Arthritis
Joint replacement may improve osteoarthritis symptoms in older adults
Older adults who have hip or knee replacement surgery for severe osteoarthritis may take several weeks to recover but appear to have excellent long-term outcomes, according to a report in the July 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
As the U.S. population ages, the number of older adults with osteoarthritis is increasing, according to background information in the article. The disease causes debilitating pain and often restricts older adults’ mobility. Non-invasive treatments such as medications and physical therapy appear to be of limited value for the advanced stages of osteoarthritis. However, surgery may be associated with risks and discomfort.
Mary Beth Hamel, M.D., M.P.H., and colleagues at Beth Israel Deaconess Medical Center, Boston, studied medical decision-making and treatment outcomes in 174 patients age 65 and older (average age 75.2) who had severe osteoarthritis of the hip or knee. Participants’ arthritis symptoms and functional status were assessed at the beginning of the study, between 2001 and 2004, and again 12 months later. Patients who chose to have joint replacement surgery were assessed six weeks, six months and 12 months after the procedure.
Rheumatoid arthritis doubles heart risk: experts
People with rheumatoid arthritis have double the risk of suffering heart attacks or strokes and should be considered for treatment with statins and blood pressure drugs, rheumatology experts said on Friday.
A report by a medical task force to the annual congress of the European League Against Rheumatism in Paris concluded the risk was comparable to that associated with type 2 diabetes, which is already an established cardiovascular risk factor.
Dr Michael Nurmohamed , leader of the task force, said the inflammatory processes underlying rheumatoid arthritis appeared to increase patients’ risk of serious heart problems.
Rheumatoid arthritis is a risk factor for cardiovascular disease
Paris, France, Friday 13 June 2008: The risk of cardiovascular disease (CVD) for people with rheumatoid arthritis (RA) has been found to be comparable to the risk of CVD in people with type 2 diabetes, according to the conclusions of two studies presented today at EULAR 2008, the Annual Congress of the European League Against Rheumatism in Paris, France.
At least one CV-event was reported in 8.6% of the RA population studied, a figure that was double that reported in the general population (4.3%), corresponding with an incidence of 3.14 per 100 patient/years (95% confidence interval (CI): 1.98-4.30) for RA patients, and 1.51 per 100 person/years (95%-CI: 1.18-1.84) for the general population.
In a second study, the age- and gender- adjusted prevalence odds ratios for CVD were found to be 2.3 (95%-CI: 1.3-4.0) for those with type 2 diabetes and 2.0 (95%-CI: 1.1-3.4) for those with RA, indicating a similar CVD risk for the two diseases.
Oily fish can protect against RA, but smoking and psychosocial stress increase its risk
Paris, France, Friday 13 June 2008: New data presented today at EULAR 2008, the Annual Congress of the European League Against Rheumatism in Paris, France, show that intake of oily fish is associated with a reduced risk of developing rheumatoid arthritis (RA), whereas psychosocial work stress and smoking can increase the risk of developing the condition. The findings, all taken from a large population-based case-control study in Sweden called EIRA (Epidemiological Investigation of Rheumatoid Arthritis), shed light on the important role of environmental and social factors in the development of RA.
Intake of Oily Fish
For the first time, the intake of oily fish has been demonstrated to have a protective effect against the development of RA, reducing an individual’s risk by 20-30%. Studying 1,899 subjects with a confirmed diagnosis of RA (fulfilling ACR criteria) and 2,145 controls (randomly selected and matched for age, sex and residential area), investigators concluded that the odds ratio (OR) for developing RA was 0.8 (0.7-1.0) for those who consumed oily fish 1-7 times per week or 1-3 times per month, compared with those who never, or seldom consumed oily fish. Interestingly, no significant association with RA risk was observed for consumption of fish oil supplements.
Combination therapy more effective in early RA
In the treatment of early rheumatoid arthritis (RA), a combination of anti-RA drugs is superior to methotrexate alone, UK researchers report.
“Our study,” lead investigator Dr. Ernest H. Choy told Reuters Health, “confirmed that there is a window of opportunity in the treatment of rheumatoid arthritis.”
Choy of King’s College School of Medicine, London and colleagues randomly assigned 467 patients with early RA to treatment with methotrexate alone or with the addition of another “disease-modifying antirheumatic drug” (cyclosporine) or the steroid prednisolone, or both, for 9 months.
Cane Use May Reduce Risk of Knee Osteoarthritis Progression
A common, incurable joint disease, osteoarthritis (OA) is the leading cause of disability in elderly people. While nearly any joint can be affected, OA most often strikes the knee, particularly the inner aspect of the tibiofemoral joint. One source of stress on this vulnerable joint compartment is the knee adduction moment, an indication of weight placement while walking. A 20 percent increase in the peak knee adduction moment is associated with a 6-fold or greater increase in the risk of knee OA progression over 6 years. To reduce knee load, pain and damage in knee OA patients, physicians often prescribe two inexpensive interventions: footwear and cane use. While these simple strategies have the potential to alter the knee adduction moment, there is little research attesting to their specific benefits for knee OA sufferers.
To assess the immediate effects of walking shoes and a walking cane on the peak knee adduction moment in people with knee OA, researchers at the University of Melbourne turned to 3-dimensional (3-D) gait analysis. Their findings, featured in the May 2008 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritis), strongly support using a cane on a regular basis to reduce the load borne across the knee, while underscoring the urgent need for studies into which aspects of shoe design best support the treatment of knee OA patients.
