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

What Is a Cortisone Shot?

What Is a Cortisone Shot?

Cortisone shots can potentially provide long-lasting relief from pain and inflammation in the joints.

Many injections can greatly reduce pain and inflammation caused by musculoskeletal injuries or chronic conditions such as arthritis, significantly shortening recovery timelines and providing lasting relief. One shot we particularly recommend to patients entails an injection of cortisone into a damaged joint. We’ll tell you what you need to know about this tried-and-true treatment for pain and inflammation in the joints.

What Is a Cortisone Shot?

A cortisone shot is an injection composed of a corticosteroid medication and a local anesthetic. Used to relieve pain and inflammation, it’s most commonly injected into a joint, often in the shoulder, hip, or knee. These shots are often one option in a comprehensive treatment plan for chronic inflammatory conditions such as arthritis, tendinitis, or rotator cuff impingements or tears.

How Long Does a Cortisone Shot Last?

A cortisone shot’s effectiveness depends on the severity of the patient’s condition. In most cases, pain and inflammation will marginally increase for about 48 hours following the injection, and will decrease precipitously thereafter. In some cases, a single injection can provide relief for as long as several months.

Generally, cortisone shots should only be given two times per joint per year. Repeated cortisone injections can damage the cartilage in the joint.

What Are the Side Effects of a Cortisone Shot?

Cortisone shots are typically safe in moderation, but since they infrequently lead to serious complications, they should be taken under a doctor’s supervision. Be sure to let your doctor know if you suffer from diabetes or other any other conditions affecting your blood sugar levels, as well as any medications that you are currently taking.

Most cortisone shots have some minor side effects, including a temporary uptick in pain and inflammation in and around the joint, and a thinning and lightening of the skin around the site of the injection. In some cases, however, they can result in a sudden spike in blood sugar if you’re diabetic and have poorly controlled blood sugar levels. .

What If the Cortisone Shot Doesn’t Work?

Cortisone shots provide a source of temporary relief from inflammation and pain. They will not solve the underlying problem, and pain may gradually return as the shot’s effectiveness subsides. As a result, cortisone shots should be administered as part of a more comprehensive treatment plan that may include physical therapy or surgery.

Fortunately, our team of orthopedic specialists at Comprehensive Orthopaedics has several years of experience in treating joint problems. Regardless of your specific condition, we’ll work with you to develop a personalized treatment plan that provides lasting relief from your symptoms.

Arthritis Diagnosis

Arthritis Diagnosis

Diagnosing arthritis may be difficult. There are more than 100 different types of arthritis. Many symptoms are similar among the different conditions affecting the joints. Arthritis may be generally categorized into the following groups: degenerative arthritis, inflammatory arthritis, metabolic arthritis, and infectious arthritis. Osteoarthritis (also known as degenerative arthritis) is the most common type. Rheumatoid arthritis and gout are two other more common types. To make an accurate diagnosis, a healthcare provider may need to:

  • Review your medical history and current symptoms.
  • Examine you, paying close attention to your joints.
  • Order laboratory tests, X-rays, and other imaging tests (such as an ultrasound or MRI).
  • Perform an arthrocentesis (the procedure of removing fluid from a joint).

What is involved in reviewing your medical history and your current symptoms?

When reviewing your medical history, your healthcare provider may ask the following questions:

  • Have you had any illnesses or injuries that may explain the pain?
  • Is there a family history of arthritis or other rheumatic diseases?
  • What medication(s) are you currently taking?

Your healthcare provider may also ask:

  • What symptoms are you having? For example, pain, stiffness, difficulty with movement, or swelling.
  • About your pain:
    • Where is it?
    • How long have you had it?
    • When do you have pain and how long does it last?
    • Describe your pain. (Constant, dull, throbbing, stabbing)
    • How intense is it? (on a scale of 1 to 10, with 1 being no pain, and 10, the worst pain)
    • What lessons the pain?
    • What makes it worse?

What is involved in laboratory testing?

