In The News: June 2011
RA Inflammation Linked to Coronary Artery Plaque Buildup
A new study shows that systemic inflammation may contribute to the progression of atherosclerosis—the buildup of plaque in artery walls—in people with rheumatoid arthritis (RA). The data, released during a recent meeting of the American College of Rheumatology, also shows that the progression may be modified favorably by TNF inhibitors and adversely by glucocorticoids. The increased incidence of atherosclerosis in RA patients is known. However, few studies have explored the predictors of atherosclerosis change in RA patients. In this study, researchers followed 158 people with RA, monitoring the thickness of their artery walls. After undergoing an ultrasound, the thickness of common-artery walls was found to increase over time in 82 percent of the patients, and the thickness of internal-carotid artery walls (those that supply blood to the head and neck) was found to increase in 70 percent of the participants. Researchers also found that those who used an anti-TNF treatment at the beginning of the study had a 37 percent lower rate of progression of the thickness of the common carotid artery. After examining the thickness in the internal-carotid artery walls, exposure to the glucocorticoid prednisone was found to be the only feature associated with the progression of atherosclerosis. The next step, said researchers, will be to randomize patients to receive one medication or another to determine the relationship between the medications and progression of atherosclerosis.
Rinsing Seen as Inexpensive Means of Preventing Post-Op Infection
Rinsing with betadine, which costs little more than a dollar per patient, may reduce the infection rate following a total knee or hip replacement. Researchers at Chicago’s Rush University Medical Center found that a three-minute diluted betadine rinse combined with painting patient’s skin with a 10 percent betadine solution prior to surgical closure nearly eliminated early infection. Post-op infection was diagnosed in 18 out of the 1,862 cases performed prior to the initiation of the betadine-rinse procedure, and in only one of the 688 total joint replacements following the betadine rinse, a reduction in the infection rate from 0.97 percent to 0.15 percent.
Vitamin D Supplements May Not Benefit Knee OA Pain
Taking a vitamin D supplement does not appear to reduce the symptoms, or slow the progression, of knee osteoarthritis (OA), according to research presented during a meeting of the American College of Rheumatology. Previous studies have suggested that vitamin D—which promotes the absorption of calcium needed for bone growth and repair—may reduce the progression of knee OA. Researchers studied 146 people with symptoms of knee OA to determine if vitamin D supplements would be effective in treating the disease. Participants were divided evenly into two groups—the first assigned to a placebo, the second to taking 2,000 IU of vitamin D daily, which was raised over the course of the study to help each subject achieve a vitamin D level higher than 30 ng/ml (nanograms per milliliter). After performing physical function tests and taking X-rays of each participant at the beginning of the study and at 24 months, no substantial differences were found between the two groups. Although the study’s authors concluded there was no benefit from vitamin D supplementation, they did encourage patients to talk with their rheumatologists to determine the best course of treatment.
High-Volume Hospitals Best for Orthpaedic Surgery
Patients who undergo orthopaedic surgeries at high-volume regional hospitals experience better results and fewer complications than those receiving surgeries at local hospitals. Researchers at the Hospital for Special Surgery (New York) analyzed more than 974,000 patients in 13 states. They found significant differences in rates of infection, depending on whether patients had surgery at a local or regional hospital. "More and more, patients consider healthcare a commodity, viewing medical centers as interchangeable," said the study’s authors. "Our analysis shows that high-volume centers, which have extensive orthopaedic experience, offer high-quality surgeries and better recovery periods for patients."