Few people go through life without having episodes of lower back pain.
For some people, though, it’s a daily struggle.
The American Academy of Family Physicians says back pain may be controlled by maintaining proper posture and sitting, lifting, standing and exercising properly.
Others have to seek medical attention for relief. The academy mentions these warning signs that you should see a doctor about your aching lower back:
- If pain radiates down your leg below your knee.
- If your leg, foot or groin feel numb.
- If you have fever, chills, nausea, vomiting, stomach pain or weakness.
- If you have difficulty going to the bathroom.
- If the pain was caused by an injury.
- If pain is so intense that you can’t move.
- If your pain doesn’t improve or gets worse after two weeks.
- If you notice any muscle atrophy.
Obesity may accelerate and amplify the crippling symptoms of rheumatoid arthritis, new research suggests.
Conversely, the researchers also found that unexplained weight loss might also signal problems for these patients, because it could mean that they’re at greater risk for disability.
“While patients and rheumatologists may be focused mostly on disease activity, we should also consider this common condition [obesity], which can contribute to problems that are usually attributed to the arthritis itself,” said study author Dr. Joshua Baker.
“In addition, unintentional weight loss should alert us that the patient may be becoming frail and is at risk for developing new disability,” he added. Baker is an assistant professor of medicine at the University of Pennsylvania’s Perelman School of Medicine.
Rheumatoid arthritis is an autoimmune condition. It develops when immune cells that normally fight germs attack the lining of the joints, or cartilage. This causes the joints to swell and the surrounding bones, ligaments and muscles to gradually erode. Rheumatoid arthritis worsens over time, often leading to disability.
For the study, Baker and his colleagues looked at the effects of obesity on the progression of rheumatoid arthritis in just over 25,000 people with the disease.
The investigators found that the disease advanced more quickly among those who were very obese. This was true regardless of the level of inflammation in their joints.
In addition, people who were thin but lost weight without trying also became disabled more quickly.
The study was published April 30 in the journal Arthritis Care & Research.
“So, this study suggests that patients with rheumatoid arthritis and obesity would benefit from intentional weight loss through a comprehensive management strategy,” Baker said in a journal news release.”
“However, when we see that someone is losing weight without trying, it’s probably a poor prognostic sign, especially if they are already thin,” he added.
Although the study could not prove a cause-and-effect link, the researchers suggested that new treatments and strategies to help people maintain a healthy weight might help prevent disability among people with rheumatoid arthritis.
And, Baker’s team noted, the findings could help doctors recognize signs of frailty among their rheumatoid arthritis patients who may benefit from strength training and physical therapy.
The Arthritis Foundation has more about obesity and rheumatoid arthritis.
SOURCE: Arthritis Care & Research, news release, April 30, 2018
If you have stiff, aching fingers and hands, you’re not alone — a new study reports that 40 percent of people will be affected by the pain of arthritis in at least one hand.
The rate seen in the new research is “just slightly below the percentage of osteoarthritis seen in knees and is significantly greater than that seen in hips,” noted Dr. Daniel Polatsch. He’s co-director of the New York Hand & Wrist Center at Lenox Hill Hospital in New York City.
Arthritis “affects hand strength and function and causes difficulty doing activities of daily living,” Polatsch said.
The study team was led by Jin Qin, of the Arthritis Program at the U.S. Centers for Disease Control and Prevention. The researchers looked at 1999-2010 data on more than 2,200 people from North Carolina. All people in the study were aged 45 or older.
The information collected included symptoms the participants reported as well as hand X-rays.
Women were at higher risk than men, with nearly half of women (47 percent) developing hand arthritis. Only about a quarter of men had hand arthritis, Qin’s team said. Whites were more prone to the ailment than blacks, with rates of 41 percent and 29 percent, respectively.
Excess weight was also a risk factor for hand arthritis. Lifetime risk among obese people was 47 percent, compared to 36 percent for non-obese people, the study found.
Dr. Steven Carsons is chief of rheumatology at NYU Winthrop Hospital in Mineola, N.Y. He said the finding that hand arthritis is more common in women “has been long thought to have a genetic and hormonal basis.”
The obesity link is more intriguing, Carsons said.
“While obesity has always been assumed to be a risk factor for osteoarthritis of weight-bearing joints, such as the knee, these data reveal the somewhat surprising association of obesity and lifetime risk of development of hand osteoarthritis,” he said.
Recent studies have suggested that obesity may set up “systemic inflammation” in the body, Carsons said, which may raise the odds of arthritis in a non-weight-bearing joint, such as the hand.
Because arthritis in the hands can be disabling, Polatsch said, “treatment options and access to hand specialists need to improve in order to minimize the impact of this potentially disabling condition in our aging population.”
The study was published May 4 in Arthritis & Rheumatology.
Find out more about arthritis at the Arthritis Foundation.
Need another reason to keep your weight under control?
Excess weight can cause dislocation of your knee and may even lead to a complication that results in amputation of your leg.
A new study attributes a surge in dislocated knees to the U.S. obesity epidemic.
“Obesity greatly increases the complications and costs of care,” said study lead author Dr. Joey Johnson, an orthopedic trauma fellow at Brown University’s Warren Alpert Medical School.
“As the rate of obesity increases, the rate of knee dislocations increases. The total number of patients who are obese is increasing, so we are seeing more of these problems,” Johnson explained.
Knee dislocations result from multiple torn ligaments. Vehicle crashes or contact sports, such as football, are common causes.
