News April 2019 Issue

In The News: April 2019

Starting Physical Therapy Early May Curb Use of Opioids

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Getting physical therapy early for musculoskeletal pain was associated with a reduction in long-term opioid use in a study published in JAMA Network Open (December 2018). Opioids are powerful pain medications, but they should be used cautiously due to the potential for addiction. Nondrug methods, such as physical therapy, can be effective for musculoskeletal pain. For the study, researchers analyzed health insurance claims data from 2007 to 2015 on about 89,000 adults with conditions causing shoulder, neck, knee or low back pain. Close to 30 percent of them received at least one physical therapy session within three months of a diagnosis. This was associated with an approximately 10 percent reduction in the number of opioid users three months to one year later. Among those who took opioid drugs, early physical therapy resulted in about a 10percent reduction in the amount of the drug used.

Weight Loss Improves Psoriatic Arthritis

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Psoriatic arthritis is a type of arthritis that affects up to one-third of people who have the autoimmune skin disease psoriasis. People with psoriatic arthritis who are obese tend to have worse symptoms, and medications are not as effective as they are for people of normal weight. A study published in Arthritis Research & Therapy (January 2019) examined the effects of weight loss on 46 obese adults who were being treated for psoriatic arthritis. They were put on a very low-energy diet of 640 calories a day for 12 to 16 weeks, followed by a less restrictive but still low-calorie diet. Participants lost an average of 18.6 percent of their body weight. Weight loss was associated with significant improvements in joint symptoms, pain, fatigue and overall health. Larger weight loss resulted in greater improvement.

Hormone Therapy Linked to Reduced Risk for Knee Osteoarthritis

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It has been hypothesized that osteoarthritis in postmenopausal women may have some connection to decreasing estrogen levels after menopause. With osteoarthritis, the cushioning cartilage that covers the ends of bones in joints deteriorates, which can cause inflammation, pain and stiffness. At high levels, estrogen has anti-inflammatory effects. Small studies examining a possible protective effect of estrogen against osteoarthritis have produced mixed results. A large study, published in the journal Menopause (December 2018), supports a potential relationship. The researchers analyzed health data on 4,766 postmenopausal women from the Korea National Health and Nutrition Examination Survey from 2009 to 2012. Past and current users of hormone replacement therapy for one year or more were significantly less likely to develop knee osteoarthritis than postmenopausal women who did not take hormones. More research is needed to confirm these findings.

Only One-Third of People with Gout Receive Long-Term Drug Therapy

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Gout is a form of arthritis that causes intermittent attacks of red, swollen and painful joints. It originates from high levels of a substance in the body called uric acid, which can settle in joints and form needle-shaped crystals that lead to the gout attacks. Data from the National Health and Nutrition Examination Survey (NHANES) on 5,467 adults in the United States showed that the rate of gout remained stable from 2007 to 2016 at close to 4 percent, which translates to about 9 million Americans. The prevalence of gout had doubled from the 1960s to the 1990s, but now seems to be remaining steady. Researchers who analyzed the data reported their findings in Arthritis & Rheumatology (January 2019). They also found that only about one-third of people with gout receive long-term therapy with drugs that lower uric acid levels.

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