New theory on genesis of osteoarthritis comes with successful therapy in mice
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, they now have evidence that the bone underneath the cartilage is also a key player and exacerbates the damage. In a proof-of-concept experiment, they found that blocking the action of a critical bone regulation protein in mice halts progression of the disease.
The prevailing theory on the development of OA focuses on joint cartilage, suggesting that unstable mechanical pressure on the joints leads to more and more harm to the cartilage - and pain to the patient - until the only treatment option left is total knee or hip replacement. The new theory, reported May 19 in Nature Medicine, suggests that initial harm to the cartilage causes the bone underneath it to behave improperly by building surplus bone. The extra bone stretches the cartilage above and speeds its decline.
“If there is something wrong with the leg of your chair and you try to fix it by replacing the cushion, you haven’t solved the problem,” says Xu Cao, Ph.D., director of the Center for Musculoskeletal Research in the Department of Orthopaedic Surgery at the Johns Hopkins University School of Medicine. “We think that the problem in OA is not just the cartilage ‘cushion,’ but the bone underneath,” he adds.
Joints are formed at the intersection of two bones. To prevent the grinding and wearing down of the ends of the bones, they are capped with a thin layer of cartilage, which not only provides a smooth surface for joint rotation but also absorbs some of the weight and mechanical strain placed on the joint. The degeneration of this protective layer causes extreme pain leading to limited mobility.
Child Abuse Ad Shows Hidden Message for Children
A Spanish foundation aiming to curb child abuse has a new bus ad that shows a hidden message for children under 10 years old – or rather, children under 4-foot-4.
The ANAR Foundation, which stands for Aid to Children and Adolescents at Risk, has created a bus ad that shows two messages: one for adults and one for children.
“How can we get our message across, even when they are accompanied by an adult?” an ANAR Foundation YouTube video about the ad asks. “How can we get our message across, even when they are accompanied by their aggressor?”
The ad visible to adults, or people over 4-foot-4, shows a child’s face and a message that says, “Sometimes, child abuse is only visible to the child suffering it.”
90 percent of pediatric specialists not following clinical guidelines when treating preschoolers with ADHD
A recent study by pediatricians from the Cohen Children’s Medical Center of New York examined to what extent pediatric physicians adhere to American Academy of Pediatrics (AAP) clinical guidelines regarding pharmacotherapy in treating young patients with Attention Deficit Hyperactivity Disorder (ADHD). The results showed that more than 90 percent of medical specialists who diagnose and manage ADHD in preschoolers do not follow treatment guidelines recently published by the AAP.
“It is unclear why so many physicians who specialize in the management of ADHD—child neurologists, psychiatrists and developmental pediatricians—fail to comply with recently published treatment guidelines,” said Andrew Adesman, MD, senior investigator and chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park. “With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten. Primary care physicians and pediatric specialists should recommend behavior therapy as the first line treatment.”
Current clinical guidelines for pediatricians and child psychiatrists associated with the American Academy of Child & Adolescent Psychiatry (AACAP) recommend that behavior therapy be the initial treatment approach for preschoolers with ADHD, and that treatment with medication should only be pursued when counseling in behavior management is not successful.