Johns Hopkins Health Alerts - Arthritis

Lupus and Heart Disease

Mon, 22 Feb 2010 06:00:00 CST

Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disease, in which the immune system mistakenly attacks the body's own organs and tissues. The sites most often affected are the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Now research reported in the journal Arthritis and Rheumatism (Volume 58, page 1458) looks at lupus and heart disease – a complication often overlooked by both doctors and patients.

Scientists have known for years that the risk of heart disease is greater for people with lupus than for those without the disease. But many people with lupus aren't getting that message, according to a recent study.

Researchers sent questionnaires to 226 people with lupus and found that only 31% were aware that they faced a significantly increased risk of cardiovascular disease because of lupus. In 58% of the cases, doctors had not discussed the risk or preventive measures.

The patients who had discussed heart disease with their physicians were more than twice as likely to understand that lupus was a risk factor and more than three times as likely to understand that they themselves were at risk. Lupus patients who were younger than 32 were more likely to understand that information than patients over 52, even though younger patients were less likely to have talked about heart disease with their doctors. The researchers speculate that younger patients may be more likely to be getting information from sources like the Internet.

If you have lupus, talk with your doctor about your risk of heart disease and the risk factors you can control: weight, blood pressure, cholesterol levels, and fitness.

Going Vegan With RA

Mon, 01 Feb 2010 06:00:00 CST

People with rheumatoid arthritis (RA) often turn to therapies that are outside the medical mainstream, especially when conventional medications are not working or are causing troubling side effects. Now a study reported in Arthritis & Rheumatism (Volume 59, page 186) suggests that following a gluten-free vegan diet may protect rheumatoid arthritis (RA) patients from heart disease and stroke. Here’s what the research suggests.

Following a gluten-free vegan diet appears to be an effective way of reducing the risk of heart disease and stroke in people with rheumatoid arthritis (RA).

Researchers asked 38 people with active rheumatoid arthritis (RA) to eliminate for one year meats and dairy foods (including eggs) and glutens, a mix of proteins in some grains (primarily wheat, oats, rye, and barley). A control group of 28 people with rheumatoid arthritis (RA) ate a healthy diet that included these foods.

At year's end, the gluten-free vegans had lowered their heart disease risk by several measures: The group lost an average of 9 lbs compared with only 2 lbs in the control group and had lower total cholesterol and lower LDL, the "bad" cholesterol that blocks arteries.

The vegans also had higher levels of an antibody -- anti-phosphorylcholine immunoglobulin A (antiPC IgA) -- associated with lower rates of atherosclerosis. And they had lower levels of C-reactive protein (CRP), a marker of inflammation associated with insulin resistance and excess weight.

More research is needed to pinpoint which elements of a vegan diet seem to do the most good for those with rheumatoid arthritis (RA). Still, cutting back on meat, dairy, and gluten-containing grains could be a boon to your health -- as long as you make sure about 10% of your diet is protein.

The Promise of Tanezumab

Mon, 09 Nov 2009 06:00:00 CST

When it comes to the pain caused by knee osteoarthritis, there is a great need for an effective drug that doesn't cause dependency, because many patients either cannot tolerate, or don't obtain sufficient pain relief from traditional nonsteroidal anti-inflammatory medication. Finally, there may be a solution: Tanezumab.

According to Nancy E. Lane, M.D., Professor of Medicine and Rheumatology at the University of California at Davis Medical Center, and Director of their Center for Healthy Aging, a Phase II clinical trial of tanezumab has shown that treatment once every eight weeks significantly reduces pain in patients with moderate to severe knee osteoarthritis

Dr. Lane and her colleagues followed 444 men and women aged 40-78 who were unable to control their pain with non-steroid anti-inflammatory medication, such as ibuprofen or naproxen, or who were candidates for more invasive treatments such as total joint replacement.

The patients enrolled in this 16-week study were treated with either tanezumab or a placebo. Tanezumab is a humanized monoclonal antibody against nerve growth factor, or NGF. NGF stimulates the growth of sensory nerve cells and increases the body's response to pain. Tanezumab appears to block the pain signals.

Tanezumab was intravenously administered at 10, 25, 50, 100, or 200 µg/kg on days 1 and 56 of the study. The researchers measured effectiveness by evaluating knee pain with walking and patient assessment of response to the treatment as well as other outcome measures, including stiffness and physical function.

The results: Tanezumab significantly improved knee pain and the patients' overall assessments of their condition by 46% to 62% compared with 22% for those patients given placebo. At weeks 12 and 16, researchers noted a significant improvement in the secondary outcome measures, including pain, physical function, and stiffness. Within three days of the first dose of tanezumab, many patients in Dr. Lane's study experienced a greater-than-50% improvement in walking knee pain. At higher doses, there was a 70 to 80% drop in knee pain that continued over the next two months.

Based on these interesting study findings from Dr. Lane, it is clear that inhibition of NGF may provide a novel type of therapy to reduce the pain of osteoarthritis and possibly other pain conditions, including fibromyalgia, metastatic cancer pain, and degenerative disease pain.

Can Vitamin D Prevent Arthritis?

Mon, 11 Jan 2010 06:00:00 CST

Many researchers now believe that the "sunshine vitamin" may one day play a key role in preventing the development and progression of arthritis. Researchers, including scientists at Johns Hopkins under the direction of Uzma Haque, M.D., Assistant Professor of Medicine in the Department of Medicine, Division of Rheumatology at Johns Hopkins, have been looking at the effect of vitamin D on rheumatoid arthritis and osteoarthritis and the data are quite suggestive. Vitamin D is proving to be a most promising area for arthritis research.

Vitamin D is a fat-soluble vitamin that's essential for human health. Vitamin D levels are assessed with a simple blood test that measures levels of 25-hydroxy vitamin D, or 25(OH)D, the metabolite that reflects vitamin D stores; results are expressed in terms of nanograms per milliliter (ng/mL).

Although there is continuing debate over what constitutes an optimal level, most experts now agree that the level should be 30 ng/mL or higher. Yet most Americans -- up to 60% by some estimates -- have suboptimal blood levels of vitamin D. In part, that's because we spend less time outdoors and absorb less vitamin D from sunlight. However, it also may be because we don't get enough vitamin D from our diet. Only a few foods contain significant amounts of vitamin D.

It has long been recognized that vitamin D is essential to bone health because it promotes calcium absorption. Vitamin D regulates as many as 1,000 different genes, including those that weed out precancerous cells and slow the runaway reproduction of cancer cells. Vitamin D also helps maintain a healthy immune system and activates cells that fight infection, including the bacterium that causes tuberculosis.

During the past decade, there's been an explosion of research suggesting that vitamin D plays a significant role in joint health and that low levels may be a risk factor for rheumatologic conditions such as rheumatoid arthritis and osteoarthritis.

Unlike other vitamins, vitamin D is not just a simple nutrient. It's also an active steroid hormone that binds to receptors in a host of vulnerable tissues -- including the joints affected by arthritis -- and works to keep these tissues healthy. Arthritis patients may be even more likely than the general population to have low levels of vitamin D. According to a study presented at the 2008 European Union League Against Rheumatism (EULAR) meeting in Paris, nearly 75% of patients who presented at a rheumatology clinic -- including those who were subsequently diagnosed with inflammatory joint diseases, soft-tissue rheumatism, uncomplicated musculoskeletal backache, or osteoporosis -- were deficient in vitamin D.

If your D level is lower than 30 ng/mL, the parathyroid gland becomes overactive and sets in motion a process that depletes calcium from bones in order to maintain normal blood levels of calcium. This currently accepted optimal level of vitamin D is based solely on vitamin D's calcium function. However, it ignores other important functions. As we learn more about vitamin D, Dr. Haque anticipates that the optimal level will be pushed considerably higher, with an ideal range between 50 and 70 ng/mL.

What Should You Do About Bone Spurs?

Mon, 19 Oct 2009 06:00:00 CDT

Bone spurs -- also called osteophytes -- are benign, bony bumps that usually form on the joints. Most are harmless and never detected. But if they limit your movement or cause pain, treatment is available. Here’s what you should know.

To some extent, bone spurs are just a normal part of aging; your body may produce them to compensate for gradual bone loss that occurs overtime. Bone spurs may also be a result of arthritis or other bone diseases. As cartilage in the joints wears away in arthritis patients, bones begin to rub directly against each other and bone spurs develop. These bumps may protrude into surrounding tendons or break off and float in the space within joints, causing swelling or interfering with range of motion.

In the spine, bone spurs may lead to stenosis (narrowing of the spinal canal) and exert pressure on the nerves, causing muscle weakness, tingling, loss of coordination, or radiating pain in the buttocks, thighs, or shoulders. Bone spurs in the spine's cervical region can push into the throat, making it difficult to swallow or breathe. Symptoms like these may indicate diffuse idiopathic skeletal hyperostosis (DISH), a condition characterized by multiple bone spurs and ossified ligaments, usually in the spine (though DISH can affect other areas of the body).

If you are experiencing symptoms, your doctor will examine you and possibly order x-rays or other imaging tests. The best way to treat a bone spur is by addressing the underlying cause. In addition to arthritis and other medical conditions like DISH, excess weight, bad posture, old athletic injuries, or even shoes that don't fit well may be to blame.

Conservative therapy usually involves rest, icing, stretching, and non-steroidal anti-inflammatory drugs (NSAIDs ). Also, even though your symptoms may seem to worsen with movement, targeted physical therapy exercises can restore range of motion in the joints and promote good posture (which reduces pressure on nerves). For temporary relief of serious pain, you may be given cortisone shots.

Surgical removal is an option for more severe symptoms, particularly if you already require surgery for arthritis. Some people choose to have bone spurs taken out for cosmetic reasons, especially when the hands are affected. Removal can be performed through open or laparoscopic procedures.

Building Bone Density With Exercise

Mon, 21 Dec 2009 06:00:00 CST

Dr. Deborah Sellmeyer, Medical Director of The Johns Hopkins Metabolic Bone Center, talks about preventing osteoporosis by building bone density with exercise.

Q. How does weight-bearing exercise affect bone density?

Dr. Sellmeyer: Physical activity is very important for preventing osteoporosis. The pure bio-mechanical pull of muscle on bone is a stimulus for the bone to grow, incorporate mineral, and become stronger. People who don't get that stimulus -- such as astronauts in space or immobilized people on Earth -- start losing bone at a very rapid rate. Ideally, people should perform weight-bearing activities throughout their lives to build bone and maintain bone density.

Physical activity makes a big difference, even in childhood. For example, there have been trials in which one group of children was assigned to an exercise program in which they jumped up and down off boxes of varying heights. A second group of children was instructed to simply continue their usual daily activities. The researchers reported that the kids in the exercise group gained significantly more bone than the other kids. That's because the jumping activity gave them more weight-bearing stress on their bones.

It's never too late to adopt a bone-friendly exercise program. In one study of postmenopausal women, researchers reported that a regimen of daily brisk walking and simple gymnastic training led to a significant increase in the women's lumbar BMD. Even a minimal amount of weight-bearing activity can help older adults gain bone, but continuous training is needed to maintain the benefits gained through exercise.

Q. What types of weight-bearing exercise do you recommend?

Dr. Sullmeyer: Certain types of exercise are more beneficial than others for preventing osteoporosis. In adults with sufficient physical capacity, running and jumping activities such as playing tennis or jumping rope are excellent. But if you don't have the physical capacity for such vigorous exercise, even daily walks will help strengthen your bones. Your regular exercise routine should include weight-bearing and resistance exercises and ideally should begin in childhood or adolescence -- or at least well before menopause.

In weight-bearing exercises -- such as brisk walking, stair climbing, jogging, and dancing -- the bones and muscles work against gravity and the feet, legs, and spine bear the body's weight. This type of exercise helps strengthen the lower body and spine. (In contrast, while activities such as swimming and bike riding can be good for your muscles, joints and heart, they are not weight-bearing activities and therefore should not be your only form of exercise.)

In resistance exercises, the muscles work against weights. Either free weights (such as dumbbells) or weight machines can be used for resistance training. This type of exercise is especially ideal for building bone mass in the upper body, an area that is weak in most women. Proper instruction and technique for performing the exercises are essential to avoid injury.

A Negative Verdict for Glucosamine and Chondroitin Supplements

Mon, 28 Sep 2009 06:00:00 CDT

The most recent study on glucosamine and chondroitin supplements seriously challenges their effectiveness at providing relief from osteoarthritis pain.

In 2006, the National Institutes of Health’s Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) showed that these popular arthritis supplements don’t help. But many patients held out hope that an ongoing second GAIT would uncover some benefit.

Now results are in for the second part of this landmark trial, and the final analysis suggests more of the same: Glucosamine and chondroitin supplements do not effectively treat osteoarthritis.

Cartilage cushions and protects joints. As osteoarthritis progresses, this cushion wears away, causing joint pain and disability. Glucosamine/chondroitin supplements (they are sold both as a combination pill and separately) contain compounds found in cartilage and are touted to help repair and slow joint deterioration. But it’s unknown how the body processes these compounds or if they ever make it to the cartilage.

The first GAIT analysis included 1,600 participants and measured how well glucosamine/chondroitin supplements reduced pain compared with a placebo and the proven pain reliever celecoxib (Celebrex). After six months researchers reported that, overall, these supplements were no more effective than placebo at relieving pain. As was expected, people taking celecoxib reported the greatest improvement.

Among a small group of participants with moderate to severe knee pain, those taking the combination supplement reported greater pain relief than people taking placebo, but this group was too small for researchers to say for sure that the combo works. Moreover, within this small group, placebo users reported as much pain relief as those taking celecoxib, which casts further doubt on the purported benefits of supplements.

Researchers hoped that the second GAIT analysis, which used x-rays to measure the physical effects of these supplements on knee joints, would clarify matters. Knee images from 357 people with osteoarthritis were analyzed to see if daily glucosamine/chondroitin supplements prevented a loss of joint space -- the distance between the ends of bones in the joint. (Bones get closer together as cartilage wears away.) There were no meaningful differences among people taking glucosamine/chondroitin, celecoxib, or placebo.

Glucosamine and chondroitin together did worse than when each was taken alone, but again, these differences were insignificant and no better than placebo. As in the first trial, a small subgroup of patients showed a trend toward improvement. This time, however, the trend was seen in patients with less severe osteoarthritis pain who were taking glucosamine alone -- not a combination supplement.

Many people will probably continue to take these supplements despite the new data -- osteoarthritis hurts, relief is hard to find, and the small group of participants who benefited is still a nagging issue. About 1,500 mg a day of glucosamine alone is the most promising dosage.

But be aware that well-designed trials done independent of supplement manufacturers have not been able to prove these supplements work, despite their enormous popularity. Moreover, pills can cost more than $30 a month; this is a lot of money to spend on what might be a placebo effect.

Getting Ready For Hip or Knee Replacement Surgery

Mon, 06 Jul 2009 06:00:00 CDT

Considering hip or knee replacement surgery? Because hip or knee replacement surgery is rarely an emergency, you have plenty of time to set your house in order before you go to the hospital. Here’s no-nonsense advice from Johns Hopkins doctors.

Hip or knee replacement surgery: Check Your Medical Coverage
The weeks before hip or knee replacement surgery are a good time to check your health insurance coverage to avoid any unpleasant surprises later on. This includes inquiring about or verifying coverage issues such as:

Need for a second opinion on your hip or knee replacement surgery

Hospital and health care providers' status as "in-network" or "preferred"

Deductibles for hospital services

Limits on length of stay

Coverage for hospital rehabilitation services

After-care services for your hip or knee replacement surgery, such as physical or occupational therapy (Ask whether the therapists must be from an approved list and how many visits or sessions are covered.)

Equipment such as wheelchairs, walkers, and crutches, and whether they must be obtained from approved vendors

Home health care coverage, what type, and for how long

Coverage of follow-up visits with your physician

Hip or knee replacement surgery: Review the Procedure With Your Doctor
Ask your doctor to explain the hip or knee replacement procedure, the type of device being implanted, and what you should expect in terms of rehabilitation. You should discuss pain management, time on crutches or a walker, length of physical therapy, type of home assistance required, time off from work, restricted activities, and time until you can resume full activities.

