osteoarthritis

Pulsed Electromagnetic Field Therapy May Relieve Osteoarthritis

Posted by

0


Pulsed electromagnetic field (PEMF) therapy shows promise in reducing pain and improving quality of life for osteoarthritis patients.

As the U.S. population grows older, an increase in agonizing joint conditions lurks on the horizon. Chief among them is osteoarthritis, a debilitating disease caused by the natural breakdown of cartilage.

But new research suggests that a solution may lie in the power of magnetic fields—a drug-free therapy that could offer relief without the risks of common painkillers.

Pulsed Electromagnetic Fields Shown to Significantly Reduce Pain

A recent systematic review published in the Journal of Clinical Medicine sheds light on the potential of pulsed electromagnetic field (PEMF) therapy, introduced into clinical practice in the 1970s with a device approved by the Food and Drug Administration to help speed up the healing of broken fractures to alleviate symptoms of osteoarthritis.

For the new review, researchers analyzed 17 randomized controlled trials involving 1,197 patients with osteoarthritis who underwent PEMF therapy. They assessed the data to evaluate the effectiveness of PEMF across different anatomical areas, focusing on levels of pain reduction and improvements in patients’ quality of life.

The findings suggest that PEMF therapy significantly improved pain reduction, as assessed through the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. VAS scores decreased by 60 percent, and WOMAC scores improved by 42 percent.

The review also noted participants’ reduced medication usage and enhanced physical function.

Despite these positive outcomes, the review highlighted the variability in treatment duration and the types of PEMF devices used, with the study authors calling for further investigation and standardization in these areas.

How Magnetic Therapy Works

PEMF therapy has gained popularity for its ability to alleviate pain and support healing across various conditions, Dr. Peter C. Lascarides, assistant professor of physical medicine and rehabilitation at the Zucker School of Medicine at Hofstra/Northwell Health, told The Epoch Times.

Easing Osteoarthritis Discomfort: Try These Tips for Symptom Relief

“It’s especially useful for people with chronic pain conditions like fibromyalgia, known for causing widespread pain and fatigue and osteoarthritis, which involves significant joint pain and inflammation,” he said.

Beyond speeding up the healing of broken bones, there is evidence that PEMF therapy helps to improve physical function and decrease stiffness, according to Dr. Lascarides.

PEMF is currently also used to stimulate the body in ways that aid in pain relief and tissue regeneration. This electromagnetic-based therapy is already commonly used for bone fractures that fail to heal within three to six months.

Patients are prescribed a small, battery-powered pulse generator connected to a coil placed next to the injury for eight to 10 hours per day. Alternatively, an electrical stimulator may be implanted near the break. Either way, the PEMF device generates a magnetic field that induces currents to flow in the nearby tissues.

“By using electromagnetic fields, PEMF therapy stimulates the body’s own healing mechanisms,” Dr. Lascarides said, “which encourages ’self-repair’ that can lead to marked improvements in comfort and mobility.”

PEMF Considered Safe With Minimal Side Effects

Overall, PEMF therapy is considered a safe treatment with minimal significant side effects.

Most people experience no issues during therapy, although a few may feel slight, brief discomfort at the point of application, Dr. Lascarides said. However, he noted that people with electronic implants, such as pacemakers, should avoid PEMF therapy to prevent potential interference with their devices.

Because of limited research on the effect of PEMF therapy on pregnant women, they should forego this treatment as a safety precaution, he said.

The existing research in this area raises some concerns. A small 2019 study published in Environmental Health found that prenatal exposure to an extremely low magnetic field had measurable adverse effects on female infants, although not on males. Effects included smaller head, upper arm, and abdomen circumferences, suggesting reduced fetal growth.

Pain Relief Without the Risks Linked to NSAIDs

Current research on PEMF therapy is “encouraging,” suggesting that it may be an effective, noninvasive method for managing pain and aiding healing without relying on drugs or surgery.

This is significant, as nonsteroidal anti-inflammatory drugs (NSAIDs) come with a broad range of side effects, including increased risk of gastrointestinal bleeding, heart attack, and stroke.

Chronic NSAID use has also been associated with an elevated risk of peptic ulcers and acute kidney failure.

Dr. Lascarides said PEMF therapy is promising as a possible treatment option to alleviate patients’ discomfort and improve their quality of life without the usual risks and side effects of traditional pharmaceutical-based pain treatments. However, there is still much to learn about it, he said.

“Ongoing and additional studies are crucial to further understand how PEMF therapy can be best applied, who stands to benefit most from it, and how it can be integrated into more comprehensive care strategies to optimize its advantages for those seeking relief,” Dr. Lascarides said.

“Zepbound,” the newest weightloss drug

Posted by

0


As Zepbound dominates headlines as a new obesity-fighting drug, experts warn that weight loss shouldn’t be the only goal.

A tube with the word Zepbond on it, designed specifically for weight loss.

Zepbound is the newest addition to the weight loss drug arena. In November 2023, it joined the list of obesity-fighting drugs – administered as an injection – to be approved by the U.S. Food and Drug Administration. 

