Booster Shots

Oddities, musings and news from the health world

Category: arthritis

Knee replacements: good for gaining function, bad for gaining weight

February 2, 2010 |  7:00 am

Knee replacements can be a boon, making it possible for people be more mobile. But there may be a catch, as a new study has discovered: with a knee replacement can come weight gain.

Jprpsgnc It seems counterintuitive, since being more mobile might motivate one to be more active. But that's not what researchers from the University of Delaware found when they studied two groups of people over the course of two years.

One group consisted of 106 men and women who had had a total knee replacement; the other, 31 people who had no knee pain and no surgery, who acted as a control group. Both groups had their body mass index tracked and were given functional evaluations that included testing the strength of their quadriceps (thigh) muscles. The surgery group went through a six-week comprehensive physical therapy program.

Over the two years the surgery group showed a substantial average weight gain--66% of people in that group gained an average of 14 pounds compared with the control group, which showed virtually no change in body mass. Those in the surgery group who had the weakest quadriceps muscles also gained more weight.

The researchers noted that despite gaining weight, those in the surgery group felt they increased their functional abilities. In the paper, the researchers wrote, "This reinforces the idea that high body weight should be treated as a separate condition that will not resolve with an increase in functional ability." The authors also make the case that while osteoarthritis is not life-threatening, gaining weight does carry risk factors such as cardiovascular disease.

The study appears in the online edition of the journal Osteoarthritis and Cartilage.

-- Jeannine Stein

Photo credit: Glenn Koenig / Los Angeles Times

Flu vaccine doesn't work in arthritis patients treated with rituximab

January 6, 2010 | 12:25 pm

PigArthritis patients being treated with the drug rituximab should be given flu vaccinations immediately before treatment begins or several months later, but not in the first two months after treatment, Dutch researchers have found. The vaccine is not dangerous when given after treatment with the drug, but it also provides no benefit, failing to stimulate the production of antibodies against the flu virus. Other drugs used to treat arthritis have no effect on immunization, however.

Rheumatoid arthritis, which affects more than 4.6 million people worldwide, is an autoimmune disease that attacks the patient's joints and surrounding tissues. It also compromises a patient's immune system, leaving him or her at risk from a variety of infections. Most physicians thus recommend that patients receive a flu vaccination every year to ward off serious illness, and also recommend immunization against pandemic H1N1 influenza.

The disease is typically treated with steroids, methotrexate and a variety of other agents that suppress the autoimmune reaction. One of the newer treatments is with rituximab--a monoclonal antibody sold under the brand names Rituxan and MabThera--which depletes the body's population of B cells that attack the joints. The drug is given in two infusions two weeks apart and its effects last for months. But researchers have been concerned about how depleting B cells would affect vaccination.

Dr. Sander van Assen of the University Medical Center Groningen in the Netherlands studied 23 patients with rheumatoid arthritis who were taking rituximab, 20 patients taking methotrexate and 29 healthy individuals, all of whom were given the seasonal flu vaccine. Among those taking rituximab, 11 received the vaccine four to eight weeks after treatment and 12 were given it six to 10 months after treatment. The team reported in the journal Arthritis & Rheumatism that those given the vaccine in the weeks after treatment developed no protective antibodies, while those given it later developed some antibodies, but not as many as healthy people. Those taking methotrexate developed normal flu protection. The doctors recommended that patients being treated with the drug be given the vaccines for seasonal flu and swine flu preemptively before treatment begins.

In other flu news:

-- New data from the Centers for Disease Control and Prevention showed a mixed bag of flu indicators for the week ending Dec. 26. Only four states were reporting widespread flu activity--Delaware, Maine, New Jersey and Virginia--down from seven the preceding week. Visits to physicians' offices for influenza-like illnesses rose slightly following eight consecutive weeks of declines. Hospitalization rates were unchanged from the previous week, while the proportion of deaths attributed to pneumonia and influenza increased slightly to rise above the epidemic threshold, after dipping below that threshold the preceding week for the first time in 11 weeks. Four pediatric flu deaths were reported during the week, compared with nine the previous week.

