StemCell Therapy

By Jane Brody

When a physically active person like me injures a joint, especially one as crucial as a knee or ankle, one of the first thoughts is likely to be How fast can I get back to my usual activities?

That kind of thinking, however, could set the stage for a painful chronic problem years later: post-traumatic osteoarthritis.

In the rush to get back in the game whether as part of a team or elite sport or simply a cherished recreational activity like jogging or tennis it is tempting to short-circuit the rehabilitation needed to allow the joint to heal fully. But adequate recovery, including rehab measures aimed at strengthening structures that support the injured joint, is critical to maximize its stability, reduce the risk of re-injury and head off irreparable joint damage.

And you dont have to be a senior citizen to pay the price of failing to build up the tissues that help protect that joint. Studies have shown that when an adolescent or young adult suffers a knee injury, for example, X-ray evidence of arthritis is often apparent within a decade.

As a team of orthopedists and rehabilitation specialists from the University of Iowa explained, Recent research suggests that acute joint damage that occurs at the time of an injury initiates a sequence of events that can lead to progressive articular surface damage. That means deterioration of the surface of the bone itself and the connecting tissues that cushion and stabilize bones of a joint like the knee, which is what arthritis is all about.

Osteoarthritis afflicts some 27 million Americans, and that number will certainly grow with the increase in obesity, the current emphasis on lifelong physical activity and the aging of the population. It is a degenerative joint disease that occurs when the protective cartilage on the ends of bones and often the surface of the bones themselves wear down, causing pain, stiffness, instability and disability that can interfere with work and mobility and diminish quality of life.

The Iowa team noted that arthritis will eventually develop in more than 40 percent of people who seriously injure the ligaments (the stabilizing bands that connect bones to one another); the meniscus (the crescent-shaped cartilage that cushions the knee and certain other joints), or the articular surface of a joint. People with a history of trauma to the knee, for example, are three to six times more likely to develop arthritis in that knee. Even without an acute injury, highly repetitive impact on a joint can damage the articular cartilage.

This may help to explain why I ended up with bone-on-bone arthritis and had to replace both knees at age 63. I had suffered three ligament injuries (while skiing) and after years of running and singles tennis, the meniscus in both knees had shredded. Although I did the recommended physical therapy after each injury, I now know that I was not sufficiently diligent about maintaining the strength and flexibility of the supporting muscles and other tissues that might have better protected my knees for years longer.

A consensus statement in the Journal of Athletic Training said that arthritis should no longer be considered a disease that affects only the elderly.

Increasing evidence demonstrates that young and middle-age adults are suffering from osteoarthritis as well, the statement said. More than half of adults with symptomatic knee osteoarthritis are younger than 65.

In fact, as Joseph M. Hart, an athletic trainer who conducts clinical research at the University of Virginia, and his colleagues wrote in the journal, A 17-year-old athlete who tears her anterior cruciate ligament could develop osteoarthritis before she turns 30, potentially leading to chronic pain and disability. Damage to this ligament, in the center of the knee, is the most common injury among young athletes, especially girls, they wrote.

Jeffrey B. Driban, an athletic trainer at Tufts Medical Center in Boston, said that one person in three who injures the anterior cruciate ligament will have X-ray evidence of osteoarthritis within 10 years whether or not the injury is repaired surgically.

Driban and co-authors pointed out that some sports soccer, elite-level long-distance running, competitive weight lifting and wrestling are associated with a higher risk of knee injuries.

Sports participants who suffer a knee injury can minimize the risk of reinjury and arthritis, Driban said, by not rushing back into activity or trying to play through pain. They must strengthen the muscles that support the joint the quads, hamstrings and hip muscles. Its important to think about the entire lower extremity, not just the knee.

After an injury, an athletic trainer, rehabilitation specialist or physical therapist who specializes in orthopedics can evaluate a persons muscle strength, endurance, balance and movement quality, then guide recovery with a structured rehab program that is maintained for six to nine months, Hart said.

It is also important to continue to pursue an active lifestyle, said Abby C. Thomas of the University of North Carolina at Charlotte.