The key to Zepbound’s weight loss potential is its active ingredient, tirzepatide. This is the same active ingredient found in the drug Mounjaro, which is approved to treat Type 2 diabetes. 

The relationship between Zepbound and Mounjaro is similar to two other popular drugs making headlines, Wegovy and Ozempic. Both Wegovy and Ozempic contain the active ingredient semaglutide, with Ozempic approved for the treatment of Type 2 diabetes and Wegovy approved for the treatment of obesity.

Tirzepatide and semaglutide both mimic the digestive hormone GLP-1, which is released by the intestines when we eat to stimulate insulin production and help regulate blood sugar. GLP-1 also suppresses appetite while promoting a sensation of fullness.

Weight loss medications are intended to be used in conjunction with lifestyle changes, such as exercise and a healthy diet. But too often, people view them as a silver bullet for weight loss. And the high price tag and variable insurance coverage for these popular weight loss drugs create a barrier for many people. 

Health risks of obesity

The potential impact of these drugs is staggering, since more than 2 in 5 American adults are obese, according to the National Institutes of Health. 

Obesity is not just an American issue, nor is it going away. The World Obesity Federation estimates that by 2030, 1 in 5 women and 1 in 7 men will be living with obesity worldwide.

Many serious health conditions are associated with obesity, including heart disease, diabetes, high blood pressure, stroke, certain cancers, and osteoarthritis. By treating obesity, a person can reduce or reverse obesity-related disease and improve both their health and quality of life.

However, long-term weight management depends on a number of complex factors. Meal timing and types of foods eaten can affect energy levels, satisfaction and hunger levels. A person’s typical schedule, culture and preferences, activity level and health history must be taken into consideration as well. No single “best strategy” for weight management has been identified, and research indicates that strategies for weight loss and maintenance need to be individualized.

In addition, it is critical to note that research on the long-term effects of these newer weight loss drugs is limited. The available research has focused specifically on weight loss, heart health and metabolism and has found that ongoing use of these new medications is necessary to maintain improvements in weight and related health benefits. 

Common side effects and the emotional toll experienced by those who regain weight once they stop taking the drugs are trade-offs that need to be considered. More research is needed to better understand the long-term impact of both direct and indirect health consequences of taking drugs for weight loss.

It’s not just what you see on the scale

Throughout my years working as a registered dietitian, I have counseled numerous people about their weight loss goals. I often see a hyperfocus on weight loss, with much less attention being placed on the right nutrients to eat.

Societal standards and weight stigma in the health care setting can negatively affect patients’ health and can lead them to obsess about the number on a scale rather than on the health outcome.

Weight loss may be necessary to reduce risks and promote health. But weight loss alone should not be the end goal: Rather, the focus should be on overall health. Tactics to reduce intake and suppress appetite require intention to ensure that the body receives the nutrients it needs to support health.

Additionally, I remind people that long-term results require attention to diet and lifestyle. When a person stops taking a medication, the condition it’s meant to treat can often return. If you stop taking your high blood pressure pills without altering your diet and lifestyle, your blood pressure goes back up. The same effects can happen with medications used to treat cholesterol and obesity.

Nourish your body with nutrients

Despite the prevalence of obesity and the emergence of newer drugs to treat it, 95% of the world’s population doesn’t get enough of at least one nutrient. According to one study, nearly one-third of Americans have been found to be at risk of at least one nutrient deficiency. Additional research indicates that those actively trying to lose weight are more prone to nutrient deficiencies and inadequate intake. 

For instance, a decline in iron intake can lead to iron deficiency anemia, which can cause fatigue as well as an increased risk of many conditions. Adequate intake of calcium and Vitamin D reduce the risk of bone fractures, yet many people get less than the recommended amounts of these nutrients. 

It is true that a healthy body weight is associated with reduced health risks and conditions. But if a person loses weight in a manner that does not provide their body with adequate nourishment, then they may develop new health concerns. For example, when a person follows a diet that severely restricts carbohydrates, such as the ketogenic diet, intake of many vitamins, minerals, phytochemicals – or biologically active compounds found in plants – and fiber are reduced. This can increase risk of nutrient deficiencies and impair the health of bacteria in our gut that are important for nutrient absorption and immune function.

Nutrition recommendations set by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine and the Dietary Guidelines for Americans provide guidance and resources to help meet nutrient needs to promote health and prevent disease, regardless of the strategy used to lose weight.

Optimizing health

There is no doubt that striving for a healthy body weight can reduce certain health risks and prevent chronic disease. Whether a person strives to maintain a healthy body weight through diet alone or with medications to treat obesity, the following tips can help optimize health while attempting to lose weight.

  1. Adopt an individualized approach to healthy behaviors that promote weight loss while considering personal preferences, environmental challenges, health conditions and nutrient needs.
  2. Focus on nutrient-dense foods to ensure the body is getting required nutrients for disease prevention and optimal function. If medications reduce your appetite, it is crucial to maximize the amount of nutrients in the foods you do consume.
  3. Include exercise in your program. Weight loss as a result of reduced calorie intake can decrease both fat and lean body mass, or muscle. An exercise routine that includes strength training will help improve muscle strength and preserve muscle during weight loss. 
  4. Seek professional help. If you are uncertain about how to adopt an individualized approach while ensuring adequate intake of essential nutrients, talk to a registered dietitian. They can learn about your individual needs based on preferences, health conditions and goals to make dietary recommendations that support health.

