News May 2006 Issue

In the News: 05/06

Low-Dose Prednisone Increases Pneumonia Risk

Despite the long-held belief that low-dose prednisone, taken to relieve the pain of rheumatoid arthritis (RA), is safe, a new study has discovered a relationship between prednisone use and pneumonia risk. Researchers at the National Data Bank for Rheumatic Disease studied 16,788 RA patients once every six months for three and a half years. After adjustment for other variables believed to contribute to pneumonia risk (diabetes, pulmonary disease, myocardial infarction), a prednisone dose of 5mg or less per day was seen to increase the risk of pneumonia by 70 percent. Patients on higher doses, researchers found, faced even greater risk. 

The study, whose results were reported in the journal Arthritis & Rheumatism, also tracked the effects of other RA treatments. No risk was seen for tumor necrosis factor therapy, methotrexate, or sulfasalazine, but leflunomide was found to be associated with a 20 percent increase in pneumonia risk. 

Despite their findings, researchers agreed that the study did not address the net benefit of prednisone use. “It is possible,” said the study’s authors, “that discontinuing prednisone, or not using prednisone in the first place, might prove to have equally undesirable effects.”   

----------

Acupressure: Better Than PT For Back Pain?

Researchers in Taiwan have found that acupressure—applying pressure with the fingertips to parts of the body stimulated by acupuncture—produces an 89 percent reduction in back pain and disability compared with physical therapy. The study, conducted by a research team at the Institute of Preventive Medicine at Taiwan University and reported online by the British Medical Journal (BMJ), consisted of 129 patients who were broken into two treatment groups, 65 receiving six sessions of physical therapy and 64 receiving six sessions of acupressure. Results were examined right after treatment and again at six months. At six months, pain improvement was still favorable.

The researchers admitted to limitations in their study: 15 percent of the patients were lost to follow-up, and practitioner skills were considered not to be universal (to avoid differences in practitioner techniques, the study used only one therapist). Said lead researcher Dr. Lisa Li-Chen Hsieh, “The effectiveness of any manipulation therapy is highly dependent on the therapist’s experience...but we hope this technique will be adopted by other therapists now that its efficacy has been shown.” 

----------

Spine Repair May Cause Other Fractures

Vertebroplasty, a procedure in which medical cement is injected into compression fractures in the spinal vertebrae, has been hailed by patients suffering from osteoporosis for not only significantly reducing pain but also for dramatically increasing their ability to function. In fact, a recent American Journal of Neuroradiology study confirmed that, among 113 patients who had undergone vertebroplasty, pain and activity scores improved significantly one week after treatment and remained favorable for one year following the procedure. That’s the good news.

The not-so-good news, as revealed in an even more recent study in the American Journal of Neuroradiology, is that vertebroplasty appears to increase the risk of new fractures in adjacent vertebrae. The study also found that vertebrae adjacent to fractures treated with vertebroplasty fracture sooner than do non-adjacent vertebrae. An analysis of 432 patients previously treated with vertebroplasty showed that 186 fractures occurred following the procedure in 86 patients, and 77 of the fractures were located in vertebrae adjacent to the treated vertebrae. Researchers also found that patient risk for new fractures in adjacent vertebrae presented 4.62 times the risk for non-adjacent fractures. In addition, new fractures occurred in adjacent vertebrae an average of 55 days following vertebroplasty for adjacent fractures and 127 days for non-adjacent fractures.

Researchers speculate that the propensity for other vertebrae to fracture may be due to the overall cushioning effect of the spine, where stiffening one part puts greater stress on another. They also speculate that adjacent fractures may be due to the biomechanics of the spine being disturbed by introducing cement, or to the type of cement that is used. If the latter, the study’s authors recommended the development of cements that are friendlier to the spine.