You may have to modify the activities you do, but you have to stay active to maintain strength and cardiovascular fitness without putting repetitive stress on a joint thats already injured, she said. If your knee hurts and you cant run, maybe get on a bike or swim, activities that place less stress on the knees.

Dont sit around on the couch because running hurts, Thomas said. Try walking, or something different, but dont give up on physical activity.

Lifelong activity is also important to prevent weight gain, since every extra pound places disproportionate stress on the knees. All the authors emphasized that pursuing a healthy lifestyle is crucial for everyone, not just elite athletes and those who play on school teams.

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Brody: Time after a joint injury can fend off arthritis - Sarasota Herald-Tribune

Dear Doctor: We were shocked when our daughter, who is 26, was diagnosed with rheumatoid arthritis. I thought arthritis was something that elderly people got. What treatments are available and what are our daughter's prospects for an active and healthy life?

Dear Reader: We're very sorry to hear about the medical challenge your family is facing and hope the information we offer will be of help.

When it comes to what is commonly referred to as "arthritis," we're actually talking about two different conditions. Osteoarthritis, which is the type of arthritis you're thinking of in regards to a more elderly population, is a degenerative disease. In osteoarthritis, the tissues of the joints deteriorate due to wear and tear. When the cartilage that cushions the joints begins to break down, it leads to swelling, stiffness and pain.

Rheumatoid arthritis, or RA, is an inflammatory autoimmune disease. Joint damage occurs because the immune system has gone haywire and begins to target the body's own tissues. Although RA most commonly affects the joints, it can also involve other parts of the body, including the lungs, digestive system, circulatory system, skin and eyes.

In the United States, about 1.5 million people (more women than men) are living with RA. It generally doesn't appear until the 40s, and becomes increasingly common as we hit our 50s and beyond, but cases in younger people are not rare.

The most common sites of inflammation in RA are the wrists and the finger joints closest to the palm. However, the knees, neck, ankles, feet, elbows and shoulders can also be involved. RA has a symmetrical pattern, so the joint on each side of the body is usually affected. In addition to that symmetry, symptoms of RA include tender and swollen joints, a feeling of warmth within the joints, fatigue and occasional fever. For many people, prolonged morning stiffness or difficulty moving again following a long period of inactivity can be some of the early signs of RA.

Treatment is tailored to each person's symptoms. Your daughter's rheumatologist will discuss lifestyle changes to address inflammation. This includes using special tools or aids to help with difficult tasks, pursuing the right kind of exercise -- hatha yoga has been found to be helpful -- and striking the optimal balance between activity and rest.

Eating a well-balanced anti-inflammatory diet can help manage RA symptoms. This treatment approach got a boost recently when a study found that RA patients who ate fish twice a week (baked, steamed, raw or broiled, but not fried) scored measurably lower on a standardized scale that measures disease activity.

Some medications for RA address pain and inflammation. Others take aim at the disease process itself. All have potential side effects, so urge your daughter to learn the risks and benefits of any proposed medication.

Looking to the future, advances in immunotherapy and the expanding study of the ever-surprising gut biome offer hope for RA sufferers. In the meantime, prompt treatment is crucial. Make sure your daughter finds a good rheumatologist she likes and begins her medical care.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.

Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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Treatments for rheumatoid arthritis unique to individual patient ... - Beatrice Daily Sun

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Carl W. Miller of Irwin started collecting guns in high school, became a marksman in the Army National Guard and spent more than 45 years teaching hunter/trapper courses in area sportsmen clubs.

He loved it, said his daughter Colleen Stubbs. He enjoyed (teaching) and they counted on him.

Mr. Miller became interested in firearms from when he could carry one in his hands, said his sister, Mary Ann Brown.

He reloaded his own ammunition. Shortly before his death, he was asking if she was interested in selling a Mossberg rifle owned by her late husband, she said.

It was his passion, she said.

Carl W. Miller died Friday, Aug. 18, 2017, in Excela Westmoreland Hospital. He was 82.

He was born July 11, 1935, in Arona, the son of the late Lawrence J. and Violet Miller.

He joined the Army National Guard in 1954 and attained the rank of sergeant in the 110th Infantry, his family said.

