News November 2013 Issue

In The News: November 2013

Shoe Inserts Offer No Relief for Knee OA
Lateral wedge shoe insoles did not appear to ease medial osteoarthritis (OA) knee pain beyond a placebo effect, according to a meta-analysis study published in the Journal of the American Medical Association (Aug. 21, 2013). While the orthotics displayed benefit compared with controls overall (the equivalent of 2.12 fewer points on the 20-point Western Ontario and McMaster Universities Arthritis Index, or WOMAC pain scale), the effect was largely seen in studies with a higher risk of bias from using regular shoes without inserts as a control. The meta-analysis included 12 randomized, controlled trials with a total of 885 participants who received lateral wedge treatment (insoles in all but one, which used shoes with variable stiffness sole) for medial knee OA. Yet, a previous study published in the Archives of Physical Medicine and Rehabilitation (July 2002) did show that compared with no insole, wearing either a five degrees or 10 degrees wedge insole is effective in reducing the varus torque (or impact) during walking. This research implies that wedged insoles are biomechanically effective and should reduce loading of the medial compartment in those with medial knee OA.

Omega-3s Shown to Protect Against RA
Adding fatty fish to a woman’s diet appears to protect against rheumatoid arthritis (RA), results of a large cohort study showed. By regularly consuming a diet rich in omega-3 fatty acids, the odds of RA over the short term were reduced by 35 percent. Long-term intake of the fatty acids found in salmon and other fatty fish equated to more than a 50 percent risk reduction. Consuming at least one serving of any fish weekly reduced the risk of RA by almost 30 percent, although the impact did not reach statistical significance, the study’s authors reported online in the Annals of Rheumatic Diseases (Aug. 14, 2013). This study indicates a potentially important role for dietary long-chain omega-3 polyunsaturated fatty acids (PUFAs) in the etiology of RA, and that adherence to existing dietary guidelines regarding fish consumption may also be beneficial in terms of RA risk.

Drug Mixture Benefits RA Treatment
Rheumatoid arthritis (RA) not adequately controlled by conventional disease-modifying anti-rheumatic drugs (DMARDs) was aided with the addition of tofacitinib (Xeljanz®), according to the ORAL Sync trial. Tofacitinib elevated the proportion experiencing at least a 20 percent improvement in their disease per the American College of Rheumatology criteria (ACR20) by 21 to 26 percent over placebo when added to nonbiologic treatments, reports the study published in the Annals of Internal Medicine (Aug. 20, 2013). The trial included 792 patients with active RA despite nonbiologic DMARD treatment, who received either five mg or 10 mg tofacitinib twice daily or placebo, and advanced to active drug at month six (or earlier if no response at month three). Tofacitinib, a Janus kinase inhibitor, is the first oral biologic to receive approval by the Food and Drug Administration (FDA) for use in active RA patients. The current cost for monthly treatment is $2,000.

Broccoli Battles OA’s Inflammation
The cruciferous vegetable broccoli contains substances that may battle inflammation caused by osteoarthritis (OA), according to a study published in the journal Arthritis & Rheumatism (Aug. 28, 2013). The research first studied broccoli’s impact in mice, and found that the animals eating a diet high in the sulforaphane found in broccoli had significantly less cartilage damage and signs of OA compared to mice who did not consume sulforaphane. Next, the team studied human and cow cartilage cells, finding that sulforaphane was equally effective in protecting these cells from damage. The sulfur-based compound may block enzymes that contribute to inflammation in cartilage. Additional research is underway in a small group of total knee replacement patients to examine broccoli’s benefits.