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NCCAM Clinical Digest: Dietary Supplements for Osteoarthritis

June 2, 2014 Comments off

NCCAM Clinical Digest: Dietary Supplements for Osteoarthritis
Source: National Center for Complementary and Alternative Medicine

Osteoarthritis, which affects an estimated 27 million Americans, is a leading cause of disability in older adults. Because the general population is aging and obesity, a major risk factor, is increasing in prevalence, the occurrence of osteoarthritis is on the rise. Clinical practice guidelines issued by the American College of Rheumatology recommend aerobic exercise and/or strength training, weight loss (if overweight), and a number of pharmacological and non-pharmacological modalities for treating OA of the knee, hip, or hand.

Many people with OA report trying various dietary supplements in an effort to relieve pain and improve function. However, there is no convincing evidence that any dietary supplement helps with OA symptoms or the underlying course of the disease. This issue of the digest summarizes current scientific evidence about several dietary supplements most often used by people with OA, including glucosamine and chondroitin sulfate, Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM), S-Adenosyl-L-methionine (SAMe), and herbal remedies.

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Falls and Fall Injuries Among Adults with Arthritis — United States, 2012

May 20, 2014 Comments off

Falls and Fall Injuries Among Adults with Arthritis — United States, 2012
Source: Morbidity and Mortality Weekly Report (CDC)

Falls are the leading cause of injury-related morbidity and mortality among older adults, with more than one in three older adults falling each year,* resulting in direct medical costs of nearly $30 billion (1). Some of the major consequences of falls among older adults are hip fractures, brain injuries, decline in functional abilities, and reductions in social and physical activities (2). Although the burden of falls among older adults is well-documented (1,2), research suggests that falls and fall injuries are also common among middle-aged adults (3). One risk factor for falling is poor neuromuscular function (i.e., gait speed and balance), which is common among persons with arthritis (2). In the United States, the prevalence of arthritis is highest among middle-aged adults (aged 45–64 years) (30.2%) and older adults (aged ≥65 years) (49.7%), and these populations account for 52% of U.S. adults (4). Moreover, arthritis is the most common cause of disability (5). To examine the prevalence of falls among middle-aged and older adults with arthritis in different states/territories, CDC analyzed data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) to assess the state-specific prevalence of having fallen and having experienced a fall injury in the past 12 months among adults aged ≥45 years with and without doctor-diagnosed arthritis. This report summarizes the results of that analysis, which found that for all 50 states and the District of Columbia (DC), the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. The prevalence of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fall prevention programs in clinical and community practice.

Clinical Digest — Spotlight on a Modality: Omega-3 Fatty Acids

September 9, 2013 Comments off

Clinical Digest — Spotlight on a Modality: Omega-3 Fatty Acids
Source: National Center for Complementary and Alternative Medicine

Omega-3 fatty acids have been in the news lately, after a new study raises concern about the association of omega-3s and an increased risk of prostate cancer. Omega-3s are a popular supplement used by many Americans. In fact, according to the 2007 National Health Interview Survey, which included a comprehensive survey on the use of complementary health practices by Americans, fish oil/omega-3/DHA supplements are the natural product (excluding vitamins and minerals) most commonly taken by adults, and the second most commonly taken by children.

Moderate evidence has emerged about the health benefits of consuming seafood, but the health benefits of omega-3s in supplement form are less clear. For example, the findings of individual studies on omega-3 supplements and heart disease have been inconsistent, and in 2012, two combined analyses of the results of these studies did not find convincing evidence that omega-3s protect against heart disease.

There is some evidence that omega-3s are modestly helpful in relieving symptoms in rheumatoid arthritis. Omega-3s may also be helpful for age-related macular degeneration (AMD; an eye disease that can cause loss of vision in older people). For most other conditions for which omega-3s are being studied, definitive conclusions cannot yet be reached. This issue of the digest provides information on what the science says about omega-3’s effectiveness and safety for several conditions for which there is the most evidence, including heart disease, rheumatoid arthritis, infant development, and diseases of the eye and brain.