He was on active duty during part of his six-year enlistment.

Mr. Miller retired from CTP Carrera Inc. in Latrobe, where he was a quality assurance technician.

He was a member of American Legion Post No. 359 in Irwin and the National Rifle Association.

Her brother was a prankster who liked to wait until the tensest moment in a horror movie to yell boo, Brown said. He was a bundle of laughter and fun.

Diagnosed with rheumatoid arthritis in the 1960s, he didn't allow the inflammatory joint disease to stop him from participating in shooting competitions as well as hunting and fishing, his daughter said. He also made muzzleloaders.

He was still able to target shoot and be very, very good, so he was very proud of that, Stubbs said.

Mr. Miller occasionally hunted elk in Colorado, but mainly hunted deer, turkey and small game in Pennsylvania and fished for trout in area streams, said his son Eric Miller of Greensburg. He had 50 to 60 guns in his collection.

He also enjoyed camping and taking vacations in Hilton Head and the Outer Banks.

He was easygoing, his son said. He got along with everybody.

Their father was a social butterfly who developed an interest in photography and video in the 1960s, Stubbs said.

At family reunions, Christmas parties and other gatherings, he was the man with the video camera long before most people had them, she said.

He had his own darkroom and collected cameras, his family said.

Whenever he traveled, his camera was always with him, Stubbs said.

His memberships included the Irwin Sportsmen's Club, the White Oak Road and Gun Club and the McKeesport Sportsmen's Association.

He was a member of as many as he could join, she said.

Mr. Miller was preceded in death by his wife of 36 years, Martha G. (Lash) Miller. He is survived by their four children, Denise Sager of Mt. Pleasant; Christine Trout and her husband, W. Ronald, of Richland; Colleen Stubbs and her husband, Jeff, of Erie; and Eric Miller and his wife, Terri, of Greensburg; 12 grandchildren, and two great-granddaughters.

A funeral service will be held at 11 a.m. Tuesday at the Joseph W. Nickels Funeral Home, 404 Sewickley Ave., Herminie. Interment with full military honors will follow at Westmoreland County Memorial Park, 150 East Side Drive, Hempfield.

Memorial donations may be made to the Arthritis Foundation, 790 Holiday Drive, Green Tree, PA, 15220.

Brian Bowling is a Tribune-Review staff writer. Reach him at 724-850-1218, bbowling@tribweb.com or via Twitter @TribBrian.

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Rheumatoid arthritis didn't stop Irwin man from enjoying the outdoors - Tribune-Review

Over time, rheumatoid arthritis can damage the joints themselves as well as the nearby cartilage.

There is no cure for the condition, however the symptoms can be treated using medication and supportive therapies such as physiotherapy.

In this large population-based study, we were able to address these questions more thoroughly than has been possible before, the researchers wrote.

Using the Pill for more than seven years - the average length of use among the study participants - was associated with a 19 per cent lower risk of developing arthritis.

Further research is required to explore the biological mechanisms behind our findings.

The oral contraceptive pill contains artificial versions of the female hormones oestrogen and progesterone, which women produce naturally to prevent the ovary releasing an egg.

Pill usage declines steeply with age, from two-thirds of women aged 20 to 24, to 11 per cent of women in their late 40s.

There is no upper age limit beyond which healthy women should not take the pill, however those who smoke are advised not to take it above 35, according to the Family Planning Association, a sexual health charity.

Published in the Annals of Rheumatic Diseases, the study also sought to identify whether breastfeeding was associated with a lower risk of arthritis, as had been suspected, however no significant link was found.

Continued here:
Does the pill prevent arthritis? New study suggests a link - Telegraph.co.uk

The human joint is a wonderfully flexible and durable evolutionary innovation, but like any good machine eventually itwears down. And in many people, this wearing is thought to causearthritis.