-- As of Tuesday morning, 130,386,600 doses of swine flu vaccine were available. Because supplies are becoming more readily available, the Department of Health and Human Services has declared next week National Influenza Vaccination Week. Monday and Tuesday will be focused on healthcare workers and people with high-risk conditions. Wednesday's effort will center on children, pregnant women and caretakers of infants under 6 months old, while Thursday will be focused on young adults. Friday will be devoted to seniors. The department is also conducting a special program this week to vaccinate athletes who will be competing in the Winter Olympics next month in Canada.

-- Canada is loaning Mexico 5 million doses of swine flu vaccine to allow the latter country to meet its immediate vaccination requirements, Canadian Health Minister Leona Aglukkaq said today. Mexico will replace the vaccines by the end of March, by which time it will have received its own shipments. Canada has so far immunized about a third of its population, Aglukkaq said, and the current wave of the pandemic is ebbing there just as it is in the United States.

-- France, meanwhile, is attempting to unload its surplus supplies of the vaccine. The country purchased 94 million doses for its population of 65 million on the assumption that two doses would be required. Now that it is clear one dose will suffice, the country is trying to sell its surplus to other countries at the price it paid for it. About 5 million people have been vaccinated in the country, but immunizations are declining as the pandemic wave has abated.

-- Thomas H. Maugh II

Tylenol Arthritis Pain Caplets recalled

December 29, 2009 | 10:03 am

McNeil Consumer Healthcare is recalling all lots of its Tylenol Arthritis Pain Caplets in 100-count bottles with the red EZ-open cap, the company said. Five lots of the product were recalled in November because of an unusual moldy, musty, or mildew-like smell that caused some consumers short-lived nausea, stomach pain, vomiting and diarrhea. As a precaution, the company is now expanding the recall to all lots, a list of which can be found at the Food and Drug Administration website.

The unusual odor is believed to be caused by trace amounts of a chemical called 2,4,6-tribromoanisole, which is thought to be a breakdown product of a chemical used to treat wooden pallets used in shipping and storing the drugs.

Consumers can go to or contact the company at (888) 222-6036 for instructions on how to return the product and obtain a refund. Consumers who have medical problems they think are linked to the drugs should contact their healthcare provider.

This has not been a good year for Tylenol.

In September, McNeil recalled 57 lots of infant and children's liquid Tylenol products because of potential bacterial contamination. In July, a research team at the Medical College of Wisconsin reported that ibuprofen was better than Tylenol No. 3 for treating children with broken arms. And in July, an FDA panel called for a lowering of the maximum dose of Tylenol and other acetaminophen products because of their potential to produce liver damage.

-- Thomas H. Maugh II

Rheumatoid arthritis sufferers have their own online show -- with a twist

August 26, 2009 | 12:11 pm

Those who suffer from rheumatoid arthritis, a chronic, inflammatory form of arthitis that causes joint paint, stiffness and damage, now have something on the Internet they can call their own: an online talk show dedicated to the disease.

Hqq4y6kf "New Way RA" is hosted by the perennially perky Deborah Norville, whose mother suffered from RA, and features information, advice and tips from several experts, including Food Network host Ellie Krieger, Dr. W. Hayes Wilson, chief of the division of rheumatology at Piedmont Hospital in Atlanta, and personal trainer Ellen Shmueli, who was diagnosed with RA at age 28. A preview of the show (seeing the entire thing requires registration) features basic information on RA, but other segments include nutrition, relationships, fitness, and work and life balance.

While the show will no doubt be helpful for those diagnosed with RA, we should mention that the enterprise is backed by Centocor Ortho Biotech Inc., a pharmaceutical unit of Johnson & Johnson that produces, among other things, rheumatoid arthritis drugs.

Forbes reports via Reuters that the Food and Drug Administration recommends using greater caution with some arthritis drugs because of a possible cancer risk in children and teens. A spokesman for Centocor Ortho Biotech Inc. said the company will work with the FDA to come up with new warnings for the drugs.

