Younger Gout Patients Have Higher Odds for Blood Clots

Younger Gout Patients Have Higher Odds for Blood Clots

MONDAY, June 3, 2019 (HealthDay News) — Older age raises the odds of many ills, but for adults with gout, it’s the younger ones who have the highest risk for developing a serious blood clot, new research indicates.

Gout patients of any age have a 25% greater risk of developing a blood clot deep in the veins in the first 10 years after diagnosis, the British study found.

But “the risk was 79% higher in gout patients, compared to those without gout, in the under-50 age group,” explained study lead author Alyshah Abdul Sultan.

Gout is the most common form of inflammatory arthritis, affecting more than 4% of U.S. adults, according to the Arthritis Foundation. It develops in people who have high levels of uric acid in the blood. The acid can cause painful crystals to form in the joints.

In this study, researchers compared roughly 62,000 gout patients with an equal number of gout-free adults. The investigators found that the raised blood clot risk was largely confined to gout patients under the age of 50.

“We did not observe much higher risk in the older population,” added Sultan, a fellow at Keele University’s arthritis research center in Staffordshire, England. But, he noted, because blood clot risk increases with age regardless of gout status, “it may have obscured the effect of gout in the older population.”

Blood clot risk rose, said Sultan, whether or not younger patients had their gout under control by means of standard uric-acid lowering medications, such as allopurinol (Zyloprim). Such drugs can dramatically lower the incidence of painful gout attacks, by tamping down the abnormally high uric acid concentrations.

Still, Sultan and other experts stressed that the bottom-line risk for developing a blood clot remains low for someone with gout. This suggests that proactive treatment to reduce clot risk might not be necessary.

According to Dr. Gregg Fonarow, “The overall risk was modest in absolute terms.” Fonarow is co-director of the preventative cardiology program at the University of California, Los Angeles.

“As the absolute increased risk is small, the presence of gout alone would not warrant use of anticoagulation [blood-thinning] therapy,” Fonarow said.

Sultan said the study findings were “not very surprising, as we already know that chronic inflammation increases the risk of blood clots through various mechanisms. Previous research has already highlighted rheumatological conditions, such as rheumatoid arthritis and lupus, as important risk factors for blood clots,” he noted.

Still, while blood clot risk may not be sufficient to warrant preventive intervention on its own, he said there may be need for clinical vigilance, particularly in younger adults with newly diagnosed gout.

For the study, the researchers reviewed primary care information collected by the England-based Clinical Practice Research Datalink.

The investigators first identified patients diagnosed with gout between 1998 and 2017, and matched them with roughly the same number of gout-free adults.

The team concluded that clot risk rose significantly among gout patients under 50 in the decade following diagnosis. Also, risk appeared to rise equally among males and females, and whether or not they took allopurinol.

“However, the results of our analysis of urate-lowering therapy may be generalizable only to those prescribed 300 milligrams of allopurinol or less, a dose level widely used in U.K. primary care,” Sultan noted.

Research is needed to determine the impact, if any, of higher doses, he added.

As to why gout might lead to a higher clot risk, Sultan said the risk association may be due to various inflammatory pathways. Although this process isn’t fully understood, he noted that uric acid “can initiate, amplify and sustain inflammatory response.”

However, Fonarow said many factors can drive up clot risk. These include a history of smoking, obesity and use of estrogen. People who are immobile or undergoing surgery are also at elevated risk of venous blood clots.

The report was published in the June 3 issue of CMAJ (Canadian Medical Association Journal).

More information

For more about blood clot risk, visit the American Society of Hematology.

SOURCES: Alyshah Abdul Sultan, research fellow, epidemiology and applied statistics, Arthritis Research U.K. Primary Care Centre Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, U.K.; Gregg Fonarow, M.D., director, Ahmanson-UCLA Cardiomyopathy Center, and co-director, preventative cardiology program, University of California, Los Angeles; June 3, 2019, CMAJ (Canadian Medical Association Journal)Copyright ©2017 HealthDay. All rights reserved.

Signs of Rheumatoid Arthritis Can Show Up Long Before Diagnosis

Signs of Rheumatoid Arthritis Can Show Up Long Before Diagnosis

FRIDAY, May 10, 2019 (HealthDay News) — Difficulties with daily activities such as dressing, walking and eating can be seen in rheumatoid arthritis patients a year or two before they’re diagnosed, a new study shows.