Glucosamine and Chondroitin for Osteoarthritis

Posted by

0


Glucosamine and chondroitin are structural components of cartilage, the tissue that cushions the joints. Both are produced naturally in the body. They are also available as dietary supplements. Researchers have studied the effects of these supplements, individually or in combination, on osteoarthritis, a common type of arthritis that destroys cartilage in the joints.

Cartilage is the connective tissue that cushions the ends of bones within the joints. In osteoarthritis, the surface layer of cartilage between the bones of a joint wears down. This allows the bones to rub together, which can cause pain and swelling and make it difficult to move the joint. The knees, hips, spine, and hands are the parts of the body most likely to be affected by osteoarthritis.

How much do we know about Glucosamine and Chondroitin Supplements?

  • We have some information about the safety and usefulness of glucosamine and chondroitin from large, high-quality studies in people.

What do we Know About the Effectiveness of Glucosamine and Chondroitin Supplements?

  • Research results suggest that chondroitin isn’t helpful for pain from osteoarthritis of the knee or hip.
  • It’s unclear whether glucosamine helps with osteoarthritis knee pain or whether either supplement lessens osteoarthritis pain in other joints.

What do we Know About the Safety of Glucosamine and Chondroitin Supplements?

  • Studies have found that glucosamine and chondroitin supplements may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin). Overall, studies have not shown any other serious side effects.
  • If you take glucosamine or chondroitin supplements, tell your health care providers. They can do a better job caring for you if they know what dietary supplements you use.

Glucosamine

Major studies of glucosamine for osteoarthritis of the knee have had conflicting results.

  • A large National Institutes of Health (NIH) study, called the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), compared glucosamine hydrochloride, chondroitin, both supplements together, celecoxib (a prescription drug used to manage osteoarthritis pain), or a placebo (an inactive substance) in patients with knee osteoarthritis. Most participants in the study had mild knee pain.
    • Those who received the prescription drug had better short-term pain relief (at 6 months) than those who received a placebo.
    • Overall, those who received the supplements had no significant improvement in knee pain or function, although the investigators saw evidence of improvement in a small subgroup of patients with moderate-to-severe pain who took glucosamine and chondroitin together.
    • For more information on the trial, see the NCCIH Web page.
  • In several European studies, participants reported that their knees felt and functioned better after taking glucosamine. The study participants took a large, once-a-day dose of a preparation of glucosamine sulfate sold as a prescription drug in Europe.
  • Researchers don’t know why the results of these large, well-done studies differ. It may be because of differences in the types of glucosamine used (glucosamine hydrochloride in the NIH study vs. glucosamine sulfate in the European studies), differences in the way they were administered (one large daily dose in the European studies vs. three smaller ones in the NIH study), other differences in the way the studies were done, or chance.
  • More than 20 studies have looked at the effect of chondroitin on pain from knee or hip osteoarthritis. The quality of the studies varied and so did the results. However, the largest and best studies (including the NIH study discussed under the heading “Glucosamine” above) showed that chondroitin doesn’t lessen osteoarthritis pain.

In general, research on chondroitin has not shown it to be helpful for pain from knee or hip osteoarthritis.A few studies have looked at whether glucosamine or chondroitin can have beneficial effects on joint structure. Some but not all studies found evidence that chondroitin might help, but the improvements may be too small to make a difference to patients. There is little evidence that glucosamine has beneficial effects on joint structure.

Experts’ Recommendations

Experts disagree on whether glucosamine and chondroitin may help knee and hip osteoarthritis. The American College of Rheumatology (ACR) has recommended that people with knee or hip osteoarthritis not use glucosamine or chondroitin. But the recommendation was not a strong one, and the ACR acknowledged that it was controversial.

For Other Parts of the Body

Only a small amount of research has been done on glucosamine and chondroitin for osteoarthritis of joints other than the knee and hip. Because there have been only a few relatively small studies, no definite conclusions can be reached.

What the Science Says About Safety and Side Effects

  • No serious side effects have been reported in large, well-conducted studies of people taking glucosamine, chondroitin, or both for up to 3 years.
  • However, glucosamine or chondroitin may interact with the anticoagulant (blood-thinning) drug warfarin (Coumadin).
  • A study in rats showed that long-term use of moderately large doses of glucosamine might damage the kidneys. Although results from animal studies don’t always apply to people, this study does raise concern.
  • Glucosamine might affect the way your body handles sugar, especially if you have diabetes or other blood sugar problems, such as insulin resistance or impaired glucose tolerance.

More to Consider

  • If your joints hurt, see your health care provider. It’s important to find out what’s causing your joint pain. Some diseases that cause joint pain—such as rheumatoid arthritis—may need immediate treatment.
  • If you take warfarin or have blood sugar problems, make sure you talk to your doctor about potential side effects if you are considering or taking glucosamine or chondroitin supplements.
  • If you’re pregnant or nursing a child, it’s especially important to see your health care provider before taking any medication or supplement, including glucosamine or chondroitin.
  • Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health.

