FRIDAY, Feb. 29 (HealthDay News) -- Methotrexate, one of the most common drugs used to ease rheumatoid arthritis symptoms, will not raise a patient's risk for blood cancer, a new study finds.

But a lesser-used medicine, cyclophosphamide, was associated with a doubling in patients' odds for lymphoma, the Canadian researchers found.

The study of almost 24,000 patients over 23 years of age showed no clear association between methotrexate and cancers of the blood, such as lymphoma. Methotrexate has been long and widely used by many patients with rheumatoid arthritis.

There was an elevation in cancer risk with cyclophosphamide, which is sometimes used to treat very severe rheumatoid arthritis that has progressed to the point of threatening or damaging organs.

The results, "add to the literature regarding the cancer risk associated with cyclophosphamide and emphasizes that we need to continue to develop safer drugs for very severe forms of autoimmune disease," said study lead author Dr. Sasha Bernatsky, an epidemiologist at McGill University in Montreal. Her team published its findings in the Feb. 25 issue of the Archives of Internal Medicine.

Bernatsky added that it is important to recognize with cyclophosphamide that "even though the risk of certain cancers in some autoimmune disease is elevated, these cancers are still relatively rare -- much less than 1 percent. People should not stop taking their drugs if their specialists really feel that they need these drugs."

Bernatsky said such patients need to, "keep in mind that cyclophosphamide has been demonstrated to have overall benefits in some cases, such as preserving kidney function when kidneys are affected by autoimmune disease."

Rheumatoid arthritis, which affects an estimated 1.3 million Americans, is a chronic inflammatory disease in which the body's autoimmune system most commonly attacks the joints, according the Arthritis Foundation. According to the study, over the past 30 years, doctors have noted an increased risk for lymphoma in patients with rheumatoid arthritis, although the exact reasons for that phenomenon remain unclear.

In the new study, the Montreal team looked at the medication use of almost 24,000 patients with rheumatoid arthritis to see if the connection might lie there. They compared rates of leukemia and lymphoma for this group for the years 1980 to 2003 against a much larger group of people unaffected by rheumatoid arthritis.

A total of 619 blood cancers (more than half of which were lymphomas) were noted among the rheumatoid arthritis patients over the study period.

Bernatsky's team found no association between the use of methotrexate and blood cancer risk, but the odds that a patient would develop a lymphoma more than doubled with use of cyclophosphamide.

Other experts agreed that the study's findings supported earlier research that had been reassuring about the impact of methotrexate. They also agreed on the need for patients and their doctors to weigh benefit and risk when considering cyclophosphamide.

Dr. Stephen Lindsey, chief of rheumatology at the Ochsner Clinic Foundation in Baton Rouge, La., said that the results on methotrexate seem "to be good news for the majority of rheumatoid arthritis patients, because they're almost all on that."

People need to recognize that rheumatoid arthritis is more than a few aching joints, he added. The disease can involve an increased risk of mortality -- in fact, patients with severe cases die an average of 10 years earlier than their peers, Lindsey said. And, he noted that rheumatoid arthritis has long been tied to an increased risk of lymphoma, separate from any risk associated with medication. Many lymphomas are curable, he said, another factor to think about when weighing the cyclophosphamide risk-benefit equation.

Dr. W. Hayes Wilson, a rheumatologist in Atlanta who is a national medical adviser for the Arthritis Foundation, added that the risks of cyclophosphamide have been recognized for years, although he personally could not recall any of his patients developing the blood cancer.

According to Wilson, cyclophosphamide is no one's first choice for treatment and is only used in the more severe cases. "You're sort of choosing between two evils," Wilson said. "No one wants to jump out of a perfectly good airplane, but if that airplane had two engines, and one was on fire, I might strap on that parachute and jump."

The study did not present data on any risks associated with new biologic medications, such as Embrel, Humira, and Remicade, which have been available since about 2000, Lindsey and Wilson said. There have been other studies with positive results for one category of these drugs, called TNF-alpha inhibitors, Wilson said. For severe cases, "when we treat them aggressively with a biologic modifier, perhaps we are bringing their risk down to similar to the general population," he said.

More information

There's more on rheumatoid arthritis at the Arthritis Foundation  .

THURSDAY, Feb. 28 (HealthDay News) -- People suffering from age-related macular degeneration (AMD) have twice the risk of dying from heart attack or stroke, Australian researchers report.

The degenerative eye disease is the most common cause of untreatable blindness among older adults in developed countries and affects the center of the retina at the back of the eye, which is essential for tasks such as reading and driving.

