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).
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.
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.
Osteoporosis is a threat to many women, especially after menopause. But the lead up to weak, brittle bones can start much earlier in life.
When bone density drops but isn’t yet at the level of osteoporosis, it’s called osteopenia. Osteopenia affects more than 33 million Americans over age 50, men and women, while 10 million have osteoporosis.
Yet the DEXA scan, the painless X-ray-based test that measures bone density, isn’t recommended for women until age 65, when they may need bone-building drugs to avoid fractures. For men, the prevalence of osteoporosis doesn’t increase with age until 80, but even then, there are no screening guidelines. So, what’s the answer?
Cost versus benefit is one reason insurers don’t universally cover the scan for women under 65. But you may be a candidate for earlier testing if you broke a bone after age 45, are losing height, are developing a slumped or hunched posture, or have sudden, unexplained back pain.
If you’re healthy but have concerns about bone health or risk factors for osteoporosis, you can talk to your doctor about earlier testing.
Factors that can increase your fracture risk include your height and weight — very thin women are at greater risk. Not getting enough exercise, smoking, drinking alcohol, a family history of osteoporosis or having a parent who broke a hip are others. Having a disease or taking medications associated with an increased risk of osteoporosis also increases your risk of fractures.
For better bone health, make sure your diet includes good sources of calcium-rich foods, that you get enough vitamin D through sunlight or a supplement, and that you get regular, weight-bearing exercise. That includes activities done while standing, like walking, which helps develop bone. Limit alcohol to one drink a day and don’t smoke.
WEDNESDAY, March 6, 2019 (HealthDay News) — Walking the dog can be great exercise for seniors, but there could be one downside: bone fractures.
Fractures suffered by elderly Americans while walking their dogs have more than doubled in recent years, new research shows.
Still, taking your dog for a walk can also bring big health rewards, one joint specialist said.
“Pets can provide companionship for older adults, and the physical exercise from regularly walking a dog may improve other aspects of physical and psychological health,” said Dr. Matthew Hepinstall, who wasn’t involved in the new study.
“So, the risks of walking a dog should be balanced against potential benefits,” said Hepinstall, who helps direct joint surgery at Lenox Hill Hospital in New York City.
The new research was led by Kevin Pirruccio, a second-year medical student at the University of Pennsylvania. His team tracked national data and found that among people aged 65 and older, fractures associated with walking leashed dogs rose from about 1,700 cases in 2004 to almost 4,400 cases in 2017 — a 163 percent rise.
More than three-quarters of the fractures occurred in women, with hip and arm fractures being the most common. About half of all fractures occurred in the upper body, with fractures of the wrist, upper arm, finger and shoulder leading the way.
The most common type of fracture was a broken hip (17 percent). That’s cause for concern, Pirruccio’s team said, because the death rate linked to hip fractures in people older than 65 is close to 30 percent.
The researchers added that the study only involved data on fractures treated at emergency departments. The actual number of dog walking-related injuries among seniors might even be higher if injuries not typically seen in a hospital — for example, tendon or muscle tears — were factored in.
Why the rising rates of fractures tied to dog walking? The study authors theorized that increased pet ownership and a greater emphasis on physical activity for older adults may be driving the trend.
In a university news release, Pirruccio stressed that walking your pooch each day “has repeatedly demonstrated social, emotional and physical health benefits.” It’s also “a popular and frequently recommended activity for many older Americans seeking new ways to stay active,” he said.
On the other hand, “patients’ risks for falls must be factored into lifestyle recommendations in an effort to minimize such injuries,” Pirruccio said.
“The take-home message for older adults and their families is that, when choosing to care for a pet, be sure to consider the strength and coordination of the older adult, and the size and expected behavior of the pet selected,” he advised.
Pet ownership and care may need to be re-assessed with age, Hepinstall added.
“When the mobility of older adults changes, they should be encouraged to re-evaluate their ongoing ability to care for any pets,” he said. “This will help ensure that the health and other needs of the adult and of the pet can be properly managed.”
SOURCES: Matthew Hepinstall, M.D., associate director, joint preservation & reconstruction, department of orthopaedic surgery, Lenox Hill Hospital, New York City; University of Pennsylvania, news release, March 6, 2019