Pain from arthritis strikes some 54.4 million U.S. adults, and is "one of the most common chronic conditions in the nation," accordingto theCenters for Disease Controlwebsite. The disease causes stiffness, swelling and pain in the joints and has been found in humans for thousands of years. (Scientists even identified evidence of arthritis inNefertari's mummified knees.) But researchers havelong assumed that arthritis rates have spiked in recent years as people live longer and populations grow heavier. Now, as Mitch Leslie reports forScience,a study of ancient knees has finally provided evidence to support the trend, and suggests that arthritis maynot be an inevitable fate ofold age.

To tease out the history of arthritis, Harvard University biologist Ian Wallace studied skeletons of middle-aged and elderly people from various time periods of America, including specimens from Native Americansup to 6,000 years old. He thought that perhaps in the early days of humanitywhen when walking was the main way to get around and many people spent their lives hunting, farming or fightingthe rates of arthritis would actually be fairly high due to the joint stress fromall this activity.

But this wasn't the case.

Instead, it appears that osteoarthritis of the knees affects far more Americans today than even just a few decades ago, Leslie reports. And aftercontrolling for weight and age, the results suggest that these factors have no effect on how many people develop the disorder. Strikingly, the rate of osteoarthritis has more than doubled among Americans just since 1940. Wallace and his team pubished their results earlier this month in the journal Proceedings of the National Academy of Sciences.

We were able to show, for the first time, that this pervasive cause of pain is actually twice as common today than even in the recent past," Wallace says in a statement. "But the even bigger surprise is that its not just because people are living longer or getting fatter, but for other reasons likely related to our modern environments.

The study doesn't make any conclusions for why this spike has occurred, but study co-author Daniel Lieberman suggests that the epidemic of sitting in mondern-day Americacould be affecting how our joints are formed and maintained, leading to more arthritis,Richard Harris reports for NPR. Changing diets and the rising rates of injuries from sports among children and adults could also play a role.

Though cause is still unknown, the study's results suggest that the disease may not be as inevitable as once believed. We should think of this as a partly preventable disease,"Lieberman says in a statement.

Today, there is no true "cure" for arthritis, only management of pain, such as takingmedications, wearing splintsand losing weight. In 2003, Americans spent some $80.8billion on diagnosis and treatment of the disease. But researchers hope to eventually stem the flow of that money. The latest study gives hope that with continued testing of treatments and ways to prevent osteoarthritis, we can eventually beat this ancient ailment.

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What a 6000-Year-Old Knee Can Teach Us About Arthritis - Smithsonian

There are more than 200 different kinds of arthritis, with symptoms not limited to joint pain and swelling but also including, for some people, fatigue, psoriasis, or even mouth ulcers, depending on the type of arthritis. Its often thought of in terms of painful hands and creaky knees, but the true impact of arthritis on daily life is all too often misunderstood, underestimated and ignored.

The two main types of arthritis are osteoarthritis and inflammatory conditions, such as rheumatoid arthritis. The most common symptom in all forms of arthritis is pain.

According to research firm Revealing Reality, who carried out a study for Arthritis Research UK, for many people living with arthritis, dealing with pain is an ongoing battle: eight out of 10 (78%) report experiencing pain most days and almost six out of 10 (57%) suffer with it every day.

As a result, many people have to give up careers or reduce working hours. Likewise, family life can be affected, with fatigue and pain making it difficult to look after children or enjoy moments of intimacy with a partner. The pain and impact caused by arthritis can also lead to mental health issues, such as anxiety or depression.

Its not a problem associated with any one group of people either: while some types of the condition are more common in older people, others can strike at any age. The word arthritis itself just means joint pain, explains Dr Tom Margham, a GP and clinical adviser to Arthritis Research UK. Its not a diagnosis in itself, its a symptom, he says. While there are effective treatments, work to find a cure for the condition is still ongoing.

Osteoarthritis is by far the most common form of arthritis, affecting at least 8 million people in the UK. Though almost anyone can get it, its more common among people who are in their late 40s or older, among women, and in people who are overweight.

It happens when the surfaces within joints become damaged, so the joint doesnt move as smoothly as it should. Joints are living tissue, Margham explains, constantly adapting in the face of stresses and strains. Its about wear and repair: if the balance of wear is bigger than the repair, thats when you start to get symptoms.