“This is a new finding, and a finding that is quite intriguing,” said lead author Dr. Elena Myasoedova, a rheumatologist at the Mayo Clinic in Rochester, Minn.

“It may reflect an accumulation of symptoms between the time of first onset and the time required for providers to actually diagnose patients,” she said in a Mayo news release.

The study also found that chronic increased levels of difficulty with daily activities (functional disability) continued even after patients were diagnosed with rheumatoid arthritis and began treatment.

That may be due to a number of factors, including increasing physical and mental pain, use of treatments such as glucocorticoids and antidepressants, and anticipation of relief from symptoms, she added.

For the study, the researchers looked at 586 rheumatoid arthritis patients and 531 people without the disease in the Rochester Epidemiology Project database of medical records.

The rate of functional disability was more than two times higher among rheumatoid arthritis patients than in those without rheumatoid arthritis. In most age groups, rheumatoid arthritis patients had a 15% or higher rate of functional disability than those without the disease.

The findings show the importance of early treatment for rheumatoid arthritis patients, according to Myasoedova.

“Alerting your health care provider to difficulties in daily living can assure that patients receive the help they need,” she said.

About 1.5 million Americans have been diagnosed with rheumatoid arthritis, an autoimmune disease that most often affects the joints but can also impact other parts of the body. Rheumatoid arthritis is one of the most common chronic conditions associated with functional disability in the United States, and has a significant impact on well-being and quality of life.

Symptoms can include joint pain or swelling, but 40% of patients have symptoms that don’t involve the joints, such as fatigue, fever and loss of appetite.

The study will be published in June in the journal Mayo Clinic Proceedings.

More information

The American Academy of Family Physicians has more on rheumatoid arthritis.

SOURCE: Mayo Clinic, news release, May 1, 2019Copyright ©2017 HealthDay. All rights reserved.

After a Stroke, Your Bones Need Care

After a Stroke, Your Bones Need Care

THURSDAY, April 25, 2019 (HealthDay News) — Stroke survivors often face limited mobility, which quadruples their odds of osteoporosis, broken bones and falls. But most are never screened for these problems, new research reveals.

“Our study adds to previous research that found despite an increased risk, only a small number of people who have recently had a stroke are tested and treated for osteoporosis,” said lead author Dr. Moira Kapral. She is director of general internal medicine at the University of Toronto.

Impaired mobility can result in bone mineral density decline, which is associated with osteoporosis. The condition weakens bones and increases risk of fractures.

In this study, researchers looked at more than 16,500 Canadian stroke survivors, aged 65 and older, from Ontario. Of these patients, only 5% had undergone bone mineral density testing; 15.5% had been prescribed medications for osteoporosis within the year after their stroke, and only a small percentage were prescribed medications for osteoporosis for the first time.

Patients most likely to have bone mineral density testing tended to be younger, female and to have had low-trauma fractures in the year after their stroke.

Patients were more likely to be prescribed medications for osteoporosis after their stroke if they were female, already had the bone-thinning disease, had previously broken bones, had previous bone mineral density testing, or had fallen or broke bones after their stroke.

The study was published April 25 in the journal Stroke.

“This study offers more evidence that there is a missed opportunity to identify people with stroke at increased risk of fractures, and to initiate treatment to prevent bone loss and fractures,” Kapral said in a journal news release.

Less than one-third of older U.S. women are screened for osteoporosis. The maximum treatment rate for some high-risk patients is about 30%, the researchers pointed out.

More information

The U.S. Office on Women’s Health has more about osteoporosis.

SOURCE: Stroke, news release, April 25, 2019

Copyright ©2017 HealthDay. All rights reserved.
Step-by-Step Exercises for a Stronger Back

Step-by-Step Exercises for a Stronger Back

THURSDAY, April 11, 2019 (HealthDay News) — Are you neglecting or even unaware of the muscles in your back? If so, you’re putting yourself at risk.

The trapezius is the diamond-shaped muscle that runs from neck to middle back and from shoulder to shoulder across the back. The latissimus dorsi — or “lats” — are the large back muscles that run from either side of the spine to your waist.

Here are two strength-training exercises that will help you develop these muscles for better upper body fitness.

