Health Tip: Understanding Childhood Arthritis

Health Tip: Understanding Childhood Arthritis

About 1 in 1,000 children has some type of chronic arthritis, the American College of Rheumatology says.

Arthritis can affect children of any age, although rarely during the first six months of life.

In the United States, a common medical term for the joint disease in children is Juvenile Idiopathic Arthritis (JIA).

Typical symptoms include: limping, stiffness upon waking up, reluctance to use a particular arm or leg, reduced activity, lasting fever and joint swelling.

If your child has JIA, the American College of Rheumatology suggests you and the child:

  • Maintain a positive outlook.
  • Consider physical and occupational therapy to increase joint motion, decrease pain and increase strength and endurance.
  • Be aware of available special accommodations at school.
Exercises for Chronic Health Conditions

Exercises for Chronic Health Conditions

Exercise can help prevent many chronic illnesses as well as make it easier to manage health conditions, from diabetes to joint pain.

In terms of prevention, aim for the recommended 150 minutes of exercise, like brisk walking or cycling, each week. Along with eating a healthy diet, this can cut your risk of diabetes by more than a third, plus increase your level of good cholesterol. Exercise also lowers body weight, blood pressure and triglycerides, thus reducing key risk factors for heart disease.

If you’re already managing a chronic illness, exercise may improve symptoms and reduce the amount of medication you need to take. It builds muscle, which helps you move more easily, and reduces stress, which can aggravate many health conditions. Back pain and arthritis improve with the right stretching and exercise plan. If you have diabetes, exercise can improve blood sugar control.

Exercise’s health effects on:

Heart disease: Regular aerobic exercise and interval training in particular are heart-healthy, boosting cardiovascular fitness.

Back pain: Core exercises strengthen the muscles around your spine, creating better support for your spine.

Arthritis: Exercise enhances the muscles that support your joints, making movement easier; it also eases stiffness.

Diabetes: Exercise helps you use insulin more effectively and lower your blood sugar level.

Asthma: Exercise can help control attacks.

If you’re managing an illness and haven’t been active, talk to your doctor about what exercises are safe, any precautions to take, what kind of discomfort is normal, and what are signs to stop, like feeling dizzy, short of breath or chest pain.

Working with your doctor is especially important when you have diabetes. Because exercise can affect blood sugar, you’ll need to take precautions to prevent blood sugar from becoming too low during workouts.

In terms of intensity, start off slow — that means you should be able to talk, but not sing, when working out.

More information

The Cleveland Clinic has detailed tips on exercising with a chronic condition to help you get started safely.

Ditch the Golf Cart. Your Aging Knees Won’t Mind

Ditch the Golf Cart. Your Aging Knees Won’t Mind

Golfers with knee arthritis should park the golf cart and walk the links instead, researchers say.

While using a golf cart may seem the obvious choice for golfers with knee problems, a new small study finds that walking provides much greater health benefits. Moreover, it’s not associated with increased pain, inflammation or cartilage breakdown, the researchers said.

“Individuals with knee osteoarthritis are often concerned about pain and may be more likely to use a golf cart,” said lead study author Dr. Prakash Jayabalan. He’s an assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago.

However, “this study has shown that golfers with knee osteoarthritis do not need to be concerned about worsening their disease through walking the course. In fact, walking provides the best health benefit,” Jayabalan said in a university news release.

More than 17 million Americans older than 50 golf regularly. Knee osteoarthritis is a leading cause of disability in this age group. The condition causes swelling, pain and difficulty moving the joint.

The study included 10 older golfers with knee osteoarthritis and five without the disease, which is usually caused by wear and tear of the joint.

On one day, the study participants played one round of golf (18 holes) walking the course. On another day, they used a golf cart to play 18 holes. On each occasion, the researchers monitored the participants’ heart rates to determine their level of exercise intensity, and took blood samples to measure markers of knee inflammation and cartilage stress.

On both occasions, the golfers had an increase in these markers, but there was no difference between use of the golf cart and walking, the findings showed.

When walking the course, the heart rates of the golfers with knee problems were in the moderate-intensity zone for more than 60 percent of the time, compared with 30 percent when using a cart.

But even using the cart, golfers met daily exercise recommendations, according to the study authors.

“Bottom line: walking the course is significantly better than using a golf cart, but using a golf cart is still better than not exercising at all,” Jayabalan concluded.

The study was presented recently at the Osteoarthritis Research Society International annual meeting in Liverpool, England. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.

More information

The Arthritis Foundation has more about osteoarthritis.

