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You are here : 3-RX.com > Home > ArthritisRheumatic Diseases



What happens when doctors give patients more power?

ArthritisNov 30 09

When patients are given the responsibility for medical decisions, they may be less willing to try a potentially risky treatment, a study published Monday suggests.

The study, of 216 patients with arthritis and other similar diseases, tested patients’ willingness to take a hypothetical “new” drug that carried important benefits but also a small risk of serious side effects.

It turned out that patients were less willing to try the drug when they were given complete power over the decision than when a doctor advised them to take the medication.

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Osteoarthritis increases aggregate health care expenditures by $186 billion annually

Arthritis • • Public Health • • Rheumatic DiseasesNov 30 09

Osteoarthritis (OA), a highly prevalent disease, raised aggregate annual medical care expenditures in the U.S. by $185.5 billion according to researchers from Stony Brook University. Insurers footed $149.4 billion of the total medical spend and out-of-pocket (OOP) expenditures were $36.1 billion (2007 dollars). Results of the cost analysis study are published in the December issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.

The Centers for Disease Control and Prevention (CDC) estimate 27 million Americans suffer from OA with more women than men affected by the disease. Forecasts indicate that by the year 2030, 25% of the adult U.S. population, or nearly 67 million people, will have physician-diagnosed arthritis. OA is a major debilitating disease causing gradual loss of cartilage, primarily affecting the knees, hips, hands, feet, and spine.

John Rizzo, Ph.D., and colleagues used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to determine the overall annual expected medical care expenditures for OA in the U.S. The sample included 84,647 women and 70,590 men aged 18 years and older who had health insurance. Expenditures for physician, hospital, and outpatient services, as well expenditures for drugs, diagnostic testing, and related medical services were included. Healthcare expenses were expressed in 2007 dollars using the Medical Care Component of the Consumer Price Index.

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Genes may be important in back, neck pain

Arthritis • • Rheumatic DiseasesNov 04 09

A person’s genetic makeup may play an important role in the odds of suffering neck or back pain, new research suggests.

In a study of more than 15,000 twins ages 20 to 71, Danish researchers found that genetic susceptibility seemed to explain a large share of the risk of suffering back and neck aches.

Chronic and recurrent pain along the spine is one of the most common health complaints among adults, yet the precise cause remains unknown in most cases. And in general, researchers know little about the mechanisms underlying these aches and pains.

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Research shows Tai Chi exercise reduces knee osteoarthritis pain in the elderly

Alternative Medicine • • Arthritis • • PainOct 29 09

Researchers from Tufts University School of Medicine have determined that patients over 65 years of age with knee osteoarthritis (OA) who engage in regular Tai Chi exercise improve physical function and experience less pain. Tai Chi (Chuan) is a traditional style of Chinese martial arts that features slow, rhythmic movements to induce mental relaxation and enhance balance, strength, flexibility, and self-efficacy. Full findings of the study are published in the November issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

The elderly population is at most risk for developing knee OA, which results in pain, functional limitations or disabilities and a reduced quality of life. According to the Centers for Disease Control and Prevention (CDC) there are 4.3 million U.S. adults over age 60 diagnosed with knee OA, a common form of arthritis that causes wearing of joint cartilage. A recent CDC report further explains that half of American adults may develop symptoms of OA in at least one knee by age 85.

For this study, Chenchen Wang, M.D., M.Sc., and colleagues recruited 40 patients from the greater Boston area with confirmed knee OA who were in otherwise good health. The mean age of participants was 65 years with a mean body mass index of 30.0 kg/m2. Patients were randomly selected and 20 were asked to participate in 60-minute Yang style Tai Chi sessions twice weekly for 12 weeks. Each session included: a 10-minute self-massage and a review of Tai Chi principles; 30 minutes of Tai Chi movement; 10 minutes of breathing technique; and 10 minutes of relaxation.

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A relief? Lower back pain unlikely to mean cancer

Arthritis • • Backache • • Cancer • • PainOct 01 09

Your lower back pain may be killing you, but there’s some good news: Such pain is very unlikely to mean serious problems such as broken vertebrae or cancer, according to a study by Australian researchers.

Dr. Christopher G. Maher, from The George Institute of International Health in Sydney, and colleagues studied 1172 patients who came to general practitioners, physical therapists, or chiropractors with a new complaint of lower back pain.

The patients were monitored for 12 months to look for broken bones, infection, arthritis, or cancer was the cause.

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Getting a new knee may boost quality of life

Arthritis • • Rheumatic DiseasesAug 13 09

People with severe osteoarthritis of the knee who have knee replacement surgery are apt to see significant improvements in their “health-related” quality of life, new research shows.

