RPsoriasis, a chronic disease that causes red, raised patches of skin, is increasingly seen as a systemic disease with links to arthritis and cardiovascular disease. The December issue of Mayo Clinic Women’s HealthSource provides an overview of this sometimes embarrassing condition, what’s known about it and how it’s treated. Highlights of the overview include:
-- Symptoms: Patches of thick, red skin covered with silvery, flaky scales commonly appear on the elbows and knees, but can appear anywhere on the body. They result from skin cells on overdrive, reproducing much faster than normal. Doctors aren’t sure why this overproduction occurs, although genetic and environmental factors likely play roles. Psoriasis symptoms come and go and flare in response to triggers that can include infections, some medications, alcohol, smoking, stress, sunburn, skin irritation or injury.
-- A systemic illness: Doctors are finding that psoriasis is more than a skin disorder. About one in four people with psoriasis develop a form of arthritis called psoriatic arthritis that can cause pain, stiffness and swelling in the joints. Studies have shown that people with psoriasis face a higher risk of heart attack, stroke and other cardiovascular problems. The underlying link may be chronic inflammation, which plays a role in psoriasis and heart disease.
-- Treatment: While psoriasis can’t be cured, a variety of topical and systemic treatment options can help control the condition. For mild-to-moderate psoriasis, topical treatments often are effective. Options include corticosteroids or retinoids to reduce inflammation; vitamin D analogs to slow skin growth; and tar, to reduce scaling, itching and inflammation. Calcineurin inhibitors (tacrolimus and pimecrolimus) can help reduce inflammation and skin cell buildup.
In addition, ultraviolet light slows the rapid growth of skin cells. Ultraviolet light therapy may be used alone or in combination with other treatments. Several systemic medications are used for severe forms of psoriasis, though these options pose the risk of serious side effects.
-- Self-help measures: Home-care measures can help prevent or manage symptoms. A daily bath removes scales and calms inflamed skin. Adding bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts can offer additional relief. After bathing, applying a thick moisturizing cream or ointment, such as petroleum jelly, can be helpful. During cold, dry weather, it’s beneficial to apply moisturizer several times a day. Short sessions in sunlight three or more times a week can improve psoriasis, as can avoiding known triggers.
Friday, January 1, 2010
Tuesday, December 1, 2009
Exercise Therapy Best for Knee Pain
For patients with severe knee pain, supervised exercise therapy is more effective at reducing pain and improving function than usual care, finds a study published on bmj.com.
Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise and is a common reason to visit the doctor. Women are more likely to be affected than men, and symptoms usually start during adolescence when participation in sporting activities is high.
General advice is to rest during periods of pain and to avoid pain provoking activities. This "wait and see" approach is considered usual care.
A recent study reported only limited evidence for the effectiveness of exercise therapy with respect to pain reduction, while there is conflicting evidence with respect to functional improvement.
So researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy compared with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.
A total of 131 participants were included in the study, 65 to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises, as well as advice to refrain from painful activities.
Patients rated their recovery, pain at rest, pain on activity, and function scores at the start of the study and again at three and 12 months.
After three months, the intervention group reported significantly less pain and better function than the control group. At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain at rest and pain on activity, but not function.
A higher proportion of patients in the exercise group than in the control group reported recovery (42% v 35% at three months and 62% v 51% at 12 months), but these results were not significantly different between the two groups.
This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and 12 months, say the authors. However, supervised exercise therapy had no effect on perceived recovery.
Further research is needed to understand how exercise therapy results in better outcome, they conclude.
Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise and is a common reason to visit the doctor. Women are more likely to be affected than men, and symptoms usually start during adolescence when participation in sporting activities is high.
General advice is to rest during periods of pain and to avoid pain provoking activities. This "wait and see" approach is considered usual care.
A recent study reported only limited evidence for the effectiveness of exercise therapy with respect to pain reduction, while there is conflicting evidence with respect to functional improvement.
So researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy compared with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.
A total of 131 participants were included in the study, 65 to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises, as well as advice to refrain from painful activities.
Patients rated their recovery, pain at rest, pain on activity, and function scores at the start of the study and again at three and 12 months.
After three months, the intervention group reported significantly less pain and better function than the control group. At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain at rest and pain on activity, but not function.
A higher proportion of patients in the exercise group than in the control group reported recovery (42% v 35% at three months and 62% v 51% at 12 months), but these results were not significantly different between the two groups.
This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and 12 months, say the authors. However, supervised exercise therapy had no effect on perceived recovery.
Further research is needed to understand how exercise therapy results in better outcome, they conclude.
Tuesday, November 24, 2009
Causes of ‘Runner’s Knee’
From professional athletes to weekend warriors, the condition known as “runner’s knee” is a painful and potentially debilitating injury suffered by millions of people – although until now, it has been unclear just what causes it.
But new research from the University of North Carolina at Chapel Hill has zeroed in on what appear to be the main culprits of the condition, formally known as patellofemoral pain syndrome.
