Brisk Walks May Help, Not Harm, Arthritic Knees

Brisk Walks May Help, Not Harm, Arthritic Knees

If you suffer from knee arthritis and worry that walking will only worsen your damaged joint, a new study suggests you put your fears aside, slip on some sneakers, and take a brief but brisk walk.

The researchers estimated that if older adults with the condition added just 5 minutes of brisk walking to their day, their odds of needing knee replacement surgery could dip by 16 percent.

On the other hand, light walking — akin to a “stroll” — may have no impact, said lead researcher Hiral Master, a Ph.D. candidate in biomechanics and movement sciences at the University of Delaware.

Her team reached those conclusions by digging into data from over 1,800 older adults with knee arthritis who wore portable devices that tracked their walking intensities for at least four days.

Over the next five years, 6 percent of the participants had total knee replacement surgery.

The researchers used the data on people’s walking habits to examine the effects of replacing “non-walking” time with time spent walking at different intensities. The findings showed that substituting just 5 minutes of down time with moderate-to-high intensity walking was linked to a 16 percent decline in the odds of needing knee replacement surgery.

The study authors defined “moderate-to-high” intensity as more than 100 steps per minute. In laymen’s terms, Master said, that’s a “brisk” walk that gets your heart rate up — not a stroll around the block.

The findings were presented Saturday at the American College of Rheumatology’s annual meeting, in Chicago. Such research should be considered preliminary until published in a peer-reviewed journal.

Knee osteoarthritis develops when the cartilage cushioning the joint gradually breaks down, which can eventually result in bone scraping on bone.

The condition is common among middle-aged and older Americans. According to the Arthritis Foundation, up to 13.5 percent of men and 19 percent of women aged 45 and older have knee arthritis that’s severe enough to cause pain and other symptoms.

And those patients often wonder whether walking is good or bad for their arthritic joints, said Dr. Paul Sufka, a rheumatologist at the University of Minnesota, in Minneapolis.

“They often ask whether they should minimize their activity, keep doing what they’re doing, or intensify,” said Sufka, who is also with the American College of Rheumatology’s communications committee.

“The general advice we give to patients is to stay active,” Sufka said. But, he added, the truth is there is too little evidence to give patients definitive recommendations.

The new findings do not prove that brisk walking directly lowers the risk of needing knee replacement surgery, Sufka noted.

But, “this gives us some useful information to bring to the discussion,” he added.

Overall, Sufka said, research does suggest it’s better for people with knee arthritis to be active rather than sedentary. And that’s not just for the sake of their knees. Physical activity has a range of health benefits, including lower risks of heart attack and stroke.

Master agreed, and pointed out that exercise can help arthritis patients’ mental well-being, as well as physical.

And it doesn’t take a huge lifestyle change, she explained. The new findings suggest people can benefit from adding a short, brisk walk to their day.

In fact, Sufka said, such incremental shifts may be best.

“The best exercise program is the one you can actually stick with,” he said. “If right now, you’re walking around the block every day, what would be 5 percent or 10 percent more than that? You can gradually build from where you are.”

And what if walking is painful? That’s a tricky question, Sufka acknowledged. Some patients might benefit from physical therapy rather than only exercising on their own, he said.

Beyond aerobic exercise like walking, strengthening exercises for the leg muscles supporting the knees can also be helpful, he suggested.

More information

The Arthritis Foundation has an overview on knee arthritis.

SOURCES: Hiral Master, P.T., M.P.H., Ph.D. candidate, biomechanics and movement sciences, University of Delaware, Newark, Del.; Paul Sufka, M.D., assistant residency director, internal medicine residency program, University of Minnesota, Minneapolis, and member, communications and marketing committee, American College of Rheumatology; Oct. 20, 2018 presentation, American College of Rheumatology annual meeting, Chicago

Seniors, Take Steps to Reduce Your Risk of Falling

Seniors, Take Steps to Reduce Your Risk of Falling

TUESDAY, Oct. 9, 2018 (HealthDay News) — One in four Americans 65 and older falls each year, with some ending up in hospitals or even dying. But new research suggests that it’s possible to avoid some of these serious injuries.