Important: Start with a weight that allows you to complete at least eight reps with proper form, perhaps as low as 2-pound dumbbells. Build up to 10 to 15 reps for one complete set, and progress from one to three complete sets before increasing the weight. Never jerk the weights — controlled, steady movement is what brings results.

Standing dumbbell rows target the trapezius muscles as well as the upper arms and shoulders. Stand straight, feet shoulder-width apart, with a weight in each hand. Your elbows should be slightly bent, the dumbbells touching the fronts of your thighs, palms facing your body. As you exhale, use a slow, controlled movement to lift the weights straight up by bending the elbows up and out to bring the weights to shoulder level. Hold for a second, then inhale as you lower your arms to the starting position. Repeat.

Bent-over one-arm rows target the lats as well as the upper arms and shoulders. To work the right side first, stand to the right side of a bench. Place your left knee and left hand on it for support. Your back should be nearly parallel to the floor. Hold a dumbbell in your right hand, palm facing inward. Using only your upper arm, bend at the elbow to lift the dumbbell straight up to your waist as you exhale. Hold for a second and then lower it with control as you inhale. Complete reps, then switch sides and repeat.

You can also do bent-over rows using both arms at once. Stand with feet about shoulder-width apart. Hold a dumbbell in each hand and, bending from the waist, bring your back to nearly parallel with the floor. Keeping arms close to your sides, bend the elbows to lift the weights, bringing them up to waist level. Hold for a second and then lower the weights with control as you inhale. Repeat.

More information

The American Council on Exercise has more on exercises targeting the back muscles.

Copyright ©2017 HealthDay. All rights reserved.
Health Tip: Joint Popping and Cracking

Health Tip: Joint Popping and Cracking

(HealthDay News) — Most people have popping and cracking of their joints, especially as they age.

Though the reasons behind these sounds are unclear, doctors think they may be caused by ligaments stretching and releasing, or the compression of nitrogen bubbles.

Usually, the phenomenon doesn’t need treatment. However, if these sounds are accompanied by swelling and pain, seeing a doctor is recommended, says Johns Hopkins Medicine.

Copyright ©2017 HealthDay. All rights reserved.
One Short, Brisk Walk a Day May Keep Arthritis at Bay

One Short, Brisk Walk a Day May Keep Arthritis at Bay

MONDAY, April 1, 2019 (HealthDay News) — Less than 10 minutes a day of brisk walking can help prevent disability in people with arthritis pain in their knee, hip, ankle or foot, researchers report.

Just one hour a week of brisk physical activity “is less than 10 minutes a day for people to maintain their independence. It’s very doable,” said lead study author Dorothy Dunlop. She’s a professor of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

“This minimum threshold may motivate inactive older adults to begin their path toward a physically active lifestyle with the wide range of health benefits promoted by physical activity,” Dunlop added in a university news release.

She and her team analyzed four years of data from more than 1,500 older adults in Baltimore, Pittsburgh, Columbus, Ohio, and Pawtucket, R.I., who had pain, aching or stiffness in their lower joints from osteoarthritis but were initially free of disability.

The participants’ levels of physical activity were monitored using a wearable device.

An hour a week of moderate-to-vigorous physical activity reduced their risk of disability, the study found. Specifically, the activity reduced the risk of walking too slowly to safely cross a street by 85 percent, and their risk of not being able to do daily living activities — for example, morning routine tasks such as walking across a room, bathing and dressing — by nearly 45 percent.

By the end of the four years, 24 percent of participants who did not get a weekly hour of brisk physical activity were walking too slowly to safely cross the street, and 23 percent had difficulty performing their morning routines, according to the study.

About 14 million older Americans have symptomatic knee osteoarthritis, the most common type of osteoarthritis. About 2 in 5 people with osteoarthritis — most of whom have it in their lower joints — develop disability.

Federal guidelines recommend low-impact physical activity for older adults with arthritis, and recommend that older adults do at least 2.5 hours a week of moderate-intensity activity.

But that amount of activity can be too much for inactive older adults with lower extremity pain, according to Dunlop.

“We hope this new public health finding will motivate an intermediate physical activity goal,” she said. “One hour a week is a stepping stone for people who are currently inactive. People can start to work toward that.”

The study was published April 1 in the American Journal of Preventive Medicine.

More information

The Arthritis Foundation offers exercise tips.

SOURCE: Northwestern University, news release, April 1, 2019

Copyright ©2017 HealthDay. All rights reserved.
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