In the worst cases of osteoarthritis, cartilage becomes so thin that it no longer covers the ends of the bones, leaving them to rub against each other and wear away. This not only causes considerable pain and stiffness, it affects mobility and dexterity, seriously limiting day-to-day life, for example by making something as simple as getting out of bed, sitting down or climbing the stairs into an arduous task.

But the idea that osteoarthritis is just an inevitable consequence of ageing that cant be helped is a myth, says Margham. Its not a condition that progresses inevitably: there are definitely lots of things that can help, he says. Its largely about trying to restore and maintain normal joint function.

That means exercising and moving the joint to strengthen it and the muscle around it, for instance by doing squats or lunges, even if it seems counter intuitive. One of the things we push really hard for people with osteoarthritis to do is to go against the natural tendency to think: I better not move it, because thats the best way to protect the area. In fact, hurt doesnt necessarily mean harm to the joint, he says.

If people stop moving when they have pain they very quickly become less fit. A colleague of mine says: If you rest, you rust, adds Margham. It doesnt take a gym or any special equipment, you just use your body weight and gravity.

Any doctor will be happy to discuss pain-management options, and its important to do so.

Treatments for osteoarthritis include steroid injections into the joint, occupational or physiotherapy and in severe cases joint replacement surgery. Painkillers, such as paracetamol, and non-steroidal anti-inflammatory drugs can reduce stiffness and swelling, as well as relieving pain, making it easier to stay active.

Inflammatory conditions are treated by suppressing the immune system a specialist treatment thats usually provided in a hospital outpatient department. Rheumatoid arthritis, estimated to affect more than 400,000 people in the UK, is a common example, with symptoms other than pain and swelling including fatigue, depression, and flu like symptoms.

The thing you need to treat is the pain, adds Margham. We would always say to people: Dont suffer in silence.

Olivia Belle, director of external affairs at Arthritis Research UK, comments: Arthritis, and its effect on individuals, is not well understood. Far from being just inevitable aches and pains, it can actually have a huge impact on peoples lives at any age. But because arthritis is invisible, the condition is underestimated and dismissed by wider society, and so people are not getting the help that they need. At Arthritis Research UK, we are committed to revealing the reality of living with arthritis to help improve the support available.

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What is arthritis? Separate the facts from the fiction - The Guardian

Sacramento Bee

A 14-foot-tall arthritis patient receives treatment at the Sacramento Zoo Sacramento Bee At 14 feet tall and nearly 1,600 pounds, Goody is an unusual arthritis patient. She's also a reticulated giraffe, and a celebrity of sorts at the Sacramento Zoo. In addition to the attention and treats she gets from zoo visitors at the feeding deck of ...

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A 14-foot-tall arthritis patient receives treatment at the Sacramento Zoo - Sacramento Bee

Saturday August 19, 2017

A new study has revealed that the prevalence of osteoarthritis in the knees of humans has doubled since the mid-20th century - and not because we're living longer.

Dr. Ian Wallace, a postdoctoral research fellow in the Department of Human Evolutionary Biology at Harvard University, studied over 2000 skeletons from three different time periods in order to reach that conclusion. He looked at 176 prehistoric skeletons, and many more from both the early industrial era and the post-industrial era, which included specimens from the early 2000's. Modern specimens were more likely to have knee arthritis than either group of older skeletons.

What was really surprising was that Dr. Wallace found that the increase in arthritis was there even if he controlled for the fact that we're living longer, and the general increase in obesity in modern times, which is a risk factor for osteoarthritis. Dr. Wallace thinks the most obvious candidate to explain the increase in knee osteoarthritis is the moderndecline in physical activity. This also means that osteoarthritis may be more preventable than previously thought.

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Quirks & Quarks - CBC.ca

The methodology of the study was fascinating. One of the researchers traveled around the country to examine collections of old and new skeletons, looking for signs of eburnation, which is a polished surface on the bones of the knee joint that occurs when the bones rub against each other because of the loss of cartilage associated with osteoarthritis.

RELATED: Marathon Training Doesnt Harm Knees, Even in Beginners

In total, he examined almost 2,500 skeletons from three distinct time periods:

The results showed that knee osteoarthritis occurred with roughly similar frequency in the prehistoric and early industrial skeletons, but was much more common in the postindustrial skeletons.