The study is believed to be the first large, long-term project to track athletes from before they developed runner’s knee, said study co-author Darin Padua, Ph.D., associate professor of exercise and sport science in the UNC College of Arts and Sciences.
“Earlier studies have usually looked at people after the problem sets in,” Padua said. “That means that while previous research has identified possible risk factors related to strength and biomechanics, it’s been unclear whether those caused the injury, or whether people’s muscles and the way they moved changed in response to their injury.”
The research appears in the November issue of the American Journal of Sports Medicine.
Runner’s knee – the bane of many types of exercise, from running to basketball to dance – affects one in four physically active people. If unchecked, it can lead to more serious problems such as patellofemoral osteoarthristis.
“Patellofemoral pain syndrome can be devastating,” said Padua. “The pain can severely curtail a person’s ability to exercise and the symptoms commonly reoccur. That said, athletes often have a high pain threshold and may ignore it. But if they do, their cartilage may break down – and if that gets to the point of bone on bone contact, nothing can be done to replace the damaged cartilage.”
Padua and his colleagues studied almost 1,600 midshipmen from the United States Naval Academy. Researchers analyzed participants’ biomechanics when they first enrolled at the academy, then followed them for several years to see if they developed patellofemoral pain syndrome.
A total of 40 participants (24 women and 16 men) developed the syndrome during the follow-up period. The study found:
• Participants with weaker hamstring muscles were 2.9 times more likely to develop the syndrome that those with the strongest hamstrings
• Those with weaker quadriceps muscles were 5.5 times more likely
• Those with a larger navicular drop (a measure of arch flattening when bearing weight) were 3.4 times more likely
• Participants with smaller knee flexion angle (those whose knees bent less on landing during a jump test) were 3.1 times more likely
Padua said the pain associated with the condition could be explained by those different factors coming together to create a focal point of pressure between the kneecap and the underlying bone.
“Overall, these people generally have weaker quads and hamstrings. As a result, they don’t bend their knees as much when doing task, such as running or jumping. That means the contact area between the kneecap and the femur is smaller, so pressure is focused and pinpointed on a smaller area.
“Also, the more a person’s arch falls when bearing weight, the more their whole leg may rotate inwards. That will mean their kneecap won’t track properly, leading to yet more pressure and more potential pain.”
Padua said the good news is that the study appears to confirm that if people can change the way they move and improve their leg strength, they can prevent or correct the problem.
Everyday athletes can also spot for themselves whether they are at risk: if their knee crosses over the big toe when squatting; the arches of their feet collapse when landing from a jump; and if they do not bend their knees much when they land, they stand a greater chance of developing the syndrome, Padua said.
The researchers are now looking into which exercises are best for improving the biomechanics involved. They have also developed a simple screening tool, called LESS (Landing Error Scoring System), for identifying people most at risk of runner’s knee and similar conditions, and of suffering ACL (anterior cruciate ligament) injuries.
But new research from the University of North Carolina at Chapel Hill has zeroed in on what appear to be the main culprits of the condition, formally known as patellofemoral pain syndrome.
The study is believed to be the first large, long-term project to track athletes from before they developed runner’s knee, said study co-author Darin Padua, Ph.D., associate professor of exercise and sport science in the UNC College of Arts and Sciences.
“Earlier studies have usually looked at people after the problem sets in,” Padua said. “That means that while previous research has identified possible risk factors related to strength and biomechanics, it’s been unclear whether those caused the injury, or whether people’s muscles and the way they moved changed in response to their injury.”
The research appears in the November issue of the American Journal of Sports Medicine.
Runner’s knee – the bane of many types of exercise, from running to basketball to dance – affects one in four physically active people. If unchecked, it can lead to more serious problems such as patellofemoral osteoarthristis.
“Patellofemoral pain syndrome can be devastating,” said Padua. “The pain can severely curtail a person’s ability to exercise and the symptoms commonly reoccur. That said, athletes often have a high pain threshold and may ignore it. But if they do, their cartilage may break down – and if that gets to the point of bone on bone contact, nothing can be done to replace the damaged cartilage.”
Padua and his colleagues studied almost 1,600 midshipmen from the United States Naval Academy. Researchers analyzed participants’ biomechanics when they first enrolled at the academy, then followed them for several years to see if they developed patellofemoral pain syndrome.
A total of 40 participants (24 women and 16 men) developed the syndrome during the follow-up period. The study found:
• Participants with weaker hamstring muscles were 2.9 times more likely to develop the syndrome that those with the strongest hamstrings
• Those with weaker quadriceps muscles were 5.5 times more likely
• Those with a larger navicular drop (a measure of arch flattening when bearing weight) were 3.4 times more likely
• Participants with smaller knee flexion angle (those whose knees bent less on landing during a jump test) were 3.1 times more likely
Padua said the pain associated with the condition could be explained by those different factors coming together to create a focal point of pressure between the kneecap and the underlying bone.
“Overall, these people generally have weaker quads and hamstrings. As a result, they don’t bend their knees as much when doing task, such as running or jumping. That means the contact area between the kneecap and the femur is smaller, so pressure is focused and pinpointed on a smaller area.