Hip or knee replacement surgery: Prepare Your Home
Take a look at the rooms in your house to identify potential problem areas. To increase safety and convenience:

Remove throw rugs and small items from the floor. Tape down electrical cords. Rearrange furniture to create wide pathways to accommodate a walker or crutches.

Set up a bedroom downstairs.

Place kitchenware and other frequently used items within arm’s reach. Buy a long-handled grabbing device.

Consider installing handrails and grab bars in the bathroom and shower. A shower bench and elevated toilet seat are also helpful.

Place a sturdy high-backed chair with arms in the room where you will spend most of your time.

Set up a recovery center. Place a table and wastebasket near your chair. Include a phone, T.V. remote control, tissues, medications, water pitcher and glass, and reading material. Use a carpenter’s apron or shoulder bag to carry items around the house.

Make or buy frozen casseroles, soups, and other easy-to-prepare foods.

Above all, don’t hesitate to ask friends and neighbors for help with groceries, transportation, or other tasks. With your new hip or knee, you’ll be able to return the favor down the road.

That Other Itis … Bursitis

Mon, 07 Sep 2009 06:00:00 CDT

Do you suffer with dull, persistent joint pain that gets worse when you move? It may be due to bursitis -- a condition that produces some of the same symptoms as arthritis, but affects the tissues surrounding the joint rather than the joint itself.

Bursitis is an inflammation of one of the small fluid-filled sacs, or bursae, that act as cushions in areas of the body where muscles or tendons move over bones or other muscles. The bursae prevent friction by protecting muscles and tendons from coming into direct contact with bones. When a bursa becomes inflamed, pain and swelling result. There are about 150 bursae in the body, but the ones most commonly affected are in the shoulders, elbows, hips, knees, and feet.

In most cases bursitis results from joint overuse due to repetitive motions. For example, bursitis in the shoulder can be brought on by excessive strain, such as from serving a tennis ball. Other causes of bursitis include:

Activities that put constant pressure on a bursa (such as resting the elbow on a desk or kneeling)

A blow or other injury to a bursa

Inflammatory arthritis, gout, and certain infections

Bursitis is not chronic -- most cases clear up by themselves within a few days to two weeks -- but bursitis can recur unless you adopt protective measures. The best way to prevent bursitis is to avoid activities that require repetitive motions (which is not always possible) and to stay in shape, since well-conditioned muscles are less susceptible to overuse injuries than tight or weak muscles.

Bursitis treatment advice:

Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), which relieve pain and swelling of bursitis, or acetaminophen, which will relieve pain but won't reduce inflammation.

Use ice packs for the first 48 hours to relieve pain and swelling. Then, if desired, switch to heat packs, which stimulate blood flow and ease pain.

To reduce swelling, your doctor may draw excess fluid from the bursa with a syringe and then tightly bandage the joint.

Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain of bursitis.

Gradually resume using the affected joint to prevent stiffening and muscle atrophy.

Surgery to remove the bursa may be necessary in severe, persistent cases.

A Pain in the Rotator Cuff

Mon, 27 Jul 2009 06:00:00 CDT

In this article from The Johns Hopkins Arthritis Bulletin, Drs. Steven A. Peterson and Edward G. McFarland answer questions about rotator cuff pain.

Of all the joints of the body, your shoulder is capable of the widest range of motion. This amazing flexibility allows you do just about anything, from picking up a suitcase, brushing your teeth, and throwing a 90-mph fastball, to scratching your back, and hugging your spouse. All of this can dramatically change, however, when shoulder pain develops, and freedom of movement is affected. An estimated 20% of Americans will suffer from shoulder pain during their lifetime, with many having their damaged shoulder joint replaced surgically to relieve the pain and restore motion. Others will require rotator cuff surgery.

Q. Can the rotator cuff be torn?

A. Rotator cuff tendons have a very low blood supply, which leaves them vulnerable to degeneration as one ages. Rotator cuff damage increases naturally with age, typically in the dominant arm. Repeating the same type of shoulder actions can accelerate shoulder degeneration, whether it be swimming laps, washing windows, or carrying a heavy briefcase.

The interesting thing about rotator cuff tears is that while rotator cuff tears are a common shoulder pain source, as many as 5-40% of people without shoulder pain have a torn rotator cuff and never know it. Ignoring existing chronic shoulder inflammation or sustaining a sharp blow or fall on an outstretched arm may cause the rotator cuff to tear partially or completely.

An initial symptom is sharp pain in the shoulder that may radiate down to the elbow. Even so, the arm can still be moved in a normal range of motion. However, when the rotator cuff completely tears, the arm often cannot move in its normal range, and sometimes the arm cannot be raised from the side without assistance.

Q. What are the options for someone with a torn rotator cuff?

A. Many people think that because their rotator cuff is torn, they need to have surgery to restore use of their arm and get back shoulder flexibility. However, all partial tears of the rotator cuff do not require surgery. Even with a tear, some people will find that they still have reasonably good function and relatively little shoulder pain.

Good candidates for nonsurgical therapy for partial tears of the rotator cuff include those who:

Are bothered by pain

Are not concerned with regaining lost shoulder strength

Will modify all activities that cause shoulder pain symptoms. When there is a complete tear of the rotator cuff tendon, the goal of rotator cuff surgery is to get the tendon to heal to the bone so that shoulder pain is reduced and strength and range of motion of the shoulder are increased

Good candidates for surgical therapy for a torn rotator cuff include those who have:

Much shoulder pain or loss of function

Failed nonsurgical management

Tears that cause profound shoulder weakness

Tears caused by acute trauma

Arthritis in the Shoulder

Mon, 15 Jun 2009 06:00:00 CDT

The shoulder is involved in almost every movement of the upper body, so it should come as no surprise that it can also hurt. About 5% of all visits to primary care physicians are for shoulder troubles, and the American Academy of Orthopedic Surgeons estimates that four million Americans seek medical care each year for shoulder sprains, strains, dislocations, or other problems. Arthritis in the shoulder can cause severe pain and limited range of motion. Here are some common questions about shoulder arthritis.

While it's less publicized than knee or hip arthritis, shoulder arthritis is a crippling condition, causing extreme pain, stiffness, and limited motion. Osteoarthritis of the shoulder can be the result of early trauma (e.g., falling, football, blunt trauma), resulting in dislocation or shoulder fracture. Over the years, this eventually leads to degradation of the articular cartilage and a wearing down of the joint surfaces.

Shoulder arthritis can also be seen in patients with long-standing tears of the rotator cuff, which is the group of muscles and tendons that connects the humerus to the scapula and stabilizes the glenohumeral joint. Immunologic problems, like rheumatoid arthritis also can affect the shoulder joint. This severe form of arthritis is characterized by pain, stiffness, swelling, and warmth in the shoulder joints.

Q. What are the symptoms of shoulder arthritis?

A. The most common symptom of arthritis of the shoulder is pain, with the pain aggravated by activity and progressively worsening. The pain is worse when the arm is gently brought across the chest. It is common for the pain to radiate into the biceps area and down the arm.

Q. Will shoulder arthroplasty (joint replacement surgery) relieve pain and restore shoulder motion for people with arthritis?

A. Yes, arthroplasty can relieve pain and restore motion in people with severe shoulder arthritis. In addition, according to a recent study done at Johns Hopkins, shoulder arthroplasty is just as safe as the much more common hip and knee replacements. Yet people with shoulder arthritis are more likely to stick with conservative treatments.

Why don't more people choose shoulder arthroplasty? Many people don't know that shoulder replacements are available, or think that shoulder arthroplasty is extremely traumatic or that shoulder replacements just don't work.

How To Find a Qualified Fitness Trainer

Mon, 13 Apr 2009 06:00:00 CDT

Has your rheumatologist recommended exercise to improve your osteoarthritis or rheumatoid arthritis symptoms, but you're not quite sure what to do or how to do it? Working with a good fitness trainer can ensure that your exercise regimen meets your needs and that you learn to do the exercises properly, minimizing the risk of overuse or injury. But beware -- the qualifications of fitness trainers vary widely: Some are nearly as qualified as physical therapists, while others have merely passed a week-long course.

So how can you find a good trainer who has worked with arthritis patients? And what's the best way to open and maintain the lines of communication between your arthritis doctor and your trainer?

The first step is to ask your rheumatologist or physical therapist to refer you to a qualified trainer. You can also check with your local chapter of the Arthritis Foundation (www.arthritis.org), which may have a list of trainers experienced in working with people who have arthritis. Although no laws require trainers to be certified or even to have particular training, certification by a reputable agency ensures that you are working with someone who understands the mechanics of exercise and arthritis.

Once you've selected several trainers and determined their certification, you'll need to interview them, asking the following:

Have you worked with someone who has my kind of arthritis? The answer should, of course, be yes. Ask for and contact one or two references from the trainers.

Are you willing to coordinate my program with my rheumatologist or physical therapist? You want someone who has worked with physicians and physical therapists and knows how to communicate with them about your arthritis.

How will you decide what program to put me on? The trainer's answer should be that his or her plan will depend on your goals, your fitness level, and the input of your doctor or physical therapist about your limitations and medications.

What would you do if someone has this kind of limitation (name one of yours)? If someone has a flare-up? If he or she has no suggestions or doesn't know what a flare-up is, that should be a red flag.

Meeting with a trainer is not a one-way street. A good trainer will ask you questions as well, such as:

What kind of arthritis do you have?

What are your goals?

What are your limitations?

Have you ever had a joint replacement?

What medications do you take for your arthritis?

Have you exercised before?

What kind of activities do you like?

Do you prefer individual or group exercise?

Can Gout Cause a Heart Attack and other Questions

Mon, 25 May 2009 06:00:00 CDT

In this Health Alert, Dr. Joan M. Bathon, Medical Editor of the Johns Hopkins Arthritis Bulletin, answers reader's questions about living with gout.

Q. I am a 51-year old man with a history of gout. Three weeks ago, I had a flare up of gout, with all the classic symptoms. The main joint on my big left toe had the most pain. My doctor prescribed colchicine. I have been taking .6 mg of colchicine a day as prescribed. I have also been drinking a lot of water, watching what I eat, and eliminated all beer.

Now that my symptoms have gone away and I have not had any new attacks, my foot still doesn't feel 100%. There seems to be some residual pain and my foot/toe seems very susceptible to injury. I have stubbed it a couple of times, which seems to cause a lot of lingering pain, although there has been no real gout flare up. Is this normal? Is it possible that one gout attack could cause joint damage? On the other hand, am I just not getting over the gout attack completely for some reason? Is a joint more sensitive to injury after a flare up? Thanks for your help. Princeton, NJ

A. Most gout attacks resolve within a few days. Medication can shorten the gout attack. Over time, though, if preventative medication (allopurinol) isn't used, the attacks tend to become more frequent and last longer and longer until they all run together in one continuous state of joint inflammation. At this stage, we refer to gout as "chronic" rather than "acute." In general, if an individual is having multiple attacks of gout per year, we will recommend the use of allopurinol. Currently, this is the most effective medication for lowering uric acid in the blood.

Uric acid is the chemical that causes gout. When levels of uric acid get too high, the uric acid crystallizes in the joint causing the inflammation. Allopurinol shuts down the body's ability to make uric acid, thus markedly reducing the possibility of developing any more gout attacks. Colchicine reduces inflammation but does not lower uric acid. Folks having repeated attacks of gout, or an attack that just won't quit, should consult with their primary care physicians for treatment recommendations.

Q. I was recently diagnosed with gout and my doctor told me that I have to keep it under control, not just to prevent the painful flares but more importantly because gout can increase the risk of having a heart attack. I had never heard of this before. How can a sore toe cause a heart attack? Hanover, NH

A. Many inflammatory conditions outside the heart are associated with a higher risk for developing heart attacks and strokes. Rheumatoid arthritis and lupus are the best examples of this. We think it is because these are systemic diseases in which highly inflammatory molecules are circulating around in the bloodstream, and may promote atherosclerosis as they bathe the heart day after day, year after year.

Gout may present a similar picture since uncontrolled gout consists of repeated bouts of inflammation. In addition, when one looks at folks who have heart disease, even without symptomatic gout, a high uric acid level (uric acid is the chemical that causes gout) is associated with a higher risk of heart disease. So, if you have gout, you should make sure it is kept under control, both for the sake of preserving your joints and perhaps for preserving a healthy heart, too.

Can Coffee Prevent Gout?

Mon, 29 Dec 2008 06:00:00 CST

Worried about gout? Researchers recently discovered that drinking coffee may lower your risk. Read what the experts think …

Gout is believed to have a genetic component, as nearly one in five individuals who develop gout has a family history of the disease. Other gout risk factors are gender (men outnumber women by nine to one); age (it is more common in adults than in children); being over weight; excessive consumption of alcohol; the presence of kidney disease, high blood pressure, high cholesterol, or diabetes; and exposure to lead. A high consumption of purine-rich foods also increases the risk of having a gout attack. Purine-rich foods include certain meats and fish, poultry, liver, dried beans, asparagus, mush- rooms, cauliflower, peas, and spinach.

Recently researchers in Canada sorted through data on more than 14,000 men and women from the six-year Third National Health and Nutrition Examination Survey and found that people who drank four or more cups of coffee a day lowered their risk of gout by 40-60%. The participants, who filled out questionnaires about their diets over the previous month, ranged in age from 40 to 75 and had no history of gout.

Coffee -- and, to a lesser extent, decaffeinated coffee -- significantly lowered the amount of uric acid in the blood. The build up of uric acid causes gout. However tea and other caffeinated beverages had little effect, leading researchers to conclude that elements other than caffeine in coffee, like an antioxidant called chlorogenic acid, caused the uric acid levels to drop. Researchers aren't suggesting that you drink four cups of coffee a day to ward off gout. But if you have gout or are at risk for it, go ahead and enjoy your morning brew.

[This data was reported in the journal Arthritis & Rheumatism, Volume 57, page 816.]

New Option for Fibromyalgia Treatment

Mon, 23 Mar 2009 06:00:00 CST

If you have fibromyalgia, you know that getting plenty of sleep and regular exercise are extremely important. While treatment options for the pain and fatigue of fibromalgia are limited, two recently available medications offer hope.

The treatment of fibromyalgia involves managing the symptoms. Drugs typically used include antidepressants, pain relievers, sleep medications, muscle relaxants, anti-anxiety agents, antiseizure medications, and medications used to control headaches.

Last spring, the FDA approved pregabalin (Lyrica) for the treatment of fibromyalgia. In clinical trials, Lyrica reduced pain of fibromyalgia better than placebo. This medication is also approved to treat neuropathic pain (pain from damaged nerves) in people with diabetes and pain in people who have had shingles (postherpetic neuralgia). It is also used to treat certain types of seizures.

Recently, results from a 12-week study reported in the journal Arthritis & Rheumatism (Volume 56, page 1336) suggest that the epilepsy drug gabapentin (Neurontin) could offer some relief. The researchers randomly assigned 150 individuals with fibromyalgia to take gabapentin (1,200–2,400 mg) for 12 weeks or placebo (inactive) pills. They found that compared with placebo, gabapentin significantly reduced pain and fatigue and improved the quality of sleep, as measured by several standardized tests. In fact, more than 50% of the gabapentin group reduced their pain severity score by at least 30% compared with only 31% of those taking placebo.

Currently, the FDA has not approved gabapentin for the treatment of fibromyalgia. However since Lyrica has a similar mechanism of action, you could ask your doctor about trying it for your fibromaylagia pain and fatigue.

How Long Will My New Hip Last?

Mon, 09 Feb 2009 06:00:00 CST

If you have arthritis and are facing hip or knee replacement surgery, you may be wondering how long the implant will last and if you'll need to replace the joint again some day. In this Health Alert, Johns Hopkins specialists answer this important question.