Reasons Why Your Fingers Are Swollen

Posted by

0


Fluid Retention

Fluid Retention

1/13

Swelling happens when body fluids collect in tissues or joints. Sometimes your pinkie might be puffy. Or you may have trouble slipping your rings on and off. A salty meal could be one culprit. That’s usually not a cause for worry. But other times, your swollen fingers and hands can signal a health problem that needs your attention.

Exercise and Heat

Exercise and Heat

2/13

Your heart, lungs, and muscles need oxygen to fuel your workout. So, more blood goes to those places and less flows to your hands. Small blood vessels react to this change and expand, and that swells your fingers. Something similar happens when your body heats up in hot weather. To cool down, blood vessels in your skin swell to allow heat to leave the surface. This is totally normal.

Injury

Injury

3/13

You may have a torn a ligament or sprained your finger. Or injured a tendon, or dislocated or even broken a bone. If the injury isn’t too bad, ice, rest, and over-the counter pain medicine may be enough. See your doctor if you can’t straighten your finger, have a fever, or you’re in great pain.

Infections

Infections

4/13

Three that can cause swollen fingers are:

  • Herpetic whitlow: A herpes infection that causes small, swollen, bloody blisters on the fingers
  • Paronychia: An infection in the nail base caused by bacteria or fungus
  • Felon: A painful pus-filled infection in the fingertip

Finger infections can spread or other parts of the body if they’re not treated early.

Arthritis

Arthritis

5/13

Rheumatoid arthritis (RA) affects the lining of joints and causes swelling, pain, and stiffness. The symptoms often appear first in the hand joints. RA usually affects both hands

Psoriatic arthritis can affect people who have a skin condition called psoriasis. It often causes sausage-like swelling in fingers and toes. Both arthritis types are serious and can cause joint damage and other body problems without treatment.

Gout

Gout

6/13

This “rich man’s disease” largely used to afflict people who could afford lots of meat, seafood, and alcohol. Today, gout can hit people of all income levels. It causes extreme pain and swelling, usually in the big toe. But you can get it in any joint, including your fingers. It happens when too much uric acid in your blood forms crystals in the joint. Drugs can help ease the pain and prevent more attacks.

Medicine

Medicine

7/13

Some common culprits include:

  • Over-the-counter pain pills like aspirin, ibuprofen, and naproxen
  • Steroids
  • Certain drugs for diabetes or high blood pressure
  • Nerve pain drugs like gabapentin and pregabalin
  • Hormonal therapies with estrogen or testosterone

Puffy fingers from medication usually isn’t a serious condition. But talk to your doctor if you’re worried.

Kidney Disease

Kidney Disease

8/13

Your kidneys get rid of waste and extra fluid from your body. One of the first signs that something is wrong is puffiness in your fingers, feet, and around your eyes. You’re more likely to get kidney disease if you have diabetes or high blood pressure. Control these problems to protect your kidneys or stop the disease from getting worse. If your kidneys don’t work well enough, you’ll need a transplant or dialysis.

Pregnancy

Pregnancy

9/13

You can expect swollen fingers, ankles, and feet when you’re expecting. But sudden swelling, especially in the hands and face, can be a sign of preeclampsia. That’s dangerously high blood pressure that can happen in the second half of pregnancy. Rarely, it comes after childbirth and is called postpartum preeclampsia. The problem affects the kidneys, triggering swelling. You may also have a bad headache, belly pain, and trouble seeing.

Sickle Cell Disease

Sickle Cell Disease

10/13

Normal red blood cells look like doughnuts and are flexible. When you have sickle cell disease, the cells are stiff and crescent-shaped. These get stuck in small blood vessels and block blood flow. In the hands and feet, this causes painful swelling. Other problems include infections, anemia, stroke, and blindness. Sickle cell is a lifelong condition. In the U.S., it’s most common in African-Americans.

Lymphedema

Lymphedema

11/13

This swelling happens when fluid in the lymph system can’t drain well. It’s sometimes a side effect of cancer treatment. Women with breast cancer often have lymph nodes in their armpits removed to check for cancer. This upsets the flow of lymph and can lead to swelling in the arms and hands. Radiation can damage nodes and make the problem worse. Lymphedema can happen any time after treatment. It can’t be cured, but it can be managed.

Raynaud’s Disease

Raynaud’s Disease

12/13

Raynaud’s Disease is a rare problem that affects blood vessels in your fingers and toes. It causes them to narrow when you’re cold or stressed. Lack of blood flow makes your digits frosty and painful. They may turn white or blue. When the vessels open up and blood returns, your fingers can throb and swell. In serious cases, lack of blood flow can cause sores or even kill tissue.

Scleroderma

Scleroderma

13/13

This is an immune system disease that tricks your body into making too much of a protein called collagen. This thickens and hardens skin and can affect other body parts too. Your hands may become stiff and your fingers may puff up like sausages. Some people have mild symptoms. In more serious cases, organs can be injured. Scleroderma does not go away but can be treated.

