there was no significant reduction in MTX efficacy, as measured by disease activity measures such as tender and swollen joint counts or physician's global assessment scores.

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Folic Acid Use in Rheumatoid Arthritis

Big Data and iConquerMS

So what is meant by ‘Big Data’ in medical research?
I asked Dr. Ken Buetow, the iConquerMS™ project team’s informatics expert from Arizona State University and former director of the National Cancer Institute’s Center for Biomedical Informatics and Information Technology, to explain.

“Big Data in biomedicine refers to large quantities of diverse types of data — clinical care encounters, demographic, geographic, individual clinical experiences, lifestyle, personal preferences, and molecular characterizations from tens of thousands of individuals. With Big Data, one has the possibility of discerning patterns and associations that would be undetectable through traditional approaches,” according to Buetow. “I’m reminded of the Michaelangelo quote that ‘every block of stone has a statute inside it, and it is the task of the sculptor to discover it.’ One might say all Big Data contains insights and it’s the job of the data scientist to find them!”

Big Data has the capacity to turn anecdote into evidence.
The more information that is shared, the better equipped researchers will be to discover patterns associated with smaller, more specific, segments of the MS population. With more data points, our multitude of individual anecdotes and experiences become a pointillistic tapestry of evidence which can begin to answer more interesting questions about the disease and its treatment.

How does it work?
“By embracing the Big Data paradigm, iConquerMS™ enables research that complements traditional approaches,” says Buetow. “iConquerMS™ collects large volumes of diverse data from all who are interested in sharing information. Questions are then asked against the collected data. These questions can come from both the research community and iConquerMS™ participants. Instead of conducting a new research study for each question – contacting new individuals and collecting new data – the data previously shared can be queried and evaluated.”



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iConquerMS Uses Big Data Approach to MS Research

RA and Thyroid Disease

It has been documented that patients with RA experience an increased occurrence of thyroid disorders of both the autoimmune and non-autoimmune types. Did you know that joint pain can be a symptom of thyroid disease? 

Common signs and symptoms of hypothyroidism (low thyroid) include dry skin, thinning hair, brittle nails, fatigue (feeling tired, sluggish, or weak), memory problems, depression, inability to tolerate cold, yellowish skin, and constipation. Less common symptoms may include modest weight gain, muscle aches and cramps, hoarseness, facial puffiness, and swelling in the limbs.

The worldwide prevalence of thyroid disease in patients with RA varies considerably, ranging from 0.5% in Morocco to 27% in Slovakia, according to a 2012 review of 17 published studies. The prevalence of thyroid disease in RA patients in North America ranges from 2.1% to 9.8%. Lack of universal agreement as to the ‘normal’ upper limit for TSH (thyroid stimulating hormone) levels in the blood may partially explain some of this variability as published upper limits range from 2.5 to 5.0 IU/mL.

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Rheumatoid Arthritis and Thyroid Disease

Using Big Data to ConquerMS

As a participant in the patient-driven iConquerMS™ initiative, established by The Accelerated Cure Project for MS, I am excited about the potential impact of research arising from topics suggested by people with MS who register at iConquerMS.org.

The type of research one reads about online, such as that investigating new disease-modifying treatments for MS, tends to focus on easily measured disease outcomes such as number of lesions, brain atrophy, or disability progression. However, people with MS may be less interested in lesions and more interested in aspects of the disease that affect their day-to-day lives.

MS patients frequently compare anecdotal notes with each other in forums and support groups. But how do you turn several anecdotes into scientific data? You begin by asking targeted questions of people who have MS; lots of questions among lots of people! What begins to emerge is often called Big Data.

Big Data has become a popular buzzword in the areas of healthcare and medical research. I’ve invited Dr. Ken Buetow, the iConquerMS™ project team’s technical expert and a well known researcher, to answer a few questions to help us understand ways that Big Data may be used to better understand multiple sclerosis.

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From Anecdote to Evidence: Using Big Data to Conquer MS, An Interview with Ken Buetow, PhD