State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011

May 7, 2013 Comments off

State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011

Source: Morbidity and Mortality Weekly Report (CDC)

Walking contributes to total physical activity and is an appropriate activity to increase overall physical activity levels among adults with arthritis. Walking also is the most preferred exercise among arthritis patients (1,2) and has been shown to improve arthritis symptoms, physical function, gait speed, and quality of life (3–5). To estimate the distribution of average weekly minutes of walking among adults with arthritis by state and map the prevalence of low amounts of walking (<90 minutes per week) among adults with arthritis, CDC analyzed data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that among adults with arthritis in the 50 states and the District of Columbia (DC), the median prevalence of walking was 53% (range: 44.3%–66.2%) for 0 minutes per week, 13.1% (range: 9.3%–16.2%) for 1–89 minutes per week, 5.3% (range: 3.2%–6.8%) for 90–119 minutes per week, 5.6% (range: 2.6%–8.3%) for 120–149 minutes per week, and 23.2% (range: 16.0%–30.6%) for ≥150 minutes per week. A state median of 66% of adults with arthritis walked <90 minutes per week, ranging from a low of 58.0% in California to a high of 76.2% in Tennessee. The large number of persons with arthritis who are not getting the full benefit of regular walking might benefit from community interventions aimed at increasing access to walking as well as specific programs that offer social support.

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis

March 22, 2013 Comments off

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis
Source: New England Journal of Medicine

Symptomatic, radiographically confirmed osteoarthritis of the knee affects more than 9 million people in the United States.1 Meniscal tears are also highly prevalent, with imaging evidence of a meniscal tear observed in 35% of persons older than 50 years of age; two thirds of these tears are asymptomatic.2 Meniscal damage is especially prevalent among persons with osteoarthritis3,4 and is frequently treated surgically with arthroscopic partial meniscectomy. This procedure, in which the surgeon trims the torn meniscus back to a stable rim, is performed for a range of indications in more than 465,000 persons annually in the United States.5

The high prevalence of meniscal tears in patients with osteoarthritis of the knee and the observation that these lesions are often asymptomatic challenge the ability of clinicians to determine whether symptoms are caused by the tear, osteoarthritis, or both. Clinicians who suspect that the tear is symptomatic may refer the patient to a surgeon for arthroscopic partial meniscectomy. The role of arthroscopic surgery in patients with osteoarthritis has been studied in two randomized, controlled trials over the past decade. One trial6 compared arthroscopic débridement and lavage with a sham surgical procedure, and the other7 compared arthroscopic débridement with a nonoperative regimen. Neither trial showed a statistically significant or clinically important difference between the arthroscopic and nonoperative groups with respect to functional improvement or pain relief over a period of 24 months.6,7

These landmark trials established that arthroscopic treatment was not superior to the other interventions in the treatment of knee osteoarthritis, but they did not focus on management of a symptomatic meniscal tear, which is a frequent indication for knee arthroscopy in patients with osteoarthritis of the knee. The efficacy of arthroscopic partial meniscectomy in symptomatic patients with a meniscal tear and osteoarthritis has been evaluated, to our knowledge, in only one randomized, controlled trial, which was a single-center study involving 90 patients.8,9 This study did not show a significant difference in pain relief or functional status between arthroscopic partial meniscectomy plus a physical-therapy regimen and physical therapy alone. Given the frequency and cost of arthroscopic partial meniscectomy and the paucity of data, we designed the Meniscal Tear in Osteoarthritis Research (METEOR) trial to assess the efficacy of arthroscopic partial meniscectomy as compared with a standardized physical-therapy regimen for symptomatic patients with a meniscal tear and concomitant mild-to-moderate osteoarthritis.

Osteoarthritis and Complementary Health Approaches

September 10, 2012 Comments off

Osteoarthritis and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine (NCCAM)

Osteoarthritis (OA) is a disease that causes pain and difficulty moving joints, particularly in the knees, hips, hands, and spine. This fact sheet provides basic information on OA, summarizes scientific research on selected dietary supplements, mind and body practices, and other complementary health approaches that have been studied for OA, and suggests sources for additional information.