About 90-95% of hip implants last at least 10 years, and approximately 80-85% of knees last at least 20 years. Lab testing suggests that new implants could now last 20 to 25 years or longer. That's because older joint replacements made of plastic and polyethylene have now been replaced with those made of longer-lasting materials such as cross-linked polyethylene, a durable plastic; ceramic surfaces; or metal-to-metal ones that resemble ball bearings.

In the real world, how long a hip or knee implant lasts depends on how much use it gets. Although implants allow a return to active sports such as golf, biking, and swimming, they're not designed for impact sports like jogging or tennis. The trade-off may be that the hip or knee wears out sooner.

If you do need a second hip or knee implant, you will have what's called revision surgery. Sometimes people need a new hip or knee implant if the original plastic liner on the implant wears out, if the replacement loosens or breaks, or if they develop an infection.

Not all revisions require a replacement of every implant part. A simple revision is the replacement of a worn liner with a new one. A complex revision might involve grafting more bone onto the joint or dealing with an infection. In the case of infection, the replacement joint would have to be removed, and you would need intravenous antibiotics for six to eight weeks before the replacement could be reinserted.

Botox and Hyaluronic Acid Injections for Osteoarthritis

Mon, 02 Mar 2009 06:00:00 CST

In this excerpt from a recent issue of the Johns Hopkins Arthritis Bulletin, Dr. Joan Balthon and colleagues answer readers questions about botox and hyaluronic injections for arthritis pain relief.

Q. I have had arthritis in my shoulders for six years, but I get by with daily flexibility exercises that I perform and a Celebrex [celecoxib] pill. I recently read that doctors are now experimenting with Botox [Botulinum toxin type A] as a treatment for arthritis pain. What is the latest research showing with Botox as an arthritis therapy? Towson, MD

A. Botox, said to be useful for more than 50 medical conditions including excessive sweating, constipation, headache, clubfoot, and even hiccups, acts by binding to the nerve endings of muscles, blocking the release of the chemical that causes muscles to contract.

When injected into a specific muscle, Botox paralyzes or weakens the muscle but leaves surrounding muscles unaffected, allowing for normal muscle function. Early reports of Botox use for treating arthritis do suggest efficacy but the studies were very small. We need much larger studies before we know for sure if Botox will play a role in arthritis therapy.

Q. I have had arthritis in my hips for five years and while I am still able to get by and complete my daily activities, the pain is gradually worsening. Since hyaluronic acid (HA) injections are used to lubricate the knees of people with severe arthritis, can they be used in the hips as well? Your help is appreciated. Dover, DE

A. Some HA is already in the fluid in your joints, where it serves as a lubricating agent. In people with knee arthritis, the HA gets thinner. When this occurs, there isn't enough HA to protect the joint and the knee becomes painful.

HA injections can put more of the acid into the knee joint to help protect it. HA injections have been approved by the Food and Drug Administration for the treatment of knee arthritis. In theory, HA can be used in the hips but injecting into the hips isn't nearly as easy as injecting into the knee. Overlying the hip joint (which is located in the groin) are a very large artery, nerve, and vein. Because of the potential danger of hitting one of these, it is important that the injection be guided by x-ray imaging during the procedure (fluoroscopy).

Talking About Rotator Cuff Injury

Mon, 17 Nov 2008 06:00:00 CST

Because of the shoulder's anatomy, it is easily subject to injury in people of any age, especially if they are engaged in activities involving overhead movement. However, aging can increase the chance of injury. Studies report that deterioration of the rotator cuff occurs in a large percentage of individuals, and the percentage goes up with each successive decade of life. In this excerpt from a longer article from a recent Johns Hopkins Arthritis Bulletin, Drs. Steve A. Petersen and Edward G. McFarland discuss rotator cuff injury.

Q. What happens when the rotator cuff is injured?

A. Crucial to the shoulder's many movements -- and yet often overlooked -- are the four small, powerful muscles that, with their tendons, make up the rotator cuff. These muscles -- supraspinatus, infraspinatus, teres minor, and subscapularis -- are located on or near the shoulder blade and tightly attach the upper arm bone to the shoulder socket, providing rotation possibilities, stability, and the ability to raise the arm.

Because the muscles are located well inside the shoulder, most people are completely unaware of their function -- until something goes wrong. Unfortunately, when the arm is repeatedly raised above the head -- the common repetitive motions involved in many activities, such as pruning hedges, swimming, tennis, and golf -- the rotator cuff tendons slowly start to fray and wear out.

It is not known exactly why this occurs but one common theory is that the tendons rub against the bony underside of the acromion part of the shoulder blade, causing them to swell and even tear slightly because of the reduced space in the joint. The result can be inflammation, pain, and eventual weakness, especially if the tendon tears.

I always tell my patients that one of the sad things about the rotator cuff is that as you "mature," your rotator cuff also matures. When that happens, it often becomes irritated and eventually tears. By age 50, about 50% of the population is walking around with rotator cuff tearing of some degree. Think of cutting through a rope with a knife and seeing strands of rope hanging down. That's what a partial tear of the rotator cuff looks like: The tendons are frayed and are just hanging there. With a full-thickness tear of the rotator cuff tendon, the tendon is cut through and is no longer attached to the bone.

As you age, you progress from rotator cuff irritation to partial-tear to full-thickness tears. Strangely enough, by age 80 upwards of 40% of the population has full-thickness tears of the rotator cuff and doesn't even know it.

Researchers Identify Genes Associated with Increased Gout Risk

Mon, 08 Dec 2008 06:00:00 CST

Johns Hopkins Bloomberg School of Public Health Press Release: More than three million adults in the United States have gout. Gout is a painful inflammation of the joints, which can occur with a build-up of uric acid in the blood. Genetic disposition, obesity, a diet high in meat and cheese, alcohol consumption, and certain medications can increase the risk for developing gout.

Now, a team of researchers from the United States and the Netherlands has identified mutations in three genes that are associated with high levels of uric acid in the blood, which is a risk factor for gout. The team developed a genetic risk score composed of the number of uric acid-increasing mutations that each person carries (0 to 6), which was associated with up to a 40-fold increased risk for developing gout when comparing persons at lowest and highest risk. The findings are published in the journal The Lancet.

The researchers conducted genome-wide association studies of more than 20,000 people enrolled in three large population-based studies investigating cardiovascular disease risk factors: the Framingham Heart Study based at Boston University Medical Center; the Rotterdam Study based at Erasmus Medical Centre in Rotterdam, the Netherlands; and the Atherosclerosis Risk in Communities (ARIC) study based at Johns Hopkins University. Of more than 500,000 genetic variations that were evaluated, the analysis identified two genes, ABCG2 and SLC17A3, as novel risk genes for gout and confirmed the association of a third gene, SLC2A9.

Bottom line: "This research gives us a better understanding of the underlying causes of gout, which could lead to better gout prevention and treatment. Our evidence supports that a common pathway, the handling of uric acid by the kidney, is important in uric acid build-up and therefore for the development of gout," said study author, Anna Köttgen, MD, MPH, an assistant scientist in the Johns Hopkins Bloomberg School of Public Health's Department of Epidemiology.

"Genetic risk scores like the one we developed for gout can help alert people at a very early age, well before uric acid levels rise, that they are susceptible to gout. The new insights are promising for drug development," said Josef Coresh, MD, PhD, MHS, professor in the Bloomberg School's departments of Epidemiology and Biostatistics.

"An important unanswered question is whether we can use genetic risk information to motivate people to change their behavior. For gout, we know that moderate changes in diet and alcohol consumption can lower uric acid levels. In the future, we will need to test if identification of high-risk individuals can lead to behavior change."

New Drugs Offer Hope to Gout Sufferers

Mon, 15 Sep 2008 06:00:00 CDT

Gout is one of the most painful yet treatable forms of arthritis. Today, it's estimated that two to five million Americans have gout, with most men suffering a first attack between 40 and 50 years of age. Women develop it later, in the years following menopause.

For people who develop gout, approximately 10% inherit enzyme deficiencies that cause the overproduction of uric acid. More commonly, however, gout is associated with a variety of factors that negatively impact the kidneys, including aging, elevated cholesterol, obesity, diabetes, and high blood pressure.

For the first gout attack, a high dosage of a nonsteroidal anti-inflammatory drug (NSAID; 600 mg of ibuprofen three to four times daily or 25–50 mg of indomethacin three to four times daily) is often chosen as a first-line therapy because of its quick onset of action, its ability to relieve the pain and swelling of acute gout, and its good tolerability. Treatment is stopped when gout symptoms resolve. Many patients will have a long duration -- sometimes even years -- between their first and second attacks of gout.

The numbers are imprecise, but experts believe there are anywhere from 25,000-100,000 treatment-failure gout patients in the United States. These patients have no alternative therapeutic options for their gout other than symptomatic relief. For these patients with chronic active gout, three new medications may soon offer relief.

Febuxostat (Uloric) -- Approved by the FDA in February 2009, Uloric is a new alternative for long-term management. This is especially good news for the nearly 20% of people with gout who have bad reactions to allopurinol (Zyloprim) and for those with kidney impairment that prevents them from using the drug.

Rilonacept (Arcalyst), an injectable drug approved to treat rare autoinflammatory syndromes is now under study as a treatment for gout -- Arcalyst works by preventing interleukin-1 (IL-1) from attaching to cell-surface receptors and creating a flare in disease. Interleukin-1 is a protein secreted by many cells in the body; secreted in excess, IL-1 can trigger disease activity in gout.

Pegloticase (Puricase) -- An injectable drug designed for people who have failed traditional gout therapy Puricase is currently awaiting FDA approval. Puricase is made from a pig enzyme called uricase. All mammals except humans and primates produce the uricase enzyme, which breaks down uric acid, leaving very low levels in the blood circulation. Uricase converts uric acid to the more water-soluble metabolite allantoin, which can be readily excreted.

Got Arthritis? Try Yoga

Mon, 27 Oct 2008 06:00:00 CST

In this Health Alert, Susan J. Bartlett, Ph.D., Associate Professor of Medicine at Johns Hopkins University and Steffany Haaz, a doctoral candidate, talk about the benefits of yoga for people with arthritis.

Q. How does yoga specifically benefit people with arthritis?

A. Dr. Bartlett: Regular physical activity is essential for people with arthritis. Joints become painful, and the natural reaction is to avoid moving a painful joint. However, the overall result to the body is a gradual loss of muscle strength, energy or vigor, and endurance. When people with arthritis don't exercise, their prognosis is worse. Several early studies suggest that yoga can help improve joint health, physical functioning, and mental and emotional well being in people with arthritis.

A. Ms. Haaz: If you have arthritis, you may not think of yourself as someone who can do a lot of physical activity. Traditional exercise is often competitive, with an emphasis on increasing speed and distance, duration of workouts, or the amount of weight you lift. There's none of that in a yoga class. The whole idea is to listen to your body and do what's right for you. People with arthritis may find yoga more enjoyable than traditional exercise and may be more likely to stick with it. That's important, because about 50% of sedentary people who start a traditional exercise program drop out within six months.

Q. What happens in a typical yoga classes for people with arthritis?

A. Dr. Bartlett: The classes combine very potent physical and psychological therapy. There's also a lot of emphasis on slow, relaxed breathing, letting go of what you're worrying about and calming the mind. Stress management is very important in the management of arthritis, especially rheumatoid arthritis, because stress very clearly exacerbates the disease and worsens pain.

A. Ms. Haaz: Every class starts out with people sitting on their mats. We find a healthy alignment, start with some slow breathing, and do an opening chant. Then we do some floor stretches, followed by a movement sequence called the Sun Salutation. This helps people warm up and get the blood flowing. This is followed by a few balancing poses and some standing poses such as Warrior or Triangle. We move back to the floor and do some stretches while lying down or sitting. Then we lie down on the floor and do progressive relaxation. We come back to a sitting position, ending with a closing chant and a short meditation. That's a typical class.

The article is an excerpt from an in-depth report published in the Johns Hopkins Arthritis Bulletin. To order a PDF download of the entire article, go to this link:

The Challenge of Driving With Arthritis

Mon, 25 Aug 2008 06:00:00 CDT

The pain and stiffness of arthritis can make it a challenge to drive a car. Knowing what types of features to look for when purchasing a new car is important. In addition, adaptive devices and car modifications after the car purchase can make driving with arthritis safer and more enjoyable. Here's some practical advice from Johns Hopkins.

If you are ready to buy a new car, keep some arthritis-friendly features in mind. These will be more or less important, depending on which joints give you the most trouble. Here are some car features to consider:

Keyless entry

Running boards and assist handles on sport utility vehicles and vans

Adjustable steering wheel (up and down and telescoping)

Fully adjustable seats (height, distance from pedals, tilt, and lumbar support)

Adjustable pedals

Padded steering wheel

Easy-to-grasp controls within easy reach

Dashboard-mounted and pushbutton ignition switch

Seat belts that are easy to reach, lock, and release

Cruise control

Easy-to-use door handles

Easy-to-adjust mirrors and sun visors

Easy-to-access trunk or rear door

Shorter turning radius for ease in maneuvering

Seat type is often a personal preference in a car. A bench seat, for example, allows more room to adjust your position for comfort than does a bucket seat. Leather seats make it easier to slide in and out of the car. Some people prefer high seats to reduce the need to bend when entering and exiting the car; others find it easier to slip into lower seats.

If you are significantly disabled, it’s important to consult a specialist in driver rehabilitation before you shop for a car. The specialist will assess your abilities and disabilities and offer advice about the types of modifications that may be helpful.

The available modifications include a left-side accelerator and brake pedal or hand controls if you are unable to use your right leg. Other devices include special mirrors, extended gearshift levers, and reduced-effort steering wheels.

Finally, don’t be afraid to discuss your driving difficulties with your physician or to seek the services of a rehabilitation specialist. Some people fear that admitting their physical limitations behind the wheel will ultimately cost them their driver’s license. However, if you are otherwise fit to drive, having the right car with some adaptations should allow you to continue driving and, most important, to continue driving safely.

For more information, contact: Association for Driver Rehabilitation Specialists 711 South Vienna Street Ruston, LA 71270 (800) 290-2344 www.aded.net

Advice for Fibromyalgia Sufferers

Mon, 04 Aug 2008 06:00:00 CDT

Fibromyalgia is famously difficult to diagnose and to treat. Now data suggest that acupuncture can relieve some of fibromyalgia's uncomfortable symptoms – very good news for everyone affected by this often-debilitating condition.

Fibromyalgia is a syndrome characterized by widespread muscle pain, fatigue, and the presence of what are called “tender points” -- 18 specific sites on the body that are exceptionally sensitive to pressure. Fibromyalgia is not a type of arthritis because it doesn’t cause inflammation or damage the joints. But it is included under the broad umbrella of rheumatic disorders, health conditions that affect the joints or soft tissues and cause chronic pain.

In addition to chronic muscle pain, tenderness, and fatigue, fibromyalgia symptoms may include sleep problems, morning stiffness, headaches, cognitive and memory problems ("ibro fog”), irritable bowel syndrome, painful menstrual periods, restless legs syndrome, numbness or tingling in the extremities, and temperature sensitivity.

What can you do to relieve your fibromyalgia discomfort? A study reported in the Mayo Clinic Proceedings (Volume 81, page 749 ) indicates that acupuncture may relieve some of the most bothersome and debilitating symptoms of fibromyalgia.

In a randomized, controlled trial, researchers assigned 50 fibromyalgia patients to receive either true acupuncture or sham (simulated) acupuncture. The patients all met the American College of Rheumatology’s diagnostic criteria for fibromyalgia. Each of them had already tried conservative treatments.

Participants’ symptoms were assessed with the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory at the outset of the study, again immediately after the treatment, and at one month and seven months after treatment.

The findings: The study results showed significant improvements among patients in the true acupuncture group compared with those who had received the sham procedure. The greatest benefits were seen in FIQ total scores at one month (42.2 in the sham group vs. 34.8 in the true acupuncture group).