When seniors who are at risk of falling have a prevention plan, they’re less likely to suffer a tumble-related hospitalization, the study found.

“We saw statistically significant change that reduced fall risk in people at risk of falls to almost the same as those who weren’t at risk of a fall [at the start of the study],” said the study’s lead author, Yvonne Johnston, an associate professor at the Binghamton University School of Nursing in New York.

“Considering the cost of one hospitalization for fall, avoiding just one hospitalization compared to the cost of the program makes it a worthwhile program,” she noted.

In 2014, 29 million older adults reported a fall, and 7 million of those resulted in an injury, according to the study. Johnston said that many falls go unreported, so these numbers may underestimate the extent of the problem.

In 2016, falls were responsible for 29,000 deaths in the United States, the study authors said. Medical costs related to falls may be as much as $50 billion.

The current study looked at a U.S. Centers for Disease Control and Prevention fall prevention initiative. It included screening to identify older people who are at risk of falling. This assessment looked at vision problems, low blood pressure, medications, home hazards and functional ability such as leg strength.

The initiative also included interventions such as a strength and balance program, medication changes, corrective eyewear and occupational therapy.

For the study, researchers divided more than 12,000 older adults into three fall-risk groups. One group was at-risk and received the “Fall Plan of Care” intervention; another group was determined to be at-risk but received no formal plan; and the final group wasn’t at risk of falling.

The study found that at-risk adults who received the intervention had similar odds for falling as adults who weren’t at risk of a fall, and 40 percent lower odds than those at risk without a fall prevention plan.

Johnston said this type of program needs to be individualized because some people need a more structured program, while others benefit from things like tai chi.

Becky Turpin, director of home and community safety for the National Safety Council, said individualizing fall prevention for seniors is crucial.

“As we age, there are natural changes that occur in the body, but that doesn’t mean that falls are a natural part of aging. There are things we can do — if we’re aware of the issue — to account for changes, like occupational therapy for lower leg strength or cataract surgery to improve vision,” she said.

Turpin said it’s important to talk to your doctor about your risk of falling. Your medications should be reviewed to make sure you’re not taking something that might increase your fall risk. Some medications can make you dizzy or sleepy.

It’s also important to get your vision checked annually. “Cataracts can have huge implications for fall risk,” Turpin said.

Seniors and their loved ones should take a good look at the home and how people live their lives.

For example, if a senior is afraid of falling on the stairs, try to figure out why. Is there trouble with depth perception? Is it hard for them to see the stairs well? These problems suggest an eye exam might be in order. If they have trouble lifting their leg up each stair, physical therapy might help.

Some seniors still get on a step stool to reach serving dishes in a high cabinet. “Could you rearrange the kitchen to make the things you need more accessible?” Turpin suggested.

It’s also important to ask your senior if he or she has already fallen. “There’s a fear of telling anyone. They don’t want to scare family members, and they’re worried about losing their independence. But falls are an indication that something is going on, and that’s when to intervene,” Turpin said.

The study was published recently in the journal Gerontologist.

More information

Learn where to find community-based fall prevention programs from the National Safety Council.

SOURCES: Yvonne Johnston, Dr.Ph., M.P.H., M.S., associate professor, Binghamton University Decker School of Nursing, State University of New York; Becky Turpin, M.S., director, home and community safety, National Safety Council; Sept. 20, 2018, Gerontologist, online

Vitamin D Supplements Won’t Build Bone Health in Older Adults: Study

Vitamin D Supplements Won’t Build Bone Health in Older Adults: Study

THURSDAY, Oct. 4, 2018 (HealthDay News) — Vitamin D supplements have long been touted as a way to improve bone health and possibly ward off the bone-thinning disease osteoporosis in older adults.

But a new study contends that claims of benefits from supplements of the “sunshine vitamin” fall flat.

A review of previously published studies found that taking either high or low doses of vitamin D supplements didn’t prevent fractures or falls, or improve bone density.

Vitamin D is found in very few foods. One of the biggest sources of the vitamin is exposure to sunlight.