Knee osteoarthritis—the wear-and-tear form of arthritis in which the cartilage cushioning the joints gradually breaks down and, in severe cases, can completely wear away—is a major cause of pain and disability, particularly in aging individuals.

“The demand for total knee replacement is increasing as patients gain considerable pain relief and increased mobility and health-related quality of life,” Dr. Montserrat Nunez, from the Hospital Clinic in Barcelona, Spain, and colleagues note in a report in the journal Arthritis and Rheumatism.

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63 percent of RA patients suffer psychiatric disorders, with depressive spectrum conditions most lik

Arthritis • • Psychiatry / Psychology • • Rheumatic DiseasesJun 12 09

Copenhagen, Denmark, Friday 12 June 2009: Over half (63%) of patients with rheumatoid arthritis (RA) also suffer from psychiatric disorders, with the majority of these (87%) occurring in the depressive spectrum, according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. Interestingly, over half (52%) of the patients studied indicated that they had experienced stress events before the onset of their RA.

The study also revealed a number of other interesting findings about the emotional burden of RA:

  * Cognitive dysfunction was diagnosed in 23% of patients, with 16% of this attributed to depression
  * A third (33%) suffered from sleep disorders
  * Those with depression also exhibited more severe RA (measured by X-ray), greater functional insufficiency and pain, as well as having received less aggressive treatment than patients without depression. (No significant differences in age, duration of illness, gender or DAS28* scores were noted between the two groups)
  * Significantly, cognitive impairments were found more often (p=0.02) in patients older than 50 years (39% vs. 9%)
  * The age of the first prednisone intake was significantly higher (p<0.05) in patients with depression compared to those without (48 vs. 30 years)

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3 studies confirm the value of etanercept therapy in treating juvenile idiopathic arthritis

ArthritisJun 12 09

Copenhagen, Denmark, Friday 12 June 2009: Three new studies have individually shown the anti-TNF (tumour necrosis factor) therapy etanercept to be effective, with a good safety profile, in children under four years of age with juvenile idiopathic arthritis (JIA), and associated with improved Health-Related Quality of Life (HRQoL) in a substantial proportion of children with JIA. The data are being presented at the Paediatric Rheumatology European Society Congress (PReS) 2009, a joint congress with the 2009 Congress of the European League Against Rheumatism (EULAR) in Copenhagen, Denmark.

The first study, conducted in Italy, showed entanercept to be effective, with a good safety profile, in children under four years of age (an as yet unlicensed patient population for the treatment). Thirty-three patients under four years of age with unresponsive JIA (24 female, 9 male) were treated with etanercept for an average of 23 months. After the first 6 months of treatment, 82% achieved the ACR Pedi 30* response and 48% achieved the ACR Pedi 70* response. There was a low rate of mild adverse events, whilst one patient temporarily suspended treatment following hospitalisation for an infection.

The second study, conducted in The Netherlands, from the Arthritis and Biological in Children (ABC) project, observed impressive improvements in the Health-Related Quality of Life (HRQoL) of 53 patients with previously refractory (unresponsive) JIA in seven Dutch centres during entanercept use of at least 27 months. These comprised both disease-specific improvements (inflamed joints, functional impairment, erythrocyte sedimentation rate (ESR), a laboratory marker of inflammation) (p<0.001) and all generic HRQoL outcomes impaired by JIA (including pain, movement and dexterity) (p<0.05).

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RA individuals from lower GDP countries keep working despite worse symptoms than richer countries

Arthritis • • Rheumatic DiseasesJun 12 09

Copenhagen, Denmark, Friday 12 June 2009: Individuals diagnosed with rheumatoid arthritis (RA) in lower gross domestic product (GDP) countries (GDP below $11,000) are more likely to continue working despite higher disease activity and functional disability scores compared to their counterparts in higher GDP countries (GDP >$24,000) according to a new multinational study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.

Among 1,650 individuals from 30 countries whose symptoms had begun during the 2000’s and who remained working after RA diagnosis, disability levels according to the Health Assessment Questionnaire (HAQ*) were 0.25 vs. 0.82 in men and 0.50 vs. 0.94 in women (p<0.001) in higher-GDP and lower-GDP countries, respectively, and the Disease Activity Scores (DAS28**) were 3.1 vs. 4.7 in men, and 3.5 vs. 4.8 in women (p<0.001). A Kaplan-Meier analysis (95% CI) showed that the probability of individuals continuing work for 2 years was 80% and the probability of continuing to work for 5 years was 68%.

Dr Tuulikki Sokka, Jyväskylä Central Hospital, Finland, who leads the project said: “Work disability is the most costly consequence of RA, and the rheumatology community would welcome better treatment strategies to effectively address this. However, real-life data from 30 countries indicate that work disability is still a major issue in early RA during this decade, and especially in low-GDP countries where people continue to work with considerable disease activity and functional limitations.”