Acupuncture relieved fibromyalgia-related pain, but its greatest benefits were in reducing fatigue and anxiety. The treatment appeared to have no effect on the patients’ activity levels or physical functioning. The researchers reported that the acupuncture treatments were well tolerated and had few adverse effects.

The Estrogen-Osteoarthritis Connection

Mon, 12 May 2008 06:00:00 CDT

Why do so many middle-aged women develop osteoarthritis? Scientists believe that declining estrogen levels may play a role.

Osteoarthritis is often called a wear-and-tear disease because it develops in joints after many years of use. Aging increases the risk of developing osteoarthritis, but it's not the sole cause. Scientists aren't sure exactly what causes the condition, but several factors play a role in its development. These include genetic predisposition, obesity, prior joint injuries, wear and tear on the joints due to repeated overuse or sports-related activities, muscle weakness, and nerve injury.

Now a study reported in the journal Arthritis and Rheumatism (Volume 54, page 2481) suggests that low estrogen levels are linked to osteoarthritis of the knee in middle-aged women.

Following up on findings from animal studies, researchers from the University of Michigan measured the estrogen levels of more than 800 premenopausal and perimenopausal women. Based on these results, they ranked the study participants into three groups according to their estrogen levels. The women had yearly x-rays of both knees and answered questions about knee pain, their general health, and various lifestyle factors.

After taking into account osteoarthritis risk factors such as body mass index, the researchers found that women with the lowest estrogen levels were nearly twice as likely to develop osteoarthritis over the next three years as were those with higher levels.

These findings may help explain why signs of osteoarthritis tend to appear when women are in their 40s, a time of fluctuating or declining estrogen levels. The relationship between estrogen and osteoarthritis isn’t clear. However, the hormone is believed to interfere with arachidonic acid, a substance in the body that is associated with pain and inflammation. The researchers suggest that a better understanding of estrogen’s apparent protective effect on the knee may lead to new approaches to osteoarthritis management.

Acetaminophen or NSAID for Arthritis Pain Relief?

Mon, 02 Jun 2008 06:00:00 CDT

If you have osteoarthritis, what's your best first line of defense against painful joints? Dr. Clifton O. Bingham III, Director of the Johns Hopkins Rheumatology Clinics, offers advice.

Q. Which pain medication has the best risk-to-benefit ratio for osteoarthritis?

Dr. Bingham: Overall, acetaminophen (Tylenol) is the safest, which is why it stands at the top of treatment recommendations for patients with osteoarthritis. As a first treatment, acetaminophen has been shown in some studies to be just as effective as most NSAIDs and is less likely to cause side effects such as stomach irritation. It’s also inexpensive.

Q. What dosage of acetaminophen do you recommend for effective osteoarthritis pain relief?

Dr. Bingham: Acetaminophen can effectively treat pain and provide enough relief so that many people with osteoarthritis can engage in more physical activity. As with every pain medication for osteoarthritis, we’ve learned that the lowest effective dose is the best dose. That's because increasing doses of any drug, including acetaminophen, are associated not only with increased pain relief but also an increased risk of side effects, which may tilt the risk-to-benefit ratio toward the riskier side.

The maximum recommended daily dosage of acetaminophen is 4,000 mg, generally taken as 1,000 mg four times a day, or as extended release or arthritis strength (1,300 mg three times a day). When taken regularly, dosages above that amount can cause dangerous side effects. Acetaminophen may be harmful for people who have liver disease or who drink large amounts of alcohol. To decrease risk of liver damage, you should not consume alcoholic beverages while taking this medication.

Acetaminophen may also be dangerous if you are taking the blood-thinning drug warfarin (Coumadin). Some research indicates that, in rare cases, heavy daily use of acetaminophen may increase the risk of kidney damage.

Important note: If you take acetaminophen for osteoarthritis, it's important to recognize that other over-the-counter preparations such as cold medicines or multi-symptom relievers often also contain acetaminophen. Therefore, if you combine the two, it's possible to get a cumulative dosage that exceeds recommended safety levels.

Q. If acetaminophen doesn't work, what are the risks and benefits of switching to traditional NSAIDs?

Dr. Bingham: Aspirin, the original NSAID, is an effective and inexpensive treatment for osteoarthritis pain, but high doses have significant side effects on the stomach. You can consider other over-the-counter NSAIDs such as ibuprofen (Advil and others), naproxyn (Aleve and others), and ketaprofen (Orudis KT).

NSAIDs work primarily as pain relievers, but also decrease inflammation, which may be present in over 30% of individuals with osteoarthritis. How osteoarthritis symptoms respond to a specific NSAID varies greatly from person to person. As a result, finding the right drug largely depends on trial and error. On average, it can take at least two weeks of treatment with a drug to know if a particular drug is effective.

As with all medications, there are risks as well as benefits, even with over the counter medications. Acetaminophen is safe for many people, but speak with your doctor about which pain reliever is right for your arthritis given your personal health history, such as a history of high blood pressure.

The Cartilage Connection

Mon, 14 Jul 2008 06:00:00 CDT

In this excerpt from a recent issue of the Johns Hopkins Arthritis Bulletin, Associate Professor Lynne C. Jones, Ph.D. talks about the importance of cartilage in the development of osteoarthritis.

In my experience here at Johns Hopkins, most patients have little awareness of cartilage until something goes wrong with it. And even then, they often have a limited understanding of what cartilage is and does, what can be done to protect joints from further damage, and what treatment options are available to help reduce pain and restore mobility. In many ways, that’s perfectly understandable. </>

Compared with most other body tissues and organs, cartilage is "out of sight and out of mind." Like a shock absorber in a car, it doesn't announce its presence until it becomes damaged and affects your ability to navigate the highways of everyday life.

Cartilage is an essential component of healthy joints. You may have experienced the pain and loss of mobility that occur when cartilage is damaged, either by a traumatic injury or by diseases such as osteoarthritis and rheumatoid arthritis. If so, you're not alone. Approximately 900,000 cartilage injuries occur each year in the United States and an estimated 20 million Americans are affected by osteoarthritis, most commonly in the knee.

Here are my answers to some the most common cartilage-related questions asked by patients.

Q. What is cartilage?

Dr. Jones: Cartilage is a translucent, connective soft tissue that's found in many areas of the body, including the joints, rib cage, spine, ear, nose, voice box, and bronchial tubes. This semitransparent substance is called hyaline cartilage, a name that derives from the Greek word hyalos, which means glass.

In normal joints, hyaline cartilage is a firm, rubbery material that covers and protects the ends of bones. Its primary components are water and two types of proteins—type II collagen and proteoglycans -- that together form a gel-like matrix that allows it to change shape when compressed. Cartilage also contains specialized cells called chondrocytes, which produce collagen, proteoglycans, and enzymes that help maintain healthy cartilage.

Q. Is aging inevitably associated with cartilage degeneration?

Dr. Jones: There are age-related cartilage changes. And yes, it seems that osteoarthritis is an age-related disease. That said, it still doesn’t mean that the changes due to aging are necessarily the changes that automatically lead to osteoarthritis. After age 60, a majority of men and women show some evidence of joint-space narrowing on X-rays (a sign of cartilage loss), but most of them have no osteoarthritis symptoms. Their cartilage is still fully functional.

Gender-Specific Knee Implants Offer Women a Choice

Mon, 21 Apr 2008 06:00:00 CDT

Now women facing knee replacement surgery can choose an implant designed to fit the narrower shape of their knees and offer greater flexibility and comfort.

According to Consumer Reports, more than 600,000 people in the United States have hip or knee replacement surgery each year, 70% of them because of osteoarthritis. One survey showed that even though recovery can be long and sometimes painful, 82% of people who had this kind of surgery were very or completely satisfied with the results.

Women account for nearly two-thirds of the knee-replacement procedures performed each year. These artificial knees have functioned well for both men and women. The anatomy of a woman’s knee, however, does differ in some ways from a man’s. Called the Gender Solutions High-Flex Knee, a women-specific knee implant addresses these differences.

Women’s knees are narrower from side to side and are shaped more like a trapezoid than a rectangle (the shape of a man’s knee). The bone in the front of a woman’s knee also is less prominent than a man’s. As a result, according to the manufacturer (Zimmer, Inc.), a conventional artificial knee may feel bulky to a woman. In addition, the angle between the pelvis and the knee is different in men and women. This can affect the way the usual artificial kneecap tracks over the end of the thighbone and may give a woman an unnatural feeling as it moves.

The Gender Solutions knee also has a high degree of flexion (up to 155 degrees), which may make movements like stair climbing easier. It’s important to note that this new knee is just one more option for women who need a knee implant. At this point, there is no actual scientific evidence that it is superior to other types of artificial knees when implanted in women. [This information was reported by the Food and Drug Administration, May 2006.]

The Good News About Exercise

Mon, 31 Mar 2008 06:00:00 CST

It may seem counterintuitive, but a recent study confirms that people with osteoarthritis can improve mobility and enhance their quality of life with modest levels of exercise.

Although arthritis is a wear-and-tear condition, mild to moderate exercise will not damage your joints. In fact, carried out routinely and carefully, an exercise program can dramatically reduce the risk of osteoarthritis by strengthening the muscles that support weight-bearing joints. Of course, exercise will also help with weight loss, which in itself will reduce your risk of arthritis.

And what if you already have osteoarthritis? A study reported in the journal Arthritis and Rheumatism (Volume 53, page 879) indicates that even modest physical activity can preserve mobility in people already diagnosed with arthritis.

For many people with arthritis, the idea of starting an exercise program can be intimidating. But the study has found that even small amounts of physical activity can help preserve mobility and the ability to carry out daily tasks.

The researchers analyzed data from the Health and Retirement Study (HRS). The HRS has monitored the health status of more than 3,500 men and women with arthritis who were ages 53–63 in 1994. Participants were categorized into three groups according to how well their physical activity level met national recommendations: Recommended group (30 minutes per day of moderate activity or 20 minutes of vigorous activity), insufficient group (some exercise but not the recommended amount), and inactive group (no regular activity).

The good news: Compared with inactivity, physical activity at the recommended -- and even at insufficient -- levels was equally protective against functional decline or disability. Both reduced the risk by about 40%. Functional ability refers to successful performance of daily tasks such as walking a short distance, climbing stairs, bathing, and preparing meals. Study participants who engaged in the most physical activity actually achieved modest improvements in their functional status over the several years of the study.

Honey, Vinegar, Water, and Cherry Juice for Osteoarthritis

Mon, 18 Feb 2008 06:00:00 CST

Is there any credible evidence that cherry juice or a drink mixture of honey, vinegar, and water relieves symptoms of osteoarthritis? Johns Hopkins specialists answer readers’ questions in this excerpt from a recent issue of the Arthritis Bulletin.

Arthritis question 1

Q. My cousin, who has osteoarthritis in her hip, swears that drinking a daily mixture of equal parts honey, vinegar, and water has alleviated her arthritis pain. Though I have never been one for folk remedies, I’m assuming that there is some logic operating behind this one. As for the honey and water, I suspect that they are simply a delivery system that makes vinegar palatable. Is my cousin’s honey-vinegar-water concoction just a homemade placebo? Kansas City, MO

A. Human physiology is quite complex, so it’s difficult to ascertain and analyze which properties of a given food or drug actually have a desired effect in a given target tissue. The body cannot be viewed as a container in which everything we ingest is evenly distributed to all tissues. The trip from mouth to joint involves many modifications, and few substances ever get to the joint in the same form as they entered the mouth. Moreover, pain modification in osteoarthritis is just as likely to happen at the level of pain perception (in other words, in the brain) as in the joint itself. To my knowledge, there have never been any studies evaluating the use of this honey, vinegar, and water mixture for the treatment of osteoarthritis or rheumatoid arthritis.

Arthritis question 2

Q. My wife reads the popular health literature religiously and is now on a cherry juice kick. We start every day not with orange juice (our breakfast drink for the past thirty years) but with a cherry juice concentrate that she buys at the local health food store.

We both have arthritis. I have arthritis my left knee and both hips. Harriet has arthritis in her neck and upper back. She insists that we drink the juice to fight off the arthritis pain. I happen to like the taste of it, but I have my doubts about its pain-relieving effects. Have you heard of any studies of cherry juice, or do you know of people who have benefited from it? Princeton, NJ

A. The pigments in the skins of cherries, blackberries, grapes, and other dark-colored fruits contain compounds known as anthocyanins. Some studies have demonstrated in vitro (test-tube) activity of these compounds as antioxidants and weak anti-inflammatories, with some studies suggesting that they may inhibit prostaglandins in animals. To our knowledge, no controlled clinical trials of these compounds in humans with arthritis have been published in the peer-reviewed medical literature. Still, I’d encourage you to include a variety of dark-colored fruits (and vegetables) in your diet simply because they offer other, proven health benefits in the form of vitamins, minerals, and fiber.

Relieving Pain of Rheumatoid Arthritis with Acupuncture

Tue, 18 Mar 2008 06:00:00 CST

Chinese researchers believe that acupuncture can reduce joint tenderness in people with rheumatoid arthritis. Should you try it? Johns Hopkins offers bottom-line advice.

Rheumatoid arthritis, the most common form of inflammatory arthritis, dramatically limits movement and function as well as causing damage to cartilage and bone. For the estimated 1.3 million Americans with rheumatoid arthritis, the inflammation causes pain, stiffness, swelling, and damage to a variety of joints.

Even though researchers have questioned the utility of acupuncture over the years, acupuncture is a potentially viable adjunctive therapy for arthritis pain, and it is rapidly gaining favor in the western world.

When an acupuncturist inserts thin needles into a person’s skin at any of 2,000 carefully defined pressure points, Qi (pronounced chi, it means "life force”) is restored throughout the various meridians, or channels, within the human body. If Qi is at optimum flow, the body is harmonized with the universal forces of yin and yang (emblematic of balance), and the patient is pain-free and physically healthy.

What’s the evidence? At a meeting of the Association of Rheumatology Health Professionals, Lai-Shan Tam, M.D., Associate Professor, The Chinese University of Hong Kong, presented his randomized, placebo-controlled acupuncture study (the best kind of medical trial).

Dr. Tam and his colleagues randomly assigned 7 male and 29 female patients (58 years old, on average) with rheumatoid arthritis that was unresponsive to other therapies to one of three acupuncture/placebo groups. The first group of 12 subjects received electro-acupuncture, in which pulsating electrical currents are sent through the acupuncture needles to stimulate target areas. The second group of test subjects was given traditional acupuncture, while the remaining 12 patients received placebo needles.

At the end of the acupuncture sessions, the researchers noted that:

Those receiving electro-acupuncture had experienced a significant reduction in the number of tender joints and a measurable decrease in pain, stiffness, and swelling.

The traditional acupuncture group experienced benefits but at a diminished rate.

Those in the placebo group saw no change.

"The patient’s comfort is as important as relieving the disease itself,” says Dr. Tam, "so, while the results were not as positive as had been hoped, this does show that acupuncture, either electro- or traditional, when used in conjunction with disease modifying agents, may still provide beneficial pain relief for those with otherwise intractable rheumatoid arthritis.”

The bottom line: If you have rheumatoid arthritis, do not stop taking medications that actually treat the underlying causes of rheumatoid arthritis in favor of acupuncture. If you have rheumatoid arthritis (or osteoarthritis) and are thinking about acupuncture for pain relief, here are some important tips:

Make sure that your physician and acupuncturist is involved in planning the duration and specifics of your treatment.

Use acupuncture as an adjunctive therapy in addition to standard arthritis treatments -- not in lieu of them.

Be certain that your acupuncturist uses disposable needles as required by law.

To find a licensed practitioner in your area, visit the website of the American Association of Acupuncture and Oriental Medicine at http://www.aaaomonline.org.

Does Weather Affect Arthritis Pain?

Mon, 07 Jan 2008 06:00:00 CST

If you have arthritis, you may be among those people (and there are many) who feel that their arthritis pain is influenced by the weather -- specifically, that they experience more arthritis pain on cold, rainy days and less arthritis pain on warm, dry days. But research studies on whether climate really does affect arthritis pain have produced conflicting results.