Chronic Pain and Complementary Health Practices

August 1, 2012 Comments off

Chronic Pain and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine

Millions of Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions, and headache costs U.S. businesses more than $61 billion a year in lost worker productivity.

Pain is the most common health problem for which adults use complementary health practices. Many people with conditions causing chronic pain turn to these practices to supplement other conventional medical treatment, or when their pain is resistant or in an effort to advert side effects of medications. Despite the widespread use of complementary health practices for chronic pain, scientific evidence on efficacy and mechanisms—whether the therapies help the conditions for which they are used and, if so, how—is, for the most part, limited. However, the evidence base is growing, especially for several complementary health practices most commonly used by people to lessen pain.

This issue highlights the research status for several therapies used for common kinds of pain, including arthritis, fibromyalgia, headache, low-back pain, and neck pain.

Women and the Risk of Disability: Insights from a Landmark Study by The State Farm® Center for Women and Financial Services at The American College

May 9, 2012 Comments off
The majority of Americans lack basic knowledge about the likelihood of a disability and are unprepared to handle this kind of life-changing event.  These gaps put families and financial futures in jeopardy, according to a new study released today by The State Farm® Center for Women and Financial Services at The American College, the nation’s leading authority on economic issues and opportunities for American women.
The risk of becoming disabled during one’s lifetime is higher than most people realize, particularly for women. The U.S. Social Security Administration estimates that one in four of today’s 20-year-olds will become disabled before they retire. Data from the Centers for Disease Control and Prevention (CDC) shows that women are increasingly more likely to experience a disabling condition during their working and senior years. The study from The State Farm Center for Women and Financial Services at The American College found a majority of Americans (97 percent) do not know arthritis is the leading cause of disability and few (20 percent) are aware of women’s increased risks. In fact, more than 30 percent of survey respondents believe accidents are the leading cause of disability.

Hat tip: PW

Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial

March 16, 2012 Comments off

Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial
Source: PLoS ONE

Background
In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.

Methods
We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.

Results
WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3–32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1–12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.

Conclusion
Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.

AHRQ — Just Released — Analgesics for Osteoarthritis

February 16, 2012 Comments off

Analgesics for OsteoarthritisSource: Agency for Healthcare Research and Quality

As an update to a 2006 report, a systematic review of 273 clinical studies published between January 2005 and January 2011 examined the comparative effectiveness, benefits, and adverse effects of analgesics and the supplements glucosamine and chondroitin for osteoarthritis. The review did not include studies on opioid medications or nonpharmacological interventions for osteoarthritis. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/analgesicsupdate.cfmwww.effectivehealthcare.ahrq.gov/analgesicsupdate.cfm. This summary, based on the full report of research evidence, is provided to inform discussions with patients of options and to assist in decisionmaking along with a patient’s values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

State-Specific Prevalence of No Leisure-Time Physical Activity Among Adults With and Without Doctor-Diagnosed Arthritis — United States, 2009

December 10, 2011 Comments off

State-Specific Prevalence of No Leisure-Time Physical Activity Among Adults With and Without Doctor-Diagnosed Arthritis — United States, 2009
Source: Morbidity and Mortality Weekly Report (CDC)

The prevalence of no leisure-time physical activity (LTPA) among U.S. residents decreased from 31% in 1989 to 25% in 2002 and was still at 25% in 2008, based on Behavioral Risk Factor Surveillance System (BRFSS) data. Further reduction in the prevalence of no LTPA among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis. Approximately 50 million adults have arthritis, the majority of whom have arthritis-specific barriers to being physically active, such as pain and fear of making their arthritis worse (1,2). Despite the known benefits of physical activity for arthritis (e.g., reduced pain), persons with arthritis are more likely to report no LTPA (3–5). To assess state-specific prevalence of no LTPA among adults with and without doctor-diagnosed arthritis, CDC analyzed BRFSS data from 2009. This report summarizes the results of that analysis, which found that among adults with arthritis 1) prevalence of no LTPA is significantly higher compared with adults without arthritis in every state and the District of Columbia (DC), 2) the disparity in prevalence of no LTPA between adults with and without arthritis is large (median: 53% disparity gap), 3) 23 (45%) states had an age-standardized prevalence of no LTPA ≥30.0%, and 4) adults with arthritis reporting no LTPA comprised a substantial proportion (median: 35.2%) of all adults reporting no LTPA in each state. To reduce the prevalence of no LTPA among all adults, physical activity promotion initiatives should include interventions such as targeted health communication campaigns and community-based group exercise programs proven safe and effective for adults with arthritis.