Old Diabetes Drug May Help Stave off Osteoarthritis

Posted by

0


Metformin-treated patients fared better than sulfonylurea users

A photo of a spilled prescription bottle of metformin pills.

Metformin may help cut the risk of osteoarthritis (OA) in those with type 2 diabetes, researchers reported.

In a retrospective cohort study of nearly 21,000 adults with diabetes, those who were taking metformin saw a 24% lower risk for developing OA compared with those taking a sulfonylurea (adjusted hazard ratio [aHR] 0.76, 95% CI 0.68-0.85), according to Matthew Baker, MD, MS, of Stanford University in Palo Alto, California, and colleagues.

Metformin-treated patients saw an OA incidence rate of 27.5 events per 1,000 person-years vs 39.6 events per 1,000 person-years for those treated with a sulfonylurea, the group wrote in JAMA Network Openopens in a new tab or window.

The models were adjusted for age, sex, race and ethnicity, geographical region, education, Charlson comorbidity score, and outpatient visit frequency.

Taking this one step further, Baker’s group stratified the analysis according to patients treated with a sulfonylurea who were previously treated with metformin. Here, the risk reduction for OA was not significantly different from current metformin users (aHR 0.92, 95% CI 0.76-1.12). But these patients previously exposed to metformin still had a significantly lower OA risk than those never exposed (aHR 0.71, 95% CI 0.62-0.81).

“One possible hypothesis for this finding is that individuals in the sulfonylurea group with prior exposure to metformin derived a degree of long-lasting protection associated with the metformin exposure,” the researchers explained. These findings fall in line with previous researchopens in a new tab or window that already suggested a protective OA benefit with metformin, Baker’s group pointed out.

“It is possible that metformin use resulted in more weight loss than sulfonylurea use, and the reduction in OA we observed was mediated primarily by weight loss,” the study authors said, but then added that they “believe metformin likely exerts protective associations beyond what can be attributed to weight loss alone.”

This protective benefit didn’t appear to extend to the risk of joint replacement (aHR 1.04, 95% CI 0.60-1.82). The incidence rate of joint replacement for individuals treated with metformin was 1.5 events per 1,000 person-years, compared with 2.1 events per 1,000 person-years for sulfonylurea-treated patients.

This particular finding diverges from another prior studyopens in a new tab or window that had suggested daily metformin was associated with a 30% lower risk for total knee and hip replacement compared with no metformin.

Data for the present study came from claims of patients covered with commercial or Medicare Advantage from the Optum deidentified Clinformatics Data Mart Database from 2003 to 2019. Among the 20,937 individuals included, 58% were male and the average age was 62 years. All individuals were at least age 40 with type 2 diabetes. Those with type 1 diabetes, existing OA, inflammatory arthritis, or joint replacement were excluded.

The researchers acknowledged that they included patients who switched from metformin to sulfonylureas, but not vice versa, potentially creating some bias in the findings. Another limitation to the study was an inability to account for medication adherence in either treatment group.

“Future interventional studies with metformin for the treatment or prevention of OA should be considered,” suggested Baker’s group.

Old Diabetes Drug May Help Stave off Osteoarthritis

Posted by

0


Metformin-treated patients fared better than sulfonylurea users

A photo of a spilled prescription bottle of metformin pills.

Metformin may help cut the risk of osteoarthritis (OA) in those with type 2 diabetes, researchers reported.

In a retrospective cohort study of nearly 21,000 adults with diabetes, those who were taking metformin saw a 24% lower risk for developing OA compared with those taking a sulfonylurea (adjusted hazard ratio [aHR] 0.76, 95% CI 0.68-0.85), according to Matthew Baker, MD, MS, of Stanford University in Palo Alto, California, and colleagues.

Metformin-treated patients saw an OA incidence rate of 27.5 events per 1,000 person-years vs 39.6 events per 1,000 person-years for those treated with a sulfonylurea, the group wrote in JAMA Network Openopens in a new tab or window.

The models were adjusted for age, sex, race and ethnicity, geographical region, education, Charlson comorbidity score, and outpatient visit frequency.

Taking this one step further, Baker’s group stratified the analysis according to patients treated with a sulfonylurea who were previously treated with metformin. Here, the risk reduction for OA was not significantly different from current metformin users (aHR 0.92, 95% CI 0.76-1.12). But these patients previously exposed to metformin still had a significantly lower OA risk than those never exposed (aHR 0.71, 95% CI 0.62-0.81).

“One possible hypothesis for this finding is that individuals in the sulfonylurea group with prior exposure to metformin derived a degree of long-lasting protection associated with the metformin exposure,” the researchers explained. These findings fall in line with previous researchopens in a new tab or window that already suggested a protective OA benefit with metformin, Baker’s group pointed out.

“It is possible that metformin use resulted in more weight loss than sulfonylurea use, and the reduction in OA we observed was mediated primarily by weight loss,” the study authors said, but then added that they “believe metformin likely exerts protective associations beyond what can be attributed to weight loss alone.”