"We found a positive long-term link between AMD and subsequent cardiovascular and stroke mortality in a population of older Australians," said lead researcher Dr. Paul Mitchell, from the Centre for Vision Research in the Department of Ophthalmology at the University of Sydney. "This was particularly increased for late-blinding cases."

"Both ophthalmologists and general practitioners should be aware of this potential link and need to consider appropriate management of traditional vascular risk factors, such as smoking, blood pressure, blood lipids in their patients with AMD," Mitchell said.

In the study, Mitchell's team studied 3,654 people aged 49 years old and older. Five years later, 2,335 people were re-examined, and after 10 years, 1,952 were re-examined.

The report is published in the Feb. 28 online issue of the British Journal of Ophthalmology.

The researchers found that for people under 75, when the study began, early AMD was linked with a doubling of their risk of dying from heart attack or stroke over the next 10 years.

For those with late-stage AMD at the start of the study, their risk of dying from heart attack increased fivefold, and their risk of dying from stroke increased 10 times, Mitchell's team found.

"While AMD, particularly in its late stage, occurs in people of relatively older ages, it may be associated with an increased vascular risk," Mitchell said. "This could, in part, reflect shared risk factors such as smoking."

One expert noted that because AMD is a vascular problem, it is not surprising that it is associated with increased cardiovascular risk.

"Age-related macular degeneration and atherosclerotic vascular share common risk factors that include hypertension, hyperlipidemia and smoking," said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles.

In addition, systemic inflammation may increase the risk of AMD and atherosclerosis, Fonarow said.

"Just as having peripheral vascular disease is associated with an increased risk of cardiovascular disease through common risk factors, having AMD is associated with an increased risk of cardiovascular disease and mortality," Fonarow said.

"Patients and physicians should recognize that patients diagnosed with AMD are more likely to have underlying cardiovascular disease and subsequent events and take appropriate steps to lower that risk though lifestyle changes and cardiovascular protective therapies," Fonarow advised.

In another report in the same issue of the journal, British researchers concluded that genes that control the production of chemicals involved in inflammation may play a significant role in AMD.

One gene variation associated with the gene that produces an inflammatory chemical called interleukin 8, was significantly more common among people with AMD, the researchers found. This gene variant has been previously linked with inflammatory diseases and cancer.

If these findings hold up, the researchers think it could lead to genetic screening for AMD and possibly the development of medications to treat the disease.

More information

For more on AMD, visit the U.S. National Eye Institute.

THURSDAY, Feb. 21 (HealthDay News) -- People who take more than one nonsteroidal anti-inflammatory drug (NSAID) may have poorer health-related quality of life, a U.S. study suggests.

NSAIDs, which are available in both prescription and over-the-counter (OTC) forms, are commonly used to treat arthritis.

These drugs are widely available, and patients may take both prescription and OTC NSAIDs at the same time, either because they need more pain relief or because they don't realize the products belong to the same class of drugs, said the study authors, who added that doctors may not know their patients are taking more than one NSAID.

This study, led by Stacey H. Kovac of Durham VA Medical Center and Duke University in North Carolina, included 138 patients enrolled in a large regional managed-care organization. All of the patients had filled at least one NSAID prescription between February and August 2002.

The researchers found that 26 percent of the patients reported taking at least two NSAIDs (prescription, OTC or both) during the previous month. These dual users scored lower than others on the physical component of a questionnaire designed to evaluate physical and mental health.

Keeping a complete list of a patient's medications would help doctors identify patients who are taking more than one NSAID, the study authors said.

"The increased awareness may lead to better communication between the patient and provider about the appropriate use of NSAIDs," they wrote.

Patients who take more than one NSAID may do so because of inadequate clinical pain management or because they have higher levels of pain than other patients, said the researchers. Future research should examine factors that may lead to dual NSAID use and methods of identifying patients taking two or more NSAIDs and may be at higher risk of adverse side effects from the drugs.

"Adequate pain management may have the potential to reduce dual use, improve patient symptoms, including physical functioning, and reduce patient safety problems," the researches concluded.

The study was published in the February issue of Arthritis Care & Research.

More information

The U.S. Centers for Disease Control and Prevention has more about arthritis.

(HealthDay News) -- Driving can become dangerous for some seniors as they decline both physically and mentally.

Here are warning signs that a senior may no longer be safe behind the wheel, courtesy of the U.S. National Library of Medicine:

• Memory problems, such as forgetting the destination or route.
• Difficulty concentrating.
• Difficulty seeing in general, or under certain conditions.
• Hearing problems.
• Arthritis, especially when it affects the hands and fingers.