Arthritis is a potential barrier to physical activity for adults with diabetes
People with diagnosed diabetes are nearly twice as likely to have arthritis, and the inactivity caused by arthritis hinders the successful management of both diseases, according to a new Morbidity and Mortality Weekly Report (MMWR) study released today by the Centers for Disease Control and Prevention (CDC). This is one of the first studies of its kind to look at the relationship between arthritis and diabetes and the outcomes associated with physical activity.
The report finds that arthritis appears to be a barrier to being physically active for people with diabetes. Despite the fact that physical activity helps control blood glucose levels and reduces joint pain, people with both diseases are more likely to be physically inactive (29.8%) compared to those with diabetes alone (20.1%).
“Arthritis is a frequent co morbid condition for adults with diabetes,” said John H. Klippel, M.D., president and CEO, Arthritis Foundation. “But for both diseases, physical activity is key to effective management. A lack of physical activity actually results in undesirable consequences including increased pain, stiffness, inflammation, physical limitation and potential disability.”
Strontium may relieve spinal osteoarthritis pain
A compound called strontium ranelate may reduce back pain in women with osteoporosis and osteoarthritis (OA) of the spine, according to new study. The compound may also delay progression of spinal OA.
Strontium ranelate has been shown to stimulate bone formation while inhibiting bone resorption.
Dr. Olivier Bruyere from University of Liege, Belgium and colleagues say their findings suggest that “strontium ranelate may have symptom- and structure-modifying effects in women with osteoporosis and OA.”
Vegan diet may help ease rheumatoid arthritis
A gluten-free vegan diet full of nuts, sunflower seeds, fruit and vegetables appears to offer protection against heart attacks and strokes for people with rheumatoid arthritis, Swedish researchers said on Tuesday.
The diet appeared to lower cholesterol and also affect the immune system, easing some symptoms associated with the painful joint condition, they said.
The study suggested diet could play an important role for people with rheumatoid arthritis who are often more prone to heart attacks, strokes and clogged arteries, said the team from Sweden’s Karolinska Institute.
Misdiagnosis of rheumatoid arthritis
In an article recommended by Annelies Boonen of Faculty of 1000 Medicine, researchers look at the way rheumatoid arthritis is diagnosed by analysing the administrative databases used by physicians in Quebec.
The authors of the paper, published in Arthritis & Rheumatism, report that general practitioners diagnosed 79% of the 10,001 rheumatoid arthritis cases but only 27% of patients then saw a rheumatologist. Half of these patients were seen in the first three months and of these it emerges that only 17% received confirmation they were actually suffering from rheumatoid arthritis.
Detecting bone erosion in arthritic wrists
Both magnetic resonance imaging (MRI) and computed tomography (CT) are more sensitive than radiography – the standard imaging technique – for detecting bone erosions in rheumatoid arthritis (RA), according to research published in the open access journal Arthritis Research & Therapy. The early detection of bone erosions is crucial for identifying those people most at risk from RA.
Uffe Møller Døhn from the Copenhagen University Hospital at Hvidovre in Denmark and co-workers carried out CT, MRI and radiography on the wrist joints of 17 RA patients and four healthy controls.
Doctors Should Watch for Depression in Arthritis Patients
Patients with rheumatoid arthritis are twice as likely to experience depression but are unlikely to talk to a doctor about it, according to researchers at the University of North Carolina at Chapel Hill.
Rheumatoid arthritis (RA) – the most common form of chronic inflammatory arthritis – is a debilitating disease characterized by inflammation of joint tissues, persistent pain, functional disability, stiffness and fatigue.
Betsy Sleath, PhD, a professor at the UNC School of Pharmacy, said that although depression in primary care settings has been well examined, no previous studies have looked at whether rheumatologists and RA patients discuss depression during medical visits.
The HLA-DRB1 gene and premature death in rheumatoid arthritis
People with rheumatoid arthritis (RA), an inflammatory autoimmune disease, tend to die younger and, largely from cardiovascular disease (CVD). One explanation for this increasingly recognized fact is that inflammation promotes atherosclerosis. A marker of inflammation, elevation of the C-reactive protein (CRP) level has been shown to predict CVD in the general population. However, other highly inflammatory diseases—Crohn’s, for example—do not carry the same high risk of premature death from heart disease.
To identify other possible suspects, researchers in the United Kingdom investigated whether genetic variants linked to the likelihood of developing RA might also make patients more likely to die from CVD. Led by Dr. Tracey M. Farragher at the University of Manchester and funded by the Arthritis Research Campaign (arc), the study focused on two genes—HLA-DRB1and PTPN22—and their interactions with known RA risk factors. The evidence, presented in the February 2008 issue of Arthritis & Rheumatism, implicates HLA-DRB1 genotypes, already associated with RA susceptibility and severity, as a predictor of premature death from CVD for inflammatory arthritis patients. For RA patients in particular, having the shared epitope (SE)—a group of HLA-DRB1 alleles with kindred amino acid traits—plus anti-cyclic citrullinated peptide (anti-CCP) antibodies and current smoking is an especially deadly combination.
Rheumatoid arthritis patients’ mortality unchanged
The decline in mortality seen in the U.S. population over the past four decades has not extended to patients with rheumatoid arthritis, despite innovations in rheumatoid arthritis treatment, according to a report in the current issue of Arthritis & Rheumatism.
Rheumatoid arthritis is known to be associated with excess mortality, the authors explain, but whether survival in rheumatoid arthritis patients has improved over time has been unclear.
Arthritis causes job limitations for many
Nearly 12 percent of Americans ages 45 to 64 face work limitations because of arthritis, the U.S. Centers for Disease Control and Prevention said in a report on Thursday.
The CDC issued its first state-by-state assessment of work limitations caused by arthritis, an inflammation of the joints that causes pain, swelling, stiffness and restricted movement.