This protective benefit didn’t appear to extend to the risk of joint replacement (aHR 1.04, 95% CI 0.60-1.82). The incidence rate of joint replacement for individuals treated with metformin was 1.5 events per 1,000 person-years, compared with 2.1 events per 1,000 person-years for sulfonylurea-treated patients.

This particular finding diverges from another prior studyopens in a new tab or window that had suggested daily metformin was associated with a 30% lower risk for total knee and hip replacement compared with no metformin.

Data for the present study came from claims of patients covered with commercial or Medicare Advantage from the Optum deidentified Clinformatics Data Mart Database from 2003 to 2019. Among the 20,937 individuals included, 58% were male and the average age was 62 years. All individuals were at least age 40 with type 2 diabetes. Those with type 1 diabetes, existing OA, inflammatory arthritis, or joint replacement were excluded.

The researchers acknowledged that they included patients who switched from metformin to sulfonylureas, but not vice versa, potentially creating some bias in the findings. Another limitation to the study was an inability to account for medication adherence in either treatment group.

“Future interventional studies with metformin for the treatment or prevention of OA should be considered,” suggested Baker’s group.

Blood Test Tracks Osteoarthritis Progression More Accurately

Posted by

0


(MorphoBio/Shutterstock)

A new blood test that can identify the progression of osteoarthritis in the knee is more accurate than current methods, researchers report.

It could provide an important tool to advance research and speed the discovery of new therapies.

The test relies on a biomarker and fills an important void in medical research for a common disease that currently lacks effective treatments. Without a good way to identify and accurately predict the risk of osteoarthritis progression, researchers have been largely unable to include the right patients in clinical trials to test whether a kind of therapy is beneficial.

“Therapies are lacking, but it’s difficult to develop and test new therapies because we don’t have a good way to determine the right patients for the therapy,” says Virginia Byers Kraus, a professor in the medicine, pathology, and orthopedic surgery departments at Duke University School of Medicine and senior author of the study in the journal Science Advances.

“It’s a chicken-and-the-egg predicament,” Kraus says. “In the immediate future, this new test will help identify people with high risk of progressive disease—those likely to have both pain and worsening damage identified on X-rays—who should be enrolled in clinical trials. Then we can learn if a therapy is beneficial.”

Kraus and colleagues isolated more than a dozen molecules in blood associated with the progression of osteoarthritis, which is the most common joint disorder in the United States. It afflicts 10 percent of men and 13 percent of women over the age of 60 and is a major cause of disability.

With further honing, the researchers narrowed the blood test to a set of 15 markers that correspond to 13 total proteins. These markers accurately predicted 73 percent of progressors from nonprogressors among 596 people with knee osteoarthritis.

The prediction rate for the new blood biomarker was far better than current approaches. Assessing baseline structural osteoarthritis and pain severity is 59 percent accurate, while the current biomarker testing molecules from urine is 58 percent accurate.

The new, blood-based marker set also successfully identified the group of patients whose joints show progression in X-ray scans, regardless of pain symptoms.

“In addition to being more accurate, this new biomarker has an additional advantage of being a blood-based test,” Kraus says. “Blood is a readily accessible biospecimen, making it an important way to identify people for clinical trial enrollment and those most in need of treatment.”

Osteoarthritis

Posted by

0


Arrow Up
older woman sits on bed with her hand on her hip in pain

Arthritis is inflammation (swelling) of the joints. It causes pain and often limits movement of the affected joints. There are many kinds of arthritis. Osteoarthritis is the most common kind.

What is osteoarthritis?

Osteoarthritis is sometimes called degenerative joint disease or “wear-and-tear” arthritis. It can affect any joint in your body. It most often happens in the hands, hips, knees, and spine. It causes the cushion layer between your bones (called the cartilage) to wear away. This happens slowly and usually gets worse over time.

There are some factors that can increase your risk of developing osteoarthritis, including:

  • Being overweight or obese. Excess weight can make arthritis worse in the weight-bearing joints like knees, hips, and spine.
  • Having a joint injury. Joints that have been injured, damaged, or had steroid injections are more likely to develop osteoarthritis.
  • Repeating movements at work. People who have jobs that require the same movement over and over (like painting or lifting) are at higher risk.
  • Being older. Osteoarthritis is more common in older people because they have been using their joints longer.
  • Being a female. Women are more likely to develop osteoarthritis than men, especially after age 50.

Symptoms of osteoarthritis

The most common symptoms of osteoarthritis include:

  • Pain or aching in the joint
  • Stiffness in the joint, especially after not moving, such as after sleeping or sitting
  • Swelling and tenderness in the joint
  • A clicking noise when moving the joint
  • A decreased range of motion in the joint

What causes osteoarthritis?

The exact cause of osteoarthritis isn’t known. It may be hereditary, which means it runs in families. People who play sports may get it because sports can be hard on joints. However, in most people, it seems to be related to the wear and tear put on joints over the years.

Normally, a smooth layer of cartilage acts as a pad between the bones of a joint. Cartilage helps the joint move easily and comfortably. In some people, the cartilage thins as the joints are used. This is the start of osteoarthritis. Over time, the cartilage wears away and the bones may rub against each other. The rubbing causes pain, swelling, and decreased motion of the joint.