Arthritis and Osteoporosis in Australia: A Snapshot, 2007-08

August 5, 2011 Comments off

Arthritis and Osteoporosis in Australia: A Snapshot, 2007-08
Source: Australian Bureau of Statistics

Arthritis and osteoporosis are leading causes of pain, disability and illness. Arthritis and musculoskeletal conditions accounted for 4% of the disease burden in Australia in 2007-08. These conditions place a large financial cost on the health care system, accounting for 7.5% ($4.0 billion) of total allocated health expenditure in 2004-05. This was the fourth highest rate of expenditure, behind cardiovascular disease ($5.9 billion), oral health ($5.3 billion) and mental disorders ($4.1 billion) (AIHW 2010). In 2007-08 there were 421,000 hospitalisations due to musculoskeletal conditions (AIHW 2010).

Arthritis is a long-term condition marked by inflammation of the joints which often causes pain, stiffness, and disability. The most common forms of arthritis are:

  • Osteoarthritis: a degenerative condition caused by wear of the cartilage which overlies the ends of the bones in a joint. Its main symptoms are joint pain, swelling and stiffness.
  • Rheumatoid arthritis: an inflammatory autoimmune disease which can affect many organs of the body as well as the joints. It can cause joint pain and swelling, often leading to deformity and disability.

Osteoporosis is a condition where a loss of bone density and decreased strength of the skeleton results in an increased risk of fracture. The prevalence of osteoporosis is thought to be underestimated in Australia because, due to its lack of signs and symptoms, it often goes undiagnosed until a fracture occurs. Fractures as a result of trauma that would not cause normal bone to break, for example falls from standing height or minor bumps, are often the first sign of osteoporosis. The risk of further fractures increases with each fracture. Osteoporotic fractures, especially hip and pelvic fractures, are associated with an increased risk of death in following years. About 24% of people who sustain a hip fracture are estimated to die in the following 12 months (AIHW 2008, 2011).

Arthritis and musculoskeletal disease was identified as either an underlying or associated cause of death for 6,400 (4.6%) deaths registered in 2009. Of all deaths due to arthritis or musculoskeletal disease in 2009, 71% were females (ABS Causes of Death, 2009).

Arthritis as a Potential Barrier to Physical Activity Among Adults with Obesity — United States, 2007 and 2009

May 19, 2011 Comments off

Arthritis as a Potential Barrier to Physical Activity Among Adults with Obesity — United States, 2007 and 2009
Source: Morbidity and Mortality Weekly Report (CDC)

Adults with obesity are less likely than adults without obesity to follow physical activity recommendations, despite the known benefits of physical activity for weight loss and weight maintenance (1,2). Arthritis is a common comorbidity of adults with obesity (3), and arthritis-related joint pain and functional limitation might contribute substantially to low rates of physical activity among adults with obesity. CDC analyzed combined 2007 and 2009 Behavioral Risk Factor Surveillance System (BRFSS) data for adults aged ≥18 years to estimate overall and state-specific prevalence of 1) self-reported doctor-diagnosed arthritis among adults with self-reported obesity, and 2) prevalence of self-reported physical inactivity among adults with obesity by arthritis status. This report describes the results of that analysis, which indicted that, overall, arthritis affected 35.6% of adults with obesity. After adjusting for age, sex, race/ethnicity, and education level, adults with obesity and arthritis were 44% more likely to be physically inactive compared with persons with obesity but without arthritis. Among states, the median prevalence of arthritis among adults with obesity was 35.6%. In every state/area except Guam, the prevalence of physical inactivity among adults with obesity was at least 5 percentage points higher (range: 5.4–15.9 percentage points) among persons with arthritis than those without arthritis. Arthritis might be a special barrier to increasing physical activity among many adults with obesity. Safe and effective self-management education and physical activity programs for adults with arthritis exist to address this barrier, are offered in many communities, and can help adults with obesity and arthritis become more physically active.