“Also, the more a person’s arch falls when bearing weight, the more their whole leg may rotate inwards. That will mean their kneecap won’t track properly, leading to yet more pressure and more potential pain.”
Padua said the good news is that the study appears to confirm that if people can change the way they move and improve their leg strength, they can prevent or correct the problem.
Everyday athletes can also spot for themselves whether they are at risk: if their knee crosses over the big toe when squatting; the arches of their feet collapse when landing from a jump; and if they do not bend their knees much when they land, they stand a greater chance of developing the syndrome, Padua said.
The researchers are now looking into which exercises are best for improving the biomechanics involved. They have also developed a simple screening tool, called LESS (Landing Error Scoring System), for identifying people most at risk of runner’s knee and similar conditions, and of suffering ACL (anterior cruciate ligament) injuries.
Thursday, September 17, 2009
SMALLER ACLs = MORE SUSCEPTIBLE TO INJURY
A study comparing images of the knees in people who did and didn’t have previous injuries to the anterior cruciate ligament suggests that people who tore their ACLs are more likely to have a smaller ligament than do similarly sized people who have never injured a knee.
Researchers calculated the total volume of the ligaments based on magnetic resonance images of human knees. The ACLs among those with previous injuries were, on average, about 10 percent smaller than were ACLs among those without an injury.
In those with previous injuries, the uninjured ACL in the opposite knee was measured for the study. Their ligaments were compared to the ACLs in uninjured people of similar height and weight.
Those who had torn their ACLs had experienced noncontact injuries, meaning the injury occurred during some sort of movement of the body rather than because of a blow to the knee.
Researchers caution that the retrospective study does not mean that a smaller ACL will necessarily result in injury. Instead, they say the research offers more clues about the variety of factors – such as activity level, neuromuscular coordination, gender and muscle strength – that appear to be contributors to ACL injury.
In this group of participants, weight was the strongest predictor of ACL volume.
“If you compared two people of the same weight, based on our data set, we would expect the injured person had the smaller ACL,” said Ajit Chaudhari, assistant professor of orthopedics at Ohio State University and lead author of the study.
Knowing that the knee’s anatomy can influence susceptibility should help researchers who are trying to figure out why ACL injuries occur and who is most likely to experience these injuries, Chaudhari said. Most study results guide the assignment of a percentage of risk to one or more factors associated with torn ACLs, but to date no research had looked solely at the size of the ligament in injured and non-injured knees.
The research is published in a recent issue of the American Journal of Sports Medicine.
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“If you have a weaker ACL, it’s more likely to tear if all other factors are equal,” he said. “If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is.”
The anterior cruciate ligament, responsible for rotational stability in the knee, is located behind the kneecap and is one of four ligaments that join the thigh and shin bones. Noncontact tears of the ACL tend to occur in athletes when they pivot, stop quickly or land from a jump. Previous research suggests that college-age women athletes are at three- to 10-times higher risk of tearing their ACLs than their male counterparts, depending on the activity, but scientists have not determined why this is.
“Comparisons of the volumes of ACLs between men and women have been done, which have suggested that ACL volume may matter. Studies have also found that female ACLs had fewer fibers than male ACLs that were tested. But even with those findings, any differences between males and females could be a coincidence. There are so many variables that interact that you can’t really tell what’s causative unless you compare people who have had an injury to those who haven’t had an injury,” said Chaudhari, also director of Ohio State’s Sports Biomechanics Laboratory.
He and colleagues took MR images of the knees of 54 participants, who were divided into two groups. Volunteers with previous injuries were matched with uninjured participants of the same age, gender, height and weight.
The previously injured participants’ healthy knees were imaged for the study. Chaudhari said the fibers of a torn ACL tend to fray like a rope, meaning the volume of injured ACLs could not be measured in a meaningful way. Chaudhari recently presented related research that indicated that there is no significant difference in the size of two ACLs in the same body.
Researchers used the MR images to determine the outline of each ACL under the guidance of an orthopedic surgeon experienced in operating on injured knees. They validated this method of determining ACL volume by practicing the measurement technique on five pig knees obtained from a butcher.
Of the 27 injured participants, 16 had smaller ACLs than their matched controls. Overall, the injured group had an average ACL volume of 1,921 cubic millimeters, while the control group had an average volume of 2,151 cubic millimeters.
In this group of participants, weight and height were strongly correlated as potential variables affecting the size of the ligament.
Chaudhari said that based on what is currently known about the fibrous makeup of the ligament, it’s no surprise that a smaller ACL is more susceptible to injury.
“If you have a weaker ACL, it’s more likely to tear if all other factors are equal,” he said. “If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is.”
It’s too soon to consider knee imaging as a way to screen potential athletes, Chaudhari said, because of the high expense and the fact that knowing the size of the ACL still doesn’t tell the whole story of how the knee will react to activity.
“I would certainly not say in any way, shape or form that people should start using ACL size as a determinant of whether they should play any sport,” he said.