Bones may even start to grow too thick on the ends where they meet to make a joint. Bits of cartilage may loosen and get in the way of movement. This also can cause pain, swelling, and stiffness.

How is osteoarthritis diagnosed?

Your doctor will ask you questions about your pain. They will probably ask you if your joint pain gets worse with activity and better with rest. Your doctor will examine you to see if you have trouble moving your joint. Your doctor may order an X-ray or an MRI of the joint that’s causing problems to see what’s causing the pain. Blood tests can help rule out other forms of arthritis.

Can osteoarthritis be prevented or avoided?

There’s not much you can do to avoid getting osteoarthritis as you age. However, the following may help:

  • Try to not overuse your joints.
  • Try to avoid jobs or activities that require repetitive movement.
  • Maintain a healthy body weight.
  • Do strength-training exercises to keep the muscles around your joints strong. This is especially important for weight-bearing joints, such as the hips, knees, and ankles.

Osteoarthritis treatment

There is no cure for osteoarthritis. It will probably get worse over time. But the right plan can help you stay active, protect your joints from damage, limit injury, and control pain. Your doctor will help you create a plan that is right for you. They will treat you with a combination of therapies.

Physical activity

It’s important to stay as active as possible. When joints hurt, people tend not to use them as much. Then the muscles get weak. This can cause the joint to work less effectively. That can make it harder to get around. This causes more pain, and the cycle begins again. Talk to your doctor about ways to control your pain so that you can stay active and avoid this problem.

Exercise keeps your muscles strong and helps you stay flexible. Exercises that don’t strain your joints are best. To avoid pain and injury, choose exercises that can be done in small amounts with rest time in between. Dancing, weight-lifting, swimming, and bike-riding are good exercises for people who have arthritis. Avoid activities that make your pain worse.

Your doctor may also prescribe physical therapy. This usually includes muscle-strengthening exercises that can help your joints work better and reduce arthritis pain.

Medicine

Your doctor will probably recommend taking over-the-counter medicines to manage your pain. These are medicines you can buy without a doctor’s prescription. Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and relieve pain. They include aspirin, ibuprofen (one brand name: Advil), and naproxen (one brand name: Aleve). Other pain relievers may help you feel better, such as acetaminophen (one brand name: Tylenol).

Your doctor can also prescribe medicine for you. This could be prescription pain relievers or prescription NSAIDs.

Medicine should be used wisely. You only need the amount that makes you feel good enough to keep moving. Using too much medicine may increase the risk of side effects.

Special devices

Special supportive devices can help people who have arthritis stay independent. These devices help protect your joints and keep you moving. Devices can include canes, crutches, and walkers. Talk to your doctor if you think a special device may help your arthritis.

Other treatments

Sometimes osteoarthritis becomes severe. It can cause severe joint pain, swelling, and stiffness. When other therapies haven’t worked, your doctor may give you a shot in your joint. The shot could contain pain medicine. This can stop the pain for days to weeks. Adding another medicine (called a corticosteroid) may keep the pain and inflammation away longer.

If this doesn’t help enough, your doctor may talk to you about hyaluronic acid injections. Your joints already contain hyaluronic acid. If you have osteoarthritis, that acid gets thinner. When this happens, there isn’t enough hyaluronic acid to protect the joint. These shots put more hyaluronic acid into your joint to help protect it. These injections are usually only used for osteoarthritis in the knee. These injections help some people, but not everyone. And some research has shown that they don’t work. The American Academy of Orthopaedic Surgeons doesn’t recommend using hyaluronic acid for osteoarthritis of the knee.

Talk to your doctor about injections to see if they would be a good choice for you.

What about surgery?

Sometimes osteoarthritis is so severe that surgery is required to relieve the symptoms. There are many types of surgery for osteoarthritis. The type of surgery you may have depends on several factors. These include your age, your activity level, which joint is affected, and how bad the damage is. Talk to your doctor to learn which surgery will be best for you.

Surgical options include:

  • Arthroscopy. With a tiny camera and special instruments, the surgeon can see how badly the joint has been damaged. They can remove damaged parts of the joint and clean the joint to remove any loose parts that may be causing you pain. It may provide temporary relief from pain or delay the need for other surgeries.
  • Osteotomy. This surgery repositions or reshapes the bones in your joint where osteoarthritis has caused damage. It can shift your weight away from an area that has been damaged or correct misalignment in a joint. This procedure restores movement in your joint and relieves the pain. People who have an osteotomy may need joint replacement surgery in the future.
  • Arthroplasty. This also is known as joint replacement therapy. A surgeon removes the damaged joint and replaces it with an artificial joint made from metals, plastic, and/or ceramic. All or part of the joint may be replaced. Joint replacement therapy can help put an end to your pain and improve or restore movement in your joint.