What the Research on Arthritis Pain Shows
One study looked for a relationship between weather and arthritis pain in 151 people with osteoarthritis, rheumatoid arthritis, or fibromyalgia (a rheumatic disorder that causes joint pain) as well as 32 people without arthritis. All participants lived in Cordoba City, Argentina, which has a warm climate. Participants kept a journal for one year recording the presence and features of any pain, and these daily reports were matched with weather conditions such as temperature, barometric pressure, and relative humidity.

Patients in all three groups experienced more pain on days when the temperature was low, while people in the control group were unaffected by any of the weather conditions. In addition, patients with rheumatoid arthritis were affected by high humidity and high pressure; osteoarthritis patients by high humidity; and those with fibromyalgia by high pressure. However, the associations were not strong enough to allow pain to predict weather, or vice versa.

Another study looked at 154 people (average age 72) who lived in Florida and had osteoarthritis of the neck, hand, shoulder, knee, or foot. Participants reported their arthritis pain scores for up to two years, then researchers matched the scores with the daily temperature, barometric pressure, and precipitation status. No significant associations were found between any of the weather conditions and osteoarthritis pain at any site, except for a slight association between rising barometric pressure and hand pain in women.

A Mild Case for Warmer Weather
Although some evidence exists that people living in warmer, drier climates experience fewer episodes of arthritis pain, climate does not affect the course of the disease. At most, it may affect symptoms of arthritis pain.

One theory holds that a drop in air pressure (which often accompanies cold, rainy weather) allows tissues in the body to expand to fill the space, meaning that already inflamed tissue can swell even more and cause increased arthritis pain. Other possibilities: Pain thresholds drop in colder weather; cold, rainy days affect mood; and during colder weather people are less likely to be outside and get the exercise that normally helps keep arthritis pain in check.

So does this possible link between cold, rainy weather and arthritis pain mean that people with arthritis should you should move to a dry, warm climate like Arizona? Not necessarily, especially if it means leaving your family, friends, doctors, and support system behind. If you are thinking of moving, first spend a considerable amount of time in your new location to see if the weather affects your arthritis pain symptoms.

But bear in mind that no environment is arthritis-proof: Even though the people in these research studies live in warm climates, they still struggle with arthritis pain. Similarly, it’s possible to get relief from arthritis pain in any climate. For example, even if cold weather means you can’t spend time outdoors, you can still get valuable exercise in a gym or heated pool.>p>

Treating Symptoms of Fibromyalgia Without Medication

Mon, 17 Dec 2007 06:00:00 CST

In a recent issue of the Johns Hopkins Arthritis Bulletin, Dr. Kevin R. Fontaine, Assistant Professor of Medicine in the Division of Rheumatology at Johns Hopkins University, talked about non-pharmacological treatments for fibromyalgia. Here’s an excerpt.

Although fibromyalgia syndrome is not curable and has no blood tests to detect it, there are a variety of non-pharmacological treatments that can help relieve symptoms. Following are several questions I am frequently asked about complementary fibromyalgia treatments, and my answers.

Q. How important is it for a person with fibromyalgia to take a majority stake in their improvement?

A. People with fibromyalgia have to understand that, in most cases, they're not going to be able to take a pill that’s going to give them tremendous relief. Rather, it’s up to them to stretch, to exercise, to walk, to try to reduce stress in their lives, to seek counsel for anything that’s going to relieve stress or family issues. A willingness to be proactive and to learn ways to take better control over their symptoms is a critical factor in managing fibromyalgia.

Q. How is fibromyalgia treated?

A. Despite the lack of a definitive cause, fibromyalgia symptoms can be significantly improved with a multifaceted approach. There are two major goals:

Lessen pain and fatigue

Improve sleep

Much of the success of fibromyalgia treatment lies with the patient, and many people report feeling better simply because a diagnosis has been made. It is reassuring for people to know that the disorder is not deforming or life threatening, and that they will be able to take steps to help better control their symptoms.

Q. What role does physical activity play in fibromyalgia treatment?

A. Getting up and moving is the key to improving fibromyalgia. A lack of physical activity worsens fibromyalgia symptoms because unconditioned muscles are more sensitive to pain. Although activity and exercise may be the last thing people with fibromyalgia want to do when they feel achy and tired, studies have shown that fibromyalgia symptoms improve after six to eight weeks of moderate aerobic exercise. It’s thought that aerobic activities such as walking, swimming, and bicycling raise the pain threshold and increase pain tolerance, along with physical stamina.

At Johns Hopkins, we encourage our fibromyalgia patients to explore different ways to become active and find what works best for them. It is important not to overdo activity, however. Start slowly, with perhaps 5 to 10 minutes of brisk walking a day, for example. As you begin to feel better, gradually increase the time of the exercise session until you are up to 30 to 40 minutes of aerobic activity at least three times a week. People whose pain is exacerbated by the jarring movements of weight-bearing exercise (such as walking or jogging) may try swimming or riding a stationary bicycle instead.

Heat, Humidity, and Gout

Mon, 05 Nov 2007 06:00:00 CST

Recent research shows that adequate hydration is an important way to prevent dehydration and the onset of a gout attack.

Today, it’s estimated that 3 million Americans have gout, with most male victims suffering a first attack between 40 and 50 years of age. Women develop gout later, in the years following menopause.

Despite the longstanding belief, for most people, dietary indulgence is only one of several causes of gout. As with many diseases, one of the main problems is the underlying genetic condition that predisposes certain people to experience the accumulation of too much uric acid (hyperuricemia). Diet, however, does exert an influence for those predisposed to gout.

Researchers now believe that climatic factors such as heat and humidity that lead to dehydration can signal a future attack for gout sufferers.

Depleting the body of fluids through perspiration has long been considered a potential trigger for recurrent gout attacks. To test the suspected effects of humidity and temperature on the chances of recurrent gout attacks, researchers recruited 197 individuals who had experienced a gout attack within the past year. Participants were asked to log onto a study Web site when they experienced a gout attack and complete a questionnaire on the risk factors they had experienced the two days prior (known as the hazard period). They also were asked to complete the same questionnaire on experiences over a two-day control period.

Climatic data on temperature, barometric pressure, humidity, and precipitation for each participant’s ZIP code, obtained from the National Oceanic and Atmospheric Administration, was then compared between hazard period and control period. Adjustments were made for alcohol consumption, purine intake, and diuretic use. Study results indicated that:

High temperature and high humidity were strongly associated with increased risk of a recurrent gout attack.

Risk of recurrent gout attacks increased almost two-fold when the maximum daily temperature increased from 0–53° F to 87–105 ° F. A similar magnitude of increased risk also was found when the humidity increased from a dew point of 4–32°F to 64–77°F.

Barometric pressure and precipitation appeared to have no influence.

"Our data indicate that both high temperature and high humidity are associated with an increased risk of recurrent gout attacks,” explains Yuquing Zhang, D.Sc., Professor of Medicine and Epidemiology at Boston University School of Medicine in Boston and an investigator in the study. "Thus, when it’s hot and humid, those with gout should consider drinking more fluids to avoid potentially painful gout attacks.”

Rheumatoid Arthritis and Your Heart

Mon, 28 Jan 2008 06:00:00 CST

Johns Hopkins Health Alerts Arthritis Rheumatoid Arthritis and Your Heart

The inflammation that damages joints also takes a toll on the heart. Johns Hopkins doctors offer bottom line advice.

People with rheumatoid arthritis understandably focus on caring for their joints. But their most serious health risk involves their heart. Compared to the general population, rheumatoid arthritis patients have a significantly increased risk of heart attack and stroke and a shorter life expectancy. Here are some of the findings from recent studies:

Heart attacks are twice as common among women with rheumatoid arthritis as among those without the disease.

Atherosclerosis ("hardening of the arteries”) starts early and progresses more rapidly in people with rheumatoid arthritis.

Carotid artery blockages (a risk factor for stroke) are three times more common in people with rheumatoid arthritis than in people without the disease (44% vs. 15%).

Cardiovascular events, such as heart attack and stroke, occur about 10 years earlier in people with rheumatoid arthritis.

Mortality is higher among rheumatoid arthritis patients after a first heart attack.

Blood vessel damage is often already apparent at the time of rheumatoid arthritis diagnosis.

Heart attacks in rheumatoid arthritis patients are more likely to be silent or to occur without the typical symptoms, and they more often result in sudden cardiac death.

Congestive heart failure (weakening of the heart’s pumping ability) is more common among people with rheumatoid arthritis.

Researchers have identified several links between rheumatoid arthritis and cardiovascular disease. Inflammation is believed to be the most important of these. Cardiologists now understand that inflammation plays a crucial role in the onset of atherosclerosis. They believe that an injury to the inner lining of the arteries (the endothelium) triggers an immune response, sending immune system cells rushing to repair the damage.

But in chronic inflammatory states such as rheumatoid arthritis, the immune response doesn’t shut off after the injury heals. The accumulating immune system cells attract deposits of cholesterol, blood platelets, cellular debris, and calcium, which clump together to form plaque. As plaque deposits grow, they restrict blood flow through the artery. If the plaque ruptures, clots can break away and travel to the heart or brain, where they may cause a heart attack or a stroke.

Bottom line advice: What Can You Do? The relationship between rheumatoid arthritis and the heart is complex, and rheumatologists still have a great deal to learn about how to reduce the risk of cardiovascular disease among people who have rheumatoid arthritis. For now, it’s important to do everything possible to reduce the traditional risk factors for heart disease and stroke: smoking, obesity, a sedentary lifestyle, high blood pressure, high cholesterol, and diabetes.

Getting regular exercise and losing extra pounds (even a 5–10% weight reduction is beneficial) will help your joints as well as your heart. Monitor your blood pressure and have your cholesterol levels checked regularly. Also, ask your physician about the possibility of taking a low-dose aspirin each day to reduce your risk of cardiovascular disease. In addition, the cholesterol-lowering medications known as statins—atorvastatin (Lipitor) and others—not only help the heart, but also have modest beneficial effects on rheumatoid arthritis -related inflammation. If your doctor hasn’t already suggested one of these, you might ask about it.

Johns Hopkins Health Alerts Arthritis Rheumatoid Arthritis and Your Heart

Music Can Ease Your Pain

Mon, 15 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Arthritis | Music Can Ease Your Pain

Many people with arthritis rely on complementary medicine, products, and techniques -- in combination with conventional treatments -- to reduce pain. Now a new study shows that listening to soothing music really helps.

If you suffer with osteoarthritis you probably know that there are many effective medications available to relieve your pain. Oral medications are used most often, but some people find that injections into the affected joint or topical products applied to the skin surrounding a painful joint also help reduce pain. However, although pain relievers make you feel better, they can’t cure your osteoarthritis. Researchers have not yet identified any medications that can reverse or prevent worsening of the condition.

But did you know that music can help to ease your pain, too? New research documents the common sense idea that listening to music for an hour every day can reduce pain, depression, and other symptoms associated with chronic pain. In the study, the researchers assigned 60 people with chronic pain to one of three groups: music of their own choosing, music chosen by the researchers for its relaxing quality, or no intervention (the control group).

The study included people with long-term pain from osteoarthritis, rheumatoid arthritis, or back problems. Their chronic symptoms were rated at the outset by standard rating scales for pain, depression, disability, and feelings of power over their pain. Compared with the control group, the two music groups showed significant improvements in these measures (whether or not they had chosen the music). People in the two music groups reported between 12% and 21% less pain, as measured on two pain scales. The control group reported an increase in pain of 1–2%.

Assessment of the music groups also showed about 25% less depression, up to 18% less disability, and about 8% more sense of power over their pain than the control group. This study was reported in the Journal of Advanced Nursing (Volume 54, page 553).

Johns Hopkins Health Alerts |

Arthritis | Music Can Ease Your Pain

Delay Knee Replacement with Osteotomy

Mon, 24 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Arthritis | Delay Knee Replacement with Osteotomy

Improved alignment of the knee through osteotomy takes stress off damaged areas and can delay the need for joint replacement by about 10 years for people with osteoarthritis of the knee.

Osteoarthritis often damages the cartilage more on one side of the knee than on the other. When that happens, the leg bones become misaligned, which can put even more stress on the already damaged joint.

Osteotomy is a "bone-cutting” surgical procedure that shifts the individual’s body weight from the damaged area of the knee toward the healthy side. This relieves pain and allows the knee to function more normally -- and that can buy time for a person who would like to delay total knee replacement surgery.

In an osteotomy for knee osteoarthritis, the surgeon removes a wedge of bone from the healthy shinbone (tibia). If the cartilage damage is on the inner side of the knee, bone is removed from the outer part of the shinbone; for damage to the outer side of the knee, bone is removed from the inner shinbone. The bone is taken from an area below the healthy cartilage. This allows the knee joint to open more freely and redistributes the weight across the joint.

Performed under general or regional anesthesia, osteotomy takes about 60–90 minutes to complete. The surgeon makes a 4- to 5-inch incision from just below the kneecap to below the top of the shinbone, and uses guide wires anchored into the top of the shinbone to outline the triangular area to be cut. The wedge is removed with an oscillating saw, and the top of the shinbone is lowered to reposition the joint. The realigned joint is held in place with staples or internal plates, or it may be immobilized with a cast.

Rehabilitation begins almost immediately after surgery with passive-motion exercises to flex and stretch the knee and restore adequate range of motion. You will be fitted with a knee brace (unless your leg is put in a cast) and will be on crutches for at least six weeks.

Physical therapy usually begins at about six to eight weeks, after the bone has had a chance to heal. The therapist will teach you stretching exercises at first and then strengthening and light aerobic activities.

Is Osteotomy Right for You? Osteotomy may be a good option for people under age 60 who want to delay a total knee replacement. Delaying knee replacement makes sense, because artificial knees wear out over time, often necessitating a second replacement surgery. Osteotomy can delay the need for joint replacement by about 10 years. The procedure is appropriate only when damage to the joint is uneven and no significant inflammation is involved.

Johns Hopkins Health Alerts | Arthritis | Delay Knee Replacement with Osteotomy

Meditation Benefits Body and Mind

Mon, 03 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Arthritis | Meditation Benefits Body and Mind

Many arthritis sufferers are trying non-traditional complementary remedies, such as meditation, to help reduce pain and discomfort.

Arthritis pain and disability have both a physical and a psychological component. People who cope best with their disease have found ways to address all of the factors that influence their pain. Pain relievers and anti-inflammatory drugs remain the mainstay of medical treatment for most moderate to severe arthritis. But adding yoga and meditation can bring a new dimension to pain relief and may even reduce the amount of medication you need.

The basics of meditation are often taught along with yoga, or you can find separate classes at colleges, community centers, or as part of mental health or cardiac rehabilitation programs.

The Transcendental Meditation approach gained prominence in the 1960s. This is the practice of focusing attention on an object, a word, or your own breathing, as a way of suspending the stream of thoughts that normally occupy your mind.

Meditation or quieting the mind in this way for 20 - 30 minutes a day has positive effects on the body. These include reducing your heart rate, respiration rate, and blood pressure and bringing about a reduction in the damaging "fight-or-flight” response that can be triggered by physical or emotional stress.

Meditation allows you to achieve a state of profound calm commonly referred to as the relaxation response. Meditation has been shown to alter physical and emotional responses to stress and may reduce the psychological distress that often accompanies chronic illness. Results of various studies suggest that the regular practice of meditation can reduce arthritis pain as well as relieve anxiety, stress, and depression.

In a study reported at an American College of Rheumatology meeting, rheumatoid arthritis patients were assigned to one of two groups. Half of the group took a class on Mindfulness- Based Stress Reduction (MBSR), a program that includes meditation, yoga, and other relaxation exercises. The rest of the group had no intervention.

After six months, patients who practiced MBSR experienced a 33% reduction in psychological distress, an 11% decrease in standard measures of disease activity such as the number of painful or swollen joints, and a 46% decrease in erythrocyte sedimentation rate (indicating a reduction in inflammation).