But what it does tell researchers is that there might be more than one way to go about trying to prevent knee ligament injuries. While many prevention efforts focus on the strength of muscles surrounding the knee, Chaudhari and other researchers hope to study whether the ACL itself can be made stronger, or larger, or both, while a child is still growing and developing.
Researchers calculated the total volume of the ligaments based on magnetic resonance images of human knees. The ACLs among those with previous injuries were, on average, about 10 percent smaller than were ACLs among those without an injury.
In those with previous injuries, the uninjured ACL in the opposite knee was measured for the study. Their ligaments were compared to the ACLs in uninjured people of similar height and weight.
Those who had torn their ACLs had experienced noncontact injuries, meaning the injury occurred during some sort of movement of the body rather than because of a blow to the knee.
Researchers caution that the retrospective study does not mean that a smaller ACL will necessarily result in injury. Instead, they say the research offers more clues about the variety of factors – such as activity level, neuromuscular coordination, gender and muscle strength – that appear to be contributors to ACL injury.
In this group of participants, weight was the strongest predictor of ACL volume.
“If you compared two people of the same weight, based on our data set, we would expect the injured person had the smaller ACL,” said Ajit Chaudhari, assistant professor of orthopedics at Ohio State University and lead author of the study.
Knowing that the knee’s anatomy can influence susceptibility should help researchers who are trying to figure out why ACL injuries occur and who is most likely to experience these injuries, Chaudhari said. Most study results guide the assignment of a percentage of risk to one or more factors associated with torn ACLs, but to date no research had looked solely at the size of the ligament in injured and non-injured knees.
The research is published in a recent issue of the American Journal of Sports Medicine.
Email this to a friend
“If you have a weaker ACL, it’s more likely to tear if all other factors are equal,” he said. “If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is.”
The anterior cruciate ligament, responsible for rotational stability in the knee, is located behind the kneecap and is one of four ligaments that join the thigh and shin bones. Noncontact tears of the ACL tend to occur in athletes when they pivot, stop quickly or land from a jump. Previous research suggests that college-age women athletes are at three- to 10-times higher risk of tearing their ACLs than their male counterparts, depending on the activity, but scientists have not determined why this is.
“Comparisons of the volumes of ACLs between men and women have been done, which have suggested that ACL volume may matter. Studies have also found that female ACLs had fewer fibers than male ACLs that were tested. But even with those findings, any differences between males and females could be a coincidence. There are so many variables that interact that you can’t really tell what’s causative unless you compare people who have had an injury to those who haven’t had an injury,” said Chaudhari, also director of Ohio State’s Sports Biomechanics Laboratory.
He and colleagues took MR images of the knees of 54 participants, who were divided into two groups. Volunteers with previous injuries were matched with uninjured participants of the same age, gender, height and weight.
The previously injured participants’ healthy knees were imaged for the study. Chaudhari said the fibers of a torn ACL tend to fray like a rope, meaning the volume of injured ACLs could not be measured in a meaningful way. Chaudhari recently presented related research that indicated that there is no significant difference in the size of two ACLs in the same body.
Researchers used the MR images to determine the outline of each ACL under the guidance of an orthopedic surgeon experienced in operating on injured knees. They validated this method of determining ACL volume by practicing the measurement technique on five pig knees obtained from a butcher.
Of the 27 injured participants, 16 had smaller ACLs than their matched controls. Overall, the injured group had an average ACL volume of 1,921 cubic millimeters, while the control group had an average volume of 2,151 cubic millimeters.
In this group of participants, weight and height were strongly correlated as potential variables affecting the size of the ligament.
Chaudhari said that based on what is currently known about the fibrous makeup of the ligament, it’s no surprise that a smaller ACL is more susceptible to injury.
“If you have a weaker ACL, it’s more likely to tear if all other factors are equal,” he said. “If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is.”
It’s too soon to consider knee imaging as a way to screen potential athletes, Chaudhari said, because of the high expense and the fact that knowing the size of the ACL still doesn’t tell the whole story of how the knee will react to activity.
“I would certainly not say in any way, shape or form that people should start using ACL size as a determinant of whether they should play any sport,” he said.
But what it does tell researchers is that there might be more than one way to go about trying to prevent knee ligament injuries. While many prevention efforts focus on the strength of muscles surrounding the knee, Chaudhari and other researchers hope to study whether the ACL itself can be made stronger, or larger, or both, while a child is still growing and developing.
Thursday, August 13, 2009
Blood Clots Follow Knee Replacement!
Scientists Find New No-Needle Approach to Prevent Blood Clots
Researchers test new treatment to prevent clots, save lives after joint replacement; Results in latest issue of New England Journal of Medicine
OU Public Affairs
Oklahoma City, OK -- OKLAHOMA CITY – The dean of the University of Oklahoma College of Public Health and a team of scientists worldwide have found a better way to prevent deadly blood clots after joint replacement surgery – a major problem that results in thousands of unnecessary deaths each year. The research appears this week in the New England Journal of Medicine.