Prevalence of Obesity Among Adults with Arthritis — United States, 2003–2009

April 29, 2011 Comments off

Prevalence of Obesity Among Adults with Arthritis — United States, 2003–2009
Source: Morbidity and Mortality Weekly Report (CDC)

Obesity and arthritis are critical public health problems with high prevalences and medical costs. In the United States, an estimated 72.5 million adults aged ≥20 years are obese, and 50 million adults have arthritis. Medical costs are estimated at $147 billion for obesity and $128 billion for arthritis each year (1–3). Obesity is common among persons with arthritis (2) and is a modifiable risk factor associated with progression of arthritis, activity limitation, disability, reduced quality-of-life, total joint replacement, and poor clinical outcomes after joint replacement (4,5). To assess obesity prevalence among adults with doctor-diagnosed arthritis, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for the period 2003–2009. This report summarizes the results of that analysis, which determined that, among adults with arthritis, 1) obesity prevalence, on average, was 54% higher, compared with adults without arthritis, 2) obesity prevalence varied widely by state (2009 range: 26.9% in Colorado to 43.5% in Louisiana), 3) obesity prevalence increased significantly from 2003 to 2009 in 14 states and Puerto Rico and decreased in the District of Columbia (DC), and 4) the number of U.S. states with age-adjusted obesity prevalence ≥30.0% increased from 38 (including DC) in 2003 to 48 in 2009. Through efforts to prevent, screen, and treat obesity in adults, clinicians and public health practitioners can collaborate to reduce the impact of obesity on U.S. adults with arthritis.

Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Effects Among Hispanic Adults, by Hispanic Subgroup — United States, 2002, 2003, 2006, and 2009

February 17, 2011 Comments off

Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Effects Among Hispanic Adults, by Hispanic Subgroup — United States, 2002, 2003, 2006, and 2009
Source: Morbidity and Mortality Weekly Report (CDC)

Arthritis affects approximately 50 million adults in the United States, making it one of the most prevalent health conditions among U.S. adults and the most common cause of disability (1). Arthritis is associated with substantial activity limitation, work disability, increased prevalence of obesity, reduced quality of life, and high health-care costs (1–3). Among U.S. adults, the prevalence of arthritis and arthritis-attributable effects (e.g., arthritis-attributable activity limitations [AAAL]) varies among racial/ethnic groups; non-Hispanic whites and non-Hispanic blacks have a higher prevalence of doctor- diagnosed arthritis compared with Hispanics, but Hispanics and non-Hispanic blacks have a higher prevalence of arthritis-attributable effects compared with non-Hispanic whites (1,2). The prevalence of arthritis and its effects among specific Hispanic subgroups has not been studied in a nationally representative sample of U.S. adults. To determine the annualized prevalence of arthritis and arthritis-attributable effects among Hispanic subgroups, CDC analyzed National Health Interview Survey (NHIS) data for 2002, 2003, 2006, and 2009 combined. This report describes the results of that analysis, which indicated that the age-adjusted prevalence of arthritis ranged from 11.7% among Cubans/Cuban Americans to 21.8% among Puerto Ricans; an estimated 3.1 million Hispanics had arthritis during these years. Among all subgroups of Hispanics with arthritis, at least 20% of persons with arthritis reported an arthritis-attributable effect: AAAL (range: 21.1% among Cubans/Cuban Americans to 48.5% among Puerto Ricans); arthritis-attributable work limitations (AAWL) (range: 32.9% among Central/South Americans to 41.6% among Mexican Americans); and severe joint pain (SJP) (range: 23.7% among Cubans/Cuban Americans to 44.1% among Puerto Ricans). These findings identify Hispanic subgroups with high burdens of arthritis who likely are in need of interventions designed to improve their quality of life.

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