For more Alerts and Special Reports, please visit the Arthritis Topic page.

Johns Hopkins Health Alerts |

Arthritis | Meditation Benefits Body and Mind

Going to Hip School

Mon, 23 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Arthritis | Going to Hip School

If you have hip or joint pain, a hip rehabilitation program can help reduce the pain and improve your quality of life.

The term “hip school” is popular in Great Britain and Europe. It refers to a formalized program of hip care that is usually conducted in groups. Some hip schools aim to help people to improve hip function so they can avoid hip replacement surgery. Other hip school programs prepare people for hip surgery or help them with post-surgery rehabilitation.

No matter what they are called, hip rehabilitation programs can help people achieve significant reductions in hip pain and disability. In a study reported in the journal Arthritis and Rheumatism, people with hip problems who attended a six-month hip school led by physical therapists had less pain, fewer limitations in their activities, and better health-related quality of life. They also had fewer sleep disturbances and greater physical mobility. These benefits lasted for at least six months after completion of the program.

If you have significant hip pain and disability, a hip rehabilitation program could help. Ask your doctor, who may give you a recommendation or referral. Local hospitals, orthopedic centers, and physical therapy groups also offer such programs.

If your hips are generally healthy but you are at risk for developing hip problems, a general program of hip-strengthening exercises is a good idea. Besides rheumatoid arthritis and osteoarthritis, risk factors for hip pain and disability include osteoporosis, previous hip injury, excess weight, and sitting for long periods each day.

If you already have mild hip discomfort, exercising in water is ideal. This doesn’t put extra stress on your joints and makes it easier to move your hip through its range of motion. Exercising against the resistance of water builds muscle strength and provides some aerobic conditioning. Many health clubs and community pools offer aquatic exercise classes. But be sure that the program is appropriate for people with arthritis. Your local chapter of The Arthritis Foundation may be able to direct you to programs geared specifically to arthritis.

Although water exercise is easiest on your joints, you also need to spend some time exercising on land. That’s because weight-bearing exercise improves balance, helps prevent osteoporosis, and is necessary to build and maintain strength in the muscles that support the hip (such as the quadriceps, gluteals, and hamstrings).

Walking is an ideal type of weight-bearing exercise. Try to walk on most days of the week. To improve and maintain flexibility, try some beginning yoga postures. Strength training also is important to build strong supporting muscles for your hips. Check with your physician first and get some instruction from a physical therapist or a personal trainer who is knowledgeable about arthritis.

For more Alerts and Special Reports, please visit the Arthritis Topic page.

Johns Hopkins Health Alerts | Arthritis | Going to Hip School

6 Tips to Prevent Bursitis

Thu, 05 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Arthritis | 6 Tips to Prevent Bursitis

Performing any movement repeatedly can irritate the bursa near the joint and cause bursitis.

Bursitis is caused by inflammation of one or more of the body's 150 small, fluid-filled sacs called bursae. Bursae cushion and lubricate areas where bones, muscles, and tendons move across one another. Like fibromyalgia, bursitis causes pain and stiffness in tissues around the joints, rather than in the joints themselves. People with arthritis are at risk of developing bursitis because of altered body alignment and movement. Improved body awareness and good mechanics will help prevent bursitis.

Bursitis is most common among people over age 40. This group is more likely to fit the profile of the "weekend warrior” -- a sedentary person who suddenly overexerts him or herself in an activity, often on the weekend or during vacation. Injury to the bursa is more likely if the muscles in the area are weak or tight. Too much tennis on Saturday or pushing yourself too hard when you first join a gym can set you up for bursitis if you aren’t properly conditioned. The solution is to ease into exercise, allow muscles and tendons to adapt gradually to the added stress, and warm up and cool down each time you engage in an activity.

Over time, people with arthritis may develop poor posture as they shift their body or alter their movements in an attempt to protect painful joints. A physical therapist can help you achieve better body alignment and restore normal body mechanics. In addition, following a personalized exercise program will strengthen muscles in vulnerable areas.

Here are some recommendations from the Arthritis Foundation on how to avoid bursitis:

Bursitis Tip 1 -- To protect your shoulders, take periodic breaks from activities such as vacuuming. Do push-ups and range-of-motion exercises to maintain your strength and flexibility.

Bursitis Tip 2 -- To protect your elbows, don’t clench your fists or grip tools or pens too tightly; use a forearm band (tennis elbow strap) while playing tennis (though true tennis elbow is actually a tendon problem).

Bursitis Tip 3 -- To protect your wrists and hands, purchase tools, utensils, pencils, and pens with large or foam-covered handles so you won’t have to grip so tightly.

Bursitis Tip 4 -- To protect your knees, do thigh strengthening exercises (straight-leg raises) to provide added support for your knees; when you have to sit for long periods, get up and walk around every 20–30 minutes; use kneepads for kneeling activities.

Bursitis Tip 5 -- To protect your hips, sit on cushioned chairs, get a shoe lift if your legs are different lengths, and bend your knees, not your back or hips, when picking up objects.

Bursitis Tip 6 -- To protect your ankles and feet, wear comfortable walking and jogging shoes that fit properly and provide good support; wear heel cups or shoe inserts if your doctor recommends them.

For more Alerts and Special Reports, please visit the Arthritis Topic page.

Johns Hopkins Health Alerts | Arthritis | 6 Tips to Prevent Bursitis

Hip Resurfacing -- A New Tool for Osteoarthritis

Mon, 21 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Arthritis | Hip Resurfacing -- A New Tool for Osteoarthritis

In a recent issue of The Johns Hopkins Arthritis Bulletin, Joan M. Bathon, M.D., director of the Johns Hopkins Arthritis Center, talked about the promise of hip resurfacing for patients suffering with the pain and disability of arthritis. Because many of our Arthritis Health Alerts subscribers have asked us about this still-experimental procedure, we include an excerpt of Dr. Bathon’s article for your information.

For those of you who don’t know about hip resurfacing, here’s how it differs from total hip replacement: Instead of removing the top of the thighbone and placing a metal stem into the femur to anchor a replacement for the femoral head, the surgeon sands down ("resurfaces”) the hip’s roughened and damaged ball-and-socket, inserts a metal cup into the hip socket, and then places a metal cap on top of a small stem that is inserted into the thighbone.

Since the implant closely matches the size of a patient’s natural femoral head, and is substantially larger than the femoral head of a traditional artificial hip, the patient may attain greater flexibility and range of motion with greater stability and less likelihood of dislocation (the ball slipping out of the cup) in the months and years following surgery.

Hip resurfacing allows the surgeon to preserve more of the patient’s natural bone structure and stability than is possible with minimally invasive hip replacement. With the femoral head and neck preserved, as well as bone from the femur, it is still possible to have a total hip replacement or some other newer technology or procedure in the future, if necessary.

At the third annual Medical Innovation Summit held at The Cleveland Clinic Foundation last year, Sir Christopher O’Donnell, the CEO of Smith & Nephew, the English medical device company that makes the Birmingham Hip Resurfacing system, was asked why hip resurfacing was so popular in Europe but had failed to be adopted in the U.S. as a viable option for people with hip arthritis.

"There were three problems when hip resurfacing was initially tried in the U.S. in the 1970s,” admitted Sir Christopher. (Hip resurfacing was tested in the U.S. three decades ago, but the outcomes were very poor.) "The initial designs were not as well developed as they are today, nor was the surgical technique. In some hospitals, the method of entering the implant wasn’t well developed and the patient selection wasn’t as strict as it should have been.” Sir Christopher noted that the ideal candidate for hip resurfacing would be under age 60, because the procedure requires that the patient’s bones still be strong.

The FDA has recently approved the Birmingham Hip Resurfacing system. It remains to be seen, though, how hip resurfacing will compare with total hip arthroplasty, which is the standard approach in the United States, and how rapidly U.S. surgeons will adopt the procedure.

"Long term results are not available for hip resurfacing procedures,” said Simon Mears, M.D., when contacted by The Johns Hopkins Arthritis Bulletin. Dr. Mears, an assistant professor of orthopedic surgery at Johns Hopkins and chief of total joint arthroplasty and trauma at the Johns Hopkins Bayview Medical Center, believes that hip resurfacing does present a risk of fracture of the femoral neck. Current reported results have shown higher failure rates for hip resurfacing than for contemporary total hip arthroplasty.

For more Alerts and Special Reports, please visit the Arthritis Topic page.

Johns Hopkins Health Alerts | Arthritis | Hip Resurfacing -- A New Tool for Osteoarthritis

The Good News on Osteoarthritis and Weight Loss

Mon, 19 Mar 2007 15:08:50 CST

Johns Hopkins Health Alerts | Arthritis | Osteoarthritis and Weight Loss

If you’re overweight and have osteoarthritis, you may wonder: How much weight do I have to lose before I see any benefits? Here’s the answer and it’s encouraging.

At Johns Hopkins we recently completed a five-year study that demonstrates that even small amounts of weight loss can result in significant improvements in osteoarthritis symptoms and functioning. We placed about 40 overweight and obese adults (average age 58) with knee osteoarthritis on a four-month program of lifestyle change. At the beginning of the study, participants with osteoarthritis experienced pain in one or both knees more than 50 percent of the time, causing difficulty in daily activities such as driving, climbing stairs, and getting in and out of bed.

The lifestyle changes we recommended for these osteoarthritis patients included moderate adjustments in both diet and daily exercise. The dietary changes emphasized principles of healthy eating (plenty of whole grains, fruits and vegetables) while limiting amounts of high calorie or nutritionally empty foods. The women were asked to eat between 1,400 to 1,600 calories a day; men were asked to stay within a range of 1,600 to 1,800 calories.

We also asked the study participants with osteoarthritis to gradually increase the number of steps they walked each day. They started at around 3,500 steps a day and gradually built up over the course of four months to around 10,000 steps a day, which was accumulated over the course of the day (10,000 steps is the equivalent of four to five miles, depending on stride length).

We were looking for a modest amount of weight loss. The average person with osteoarthritis in the program lost only about 15 pounds. However, with this modest weight loss, we saw significant improvements, both in the amount of osteoarthritis pain our subjects experienced and in their ability to function. Their reductions in pain averaged 41%; their improvements in functioning averaged over 50%. Again, that was from a weight loss of only 15 pounds. That degree of improvement exceeds the benefit we typically see in people who use even the strongest prescription anti-inflammatory medications.

We consider that degree of benefit from a relatively minor weight loss to be very encouraging news. Some of these people with osteoarthritis may still be heavy enough to be defined as obese, and yet they experienced impressive benefits. The anecdotal evidence from the trial was also very impressive. A number of osteoarthritis patients in the study were people who love to garden, but they’d essentially stopped gardening because it was just too painful and too difficult. After the weight loss, these osteoarthritis patients resumed gardening and they were thrilled. Did that mean they never had pain? No, it didn’t. After a day of gardening, they did experience some pain. However, their baseline level of pain was much lower, and they seemed much more able to tolerate the pain that they had in the past. I think, in part, this is because they felt so much better. They were recovering some of their zest for life.

Johns Hopkins Health Alerts | Arthritis | Osteoarthritis and Weight Loss

The Approaching Storm in American Health Care

Mon, 09 Apr 2007 06:00:00 CDT

Johns Hopkins Health Alerts Arthritis Arthritis, Aging and Obesity

If you read Sebastian Junger’s Perfect Storm or saw the Hollywood adaptation, you will probably recall the scene in which a weatherman stares in horror at the radar charts on his computer screen. He watches as three massive weather systems converge toward a point at which they will all collide with unprecedented force. The perfect storm is gathering.

Today, another sort of perfect storm is gaining momentum in American health care. The three factors that are converging with potentially unprecedented impact are:

Arthritis. Today approximately one in five American adults have arthritis. Women are particularly at risk for arthritis. According to the Arthritis Foundation, 60% of people who have arthritis are women. Arthritis is now the leading cause of disability among older women in the United States and the second most common cause of disability among older men. The Arthritis Foundation estimates that the various forms of the disease cost the U.S. economy more than $128 billion annually.

Age. Nearly 77 million Americans were born between 1946 and 1964, the years of the postwar baby boom. And that massive bulge in the American population is just hitting prime time as far as arthritis is concerned. More than 32 million boomers are now over age 50; by 2011, the leading edge of the boomer population will be turning 65, at which point any medical issues they have will exert a major influence on the American health care system.

Obesity. A huge percentage of the boomer population is overweight or obese. Researchers from the Beth Israel Deaconess Medical Center and the Harvard School of Medicine compared the rates of obesity among baby boomers with the rates of obesity in the previous generation (those born between 1926 and 1945). Up to 32% of the boomers were obese by age 44, whereas in the previous generation fewer than 18% were obese at that age. In other words, boomers are spending more years of their lives obese, so the excess weight has a longer period during which to exert its destructive effects, which include the development of arthritis. It’s no secret that obesity has already reached epidemic proportions in the United States: Almost 67% of the U.S. population is currently overweight or obese.

When taken together, these numbers clearly indicate that arthritis will be one of the most important public health challenges we face in the next 20 years. However, there is reason for hope, not only for people who have arthritis, but also for people who struggle with their weight. Arthritis and obesity are indeed linked, but important progress is being made in research on both fronts, with reason to be hopeful about the future.

One thing in particular we have learned: The combined impact of aging, obesity, and arthritis is neither inevitable nor unbeatable. People with arthritis who manage to lose even modest amounts of weight can enjoy major reductions in pain, major increases in mobility, and the enhanced quality of life that results from these changes.

Johns Hopkins Health Alerts Arthritis Arthritis, Aging and Obesity

Arthritis and Exercise

Mon, 11 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Arthritis | Arthritis and Exercise

What’s the most dangerous type of exercise for a person with arthritis? Answer: None at all. And the surprising fact is that more than a third of adults with arthritis don’t exercise. If you’re one of them, you’ll want to read this helpful advice from Dr. Susan Bartlett.

Susan Bartlett, Ph.D., Assistant Professor of Medicine, Division of Rheumatology at Johns Hopkins University, lectures frequently about physical activity, weight issues, and arthritis. Dr. Bartlett provided an in-depth report on Arthritis and Exercise in a recent issue of the Arthritis Bulletin. As Dr. Bartlett notes, the best thing exercise does is help reduce joint pain and the attendant joint stiffness, enhance flexibility and endurance, and build strong muscles around your joint.

While beginning an exercise program often seems like a major undertaking for many people with arthritis, you can do it if you start slowly and maintain consistency. Here’s some practical advice from Dr. Bartlett.

Q. How much should people with arthritis exercise?

A. Don’t be a weekend athlete: It just doesn’t work. Exercising only once a week is not productive. Fitness can be achieved and maintained if your exercise is regular, rhythmic, and continuous. Current public health guidelines recommend that all adults accumulate at least 30 minutes of moderate intensity physical activity most days of the week.

Anyone can find the time to exercise even on a busy day. Exercise periods of 30 minutes, six times a week, add up to a mere three hours out of the 168 hours in the week. You can, for example, ride your stationary exercise bike while watching the news on TV; go for a walk before breakfast or during lunch; walk or swim after work; or lift weights to your favorite music before dinner.

To be effective, then, exercise should be done on a regular basis. Often, however, you may find yourself away from home, or stuck at the office, and so start to feel guilty when you miss your regular bouts of physical activity. However, there is a delicate balance between a firm commitment to exercise and a rigid compulsion about keeping to a predetermined workout schedule. By developing a flexible, healthy attitude about your exercise program -- making it part of your life, not your entire life -- your enthusiasm for being physically active will always remain high. Remember, brisk walking is a safe and effective form of exercise that can be done almost anywhere.

Q. How can you fit physical activity into your busy schedule?

A. The average American watches four hours of TV daily! That suggests that finding time to exercise is a matter of establishing priorities. Let’s take a closer look at the time element and see how it actually breaks down for most people. Of the 168 hours in a week, you spend an average of 40 to 50 hours working and 50 or so sleeping. Simple math leave you with 68 “free” hours.

