Health Tip: Preventing Stress Fractures

Health Tip: Preventing Stress Fractures

(HealthDay News) — Stress fractures are overuse injuries and usually occur in the lower leg.

Typically, they are triggered by increasing the amount or intensity of an activity too quickly, says the American Academy of Orthopedic Surgeons.

To prevent stress fractures, the AAOS suggests:

  • Set incremental goals for sports and activities.
  • Cross-train, rather than repeat the same exercise daily.
  • Maintain a healthy diet, including vitamin D and calcium.
  • Stop and rest if pain or swelling occurs.
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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.

Health Tip: Preventing Falls on Crutches

Health Tip: Preventing Falls on Crutches

(HealthDay News) — To use crutches safely, be sure they fit you properly. Also use care when carrying objects, says the Ohio State University Medical Center.

To prevent falls, the center encourages those on crutches to:

  • Clean the crutch tips often.
  • Put away all throw rugs on the floor.
  • Take your time. Do not try to walk too fast.
  • Look ahead. Do not look at your feet while walking.

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.

1 in 4 American Workers Struggles With Back Pain

1 in 4 American Workers Struggles With Back Pain

MONDAY, May 13, 2019 (HealthDay News) — If your back aches while on the job, you have plenty of company: New research shows that nearly 40 million American workers suffer from chronic lower back pain.

In all, that’s more than a quarter of the workforce reporting lower back pain severe enough to affect their ability to work. As striking as these findings are, the researchers believe that many more workers suffer from lower back pain than the study captured.

“A lot of the cases of back pain have been attributed to work, but most workers haven’t even discussed with their doctor whether it might be related to work,” said lead author Dr. Sara Luckhaupt, a medical officer at the U.S. National Institute for Occupational Safety and Health.

In addition, many workers miss work because of the pain or change jobs because of it, she said.

Luckhaupt said that both men and women reported suffering from lower back pain. Sufferers were more likely to be 45 to 64. Obesity can also contribute to lower back pain, she added.

The greatest number of workers with lower back pain worked in construction, building maintenance and grounds cleaning, Luckhaupt said, “so, jobs that require a lot of manual labor.”

In addition, people whose jobs requires lifting, pulling or standing reported more lower back pain, Luckhaupt said.

One specialist said it’s difficult to determine if someone’s lower back pain is really work-related.

“Work environment can worsen back pain, but often it’s difficult to assign causative factors to the back pain in the absence of a specific incident,” said Dr. Qusai Hammouri, an orthopedic surgeon at Staten Island University Hospital in New York City.

“So, it’s difficult to say if work caused your back pain, or you had back pain and then it got worse as you worked more,” said Hammouri, who wasn’t involved with the research.

For the study, Luckhaupt and her colleagues surveyed more than 19,000 adults in 2015. The participants were asked whether they had lower back pain and if it was work-related, and whether their pain affected their work.

More than a quarter of those surveyed (26%) said they suffered from lower back pain. Extrapolating the data, the researchers determined that represents nearly 40 million workers.

The report was published online May 13 in the Annals of Internal Medicine.

Another expert not part of the study says back pain can be made worse by repeat motions.

“Pain in the back in working-age adults who are otherwise well occurs without a violent precipitant and is exacerbated by motion of the low back,” said Dr. Nortin Hadler, an emeritus professor of medicine and microbiology and immunology at the University of North Carolina, Chapel Hill.

Hadler added that this kind of pain is not necessarily work-related. “It can start in workers when not at work and persists outside work,” he said.

For example, it can be difficult to lift a package, whether in the warehouse, or “in the crib [such as a baby] — where the ‘package’ has no handles and squirms,” Hadler said.

Luckhaupt said that treating lower back pain often involves several kinds of treatment, including physical therapy and painkillers.

She added that often pain can be controlled with nonopioid painkillers.

“Most importantly, workers with back pain should talk with their employers to see if there are things that they can do to make the work healthier,” Luckhaupt said.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on back pain in the workplace.

SOURCES: Sara Luckhaupt, M.D., M.P.H., medical officer, U.S. National Institute for Occupational Safety and Health, U.S. Centers for Disease Control and Prevention, Cincinnati; Nortin Hadler, M.D., emeritus professor, medicine and microbiology/immunology, University of North Carolina, Chapel Hill; Qusai Hammouri, M.D., orthopedic surgeon, Staten Island University Hospital, New York City; May 13, 2019, Annals of Internal Medicine, onlineCopyright ©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

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