“Vitamin D supplement use is common, particularly in North America,” where up to 40 percent of older people take them, said lead researcher Dr. Alison Avenell. She is clinical chair in health services research at the University of Aberdeen in Scotland.

“Most adults don’t need to take vitamin D supplements, although they are unlikely to do harm if taken in low doses,” she added.

Vitamin D supplements do prevent rare conditions, such as rickets in children and osteomalacia (softening of bones) in adults. People at risk of vitamin D deficiency include those with little or no sun exposure, such as nursing home residents who are indoors all the time, or those who always cover their skin when outside, Avenell said.

There’s also existing evidence that vitamin D helps prevent cancer or heart disease, she added.

“Preserving bone strength involves keeping active, not smoking, not being too thin, and taking medications for osteoporosis,” Avenell said.

Based on the new findings, Avenell thinks guidelines that recommend vitamin D supplements for bone health should be changed.

For the new report, Avenell and her colleagues reviewed 81 studies, most of which dealt with vitamin D alone, not in combination with the mineral calcium.

“Calcium supplements on their own have minimal effect on bone mineral density and fracture, and may increase the risk of cardiovascular disease,” Avenell said.

The only evidence that calcium and vitamin D together prevent fractures comes from a trial of older people with very low vitamin D levels in nursing homes. But calcium and vitamin D may also increase the risk of cardiovascular disease, Avenell said.

In addition, most of the studies covered in the new review included women aged 65 and older who took more than 800 IUs (international units) of vitamin D daily.

The new study found no meaningful effect of vitamin D supplementation when it came to reducing any fracture, hip fractures or falls.

This type of study, called a meta-analysis, tries to find common elements among previously published studies. This kind or research, however, is limited by differences in the methods and conclusions of the different studies analyzed by researchers, so the findings may not be consistent across the board.

Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, said this new study should convince doctors that vitamin D supplements don’t have a role in maintaining healthy bones, but they do have other benefits.

Previous research suggests that vitamin D, when taken in tandem with calcium, may help prevent certain cancers and protect against age-related declines in thinking and memory.

“What is important to keep in mind is that those with low vitamin D were not represented in this meta-analysis, and vitamin D supplementation — repletion, actually — is still necessary for those with low vitamin D levels, regardless of age,” Sood said.

The findings were published online Oct. 4 in The Lancet Diabetes and Endocrinology.

More information

For more on vitamin D, visit the U.S. National Institutes of Health.

SOURCES: Alison Avenell, M.D., clinical chair, health services research, University of Aberdeen, Scotland; Minisha Sood, M.D., endocrinologist, Lenox Hill Hospital, New York City; Oct. 4, 2018, The Lancet Diabetes and Endocrinology, online

Three New Genes Linked to Chronic Back Pain

Three New Genes Linked to Chronic Back Pain

New research pinpoints three genes responsible for skeletal development that appear to be connected to chronic back pain.

The study authors said their findings could shed new light on the biological factors involved in the development of the condition and lead to new treatments for back pain, which is the leading cause of disability around the world.

For the study, an international team of researchers conducted a genome-wide association to search for gene variants associated with back pain. The study involved 158,000 adults of European ancestry. Of these participants, more than 29,000 suffered from chronic back pain.

The scientists identified three new genetic variants linked to chronic back pain. The SOX5 gene, which is involved in nearly all phases of embryonic development, had the strongest link to the condition.

Previous animal studies have shown that deactivation of this variant is linked to defects in cartilage and skeleton formation in mice.

The study also showed that another gene, which has been associated with intervertebral disc herniation (commonly called a slipped disc), was also linked to back pain. The researchers also identified a third gene involved in spinal cord development, which could affect the risk for back pain due to its influence on pain sensation.

The findings were published Sept. 27 in the journal PLOS Genetics.

“The results of our genome-wide association study point to multiple pathways that may influence risk for chronic back pain,” said study leader Dr. Pradeep Suri, of the U.S. Department of Veterans Affairs in Seattle.