For the study, the researchers analyzed more than 19,000 knee dislocations nationwide between 2000 and 2012. Over that time, people who were obese or severely obese represented a growing share of knee dislocation patients — 19 percent in 2012, up from 8 percent in 2000.
Obesity is also linked to more severe knee dislocations, longer hospital stays and higher treatment costs, according to the study published recently in the Journal of Orthopaedic Trauma.
And the chances that a knee dislocation would also injure the main artery behind the joint and down the leg were twice as high for obese patients than for those whose weight was normal, the findings showed. This severe complication of knee dislocation — known as a vascular injury — can lead to leg amputation if not treated, the study authors said.
Patients with a vascular injury averaged 15 days in the hospital, compared with about one week for other patients. Their average hospitalization costs were just over $131,000 and $60,000, respectively.
The study authors said doctors should be especially watchful for vascular injury in obese patients whose knees are dislocated.
“That subset of obese patients who come in with complaint of knee pain need to be carefully evaluated so as not to miss a potentially catastrophic vascular injury,” said study co-author Dr. Christopher Born, a professor of orthopedics at Brown.
Reducing obesity rates could help reverse the growing number of knee dislocations, the researchers suggested.
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on knee problems.
SOURCE: Brown University, news release, Nov. 3, 2017
Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.
Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.
“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.
“After 24 hours, risk began to clearly increase,” Pincus said.
U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.
In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.
Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.
“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”
Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.
“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”
To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.
The investigators compared patients based on whether they had surgery before or after 24 hours.
Overall, about 12 percent of hip fracture patients died within the month following their surgery.
However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.
Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.
“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”
People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.
“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.
Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.
“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”
The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.
“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.
The study was published Nov. 28 in the Journal of the American Medical Association.
For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.
SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association
WEDNESDAY, Sept. 27, 2017 (HealthDay News) — Falls and fractures are a major cause of disability in old age. An influential U.S. medical task force is recommending exercise and, in some cases, medical evaluation to help seniors stay on their feet.
But the new draft recommendations from the U.S. Preventive Services Task Force (USPSTF) say there isn’t enough evidence at this time to either endorse or advise against taking vitamin D or calcium supplements to prevent broken bones.
And based on current evidence, the panel recommends against taking vitamin D solely to prevent falls.
For Americans 65 and older, falls are the leading cause of injuries and injury-related deaths, according to the U.S. Centers for Disease Control and Prevention. On average, one older person falls every second in the United States, the CDC says.
“Fortunately, there are things we can do to help prevent falls,” said Dr. Alexander Krist, a task force member.
However, “we found that it is unclear whether vitamin D and calcium can help prevent fractures at higher doses,” said Krist, an associate professor of family medicine and population health at Virginia Commonwealth University. “They do not prevent fractures at lower doses.”
More research is needed to evaluate the potential benefit of high-dose calcium and vitamin D supplementation for fracture prevention after menopause, the task force noted.
“We hope that you talk to your primary care provider about exercise to prevent falls if you have any concerns about falling, as well as vitamin D or calcium supplementation if you have any questions about your personal risk of fractures,” Krist added.
The USPSTF, an independent panel of experts, provides guidance to physicians about how to prevent medical problems.
The proposed guidelines are intended to help prevent falls and fractures in generally healthy adults aged 65 and older who live at home and don’t have medical problems such as osteoporosis, vitamin D deficiency, Parkinson’s disease or dementia.
After reviewing the available studies, “we found that exercise had a moderate benefit in preventing falls in older adults at increased risk for falls,” Krist said.
The task force didn’t suggest any particular type of exercise. Still, “supervised exercise that improves balance, the way someone walks, and helps with completing common tasks are helpful,” Krist said.
“These can be done in group or individual classes and either at home or in the community. Patients should talk with their clinician about what exercise programs are best for them,” he added.
The task force also recommends that health care providers “selectively check older adults’ risks for falls, and then offer tailored interventions that address those specific risks.”
However, one expert doubts that such risk assessments will become common.
“Medical offices are businesses. Anything that adds time to the office visit, without adding revenue, is unlikely to be added to the majority of visits,” said Dr. Chris Sciamanna, a professor of medicine and public health sciences at Penn State College of Medicine. He wasn’t involved in writing the draft recommendations.
Sciamanna suggested that seniors test themselves: “If you can’t stand on either leg for 10 seconds without grabbing onto something, you’re at risk and should talk to your doctor,” he said.
But, he added, “the reality is that there’s little for doctors to do other than to refer you to an exercise program or, in some cases, reduce the dose of a medicine that may be hurting your balance, like a blood pressure medicine.”
In a perfect world, Sciamanna said, he would have his patients enroll in a strength and balance program three times each week, and also “get aerobic exercise, preferably something that would be fun and build their agility.”
Although the task force recommends against taking vitamin D to prevent falls, there’s no recommendation regarding whether seniors should take vitamin D for general health.
As for other ideas, the task force said there’s not enough evidence to show the value of single strategies like managing medications or making the home environment safer.
The task force released its draft recommendations Sept. 26 and is accepting comments about them on their website until Oct. 23.
For more about preventing falls, see the U.S. National Institutes of Health.
SOURCES: Alexander Krist, M.D., MPH, associate professor of family medicine and population health, Virginia Commonwealth University, Richmond, Va.; Chris Sciamanna, M.D., MPH, professor, medicine and public health sciences and vice chair, research, department of medicine, Penn State College of Medicine, Hershey, Pa.; U.S. Preventive Services Task Force, draft recommendations, Sept. 26, 2017