Make a commitment and set aside at least three of those free hours for physical activity during the week. Make becoming more physically active your number one priority and let those three hours be a gift to yourself each and every week. Personal workouts can be difficult to schedule, but they’re imperative. Scheduling exercise time into your week helps turn these “appointments” into a habit. Just like making your bed, brushing your teeth, and combing your hair in the morning, exercise can become a regular part of your day. Moreover, for many it becomes one of the more enjoyable times of time day.

If you or someone you love has arthritis, you’ll want the latest advice and research available. The Johns Hopkins Arthritis Bulletin is a unique source of arthritis information. Interested? Click here to find out more.

Johns Hopkins Health Alerts |

Arthritis | Arthritis and Exercise

Evidence Mounts Against Glucosamine Use for Osteoarthritis Pain

Sat, 17 Feb 2007 06:00:00 CST

Johns Hopkins Health Alerts |

Arthritis | Evidence Against Glucosamine Use for Osteoarthritis Pain

Do glucosamine chondroitin supplements actually work for osteoarthritis pain, or are their “effects” really just wishful thinking by people desperate to find some relief?

Over 20 million Americans suffer from osteoarthritis -- which means that 20 million Americans are looking for relief from osteoarthritis pain. That’s no small task, especially after the recall of the two COX-2 inhibitors, Vioxx and Bextra.

One popular treatment for osteoarthritis is the supplement glucosamine. Glucosamine, usually made from crustacean shells, contains an amino sugar compound found in cartilage. Supplement manufacturers claim that taking glucosamine supplements will help preserve and repair cartilage in arthritic joints, although it is unknown exactly how the body processes this extra glucosamine -- or even whether it is delivered to the joints. Some glucosamine supplements also contain chondroitin, another natural component of cartilage. Chondroitin is believed to promote cartilage elasticity and prevent cartilage breakdown, but again it’s unknown how or if the chondroitin reaches the joint tissue.

How effective are glucosamine chondroitin supplements? A large-scale study conducted by the National Institutes of Health hopes to answer this question. While the full verdict isn’t in yet, preliminary results suggest that glucosamine chondroitin supplements may not live up to manufacturers’ claims.

The Glucosamine Chondroitin Arthritis Intervention Trial (GAIT) involved almost 1,600 patients with knee osteoarthritis. Participants were assigned to six months of treatment with one of five regimens: 1,500 mg of glucosamine hydrochloride daily, 1,200 mg of chondroitin sulfate daily, a full-dosage combination of both glucosamine and chondroitin sulfate daily, 200 mg of celecoxib daily, or placebo. All study participants were allowed up to 4,000 mg of acetaminophen per day if needed for pain relief, though on average they took less than 1,000 mg per day. Patients reported the intensity of their pain symptoms on a scale from 1 to 5. Effective treatment was defined as a 20% improvement in pain.

Overall, glucosamine and chondroitin supplements were no more effective than placebo: Both groups reported similar improvements. As was expected, people taking celecoxib had the greatest improvement. Glucosamine chondroitin supplements did appear to work better for participants suffering from moderate to-severe pain: 79% of the glucosamine chondroitin supplement group reported an effective reduction in pain, compared with just 54% of the placebo group.

So are glucosamine chondroitin supplements worth the expense? Clifton O. Bingham III, M.D., assistant Professor of Medicine at Johns Hopkins in the Arthritis Center says, “If people are not having any improvement after taking a supplement for some time, our data would suggest that there is little point in continuing.” In the end, proven painkillers— such as acetaminophen, NSAIDs, and celecoxib—will get you the most pain relief for your money. However, Dr. Bingham stresses that pain relievers are only one component of effective osteoarthritis management. "Though most people want a magic bullet, the fact remains that the best responses are seen in people who are willing to engage in regular activity and lose weight.” He also stresses that when discussing treatment options with your doctor, it’s important to mention any medications and supplements you use.

For more Alerts and Special Reports, please visit the Arthritis Topic page.

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Arthritis | Evidence Against Glucosamine Use for Osteoarthritis Pain

New Research on Hip and Knee Osteoarthritis

Tue, 19 Sep 2006 14:31:55 CDT

Johns Hopkins Health Alerts | Arthritis |

New Research on Hip and Knee Osteoarthritis

Osteoarthritis Update #1: Statin Use Linked to Increased Risk of Developing Hip Osteoarthritis

Many older people who take statin drugs (such as atorvastatin [Lipitor]) to lower their cholesterol levels have osteoarthritis or are at risk for developing it. A recent study in the Journal of Rheumatology shows that elderly women who take statins may have a small increase in their risk of developing hip osteoarthritis (OA), but statin use does not worsen progression of existing hip osteoarthritis.

A total of 5,678 white women aged 65 years and older had x-rays of the pelvis taken at the start of the study (baseline) and again an average of eight years later. X-ray evidence of hip osteoarthritis was found in 745 women (936 hips) at baseline. X-rays in the remaining 4,933 women (9,318 hips) showed no hip osteoarthritis. Overall, 7% of participants took statins during the sixth and/or the eighth year of the study.

In the group who did not have evidence of hip osteoarthritis at baseline, statin users had almost twice the risk of developing severe osteoarthritis of the hip but only a small increase in the risk of less severe osteoarthritis, compared to similar women who didn't take statins. In contrast, statin users with evidence of hip osteoarthritis at baseline showed a moderately decreased risk of osteoarthritis progression. The study shows that in elderly white women who don't have osteoarthritis of the hip, statin use may increase the risk of developing it.

Osteoarthritis Update #2: Use of Prescribed Exercises Decreases Disability in Knee Osteoarthritis

A study reported in the journal Arthritis and Rheumatism shows that people with knee osteoarthritis who exercised for as long as 18 months had less disability and were able to walk much greater distances than people who dropped out of the program.

A group of 156 overweight and obese older adults (age 60 and older) with knee osteoarthritis were randomly assigned to an 18-month program of exercise for 60 minutes a day, three days a week, or the same exercise regimen plus weight loss. During the first six months, all patients were required to exercise at a supervised facility. At 7–18 months, they could continue at the facility or exercise at home, keeping daily exercise logs.

Researchers determined which participants had low, intermediate, or high exercise adherence. After six months, people with the highest adherence showed the greatest improvement in the distance they could walk in six minutes and on an index of osteoarthritis-related pain and disability. At the 18-month point, 69 people in the exercise-only group and 65 in the exercise plus diet group were still following the exercise program to some degree and maintained improvements in walking performance. The study shows that adherence to prescribed exercise regimens can produce significant improvements in physical function and disability in overweight and obese people with knee osteoarthritis.

Johns Hopkins Health Alerts | Arthritis |

New Research on Hip and Knee Osteoarthritis

Could Your Pain and Stiffness Be Caused By Ankylosing Spondylitis?

Tue, 19 Dec 2006 06:00:00 CST

Johns Hopkins Health Alerts | Arthritis |

Ankylosing Spondylitis

Ankylosing spondylitis can be hard to diagnose because early symptoms mimic other arthritic conditions.

Ankylosing spondylitis is a systemic rheumatic disease characterized by inflammation of the spine and the sacroiliac joints. These joints are located in the lower back where the sacrum (the bone directly above the tailbone of your back) meets the iliac bones (bones on either side of the upper buttocks). Inflammation in these areas (spondylitis) causes pain and stiffness in and around the spine. Eventually, this can lead to a complete fusion of the vertebrae, a process referred to as ankylosis, which in turn leads to loss of spinal mobility. In addition to harming the spine, ankylosing spondylitis can inflame and injure joints in other parts of the body. Ankylosing spondylitis can also damage organs such as the heart and kidneys.

Ankylosing spondylitis is believed to be genetically inherited. The majority of people with this condition (nearly 90%) are born with a gene known as HLA-B27. Not everyone with the HLA-B27 gene gets ankylosing spondylitis, however. Researchers believe other conditions, perhaps environmental, are necessary for ankylosing spondylitis to become expressed.

The symptoms of ankylosing spondylitis are caused by inflammation of the spine, joints, and other organs. Symptoms include pain and stiffness in the lower back and the rest of the spine, upper buttocks, and neck. The pain and stiffness usually progress gradually over a matter of months, although onset can be rapid and intense. The pain and stiffness of ankylosing spondylitis are often worse in the morning or after periods of inactivity. These symptoms are sometimes relieved by motion, applied heat, or a warm shower. Other areas of the body affected by inflammation include the kidneys, heart, lungs, and eyes.

In advanced stages, for example, ankylosing spondylitis can lead to deposits of a substance called amyloid in the kidneys, which can cause kidney failure. Dialysis is sometimes needed to clear the kidneys. Rarely, people with ankylosing spondylitis develop scarring of the heart’s electrical system, which causes an abnormally slow heart rate. This requires correction with implantation of a pacemaker.

Johns Hopkins Health Alerts | Arthritis |

Ankylosing Spondylitis

Why Do Some People Get Rheumatoid Arthritis?

Fri, 05 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Arthritis |

Causes of Rheumatoid Arthritis

Several factors may increase your risk of developing rheumatoid arthritis, but for now the true cause of rheumatoid arthritis remains a mystery.

Rheumatoid arthritis affects approximately 1.3 million Americans. Unlike osteoarthritis, which occurs equally in both sexes, more than three times as many women as men have rheumatoid arthritis. Osteoarthritis usually begins late in life; rheumatoid arthritis often begins between ages 30 and 50, though it can develop at any age.

The major distinguishing characteristic of rheumatoid arthritis is that it is a chronic, systemic (affecting the whole body), inflammatory autoimmune disease. What does this mean? In an autoimmune disease, something triggers the body to mount an immune system attack against itself, much the way the immune system normally attacks harmful bacteria and viruses. In rheumatoid arthritis, the primary target of this attack is the synovial membrane that lines joints in every part of the body.

The exact cause of rheumatoid arthritis is still unknown, but researchers have identified some factors that may increase your risk of developing the disease.

The Role of Genetics and Rheumatoid Arthritis
Rheumatoid arthritis can run in a family. But even if you have rheumatoid arthritis, your children’s risk of developing it is not greatly increased. Researchers have identified a specific genetic marker called HLA-DR4, which is found in more than two thirds of white men and women who have rheumatoid arthritis. However, about 20% of people without rheumatoid arthritis have the same genetic marker. So having the marker increases your risk of rheumatoid arthritis but does not mean that you’ll inevitably develop the disease.

The Role of Infection and Rheumatoid Arthritis.
Several types of arthritis occur as a result of infections. You’re probably familiar with Lyme disease, which is the result of a bite from an infected deer tick. The bacterium the tick transmits first causes a rash, fever, and neck stiffness. Weeks later, victims may develop severe joint inflammation (Lyme arthritis) that can last for months, or even for a lifetime. Some researchers think that in people who are genetically susceptible to rheumatoid arthritis, exposure to certain bacteria or viruses can trigger the abnormal immune response that causes the disease.

Environmental Factors and Rheumatoid Arthritis.
Several studies have found that heavy smokers are more likely to develop rheumatoid arthritis than nonsmokers. Other studies suggest that drinking coffee might also increase the risk of rheumatoid arthritis and that drinking tea might decrease the risk. However, a review of data from more than 80,000 women studied for nearly 20 years concluded that neither beverage affects rheumatoid arthritis risk.

Johns Hopkins Health Alerts | Arthritis |

Causes of Rheumatoid Arthritis

Advance Planning for Hip or Knee Replacement Surgery Makes for Smoother Sailing

Thu, 19 Oct 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Arthritis |

Planning for Hip or Knee Replacement Surgery

Considering hip or knee replacement surgery? Here’s practical advice from Johns Hopkins doctors.

Because hip or knee replacement surgery is rarely an emergency, you have plenty of time to set your house in order before you go to the hospital. That includes arranging your home so that it will be rehab-friendly when you return home, taking care of important paperwork, and lining up neighbors and friends to help.

Hip or knee replacement surgery: Financial Concerns

The weeks before hip or knee replacement surgery are a good time to pay upcoming bills and review your health insurance coverage to avoid any unpleasant surprises later on. This includes inquiring about or verifying coverage issues such as:

Need for a second opinion on your hip or knee replacement surgery.
Hospital and health care providers’ status as “in-network” or “preferred.”
Deductibles for hospital services.
Limits on length of stay.
Coverage for hospital rehabilitation services.
After-care services for your hip or knee replacement surgery, such as physical or occupational therapy. (Ask whether the therapists must be from an approved list and how many visits or sessions are covered.)
Equipment such as wheelchairs, walkers, and crutches, and whether they must be obtained from approved vendors.
Home health care coverage, what type, and for how long.
Coverage of follow-up visits with your physician.

Hip or knee replacement surgery: Health Issues

Ask your doctor to explain the hip or knee replacement procedure, the type of device being implanted, and what you should expect in terms of rehabilitation (pain management, time on crutches or a walker, length of physical therapy, type of home assistance required, time off from work, restricted activities, and time until you can resume full activities). Your doctor or hospital may have printed material on the procedure, or you can request information from organizations such as The Arthritis Foundation.

Hip or knee replacement surgery: Home Improvements

Take a look at the rooms in your house to identify potential problem areas. To increase safety and convenience:

Remove throw rugs and small items from the floor. Tape down electrical cords. Rearrange furniture to create wide pathways to accommodate a walker or crutches.
Set up a bedroom downstairs.
Place kitchenware and other frequently used items within arm’s reach. Buy a long-handled grabbing device.
Consider installing handrails and grab bars in the bathroom and shower. A shower bench and elevated toilet seat are also helpful.
Place a sturdy high-backed chair with arms in the room where you will spend most of your time.
Set up a recovery center. Place a table and wastebasket near your chair. Include a phone, T.V. remote control, tissues, medications, water pitcher and glass, and reading material. Use a carpenter’s apron or shoulder bag to carry items around the house.
Make or buy frozen casseroles, soups, and other easy-to-prepare foods.

Above all, don’t hesitate to ask friends and neighbors for help with groceries, transportation, or other tasks. With your new hip or knee, you’ll be able to return the favor down the road.

Johns Hopkins Health Alerts | Arthritis |

Planning for Hip or Knee Replacement Surgery

Q & A on Hip Replacement Surgery

Fri, 17 Nov 2006 06:00:00 CST

Johns Hopkins Health Alerts | Arthritis |

Q & A on Hip Replacement Surgery

Considering hip replacement surgery, but not sure when the time is right? Frank Frassica, M.D., Professor of Orthopedic Surgery at Johns Hopkins, offers advice.

Q. When should a damaged hip be replaced?

A. I have been an orthopedic surgeon for 20 years, and in my experience, the people who are least satisfied with hip replacement surgery are those who had the surgery too early. They were unsuitable hip replacement candidates because their pain and debilitation levels were too low to justify surgery. After the hip replacement, they still have some pain from the surgery, which leaves them not only uncomfortable and unhappy, but also angry.

I regularly tell people to delay arthroplasty of the hip for as long as possible. How long is long? People who can walk one to two miles, but can’t walk five miles, are not good candidates for hip replacement. If you can still walk one to two miles, meet the demands of your job, go to the mall, and buy groceries, then it is too early to have hip replacement.

On the other side of the coin, if you cannot walk one to two miles, can’t shop or enjoy activities with your spouse and children as you used to, if physical therapy sessions have not helped, and if you have so much pain that you need a narcotic, then it’s probably time to have your hip replaced. When you’re ready to admit that the pain and disability are disrupting your life, make an appointment to consult with an orthopedic surgeon.

Once the decision is made, you need to have realistic expectations. When physically active people tell me they want a hip replaced so they can go back to competitive tennis, or take up aggressive downhill skiing or jogging, I make it clear that there will be serious problems down the road. I can almost guarantee that if they try those activities with their new hips, the artificial joint will eventually loosen, wear out, or fracture.

Total hip replacement will provide complete or nearly complete pain relief to almost all patients. Moreover, those patients with stiff hips before hip replacement surgery should be able to return to nearly normal hip motion. However, there are still some unsolved problems in the total hip replacement procedure. For example, the materials we use for hip replacements don’t last forever, although depending on the patient’s age and activity level, a hip replacement can last for 15 to 20 years or even longer before it has to be revised (replaced).