In addition to a complete medical history and physical examination, the following are common laboratory tests:

  • Antinuclear antibody. This test measures blood levels of various antibodies, which may be present in persons with some types of arthritis.
  • Arthrocentesis (also called joint aspiration). This is an exam of joint fluid. A thin needle is inserted into the joint. Synovial fluid is removed with a syringe and examined for cell counts, crystal analysis, culture, and other tests.
  • Complement tests. This test measures the level of complement, a group of proteins in the blood. It is used to help diagnose and monitor systemic lupus erythematosus (SLE) and rheumatoid arthritis.
  • Complete blood count. Measures the number of white blood cells, red blood cells, and platelets present in a sample of blood. A low white blood count (leukopenia), low red blood count (anemia), or low platelet count (thrombocytopenia) are associated with some forms of arthritis or the medications to treat them.
  • Creatinine. A blood test to monitor for underlying kidney disease.
  • C-reactive protein. This is a protein that is elevated when there is inflammation in the body as in some types of arthritis.
  • Erythrocyte sedimentation rate (also called ESR or sed rate). This measures how quickly red blood cells fall to the bottom of a test tube. It is also elevated when there is inflammation in the body. This occurs in some types of arthritis.
  • Hematocrit (PCV, packed cell volume). Measures the number of red blood cells present in a sample of blood. Low levels of red blood cells (anemia) are common in people with some types of arthritis.
  • Rheumatoid factor. Checks for an antibody that is present in most people with rheumatoid arthritis.
  • Urinalysis. Laboratory examination of urine to check for kidney disease that may be associated with several types of arthritis.
  • Uric acid. It is elevated in gout.

What imaging techniques may be used to diagnose arthritis?

Imaging techniques may give your healthcare provider a clearer picture of what is happening to your joint(s). Imaging techniques may include the following:

  • X-ray. X-rays may show joint changes and bone damage found in some types of arthritis. Other imaging tests may also be done.
  • Ultrasound. Ultrasound uses sound waves (not radiation) to see the quality of synovial tissue, tendons, ligaments, and bones.
  • Magnetic resonance imaging (MRI). MRI images are more detailed than X-rays. They may show damage to joints, including muscles, ligaments, and cartilage.
  • Arthroscopy. This procedure uses a thin tube containing a light and camera (arthroscope) to look inside the joint. The arthroscope is inserted into the joint through a small incision. Images of the inside of the joint are projected onto a screen. It is used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation, and to treat certain conditions.
Joints Achy? New Study Says Don’t Blame Mother Nature

Joints Achy? New Study Says Don’t Blame Mother Nature

TUESDAY, Jan. 10, 2017 (HealthDay News) — You might want to think twice the next time you’re ready to blame the weather for your aches and pains, researchers say.

Some people swear that changes in humidity, temperature, air pressure and the like trigger back pain and arthritis. But a team at the George Institute for Global Health in Newtown, Australia said it found no evidence to support that theory.

“The belief that pain and inclement weather are linked dates back to Roman times. But our research suggests this belief may be based on the fact that people recall events that confirm their pre-existing views,” said Chris Maher, director of the institute’s musculoskeletal division.

The study included nearly 1,350 Australians with either lower back pain or osteoarthritis of the knee. The study participants’ pain flare-ups were compared with weather data.

There was no association between back pain/knee arthritis and temperature, humidity, air pressure, wind direction or precipitation, the investigators found.

“Human beings are very susceptible so it’s easy to see why we might only take note of pain on the days when it’s cold and rainy outside, but discount the days when they have symptoms but the weather is mild and sunny,” Maher explained in an institute news release.

Maher is also a professor of physiotherapy at the University of Sydney.

Back pain affects up to one-third of people worldwide at any one time. Nearly 10 percent of men and 18 percent of women over the age of 60 have osteoarthritis, the study authors said in background notes.

Manuela Ferreira, an associate professor of medicine who led the osteoarthritis research, said, “People who suffer from either of these conditions should not focus on the weather as it does not have an important influence on your symptoms and it is outside your control.

“What’s more important is to focus on things you can control in regards to managing pain and prevention,” he concluded.

Ferreira is a senior research fellow at the George Institute and the Institute of Bone and Joint Research at the University of Sydney.

More information

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

SOURCE: George Institute for Global Health, news release, Jan. 10, 2017

Osteoarthritis

Osteoarthritis

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis. It is a chronic degenerative joint disease that affects mostly middle-aged and older adults. Osteoarthritis causes the breakdown of joint cartilage. It can occur in any joint, but it most often affects the hands, knees, hips, or spine.