Living with osteoarthritis

There are some things you can do to help you manage your life when you have osteoarthritis. They include:

  • Lose weight if you’re overweight. This can reduce stress on your joints, especially the hips and knees.
  • Exercise regularly for short periods. This can also help with losing weight. Talk to your doctor about a safe exercise program for you.
  • Use a cane and other special devices to protect your joints.
  • Avoid overusing your joints.
  • Take your medicine the way your doctor tells you to.
  • Use heat and/or cold therapies to reduce joint pain or swelling.
  • Consider taking nutritional supplements, such as glucosamine and chondroitin sulfate. They may help improve symptoms.
  • Get support. Arthritis support groups, self-management programs, and patient education programs can help you learn about self-care and improve your outlook.

What are the drugs used for the treatment of knee osteoarthritis?

Posted by

0


medwiki image

Osteoarthritis (OA) is a musculoskeletal progressive disease, with an affected knee joint. The pharmacological treatment of knee osteoarthritis is considered symptomatic therapy, which often secures the retainment of mobility of the patient. The pharmacological interventions of OA are suggested by recent guidelines, such as AAOS (American Academy of Orthopedic Surgeons), and ACR/AF (American College of Rheumatology/Arthritis Foundation).

DrugDosage
Acetaminophen (Paracetamol)Maximum 4g/day
Non-steroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen low dose (400 mg thrice daily) or medium dose (600 mg thrice daily), max 3200 mg daily
Naproxenlow dose (250 mg thrice daily) or medium dose (500 mg twice daily), with a maximum of 1250 mg daily.
Diclofenac50 mg twice daily or 75 mg twice daily, with a maximum of 200 mg daily
Celecoxib200 mg once daily of low dose to maximum dose of 200 mg twice daily
Gastroprotective agents
Misoprostol Standard dose 200 μg once daily
Proton pump inhibitor
Omeprazole 40 mg once daily
Opioid analgesics
Codeine10 mg twice daily
Fentanyl patch25 μg 
Tramadol50 to 100 mg every 4 to 6 hours
Oxycodone20 mg daily
Topical NSAIDs
Topical Capsaicin
Glucosamine and Chondroitin sulfate
Intraarticular glucocorticoids
Methylprednisolone acetateTriamcinolone acetonide 20 to 40 mg; once in every 3 months
Intraarticular Hyaluronic acid
Duloxetine
Bisphosphonates
Hydroxychloroquine
Methotrexate
Intraarticular Botullinum toxin.[1]

Suggested approach to the treatment of OA as per the American Academy of Physicians:

First-line pharmacotherapy: Full-dose of Acetaminophen, topical therapies.

Second-line treatments: Oral NSAIDs

Third-line treatments: Tramadol or Duloxetine 

Fourth-line treatments: Opiates (50 mg of Hydrocodone or ≤ 30 mg of Oxycodone per day)

Medical cannabis may reduce opioid use for OA

Posted by

0


 Access to medical cannabis may reduce opioid prescriptions in patients with osteoarthritis, with opioids no longer required in more than one-third of patients after medical cannabis certification, results presented here show.

“We believe that medical cannabis may have a role in the management of chronic pain in the future while simultaneously decreasing our reliance on opioids,” Asif M. Ilyas, MD, MBA, FAAOS, president of the Rothman Opioid Foundation and professor of orthopedic surgery at the Rothman Orthopaedic Institute and Thomas Jefferson University, told Healio. “However, we’re early on the process of understanding medical cannabis. We don’t have a good sense yet, fully, of its long-term outcomes, long-term side effects, best dosages, best frequencies and best concentrations or combinations.”

Marijuana plant

Using a prescription drug monitoring program system for patients with OA, Ilyas and colleagues compared average morphine milligram equivalents per day of opioid prescriptions filled within 6 months prior to and 6 months after access to medical cannabis. Researchers considered change in opioid prescriptions filled before and after medical cannabis certification and use as the primary study outcome measure. Researchers collected patient outcome measures, including VAS pain score, global mental health quality of life score and global physical health quality of life score, at 3, 6 and 9 months post-medical cannabis certification using the Patient-Reported Outcome Measurement Information System questionnaire. Researchers also collected and analyzed data on route of medical cannabis administration during the 3-to-6-month follow-up visit.

Asif M. Ilyas

Asif M. Ilyas

Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed a significant decrease in average morphine milligram equivalents per day from 18.2 to 9.8 after access to medical cannabis. Researchers found an average drop in morphine milligram equivalents per day of 46.3%, while 37.5% of patients dropped to 0 morphine milligram equivalents per day. Researchers noted a significant decrease in pain scores from 6.6 to 5 at 3-month follow-up and to 5.4 at 6-month follow-up, while the global physical health score increased significantly from 37.5 to 41.4 by 3-month follow-up.

Researchers identified vaporized oil, vaporized flower, oral, topical and sublingual tincture as the various routes of medical cannabis administration. Among 33 patients who had data on route of medical cannabis administration, results showed 63.6% used a single route of administration, 33.3% used two routes and 3% used three routes. Researchers found 66.7% of patients used sublingual tincture as the route of medical cannabis administration, 33.3% used a topical administration route, 21.2% used vaporized oil, 9.1% used an oral administration route and 9.1% used vaporized flower.