The research team, which includes scientists from Oklahoma, Denmark, Australia and Canada, set out to find a better way to prevent blood clots without increasing the risk of bleeding. Blood clots, known as deep-vein thrombosis (DVT), affect the large veins in the lower leg and thigh. If the clot breaks free and moves through the bloodstream, it can lodge in the lungs, a condition known as pulmonary embolism (PE), which is often fatal. Pulmonary embolism is the most common preventable cause of sudden death after surgery.
Current preventive treatments include uncomfortable injections and one oral anti-clotting medicine that is difficult for patients and physicians to manage. Researchers wanted to find something better.
In a double-blind study of more than 3,000 patients, researchers tested a new type of anti-clotting drug called Apixaban, which is an oral medication. The medicine proved just as effective at preventing blood clots and reduced the risk of bleeding by half. Most importantly for patient convenience, it was much easier to use.
“This is a major step in our fight to prevent DVT and the many unnecessary deaths each year caused by blood clots after joint replacement surgery. We now have a better treatment that reduces the risk of bleeding, and a patient no longer has to endure injections by needle,” said Gary Raskob, Ph.D., a lead researcher on the project and dean of the OU College of Public Health.
Raskob, who is a renowned expert in the field, said as our population ages, the number of hip and knee replacements will skyrocket in the coming years, so an easier to use and safe preventive medicine is essential. According to the American Academy of Orthopaedic Surgeons, more than 700,000 primary total hip and knee replacements are performed each year in the United States, and that number is expected to grow to more than 3.5 million by 2030.
On average, 1 percent to 3 percent of people undergoing total joint replacement will end up with a symptomatic deep-vein thrombosis (blood clot in the legs) or a pulmonary embolism (a blood clot in the lungs).
Apixaban is now being studied in Phase III clinical trials and, if approved by the U.S. Food and Drug Administration, will be an important option for patients having joint replacement surgery.
Researchers test new treatment to prevent clots, save lives after joint replacement; Results in latest issue of New England Journal of Medicine
OU Public Affairs
Oklahoma City, OK -- OKLAHOMA CITY – The dean of the University of Oklahoma College of Public Health and a team of scientists worldwide have found a better way to prevent deadly blood clots after joint replacement surgery – a major problem that results in thousands of unnecessary deaths each year. The research appears this week in the New England Journal of Medicine.
The research team, which includes scientists from Oklahoma, Denmark, Australia and Canada, set out to find a better way to prevent blood clots without increasing the risk of bleeding. Blood clots, known as deep-vein thrombosis (DVT), affect the large veins in the lower leg and thigh. If the clot breaks free and moves through the bloodstream, it can lodge in the lungs, a condition known as pulmonary embolism (PE), which is often fatal. Pulmonary embolism is the most common preventable cause of sudden death after surgery.
Current preventive treatments include uncomfortable injections and one oral anti-clotting medicine that is difficult for patients and physicians to manage. Researchers wanted to find something better.
In a double-blind study of more than 3,000 patients, researchers tested a new type of anti-clotting drug called Apixaban, which is an oral medication. The medicine proved just as effective at preventing blood clots and reduced the risk of bleeding by half. Most importantly for patient convenience, it was much easier to use.
“This is a major step in our fight to prevent DVT and the many unnecessary deaths each year caused by blood clots after joint replacement surgery. We now have a better treatment that reduces the risk of bleeding, and a patient no longer has to endure injections by needle,” said Gary Raskob, Ph.D., a lead researcher on the project and dean of the OU College of Public Health.
Raskob, who is a renowned expert in the field, said as our population ages, the number of hip and knee replacements will skyrocket in the coming years, so an easier to use and safe preventive medicine is essential. According to the American Academy of Orthopaedic Surgeons, more than 700,000 primary total hip and knee replacements are performed each year in the United States, and that number is expected to grow to more than 3.5 million by 2030.
On average, 1 percent to 3 percent of people undergoing total joint replacement will end up with a symptomatic deep-vein thrombosis (blood clot in the legs) or a pulmonary embolism (a blood clot in the lungs).
Apixaban is now being studied in Phase III clinical trials and, if approved by the U.S. Food and Drug Administration, will be an important option for patients having joint replacement surgery.
Thursday, July 16, 2009
Hip exercises fight osteoarthritis in the knee joints
Study to assess hip exercises as treatment for osteoarthritis in the knee joints
Goal is to prevent the disease from progressing
Researchers at Rush University Medical Center are testing a novel regimen of hip-muscle exercises to decrease the load on the knee joints in patients with osteoarthritis. The goal is not only to relieve pain but also, possibly, to halt progression of the disease.
"Each time you take a step, a load, or force, is placed on the knee joints. How much load depends not just on your weight, but also on the way you walk and the alignment of your leg," said Laura Thorp, PhD, assistant professor of anatomy and cell biology at Rush Medical College and principal investigator for the study. "If we can appropriately alter the gait patterns of patients with osteoarthritis, we can minimize the load and relieve pain.
"Ultimately, we're hoping we can prevent the disease from advancing. No treatment currently exists that can stop osteoarthritis from progressing in the knees, other than joint replacement surgery."
