Arthritis

Stephanie Watson

Insoles no help for knee osteoarthritis

Nearly a third of Americans will develop osteoarthritis of the knee before age 70. With no “cure” beside knee replacement on the horizon for this painful joint condition, relief often has to come from pain pills. Assistive devices such as wedge insoles are often prescribed as a less drastic, side effect-free treatment option. But do they really work? A review of research published today in JAMA indicates that these shoe inserts do little—if anything—to relieve arthritis pain. The findings echo new osteoarthritis treatment guidelines released by the American Academy of Orthopaedic Surgeons (AAOS) in May. Based on current research, the AAOS said it couldn’t recommend lateral wedge insoles for people with medial knee osteoarthritis.

Patrick J. Skerrett

Exercise is good, not bad, for arthritis

When pain strikes, it’s human nature to avoid doing things that aggravate it. That’s certainly the case for people with arthritis, many of whom tend to avoid exercise when a hip, knee, ankle or other joint hurts. Although that strategy seems to make sense, it may harm more than help. Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body. Yet a new survey from the Centers for Disease Control and Prevention shows that more than half of people with arthritis don’t walk at all for exercise, and only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function.

Patrick J. Skerrett

Physical therapy works as well as surgery for some with torn knee cartilage

Tiny shock absorbers in the knee (each one is called a meniscus) provide a key cushion between the thighbone and the shinbone. They are prone to tearing, and sometimes just wear out. A torn meniscus can cause pain or other symptoms, like a knee that locks. But sometimes they don’t cause any symptoms. In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published yesterday in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery. Both therapies led to similar improvements in knee function and pain at six and 12 months.

Daniel Pendick

Rub-on pain reliever can ease arthritis discomfort

When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers. These so-called topical analgesics work best for more superficial joints like the knees, ankles, feet, elbows, and hands. The active ingredient in most topical analgesics is a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, aspirin, or diclofenac. These medications target inflammation, which contributes to pain, swelling, and stiffness. The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSAIDs.

Howard LeWine, M.D.

Common painkillers boost risk of repeat heart attack

Most people don’t think twice about taking Motrin, Advil, Aleve, or similar over-the-counter painkillers. A new study suggests that heart attack survivors should use these drugs, known as nonsteroidal anti-inflammatory drugs (NSAIDs), as little as possible. A team of Danish researchers found that among heart attack survivors, those who used an NSAID were about 60% more likely to have died during each year of the five-year study than those who didn’t use an NSAID. Of all the NSAIDs, diclofenac (Cataflam, Voltaren, generic) was linked to the largest increases in death or heart attack rates, while naproxen (Naprosyn, Aleve, generic) appeared to carry the lowest risk. The lower risk with naproxen confirms what has been seen in older studies. If you have heart disease and need pain relief, try acetaminophen first. If you need an NSAID, naproxen is probably the best choice for your heart. But whatever you and your doctor decide is best for you, use the lowest dose possible for the shortest period of time.

Daniel Pendick

Increase in heart attack risk after joint surgery low but persistent

A recent study in the Archives of Internal Medicine indicates that the risk of having a heart attack is up to 31 times higher immediately following joint replacement surgery. Those relative risk numbers could be terrifying for someone who needs to have a knee or hip replaced. The absolute risk numbers offer some reassurance. In the six weeks following surgery, one in 200 people in the study who got a new hip and one in 500 who had a knee replaced suffered a heart attack. One new point the study underscored is that the elevated risk may last longer than previously thought. Though earlier research had suggested a danger zone lasting four to five days after joint replacement—coincidentally, the period in which many people are discharged from the hospital—the elevated heart attack risk may persist for two to six weeks.

Julie Silver, M.D.

Chicken Soup for the Soul and Harvard Health serve up inspiration, information

A new series of books is bringing readers the kind of inspirational stories that have made Chicken Soup for the Soul books international bestsellers plus with trusted health advice from Harvard Medical School. The combination of stories providing hope, inspiration, and great person-to-person advice plus straight talk and life-changing medical information from Harvard doctors will help readers live healthier, more satisfying lives. Each book focuses on a single topic. The first four will be available beginning May 22, 2012. They are Chicken Soup for the Soul: Boost Your Brain Power! by top neurologist Dr. Marie Pasinski; Chicken Soup for the Soul: Say Goodbye to Back Pain! by leading physical medicine expert Dr. Julie Silver; Chicken Soup for the Soul: Say Goodbye to Stress! by noted psychologist Dr. Jeff Brown; and Chicken Soup for the Soul: Say Hello to a Better Body! by respected internist Dr. Suzanne Koven.

Howard LeWine, M.D.

Painkillers pose problems for people with heart disease

Millions of people take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), and celecoxib (Celebrex) to relieve pain and inflammation. During the last few years, researchers have raised concerns that taking these drugs often may be hard on the heart as well. The latest study, published in the July 2011 issue of the American Journal of Medicine, suggests that regular use of NSAIDs poses a special problem for people who already have heart disease, boosting their chances of having a heart attack or stroke. This research doesn’t mean that people with high blood pressure and heart disease should stop taking NSAIDs, especially if they are used to ease pain from a chronic condition like arthritis. But it may make sense to try an alternative first.

Kay Cahill Allison

Taking the pain out of runner’s knee

Patellofemoral pain syndrome, also known as runner’s knee, makes it painful to walk up and down stairs, get out of the car, and, of course, run. It happens when the kneecap doesn’t run smoothly up and down its track—a groove called the trochlea. Although anyone can get patellofemoral pain syndrome, it is more common in women than men—especially in mid-life women who’ve been running for many years. Strengthening the quadriceps (thigh) muscles and stretching the iliotibial band, connective tissue that runs from the knee to the hip, can help, as can cutting back on exercises or movements that put repetitive force on the knees.

Patrick J. Skerrett

Gaining awareness about arthritis and its prevention

Many Americans are remarkably unaware and uninformed about arthritis, a disease that affects about one of every five U.S. adults. Arthritis runs under the public’s radar because it isn’t a killer like heart disease and cancer. Yet it can take a huge toll on the quality of life through the pain and problems it causes. Arthritis is often viewed as an inevitable part of growing old. But it isn’t—there are many things you can do to keep your joints healthy. If you do have joint pain, a new Special Health Report from Harvard Health Publications called Arthritis: Keeping Your Joints Healthy, can help you manage your condition.