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ACL surgery an option for active older adults

Arthritis • • Surgery • • TraumaMar 19 09

Active older adults no longer have to settle for a wobbly knee after injuring their anterior cruciate ligament (ACL), according to a new article in the Mayo Clinic Health Letter.

The ACL is the key ligament stabilizing the knee, and is especially important for holding the joint steady during jumping, pivoting and twisting. When a person ruptures the ACL—an injury typically accompanied by a loud popping sound and severe pain—it can be repaired using a piece of tendon from the leg or from a cadaver.

However, until fairly recently, ACL repair hadn’t been considered an option for people over 50, or even in some cases people in their 40s, according to the Health Letter article. Instead, these individuals would undergo physical therapy to restore strength and balance. Non-surgical treatment can improve knee function, but it doesn’t completely restore knee stability, so older patients had to curtail their activity levels.

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Arthritic heart patients fear exercise, CDC says

Arthritis • • HeartFeb 27 09

Patients with arthritis and heart disease may be afraid to get the exercise they need to improve their health, U.S. government researchers said on Thursday.

They may not realize that a little exercise will relieve both conditions, the team at the U.S. Centers for Disease Control and Prevention said.

The researchers studied data from two national health surveys to find that 57 percent of adults with heart disease have arthritis, too, the team reported in the CDC’s weekly report on death and disease.

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Investigational study of ustekinumab in the treatment of psoriatic arthritis published

Arthritis • • Skin CareFeb 12 09

A group of patients suffering from potentially debilitating psoriatic arthritis showed significant and prolonged improvement after treatment with ustekinumab, according to data from a randomized, double-blind, placebo-controlled study in patients with moderate to severe psoriatic arthritis (PsA). The Phase 2 study was published in the British medical journal The Lancet.

“This is a positive development for patients living with the joint pain and swelling that characterizes the disease, even as more research is needed to further test the efficacy of this treatment in psoriatic arthritis,” said Alice Gottlieb, MD, Chairperson of the Department of Dermatology at Tufts Medical Center and lead author of the study.

Tufts Medical Center was among several academic medical centers which participated in the study. Tufts Medical Center is a 451-bed hospital in Boston and the primary teaching hospital for Tufts University School of Medicine.

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TNF-blocker therapy for RA may trigger psoriasis

Arthritis • • Rheumatic Diseases • • Skin CareFeb 03 09

Evidence continues to mount that so-called TNF-blockers used to treat rheumatoid arthritis (RA) may lead to psoriasis. The latest study by UK researchers adds to individual case reports of psoriasis occurring in RA patients treated with TNF blockers.

“We observed 25 cases of new-onset psoriasis in our cohort of almost 10,000 patients with rheumatoid arthritis receiving anti-TNF therapy,” investigator Dr. Kimme L. Hyrich told Reuters Health. This compared to “no cases reported in our non-biologic treated control cohort.”

As reported in the Annals of the Rheumatic Diseases, Hyrich of the University of Manchester and colleagues studied data on 9826 anti-TNF-treated patients and 2880 treated with so-called DMARDS (short for disease modifying anti-rheumatic drugs).

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ACL repair often unnecessary: study

Arthritis • • SurgeryDec 15 08

Most people who tear the main ligament responsible for stabilizing the knee do not need surgery to rebuild it, according to a study in which researchers compared surgery to physical therapy.

“Our research showed that reconstruction of the anterior cruciate ligament (ACL), which is quite common, is not a prerequisite for restoring muscle function,” Dr. Eva Ageberg of Lund University, Sweden, told Reuters Health. She and her colleagues note that about half of Swedish patients who rupture the ligament undergo reconstructive surgery, while 90 percent of US patients do.

People who injure the ACL lose stability in the knee, boosting their risk of developing osteoarthritis. But despite widespread use of ACL reconstructive surgery, there is no evidence that patients who have the operations are any less likely to develop osteoarthritis.

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Gout may protect against Parkinson’s disease

Arthritis • • BrainDec 08 08

Having gout apparently lowers the risk of developing Parkinson’s disease in older individuals, new research hints.

Gout is caused by high levels of uric acid in the blood. Some studies have shown that uric acid exerts beneficial antioxidant effects on neurons. With these antioxidant properties, uric acid has been hypothesized to protect against oxidative stress, a process in which cell-damaging free radical particles are produced, which is a prominent contributor to nerve degeneration seen in Parkinson’s disease (PD).

Dr. Hyon Choi, of the University of British Columbia, Vancouver, BC, Canada, and colleagues assessed the relationship between gout and the risk of PD in a large group of people aged 65 and older. They compared rates of PD between 11,258 people with gout and 56,199 matched control subjects.

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