Osteoarthritis is the most common form of arthritis and a significant source of disability and impaired quality of life. A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of the osteoarthritis and its progression, according to Thorp.
Thorp is enrolling patients with mild to moderate osteoarthritis in their knees in a research study to determine the effectiveness of certain hip exercises in treating the disease. Study participants have their knees x-rayed and undergo an initial assessment in Rush's Human Motion Laboratory to measure the load on their knee joints while walking. Participants then follow a specific regimen of hip exercises for four weeks under the direction of Charles Cranny, clinical manager of outpatient physical therapy.
The exercises focus on strengthening the hip abductor muscles, such as the gluteus medius, a broad, thick, radiating muscle that helps to stabilize the pelvis during ambulation. In patients with osteoarthritis in the knees, these muscles tend to be weak, causing the pelvis to tilt toward the side of the swing leg when walking, instead of remaining level with the ground, which increases the load on the knee joints. Strengthening these muscles helps the pelvis and the knee remain in better alignment, and thereby lessens the load.
After the four weeks of supervised physical therapy, participants are reassessed to determine whether the load on the knees has decreased, and whether the pain has subsided.
The trial continues for another four weeks, with patients exercising at home to determine whether the adjustments in gait can be maintained.
According to Thorp, exercise regimens to date have focused largely on strengthening the quadriceps and hamstring muscles, which stabilize the knee joint but likely do little to correct alignment with the rest of the leg or alter the load on the joint.
Preliminary evidence in the present trial has already shown that a decrease in load is attained with hip-muscle exercises.
"By lessening the load on the knees, we can remove one of the major known risk factors for the progression of osteoarthritis," Thorp said.
Goal is to prevent the disease from progressing
Researchers at Rush University Medical Center are testing a novel regimen of hip-muscle exercises to decrease the load on the knee joints in patients with osteoarthritis. The goal is not only to relieve pain but also, possibly, to halt progression of the disease.
"Each time you take a step, a load, or force, is placed on the knee joints. How much load depends not just on your weight, but also on the way you walk and the alignment of your leg," said Laura Thorp, PhD, assistant professor of anatomy and cell biology at Rush Medical College and principal investigator for the study. "If we can appropriately alter the gait patterns of patients with osteoarthritis, we can minimize the load and relieve pain.
"Ultimately, we're hoping we can prevent the disease from advancing. No treatment currently exists that can stop osteoarthritis from progressing in the knees, other than joint replacement surgery."
Osteoarthritis is the most common form of arthritis and a significant source of disability and impaired quality of life. A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of the osteoarthritis and its progression, according to Thorp.
Thorp is enrolling patients with mild to moderate osteoarthritis in their knees in a research study to determine the effectiveness of certain hip exercises in treating the disease. Study participants have their knees x-rayed and undergo an initial assessment in Rush's Human Motion Laboratory to measure the load on their knee joints while walking. Participants then follow a specific regimen of hip exercises for four weeks under the direction of Charles Cranny, clinical manager of outpatient physical therapy.
The exercises focus on strengthening the hip abductor muscles, such as the gluteus medius, a broad, thick, radiating muscle that helps to stabilize the pelvis during ambulation. In patients with osteoarthritis in the knees, these muscles tend to be weak, causing the pelvis to tilt toward the side of the swing leg when walking, instead of remaining level with the ground, which increases the load on the knee joints. Strengthening these muscles helps the pelvis and the knee remain in better alignment, and thereby lessens the load.
After the four weeks of supervised physical therapy, participants are reassessed to determine whether the load on the knees has decreased, and whether the pain has subsided.
The trial continues for another four weeks, with patients exercising at home to determine whether the adjustments in gait can be maintained.
According to Thorp, exercise regimens to date have focused largely on strengthening the quadriceps and hamstring muscles, which stabilize the knee joint but likely do little to correct alignment with the rest of the leg or alter the load on the joint.
Preliminary evidence in the present trial has already shown that a decrease in load is attained with hip-muscle exercises.
"By lessening the load on the knees, we can remove one of the major known risk factors for the progression of osteoarthritis," Thorp said.
Monday, April 13, 2009
Osteoarthritis of the Knee: A Guide for Adults
1. Introduction
Treatments for osteoarthritis of the knee can help reduce pain. They can also help you stay active. Most people can find a treatment plan that works for them. A combination of treatments often works best.
This guide can help you learn about options. It can help you come up with a treatment plan that works for you. This guide covers ways to help you feel better. It also covers research about treatments that usually don’t help.
2. About Osteoarthritis
Osteoarthritis is common in the knee joint. It happens when cartilage in the joint wears down.
Cartilage is a rubbery tissue at the end of bones that allows the joint to move easily. With osteoarthritis, cartilage breaks down over time. The knee can become painful, stiff, and swollen.
The knee contains a small amount of fluid that lubricates the cartilage. It also helps cushion the joint. With osteoarthritis, this fluid does not work as well, so it can be hard to move your joints.
