News March 2014 Issue

In The News: March 2014

Rheumatoid Arthritis Patients Fare Better Than Decades Ago
A diagnosis of rheumatoid arthritis (RA) is not as disabling as it was 20 years ago, researchers reported online in Arthritis Care & Research (Dec. 3, 2013). The study found that about half as many people were considered disabled after the first four years of RA treatment in 2011, compared to 1990. The study analyzed data on 1,151 people diagnosed with RA between 1990 and 2011 between the ages of 17 and 86 years old. When assessing patients diagnosed with RA in the 1990s, more than 50 percent had significant disability. In contrast, only 31 percent were disabled four years after diagnosis in 2011. The improvement in rates of disability corresponded with the advent of potent biologic medications for RA, which has been shown to slow or prevent disease progression.

MoM Hip Resurfacing: Offering a Potential Advantage?
Patients with hip osteoarthritis (OA) who had metal-on-metal (MoM) hip resurfacing were half as likely to die from any cause compared to those undergoing cemented or uncemented total hip replacement, according to a study published in The BMJ (Nov. 27, 2013). In a retrospective cohort study, 10-year cumulative mortality was 3.6 percent for MoM compared to 6.1 percent for cemented joints and 3 percent for MoM in a different cohort versus 4.1 percent for uncemented joints. Each patient who underwent MoM hip resurfacing was matched to three comparable controls that totaled separately more than 15,500 for the MoM group and over 46,000 for the hip replacement recipients. Approximately 60 percent of all deaths in the study were due to either cancer or ischemic heart disease. Its important to note the retrospective nature of this study, explains Cleveland Clinic orthopaedic surgeon Robert Molloy, MD. An attempt was made to control for confounding variables; however, in a retrospective, observational study this is not entirely possible. In addition, there are other limitations of this study that hinder the generalizability of this study. Further study, preferably in a prospective, randomized, fashion is needed.

Platelet-Rich Plasma Support Emerges
New research offers guidance as to the effectiveness of platelet-rich plasma (PRP) injections for injuries and arthritic joints. The paper, published in the Journal of the American Academy of Orthopaedic Surgeons (Dec. 12, 2013), offers the first evidence-based recommendations for use of PRP in orthopaedic care. The research concludes that current evidence supports PRP as a treatment for conditions including arthritis in the ankle and tennis elbow, and that injecting PRP during ACL reconstruction contributes to healing. Regarding use of PRP for osteoarthritis (OA) of the knee, the authors were encouraged by early research, but recommended further study. Additional study was also suggested regarding use for Achilles tendon repair, rotator cuff injuries and other chronic tendinopathies aside from the elbow. PRP is not beneficial in bone healing applications, the authors concluded. PRP injections are not covered by most insurance plans, due to lack of evidence supporting their use.

Support for Surgery for Herniated Discs
A new study suggests that surgery is a better treatment for herniated discs in the lumbar spine region than non-invasive options. In the study, published in the journal Spine (Dec. 31, 2013), researchers assessed data on 1,244 patients involving approximately 500 patients undergoing discectomy to those who chose non-surgical interventions such as physical therapy, exercise and pain medication. Pain scores were about 11 points lower on a 100-point scale for patients who underwent surgery, with the benefits of surgery peaking within six months and lasting eight years. However, the study indicates that both surgical and non-surgical treatments led to similar improvements in physical function, patient satisfaction and self-rated improvement as well as relief of sciatica-related leg pain.