SOURCE: Northwestern University, news release, April 28, 2018

Too Much or Too Little Weight May Worsen Rheumatoid Arthritis

Too Much or Too Little Weight May Worsen Rheumatoid Arthritis

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.

More information

The Arthritis Foundation has more about obesity and rheumatoid arthritis.

SOURCE: Arthritis Care & Research, news release, April 30, 2018

Exercise In, Vitamin D Out for Preventing Falls: U.S. Panel

Exercise In, Vitamin D Out for Preventing Falls: U.S. Panel

With aging often comes worry about falls and the bone fractures they cause. Now, a panel of U.S. experts has new advice on what helps and what doesn’t when it comes to staying upright.

For starters, get off the sofa. And don’t rely on vitamin D to keep you from falling.

In a change from its 2012 recommendations, the U.S. Preventive Services Task Force (USPSTF) is recommending against vitamin D supplements for “community-dwelling” (those living at home) adults over 65 for preventing falls. A review of existing research showed insufficient evidence to recommend a supplement.

So what does help people prevent falls? Exercise, the task force said.

“The strongest evidence is for exercise. If you’re at risk of falling, you should think about exercise,” said the task force’s vice chair, Dr. Alex Krist, from Virginia Commonwealth University in Richmond. He added that about 20 percent of Americans over 65 have a fall each year.

The review and recommendations were published April 17 in the Journal of the American Medical Association.

An author of an editorial that accompanies the new recommendations agreed exercise can be beneficial.

“These recommendations are suggesting that we need to go beyond popping pills in order to have a major impact in preventing falls and fractures,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.

“Regular exercise can reduce falls with injury and it can also reduce heart disease, stroke, type 2 diabetes, dementia and some forms of cancer,” Manson said.

“Physical activity is as close to a magic bullet as there is. And it doesn’t take that much — just 30 or 40 minutes three times a week can make a difference,” she added.

Both Krist and Manson advocated for a variety of exercises. They said for someone healthy enough, the general physical activity guidelines of 30 minutes of aerobic activity most days of the week, and strength training twice a week, are a good place to start.

But not everyone over 65 can achieve that goal. Krist said to start with your doctor to get a better idea of what exercise might be right for you. For some people, the supervision that comes with physical therapy is helpful. For others, a class such as tai chi might work best. And for others, more vigorous activity may be fine.

The USPSTF is a volunteer panel of national experts. They develop recommendations for disease and injury prevention after a rigorous review of scientific evidence.

The new recommendations suggest that doctors should selectively offer multifaceted interventions to seniors at a high risk of falling.

These might include: group or individual exercise, psychological therapy, nutrition therapy, education, medication management, urinary incontinence management, environmental modification, and physical or occupational therapy. Social services and referral to specialists such as an ophthalmologist, neurologist or cardiologist are other options.

Referrals can be important because some issues may be reversible. For example, sometimes addressing problems with vision can aid in fall prevention.

“Often, older individuals assume vision loss is inevitable and a normal part of the aging process. Very often, though, problems such as cataracts or glaucoma are treatable,” Manson said.

“Falling is a major concern for older adults, and some are afraid to go outdoors because they’re afraid of falling,” she said. That leads to a double whammy as they stay inside, their muscles may atrophy, they don’t get any sunlight and may develop a vitamin D deficiency, and they’re losing out on important social interactions, Manson explained.

“I recommend at least doing strength training inside the home, or getting a treadmill to use at home. Or find a friend or family member that can go out for a walk, or start a walking club in your neighborhood,” she suggested.

The task force also recommended against daily supplementation of 400 international units of vitamin D and 1,000 milligrams (mg) or less of calcium to prevent fractures in postmenopausal women living at home.

It wasn’t clear, however, if higher doses might provide a benefit, according to the new USPSTF recommendations. There also wasn’t enough evidence for the task force to determine whether vitamin D and calcium supplements could help men or premenopausal women avoid fractures.

More information

Learn more about preventing falls from the U.S. National Institute on Aging.

SOURCES: Alex Krist, M.D., M.P.H., U.S. Preventive Service Task Force vice chair, and professor, family medicine, Virginia Commonwealth University, Richmond; JoAnn Manson, M.D., Dr.P.H., professor, medicine, Harvard School of Medicine, and chief, preventive medicine, Brigham and Women’s Hospital, Boston; April 17, 2018, Journal of the American Medical Association

4 in 10 People Will Suffer Arthritic Hands Over Lifetime

4 in 10 People Will Suffer Arthritic Hands Over Lifetime

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.

More information

Find out more about arthritis at the Arthritis Foundation.