3. Fast Facts for Treatments That Help
Fast Facts on Pain Relievers
There is no cure for osteoarthritis.
Staying active and losing weight are ways to help you feel better.
Some people need to take pain medicine to stay active and control the pain.
4. Treatments That Help
Getting active and staying at a healthy weight are important for everyone with osteoarthritis of the knee. Some people also may need to take pain medicine to help lower pain and keep them moving.
Getting Active
Exercise is a great way to improve your health. You may think that exercise is not good for osteoarthritis. But it is. Being more active and staying active can help you have less pain and move more easily.
Walking, swimming, and water aerobics are good choices for people with osteoarthritis. Talk with your doctor or nurse about making an exercise plan that works for you.
Your doctor also may recommend physical therapy. Physical therapy is a special exercise program done with a trained professional. The exercises help you move and be flexible. They also can help reduce knee pain.
Getting to a Healthy Weight
Losing weight can help take the stress off of your knees. Each pound lost will help. Staying at a healthy weight can help keep you more active and moving.
Pain Medicine
Medicines can help relieve the pain of knee osteoarthritis. Some people need to take pain medicine to stay active. There are pain medicines that work for osteoarthritis. Your doctor or nurse may recommend over-the-counter or prescription drugs.
If you want to learn more about choosing pain medicine for osteoarthritis, the Agency for Healthcare Research and Quality has published another guide that may be useful to you. That guide is called Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers (2007).
5. Fast Facts for Treatments That Usually Do Not Help
Fast Facts for Treatments That Usually Do Not Help
Glucosamine and chondroitin usually do not reduce pain or improve knee movement.
Joint lubricant shots (not the same as cortisone shots) usually do not reduce pain or improve knee movement.
Arthroscopic knee surgery usually does not reduce pain or improve knee movement.
6. Treatments That Usually Do Not Help
This information comes from a government-funded review of research about three treatments for osteoarthritis of the knee. Research shows that these treatments often do not help people who have knee osteoarthritis.
Glucosamine and Chondroitin
Glucosamine and chondroitin are nutritional supplements. People take them to help build new cartilage. Glucosamine and chondroitin are not regulated as drugs in the United States, so their quality may vary. Minor side effects include upset stomach, diarrhea, and headache.
Research studies tell us that more than half the people with osteoarthritis taking glucosamine and chondroitin improve. They have less pain and better movement. But in these studies, the same number of people who do not take the supplements also improve. This means that glucosamine and chondroitin are not the reason that some people improve.
Joint Lubricant Shots
Joint lubricant shots are not the same as cortisone shots. In this treatment, a gel-like material is given by a shot into the knee joint. Usually three to five shots are given over a few weeks. It is also called viscosupplementation (VIS-co-SUP-luh-men-TAY-shun).
Possible side effects from joint lubricant shots include minor infection, pain, and swelling. These side effects last a short time and go away without treatment. It is rare, but these shots also can cause swelling and pain that do not go away on their own. This happens with about 2 out of 100 people who get the shots. If it happens, medicines or another procedure may be needed.
Many research studies have compared people getting the shots with those who do not. These studies have found that most people getting the shots do not have much improvement. The shots usually do not reduce pain or improve knee movement.
Arthroscopic Surgery for Osteoarthritis
Arthroscopic (ahr-thruh-SKOP-ik) knee surgery is a minor surgery. Doctors insert a flexible tool into the knee joint. They then rinse the joint. Sometimes they smooth out the cartilage and remove loose pieces. Possible problems can happen after surgery, like pain, swelling, and infection. Blood clots in the legs also can happen.
Research shows that arthroscopic knee surgery usually does not reduce the pain of knee osteoarthritis. Doctors may use arthroscopic surgery for other types of knee problems, like sports injuries. It is sometimes helpful for those problems but not for knee osteoarthritis.
7. Things to Think About
Am I getting the right amount of exercise?
A small increase in activity several times a week can increase your strength and help with osteoarthritis symptoms.
The goal is to help with joint movement. Exercise does not need to be difficult. What’s important is to get moving.
Find a kind of exercise that fits your lifestyle.
How can I get the most out of my doctor visits?
Plan for the visit by writing down what you want to talk about.
Make sure your doctor or nurse knows all the medicines, vitamins, and supplements you take.
Take a list of questions you want to ask.
What should I ask my doctor or nurse?
How bad is my knee osteoarthritis?
What options are available to decrease my knee pain?
How will this treatment help me?
How will I know the treatment is working?
What are all the possible side effects?
8. Source
The information in this guide comes from a detailed review of 86 research reports. The review is called Treatment of Primary and Secondary Osteoarthritis of the Knee (2008) and was written by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center.
Treatments for osteoarthritis of the knee can help reduce pain. They can also help you stay active. Most people can find a treatment plan that works for them. A combination of treatments often works best.
This guide can help you learn about options. It can help you come up with a treatment plan that works for you. This guide covers ways to help you feel better. It also covers research about treatments that usually don’t help.
2. About Osteoarthritis
Osteoarthritis is common in the knee joint. It happens when cartilage in the joint wears down.