-- Jeannine Stein

Photo: Deborah Norville. Credit: Jennifer Graylock / Associated Press

Bad knees: Experts don't recommend some common therapies

December 12, 2008 |  2:59 pm

Knee1Osteoarthritis of the knee is a common condition that eventually leads a lot of people to knee replacement surgery. But does anything short of this drastic surgery help?

New recommendations from the American Academy of Orthopaedic Surgeons advise people to lose weight, begin exercising and take acetaminophen or non-steroidal anti-inflammatory drugs (as well as intra-articular corticosteroids for short-term pain relief).

The guidelines, titled "Treatment of Osteoporosis of the Knee" advises against such common remedies as: arthroscopic lavage -- or washing out the joint; glucosamine and/or chondroitin sulfate or hydrochloride; needle lavage or custom-made foot orthotics.

Arthroscopic lavage is not recommended when the patient's only symptom is osteoarthritis. The procedure may be helpful in patients with other problems such as loose bodies in the knee or meniscus tears. "The current science shows us that just washing out the joint does not decrease the patient's osteoarthritis symptoms and can expose the patient to additional risk," said Dr. John Richmond, chairman of the AAOS work group, in a news release.

What may be most helpful for people whose body mass index is greater than 25 is to lose a minimum of 5% of their body weight and begin or increase participation in low-impact aerobic exercise. "As far as losing weight, this has the highest potential to actually slow the progression of the disease," Richmond said.

The committee was not able to recommend for or against bracing, acupuncture or intra-articular hyaluronic acid because not enough scientific evidence exists on those therapies.

A copy of the guidelines can be found on the AAOS website.

- Shari Roan

Photo credit: Glenn Koenig / Los Angeles Times

Another solution for knee osteoarthritis: tai chi

October 28, 2008 | 12:59 pm

The pain caused by knee osteoarthritis can be debilitating and kick off a downward spiral of inactivity, exacerbating the problem.

TaichiMounting evidence shows that for those who suffer from knee osteoarthritis, exercise may be a key component in dealing with pain and difficulty walking. One 2006 study showed that by strengthening the quadriceps — those muscles in the front of the thigh — less cartilage was lost behind the kneecap, possibly resulting in more range of motion and less pain.

A new study suggests that the Chinese martial art tai chi may be effective in treating pain and disability from knee osteoarthritis. The mind-body discipline features slow, controlled movements that increase strength, balance and flexibility, and been shown in at least one other study to improve strength and possibly reduce the risk of falling in older people.

In this study, presented this week at the annual science meeting of the American College of Rheumatology in San Francisco, 40 people who had knee pain were assigned to tai chi instruction twice a week for 12 weeks, or to a control group in which they did stretching and received wellness education. At the end of the 12 weeks, those in the tai chi group showed much greater improvements in pain, physical function, depression, self-efficacy and health status than the control group. Those who stuck with the tai chi program continued to show benefits in lessening pain and increasing function.

"Tai chi mind-body exercise appears to provide an important approach for self-care and self-management for knee OA," said lead author Dr. Chenchen Wang, a physician in the division of rheumatology at Tufts Medical Center in Boston, in a news release. He added that the results need to be confirmed by large studies. Also, people are cautioned to talk to their doctors before starting any exercise program.

-- Jeannine Stein

Photo credit: Los Angeles Times

Ailments linked to obesity: add arthritis

October 25, 2008 |  7:00 pm

When knees and hips are forced to carry around extra body poundage day after day, year after year, it takes a toll. The first and largest study examining the association between overweight, body mass and osteoarthritis, the most Knee2 common form of arthritis usually affecting middle-age and older people, found that overweight people are more likely to suffer the pain of arthritis in their hips and knees as they age.

The research, led by Dr. Stefan Lohmander, professor of orthopedics at Lund University in Lund, Sweden, measured the body mass, waist, waist-to-hip ratio, weight and percentage of body fat in about 28,000 men and women ages 45 to 73. They also adjusted for other risk factors, such as age, sex, smoking history and level of physical activity. The study was presented Sunday at the American College of Rheumatology annual scientific meeting in San Francisco.

