In The News: August 2018
Chiropractic Care Effective for Low Back Pain
Low back pain is a common problem and a leading cause of disability. A variety of treatments are used to address it. Recent guidelines from the American College of Physicians recommend nondrug treatment first, including heat, massage, acupuncture and spinal manipulation by a chiropractor or other healthcare provider. Findings from a study published in JAMA Network Open (May 2018) back up the effectiveness of spinal manipulation. The study included 750 active-duty service members aged 18 to 50 with low back pain. Half of them received usual medical care, including medications, physical therapy and referral to a pain clinic. The other half also received up to 12 visits with a chiropractor for spinal manipulation and other therapies. After six weeks, the group receiving usual care plus chiropractic care had greater improvements in lowering pain intensity and disability than those getting usual care alone.
Too Few Doctors Counsel Arthritis Patients about Weight Loss
Over 54 million adults in the United States have arthritis, and about one-third of them are overweight or obese. (Overweight is a body mass index [BMI] of 25 to 29, and obesity is 30 or more.) Carrying excess weight increases risk for arthritis and can make symptoms worse. People who receive counseling about weight loss from a healthcare provider are about four times more likely to attempt to lose weight than those who don’t receive it. A study published in the Morbidity and Mortality Weekly Report (May 2018) analyzed data from the National Health Interview Survey and found that weight-loss counseling increased about 10 percent from 2002 to 2014. However, about 75percent of adults who are overweight and 50 percent of those who are obese are still not getting help with weight loss.
FDA Approves New Drug for Rheumatoid Arthritis
The Food and Drug Administration (FDA) approved a new drug for the treatment of moderate-to-severe rheumatoid arthritis. The drug, baricitinib (Olumiant®), is a type of drug called a Janus kinase inhibitor, which works by inhibiting the inflammatory mechanism inside cells. The approval was based on data from a study published in Rheumatology (May 2018), which compared the drug at two doses with placebo in 527 people with rheumatoid arthritis who failed to get an adequate response with one of the anti-TNF drugs (which include adalimumab [Humira®], certolizumab [Cimzia®], etanercept [Enbrel®], golimumab [Simponi®] and infliximab [Remicade®]). Patients who received baricitinib had a significantly greater response and symptom relief than those on placebo. Because of troubling adverse effects with the higher dose of the drug, the FDA approved the drug only at the lower 2-mg dose. Olumiant is taken as a pill.
Risk for Bone Fracture Increases during Drug Holidays
People who take a bisphosphonate drug (alendronate [Fosamax®], risedronate [Actonel®], ibandronate [Boniva®] or zoledronic acid [Reclast®]) for osteoporosis may be told to stop it temporarily after a few years to lower the risk for rare side effects, such as an atypical thigh bone fracture. A study published in the Journal Endocrine Practice (February 2018) found that stopping these drugs for too long can increase the chances for more common bone fractures. The researchers reviewed the medical records of 401 people who were on a bisphosphonate drug and stopped it for a period of time (adrug holiday). About 15 percent of them had a bone fracture during the drug holiday. The incidence of fractures increased over time, with the most occurring during the fourth and fifth years of the drug suspension. The researchers recommended more careful analysis of fracture risk and shorter drug holidays for some people.