“Chronic back pain is linked to changes in mood, and the role of the central nervous system in the transition from acute to chronic back pain is well-recognized,” he said in a journal news release.

“However, the top two genetic variants we identified suggest causes implicating the peripheral structures, such as the spine,” Suri added. “We expect that further large-scale genetic studies will reveal the importance of both peripheral and central contributors to the complex experience of chronic back pain.”

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases provides more information on chronic back pain.

SOURCE: PLOS Genetics, news release, Sept. 27, 2018

Injected Drug May Be New Weapon Against Gout

Injected Drug May Be New Weapon Against Gout

A new approach to preventing gout attacks looks promising for people not already helped by existing treatments.

Researchers are looking at an anti-inflammatory drug called canakinumab (Ilaris) to treat this painful form of arthritis.

Instead of targeting excessively high uric acid levels as existing gout drugs do, the new strategy aims to reduce overall inflammation. The drug goes after a specific inflammatory molecule called interleukin-1.

The result was a 50 percent drop in gout attack risk, the researchers found.

“This was a very large effect,” said study lead author Dr. Daniel Solomon, a rheumatologist with Brigham and Women’s Hospital in Boston.

He acknowledged it was “very surprising” that the drug packed an equally protective punch whether patients had normal uric acid levels or very high levels.

But Ilaris is unlikely to be the preventive drug of choice any time soon, said Solomon.

For one, it has not yet received approval for gout treatment in the United States. And most patients already achieve risk reduction with standard uric acid-lowering treatments, such as allopurinol (brand names Zyloprim, Aloprim).

What’s more, decades-old allopurinol is a cheap daily pill.

“Canakinumab is very expensive,” said Solomon. Its main role to date is as a last-ditch treatment for rare, so-called “orphan” diseases. At its current price, he said, “it is not a viable option for most patients with gout.”

Also, it must be injected every three months by a caregiver.

Still, Solomon said Ilaris may have a clinical role for patients who don’t respond to or tolerate standard medications.

Prior research had shown that interleukin-1B inhibitors can shorten gout attacks, but it wasn’t known if they could prevent them, the study authors said.

The new research was funded by Novartis, the maker of Ilaris. The results were published online Sept. 17 in Annals of Internal Medicine.

Gout is the most common form of inflammatory arthritis. When a chemical called uric acid builds up in the body, it triggers the formation of tiny jagged crystals that cause severe joint paint, most often in the foot, particularly the big toe. Gout’s prevalence has increased considerably in recent decades.

Heart disease and gout often overlap, the researchers noted. To explore whether Ilaris has potential as a preventive measure, investigators conducted a secondary analysis of the so-called Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS). This enlisted more than 10,000 heart attack patients to see if Ilaris might help reduce future cardiovascular complications among high-risk individuals.

The researchers found that patients treated with four injections of Ilaris a year faced half the risk for a gout attack, compared with those given a dummy (placebo) treatment, regardless of uric acid levels.

“We have no strong reason to believe that [Ilaris] would be less effective in patients without known heart disease,” said Solomon.

Howard Feinberg, a professor of rheumatology at Touro University in Vallejo, Calif., agreed.

Based on the current and prior research, “we can assume that this drug will work for most patients,” including those without a history of heart disease, he said.

Feinberg said he “would not recommend its use for someone who did well on older medications” because of its high cost and the need to give it as in injection.

“The type of patient who would benefit the most is someone who was allergic or could not take standard therapy,” Feinberg said, mentioning patients with kidney disease. “This treatment is also ideal for someone whose gout could not be controlled on allopurinol or other older therapies.”

More information

Learn more about gout treatment at the Arthritis Foundation.

SOURCES: Daniel H. Solomon, M.D., MPH, chief, clinical sciences, division of rheumatology, Brigham and Women’s Hospital, Boston, and professor, medicine, Harvard Medical School; Howard L. Feinberg, D.O., F.A.C.O.I., F.A.C.R., professor, rheumatology, and regional director, medical education and clerkship performance, clinical education department, Touro University, Vallejo, Calif.; Sept. 17, 2018, Annals of Internal Medicine, online