Cartilage is a rubbery tissue at the end of bones that allows the joint to move easily. With osteoarthritis, cartilage breaks down over time. The knee can become painful, stiff, and swollen.
The knee contains a small amount of fluid that lubricates the cartilage. It also helps cushion the joint. With osteoarthritis, this fluid does not work as well, so it can be hard to move your joints.
3. Fast Facts for Treatments That Help
Fast Facts on Pain Relievers
There is no cure for osteoarthritis.
Staying active and losing weight are ways to help you feel better.
Some people need to take pain medicine to stay active and control the pain.
4. Treatments That Help
Getting active and staying at a healthy weight are important for everyone with osteoarthritis of the knee. Some people also may need to take pain medicine to help lower pain and keep them moving.
Getting Active
Exercise is a great way to improve your health. You may think that exercise is not good for osteoarthritis. But it is. Being more active and staying active can help you have less pain and move more easily.
Walking, swimming, and water aerobics are good choices for people with osteoarthritis. Talk with your doctor or nurse about making an exercise plan that works for you.
Your doctor also may recommend physical therapy. Physical therapy is a special exercise program done with a trained professional. The exercises help you move and be flexible. They also can help reduce knee pain.
Getting to a Healthy Weight
Losing weight can help take the stress off of your knees. Each pound lost will help. Staying at a healthy weight can help keep you more active and moving.
Pain Medicine
Medicines can help relieve the pain of knee osteoarthritis. Some people need to take pain medicine to stay active. There are pain medicines that work for osteoarthritis. Your doctor or nurse may recommend over-the-counter or prescription drugs.
If you want to learn more about choosing pain medicine for osteoarthritis, the Agency for Healthcare Research and Quality has published another guide that may be useful to you. That guide is called Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers (2007).
5. Fast Facts for Treatments That Usually Do Not Help
Fast Facts for Treatments That Usually Do Not Help
Glucosamine and chondroitin usually do not reduce pain or improve knee movement.
Joint lubricant shots (not the same as cortisone shots) usually do not reduce pain or improve knee movement.
Arthroscopic knee surgery usually does not reduce pain or improve knee movement.
6. Treatments That Usually Do Not Help
This information comes from a government-funded review of research about three treatments for osteoarthritis of the knee. Research shows that these treatments often do not help people who have knee osteoarthritis.
Glucosamine and Chondroitin
Glucosamine and chondroitin are nutritional supplements. People take them to help build new cartilage. Glucosamine and chondroitin are not regulated as drugs in the United States, so their quality may vary. Minor side effects include upset stomach, diarrhea, and headache.
Research studies tell us that more than half the people with osteoarthritis taking glucosamine and chondroitin improve. They have less pain and better movement. But in these studies, the same number of people who do not take the supplements also improve. This means that glucosamine and chondroitin are not the reason that some people improve.
Joint Lubricant Shots
Joint lubricant shots are not the same as cortisone shots. In this treatment, a gel-like material is given by a shot into the knee joint. Usually three to five shots are given over a few weeks. It is also called viscosupplementation (VIS-co-SUP-luh-men-TAY-shun).
Possible side effects from joint lubricant shots include minor infection, pain, and swelling. These side effects last a short time and go away without treatment. It is rare, but these shots also can cause swelling and pain that do not go away on their own. This happens with about 2 out of 100 people who get the shots. If it happens, medicines or another procedure may be needed.
Many research studies have compared people getting the shots with those who do not. These studies have found that most people getting the shots do not have much improvement. The shots usually do not reduce pain or improve knee movement.
Arthroscopic Surgery for Osteoarthritis
Arthroscopic (ahr-thruh-SKOP-ik) knee surgery is a minor surgery. Doctors insert a flexible tool into the knee joint. They then rinse the joint. Sometimes they smooth out the cartilage and remove loose pieces. Possible problems can happen after surgery, like pain, swelling, and infection. Blood clots in the legs also can happen.
Research shows that arthroscopic knee surgery usually does not reduce the pain of knee osteoarthritis. Doctors may use arthroscopic surgery for other types of knee problems, like sports injuries. It is sometimes helpful for those problems but not for knee osteoarthritis.
7. Things to Think About
Am I getting the right amount of exercise?
A small increase in activity several times a week can increase your strength and help with osteoarthritis symptoms.
The goal is to help with joint movement. Exercise does not need to be difficult. What’s important is to get moving.
Find a kind of exercise that fits your lifestyle.
How can I get the most out of my doctor visits?
Plan for the visit by writing down what you want to talk about.
Make sure your doctor or nurse knows all the medicines, vitamins, and supplements you take.
Take a list of questions you want to ask.
What should I ask my doctor or nurse?
How bad is my knee osteoarthritis?
What options are available to decrease my knee pain?
How will this treatment help me?
How will I know the treatment is working?
What are all the possible side effects?
8. Source
The information in this guide comes from a detailed review of 86 research reports. The review is called Treatment of Primary and Secondary Osteoarthritis of the Knee (2008) and was written by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center.
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