Johns Hopkins Health Alerts | Arthritis |

Q & A on Hip Replacement Surgery

The Benefits of Weight Loss for Osteoarthritis

Mon, 26 Feb 2007 06:00:00 CST

Johns Hopkins Health Alerts | Arthritis |

Benefits of Weight Loss for Osteoarthritis

Experts agree: weight loss should be a first choice therapy for knee osteoarthritis.

If you suffer from chronic pain due to knee osteoarthritis, a study in the journal Osteoarthritis and Cartilage offers hope. The study shows that for obese people who already have knee osteoarthritis, a rapid loss of 10% of their weight can quickly and dramatically improve their physical function.

Eighty people with knee osteoarthritis (average age 62) who were overweight or obese (body mass index 28–35 or more) participated in an eight-week dietary weight loss program. Half of the participants had six meals a day of nutrition powder dissolved in water that met all requirements for daily intake of protein, fat, and fiber. The other participants (control group) followed an eight-week regular, high-energy, high-protein diet of regular food. Both groups received nutrition recommendations from the same dietitian, and the low-energy diet group attended motivational sessions with the dietitian each week.

People in the low-energy diet group lost an average of 11% of their body weight and 2% of their body fat vs. a 4% weight loss in the control group. For people in both groups, a weight loss of 10% produced an average 28% decrease in functional disability related to knee osteoarthritis.

The study shows that a brief eight-week diet program can produce a 10% weight loss that significantly improves physical function in overweight and obese patients with knee osteoarthritis. The authors suggest that weight loss should be a first choice therapy for knee osteoarthritis.

This finding is confirmed by a study from The Arthritis, Diet, and Activity Promotion Trial (ADAPT), which focused on osteoarthritis patients over age 60 who were overweight. It also found that a combination of “modest” weight loss plus moderate exercise provided the greatest improvement in knee pain and mobility.

Other research has shown that people who have osteoarthritis in one knee can reduce the chance of it occurring in the other knee if they lose weight. So if you haven’t been successful in your weight-loss efforts, consult a nutritionist for help in changing your eating habits.

Johns Hopkins Health Alerts | Arthritis |

Benefits of Weight Loss for Osteoarthritis

Fibromyalgia Syndrome -- Common and Difficult to Diagnose

Thu, 20 Jul 2006 13:11:30 CDT

Johns Hopkins Health Alerts | Arthritis |

Fibromyalgia Syndrome

If you suffer from aches, stiffness, increased sensitivity to pain, or other arthritis-like symptoms, it could be fibromyalgia.

Fibromyalgia is a common rheumatic condition. It is not a form of arthritis as it does not cause inflammation to the joints, muscles, or other tissues. Instead, fibromyalgia causes pain and stiffness in tissues around the joints.

The exact cause of fibromyalgia is unknown, but there are several theories under study, including abnormalities of the central nervous system, sleep disturbances, and the possibility that it is triggered by a viral infection or an injury.

Symptoms of fibromyalgia include pain, aches, and stiffness that may occur all over the body, moderate to severe fatigue, trouble sleeping, depression and anxiety, difficulty thinking and concentrating, and increased sensitivity to pain.

Because symptoms of fibromyalgia are similar to those of many other disorders, it is difficult to diagnose. You may see several doctors before getting a correct diagnosis. No x-ray, biopsy, or blood test can identify fibromyalgia. However, the American College of Rheumatology has developed a set of criteria to diagnose fibromyalgia, including widespread pain, present for at least three months; pain located on both sides of the body, above and below the waist; and pain in at least 11 of 18 tender points.

Once you are diagnosed with fibromyalgia, your doctor will work with you to develop a multifaceted treatment approach that may include pain medications, improving sleep patterns, exercise, psychological counseling, and complementary therapies. You may also need to work on your day-to-day activities to avoid repetitive motions that cause fatigue and increase pain. Treatments that are not recommended include excessive rest and avoidance of activities, botox injections, and herbs or supplements that claim to cure fibromyalgia.

If you are living with fibromyalgia, working with your doctor and sticking to your treatment plan can do a lot towards relieving your symptoms. Also, medications are under study that may soon yield new treatments.

Fibromyalgia Trigger Points

Tender points—specific spots that are quite painful when pressure is applied to them—are typical in fibromyalgia. Tender points usually are present on both sides of the body. To test for pain at the tender points, your physician will apply about nine pounds of pressure per square inch (equivalent to pressing your thumb on a hard surface until the tip of your thumbnail begins to turn white). The pressure may be applied with one or two fingers, or with a special device called a dolorimeter. Fibromyalgia is easily overlooked or misdiagnosed. It is important that you seek medical attention from a rheumatologist or a physician who is experienced in diagnosing and treating fibromyalgia.

Johns Hopkins Health Alerts | Arthritis |

Fibromyalgia Syndrome

Arthritis Q and A on Minimally Invasive Hip Replacement Surgery

Fri, 18 Aug 2006 15:23:45 CDT

Johns Hopkins Health Alerts | Arthritis |

Arthritis Q and A on Minimally Invasive Hip Replacement Surgery

Is minimally invasive hip replacement surgery all that it’s cracked up to be? Simon Mears, M.D., chief of total joint arthroplasty and trauma at the Johns Hopkins Bayview Medical Center, explains the advantages.

Q. What are the benefits of minimally invasive hip replacement surgery?

A. Patients must understand that although the term “minimally invasive” sounds attractive, the surgery is still the same as the standard procedure, only it is performed through smaller incisions. In fact, recent research has found little difference in patient recovery when the length of the incision was studied. The surgery still entails cutting bone, removing damaged hip parts, and affixing the implant to the thighbone and hip.

There are several possible advantages when a hip is replaced with minimally invasive technique. These factors include:

A smaller incision. Typical incisions are now 3 to 4 inches, on average, compared to 9 inches with traditional surgery. In some cases, surgeons can perform the surgery through two 1.5-inch incisions. The socket portion of the prosthesis is placed through an incision in the front of the leg, while the ball portion of the prosthesis is placed—with x-ray guidance—through an equally small incision in the buttock. Instead of cutting through muscles and tendons to reach the hip, the surgeon will part between them with small instruments and his fingers.

Current studies are investigating the exact amount of muscle damage after a minimally invasive procedure. Some authors have suggested that by making smaller incisions more muscle damage actually occurs because the surgeon cannot completely visualize the muscles and tendon.

Less pain. With a smaller incision and no need to cut through muscle and tendon, post-operative pain levels are thought to be significantly reduced. The pain of the procedure has been altered by the use of newer anesthetic methods. This includes the use of new peripheral nerve blocks and indwelling nerve catheters. These techniques can numb the specific nerves that go to the hip during and after surgery. This allows for the use of less pain medicine and anesthetic, preventing common side effects such as postoperative nausea and vomiting. Researchers are trying to differentiate whether reduced pain after surgery is due to better anesthesia or if the approach itself causes less surgical pain.

Lower blood clot risk. Although this has not yet been proven with a study, I find that when using the two-incision approach I do not have to twist the patients’ leg during surgery as I do in a traditional hip replacement. This seems to reduce the 24 risk of blood clot development, although it will require tens of thousands of patients to prove this. Patients are encouraged to get out of bed the day of surgery, which limits the immobility that may increase the risk for blood clots.

Surgical confidence. Since an x-ray machine is used for prosthesis placement during a two-incision minimally invasive hip procedure, I am confident that the stem and cup are properly placed and affixed to the bone.

Quicker hospital discharge. Some highly experienced surgeons now perform the procedure as an outpatient surgery. Patients leave the hospital 12 hours after their surgery as long as they can get out of bed by themselves, rise from a chair, walk 100 feet, and walk up and down stairs.

In general, younger healthy patients will be discharged within 48 hours. Patients use a cane but are quickly weaned from this. Contrast this with a conventional procedure, where hospitalization is usually four days and additional rehabilitation is needed over the course of the next few weeks.

Fewer restrictions. After conventional hip replacement, patients are usually instructed to avoid certain motions to prevent the risk of hip dislocation. High on the list are the recommendations not to bend the hip past 90 degrees or cross the legs when seated. To prevent pain and possible dislocation, patients are also given a special restrictive pillow to place between their legs at night. Following surgery with the two-incision approach, the hip now has good innate stability and the chance of dislocation is much less likely. Therefore, I do not put any restrictions on motion or recommend the use of a pillow for my patients.

Got Arthritis? Get Exercise!

Tue, 20 Jun 2006 10:34:02 CDT

Johns Hopkins Health Alerts | Arthritis |

Got Arthritis? Get Exercise!

Studies show that most Americans with arthritis are not active enough. Here are some tips for exercise that’s easy on the joints and can be done regularly by those of us who suffer from arthritis.

More than 60% of U.S. adults with arthritis aren’t getting enough exercise to make a difference in their health, national statistics show. This widespread inertia among arthritis sufferers is “troubling,” researchers say, because regular exercise can ease arthritis pain and improve joint function, as well as maintain overall health.

Public health officials recommend that at minimum, adults get 30 minutes of moderate exercise, such as brisk walking, on most days of the week. Although arthritis may present special barriers—from painful joints and fatigue to people’s fears that activity will worsen their arthritis symptoms—the researchers point out that many forms of exercise, such as swimming, biking, and moderate walking, are easy on the joints and can be done regularly by arthritis sufferers.

An arthritis exercise program should be started with the approval of a physician and, preferably, under the guidance of a physical therapist who can design and teach exercises to do at home, as well as provide periodic monitoring of progress. Ideally, your arthritis exercise program should include the three basic forms of exercise: range of motion, muscle strengthening, and endurance (also called aerobic or “fitness” exercise).

Arthritis exercise #1: Range-of-motion exercises. Range-of-motion exercises involve moving a joint as far as possible in every direction without causing pain. The purpose is to maintain flexibility, reduce pain and stiffness, and improve joint function. These exercises are recommended as a warm-up before a workout.

Arthritis exercise #2: Muscle-strengthening exercises. Strengthening muscles increases structural support for the joints and thereby lessens the load placed on them. Isometric exercises—pushing or pulling against a fixed object—can strengthen muscles without damaging joints, which remain immobile during the exercise. Stationary bicycling is often recommended to strengthen the muscles supporting the knees. In one study, an eight-week muscle-strengthening program improved muscle tone and decreased pain significantly in people with osteoarthritis of the knee.

Arthritis exercise #3: Aerobic exercises. Aerobic activities improve overall body fitness. It is possible that high-impact aerobic activities such as running might accelerate the breakdown of cartilage in weight-bearing joints (although not all studies have shown this to be the case), so most doctors recommend low- or no-impact activities such as swimming, walking, and bicycling.

Johns Hopkins Health Alerts | Arthritis |

Got Arthritis? Get Exercise!

The Best Way To Prevent Osteoarthritis

Mon, 17 Apr 2006 08:20:45 CDT

Johns Hopkins Health Alerts | Arthritis | Best Way To Prevent Osteoarthritis

Studies have shown that overweight or obese women who lose just 11 pounds decrease their risk of osteoarthritis by about 50%.

Over 20 million Americans have osteoarthritis, the most common form of arthritis. One of the most frequent causes of physical disability in adults, osteoarthritis involves the progressive breakdown of cartilage and other joint tissues. By age 40, about 90% of people have some degree of osteoarthritis in their weight-bearing joints, such as the hips and knees—though symptoms of pain and stiffness generally do not appear until later in life.

There is no sure-fire way of avoiding osteoarthritis. But the best way to reduce the risk of developing symptoms of osteoarthritis is to lose weight if you are overweight or obese.

Osteoarthritis occurs most often in your hands and in the joints of your lower back, hips, and knees. The latter are all weight-bearing joints, and obesity increases the pressure on them. Obesity is especially hard on knees—osteoarthritis of the knee is about four to five times more prevalent in obese men and women than in people at normal weight.

It doesn’t take much weight loss for benefits to appear. Studies have shown that overweight or obese women who lose just 11 pounds decrease their risk of osteoarthritis by about 50%.

Johns Hopkins Health Alerts | Arthritis | Best Way To Prevent Osteoarthritis

Acetaminophen -- The First Drug of Choice for Arthritis Pain Relief

Fri, 19 May 2006 05:35:09 CDT

Johns Hopkins Health Alerts | Arthritis |

Benefits of Acetaminophen for Relief of Osteoarthritis Pain

In most cases, osteoarthritis can be treated quite effectively with acetaminophen, which is sold as over-the-counter Tylenol.

Because of the advertising dollars spent on prescription drugs, many arthritis sufferers had come to assume that the drugs known as COX-2 inhibitors—including Celebrex and Vioxx— were best for easing the symptoms of osteoarthritis. The drugs were marketed as improved versions of other common pain relievers that reduce inflammation. Until studies released during 2004 indicated that COX-2 inhibitors were associated with health risks, both Celebrex and Vioxx were widely advertised and widely used. Vioxx was taken off the market and is no longer available to patients; Celebrex continues to be used.

But in most cases, osteoarthritis can be treated quite effectively with a much cheaper drug—acetaminophen, which is sold as over-the-counter Tylenol (and also in even less expensive generic drugstore brands). Inflammation plays only a minor role in osteoarthritis, so an anti-inflammatory effect from medication is not necessary. Acetaminophen provides pain relief and is less likely to cause side effects (such as stomach irritation) than anti-inflammatory drugs.

As is true with any drug for arthritis, you need to discuss taking acetaminophen with your doctor. The maximum daily dosage of acetaminophen is 4,000 mg, and it can cause dangerous side effects if you take it in excessive dosages or you have liver disease or drink large amounts of alcohol. Several years ago, a study linked heavy daily use of acetaminophen to a higher risk of end-stage kidney disease. But since end-stage kidney disease is rare (only 1 in 5,000 people develop the condition each year), even regular users of acetaminophen are unlikely to develop the disorder.

Even though acetaminophen is the drug with the lowest overall risk of side effects, if you use acetaminophen regularly, you should see your doctor periodically to be monitored for adverse effects.

Johns Hopkins Health Alerts | Arthritis |

Benefits of Acetaminophen for Relief of Osteoarthritis Pain

Don't Let Arthritis Lead To Another "-Itis" ...Bursitis!

Fri, 19 May 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Arthritis |

Joint Pain from Bursitis and Bursitis Prevention Advice

Prevent bursitis by avoiding activities that require repetitive motions.

Stay in shape! Well-conditioned muscles are less susceptible to overuse injuries than tight or weak muscles.

Dull and persistent joint pain—pain that increases with movement—may be due to bursitis. While bursitis may produce some of the same symptoms as arthritis, bursitis affects the tissues surrounding the joint rather than the joint itself.

Bursitis is an inflammation of one of the small fluid-filled sacs, or bursae, that act as cushions in areas of the body where muscles or tendons move over bones or other muscles. The bursae prevent friction by protecting muscles and tendons from coming into direct contact with bones. When a bursa becomes inflamed, pain and swelling result. There are about 150 bursae in the body, but the ones most commonly affected are in the shoulders, elbows, hips, knees, and feet.

In most cases bursitis results from joint overuse due to repetitive motions. For example, bursitis in the shoulder can be brought on by excessive strain, such as from serving a tennis ball. People with arthritis are at greater risk for developing bursitis because they may try to compensate for joint pain by making awkward or exaggerated movements that lead to improper body mechanics. Thus, even everyday activities may irritate the bursae.

Bursitis is not chronic (most cases clear up by themselves within a few days to two weeks), but it can recur unless you adopt protective measures. The best way to prevent bursitis is to avoid activities that require repetitive motions (which is not always possible) and by staying in shape, since well-conditioned muscles are less susceptible to overuse injuries than tight or weak muscles. Even then, be sure to increase the pace or intensity of exercise gradually—and stop any activity immediately if sudden joint pain occurs.

Johns Hopkins Health Alerts | Arthritis |

Joint Pain from Bursitis and Bursitis Prevention Advice