In The News: October 2018
Rheumatoid Arthritis Sufferers Often Don’t Reveal Supplement Use
About half of all people with rheumatoid arthritis use natural supplements, such as fish oil, glucosamine, chondroitin and vinegar. A study published in Arthritis Care & Research (July 2018) found that most don’t tell their doctors. The researchers analyzed results from 23 studies and found that 47 percent of people with rheumatoid arthritis used natural supplements that were not vitamins or minerals. They were usually taken along with prescribed medication for rheumatoid arthritis. Forty-seven percent of people found the supplements to be effective, and 13 percent reported adverse side effects. Only 30 percent of them informed their physicians they were taking supplements. It’s important to discuss everything you take with your doctor. Even something that is “natural” may have side effects or harmful interactions with drugs.
Nondrug Therapies Underutilized for Osteoarthritis
There’s not one single treatment for osteoarthritis. Instead, a combination of nonsurgical treatments and lifestyle measures are recommended, with joint replacement a last resort. Osteoarthritis occurs when cartilage (which covers the ends of bones in joints) wears down. This can cause pain, swelling and stiffness in the joint. A study published in Arthritis Care & Research (August 2018) analyzed data from three clinical trials with a combined 1,210 people with hip or knee osteoarthritis. Use of pain medication (such as nonsteroidal anti-inflammatory drugs, acetaminophen and opioids) was reported by 70 to 82 percent of study participants. Physical therapy was used by 39 to 52 percent, knee injections by 55 to 60 percent, and topical creams by 25 to 39 percent. Although nondrug therapies, particularly physical therapy, have been shown to decrease pain and improve function, the researchers concluded that they are underutilized.
Opioid Use before Joint Replacement Raises Risk for Complications
People who undergo joint replacement surgery are at greater risk for postoperative complications if they were taking opioid pain medication for more than 60 days before the surgery, according to a study published in The Journal of Bone & Joint Surgery (July 2018). The researchers reviewed data from private insurance and Medicare on over 324,000 people who underwent hip or knee replacement surgery between 2003 and 2014. One year after surgery, about 1 percent of knee replacement patients who had not used opioids before surgery required revision surgery, compared to about 2 percent of patients who had taken opioids for more than 60 days before surgery. After three years, these numbers were 2.58 percent and 5 percent. Numbers for total hip replacement were similar. In addition, people who did not take opioids before surgery were less likely to be readmitted to the hospital for complications after surgery.
Rheumatoid Arthritis Drugs May Decrease Blood Pressure
People with rheumatoid arthritis face an increased risk for heart disease and also for high blood pressure. There may be some good news. A study published in the Journal of Clinical Rheumatology (June 2018) found that blood pressure was modestly reduced in people taking disease-modifying antirheumatic drugs (DMARDs). The researchers analyzed data on over 21,000 patients with rheumatoid arthritis who were started on methotrexate, leflunomide, sulfasalazine, hydroxychloroquine or tumor necrosis factor inhibitors. There were no changes in blood pressure before starting a DMARD. During the six months after beginning the drug, both systolic (the top number) and diastolic (the bottom number) blood pressure decreased. The effect was greatest in those taking methotrexate or hydroxychloroquine. Blood pressure increased among those taking leflunomide. The reasons for the effect on blood pressure are not entirely known.