They found that of all the factors, a higher body mass index was the highest risk factor for developing painful arthritis in the hips or knees. Body mass index is a calculation of body fat by using height and weight, and you can calculate yours at this National Institutes of Health site.

“[Being] overweight is one of the few factors leading to osteoarthritis that we can actually do something about,” Lohmander said in a news release. “Understanding the connection between being overweight and getting osteoarthritis, and the size of the risk, is therefore important when considering disease prevention. We have shown that the risk increase starts already with being moderately overweight, and increases with each further increase in body mass. This is true for men and for women, and for knees and for hips.”

Those extra pounds, it seems, accelerate the progressive damage done to the cartilage around joints. The damage can lead to fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons around the joints. It's not surprising that it hurts enough to limit movement.

The study was done in Sweden, where the incidence of obesity is far less than in the U.S. Here in America, we ought to add arthritis to the growing list of ailments -- heart disease, diabetes, some cancers -- that are linked to the obesity epidemic.

-- Susan Brink

Photo credit: Toby Maudsley / Getty Images

Forget about arthroscopy for achy knees

September 10, 2008 |  1:56 pm


Osteoarthritis of the knee plagues millions of people -- and many undergo arthroscopic surgery looking for relief from the stiffness and pain. But a new study says this popular approach just doesn't work. It's the second such study to find that minimally invasive surgery to remove cartilage fragments and smooth the knee surface is ineffective.

The new study, published in the Sept. 11 issue of the New England Journal of Medicine, examined 178 Canadian men and women with an average age of 60. All of the study participants received physical therapy and medications, such as ibuprofen. But half of the participants also underwent arthroscopy at the Fowler Kennedy Sport Medicine Clinic at London Health Sciences Centre.

The eight-year study found that all the patients reported improvements in pain, stiffness and joint function and that surgery provided no additional benefit. A study published in 2002 in the New England Journal of Medicine also concluded that arthroscopic surgery didn't help with knee osteoarthritis, but that study never gained traction with doctors. Now, said the authors of the new study, maybe doctors and patients will think twice.

"Based on the available evidence, we believe that the resources currently allocated towards arthroscopic surgery for osteoarthritis would be better directed elsewhere," said the researchers, from the University of Western Ontario and Lawson Health Research Institute.

Arthroscopy is still helpful for other knee conditions, such as meniscal repair and ligament reconstruction. But for those with worn-out, achy knees, find a good physical therapist.

- Shari Roan

Photo: Arthroscopic knee surgery. Credit: University of Western Ontario

Hey, Wise Man, got anything for my aching back?

August 1, 2008 |  2:45 pm

Around the time that the Magi, according to the traditional Christmas story, made it one of their gifts to Jesus, frankincense was being used in Indian Ayurvedic medicine. Now, 2,008 years later, medical Frank1 science has proved that frankincense, an aromatic resin used in incense and perfumes, provides relief to arthritis sufferers.

In a study in the journal Arthritis Research & Therapy, researchers found that an enriched extract of Indian frankincense, known as 5-Loxin, a product developed by Laila Nutraceuticals, not only reduces the pain of arthritis, but does it quickly.

Researcher Siba Raychaudhuri, professor at UC Davis, recruited 75 patients who had the pain of arthritis in their knees, hips, hands, wrists, feet or spines. One group of 25 people got a placebo. Two other groups of 25 each got the supplement, one taking 100 mg daily for three months, and the other taking 250 mg daily for three months. Both groups that took the supplements reported they could move with less stiffness and pain, and the group that took the higher dose began feeling relief in about a week.

Tests of the fluid within their affected joints showed lower levels of enzymes linked to arthritis, and the people taking the pills had no ill side effects. But because the study size was small, some scientists urge caution and more study, according to a BBC news report.

But if future studies hold up, the nations 21 million arthritis suffers could find frankincense to be worth its weight in gold.

-- Susan Brink

Varieties of frankincense. Photo by Anne Cusack, Los Angeles Times


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