What causes osteoarthritis?

Osteoarthritis can be classified as primary or secondary. Primary osteoarthritis has no known cause. Secondary osteoarthritis is caused by another disease, infection, injury, or deformity. Osteoarthritis starts with the breakdown of cartilage in the joint. As the cartilage wears down, the bone ends may thicken and form bony growths (spurs). Bone spurs interfere with joint movement. Bits of bone and cartilage may float in the joint space. Fluid-filled cysts may form in the bone and limit joint movement.

Who is at risk for osteoarthritis?

The risk factors of osteoarthritis include:

  • Heredity. Slight joint defects or double-jointedness (laxity) and genetic defects may contribute to osteoarthritis.
  • Excess weight. Being overweight or obese can put stress on such joints as the knees over time.
  • Injury or overuse. Severe injury to a joint, such as the knee, can lead to osteoarthritis. Injury may also result from overuse or misuse over time.

What are the symptoms of osteoarthritis?

The most common symptom of osteoarthritis is pain after overuse or inactivity of a joint. Symptoms usually develop slowly over years. Symptoms can occur a bit differently in each person, and may include:

  • Joint pain
  • Joint stiffness, especially after sleep or inactivity
  • Less movement in the joint over time
  • A grinding feeling of the joint when moved, as the cartilage wears away (in more advanced stages)

The symptoms of osteoarthritis can look like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is osteoarthritis diagnosed?

The process starts with a medical history and a physical exam. You may also have X-rays. This test uses a small amount of radiation to create images of bone and other body tissues.

How is osteoarthritis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. The goal of treatment is to reduce joint pain and stiffness, and improve joint movement. Treatment may include:

  • Exercise. Regular exercise, including stretching and strengthening, may help reduce pain and other symptoms.
  • Heat treatment. Treating the affected joint with heat may help reduce pain.
  • Physical and occupational therapy. These types of therapy may help to reduce joint pain, improve joint flexibility, and reduce joint strain. Splints and other assistive devices may also be used.
  • Weight maintenance. Keeping a healthy weight or losing weight if needed may help to prevent or reduce symptoms.
  • Medicines. These may include pain relievers and anti-inflammatory medicines. Either may be taken by mouth as a pill, or rubbed on the skin as a cream.
  • Injections of thick liquids into the joints. These liquids mimic normal joint fluid.
  • Joint surgery. Surgery may be needed to repair or replace a severely damaged joint.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all medicines.

What are the complications of osteoarthritis?

Because osteoarthritis causes joints to degenerate over time, it can cause disability. It can cause pain and movement problems that make a person less able to do normal daily activities and tasks.

Living with osteoarthritis

Although there is no cure for osteoarthritis, it is important to help keep joints functioning by reducing pain and inflammation. Work on a treatment plan with your healthcare provider that includes medicine and therapy. Work on lifestyle changes that can improve your quality of life. Lifestyle changes include:

  • Weight loss. Extra weight puts more stress on weight-bearing joints, such as the hips and knees.
  • Exercise. Some exercises may help reduce joint pain and stiffness. These include swimming, walking, low-impact aerobic exercise, and range-of-motion exercises. Stretching exercises may also help keep the joints flexible.
  • Activity and rest. To reduce stress on your joints, alternate between activity and rest. This can help protect your joints and lessen your symptoms.
  • Using assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and improve balance.
  • Using adaptive equipment. Reachers and grabbers allow people to extend their reach and reduce straining. Dressing aids help people get dressed more easily.
  • Managing use of medicines. Long-term use of some anti-inflammatory medicines can lead to stomach bleeding. Work with your healthcare provider to develop a plan to reduce this risk.

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about osteoarthritis

  • Osteoarthritis is a chronic joint disease. It affects mostly middle-aged and older adults.
  • It starts with the breakdown of joint cartilage.
  • Risk factors include heredity, obesity, injury, and overuse.
  • Common symptoms include pain, stiffness, and limited movement of joints.
  • The goals of treatment are to reduce joint pain and stiffness, and improve joint movement.
  • Treatment may include medicines, exercise, heat, and joint injections.
  • Surgery may be needed to repair or replace a severely damaged joint.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.