Of course, thats exactly what youd expect if you subscribe to the old-age-and-obesity theory. Fortunately, in many of the early industrial and postindustrial skeletons, age and body mass index (BMI) at death were recorded, which allowed the researchers include those factors in their analysis. The surprising result: Even accounting for age and BMI, knee osteoarthritis was still roughly twice as common for people born after World War II than it was for people born before it.

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So if its not obesity or age, what explains the apparent rise in osteoarthritis rates? This study cant answer that, but the researchers do float a few hypotheses in their discussion.

One possibility is that walking around on hard, paved surfaces all the time isnt good for our knees. In support of that possibility, they cite a 1982 paper in which sheep spent 2.5 years living either on concrete and tarmac or on wood chips and pastures. The sheep in the concrete jungle had noticeable changes in the cartilage and bone of their knee joints, and maybe we do too.

Another possibility is shoesand theyre not talking about trainers. They cite a 1998 study showing that high-heeled shoes generate abnormally high forces on the knee joint, and note that, in their analysis, women were about 50 percent more likely to have knee osteoarthritis than men.

But the biggest factor, they suspect, may be physical inactivity. Joints, like muscles, have a use-it-or-lose-it aspect. If you sit at a desk all day, you end up with thinner, lower-quality cartilage in your joints, and weakness in the muscles that would otherwise take some of the load off your joints. The problem, in other words, isnt too much running; its not enough running.

In real life, of course, things are never that neat and tidy. As the authors are careful to point out, theres lots of work remaining to explore some of these hypotheses. And even if the theories are confirmed, the fact remains that some runners, despite doing everything right, will still get osteoarthritis.

Still, the results are significant because they join a growing body of evidence that argues against osteoarthritis as a wear-and-tear disease, in which your knee are delicate instruments that will wear out if you use them too much. Your knees were made to be used, and are healthiest when used regularly. So use them!

***

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Knee Arthritis Has Doubled... And It's Not Because of Running - Runner's World

New York Daily News

There's no known cure for arthritis, but marijuana works wonders New York Daily News Here's some good news: Medical marijuana is helping people with arthritis improve their quality of life. Most of us know someone an aunt, uncle or grandmother suffering from arthritis. It is one of the most common health ailments in the world ... Arthritis doesn't affect only the elderly! Watch out for these signsEconomic Times Medical Marijuana May Help Ease Chronic PainImmortal News all 3 news articles »

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There's no known cure for arthritis, but marijuana works wonders - New York Daily News

(Reuters Health) - Workers exposed to airborne toxins may have an elevated risk of developing rheumatoid arthritis, an immune system disorder that causes debilitating swelling and pain in the joints, a Swedish study suggests.

Among men, bricklayers, concrete workers and electricians had at least twice the risk of rheumatoid arthritis they would have in certain other occupations, the study found. For women, jobs in nursing carried a 30 percent higher risk than other careers.

Previous studies have indicated that occupations within the manufacturing sector are associated with an increased risk of rheumatoid arthritis, said lead study author Anna Ilar of the Karolinska Institute in Sweden.

The novelty of our findings is that we showed that occupations within this sector are related to an increased risk of rheumatoid arthritis even after controlling for lifestyle-related factors including smoking, alcohol use, education and (obesity), Ilar said by email.

Unlike the more common osteoarthritis, which is caused by mechanical wear and tear on joints, in rheumatoid arthritis the immune system attacks the body's joints.

While smoking is a known risk factor for rheumatoid arthritis, the findings add to evidence suggesting that environmental factors could trigger the disease in some people. Previous research suggests that lung changes caused by inhaled pollutants may trigger immune responses that lead to rheumatoid arthritis, particularly in individuals with a genetic predisposition for the disease.

For the current study, reported in Arthritis Care and Research, researchers examined data on 3,522 people with rheumatoid arthritis and 5,580 similar individuals without the condition. They gathered information on work history from questionnaires and analyzed results form blood samples looking for genetic factors that can contribute to the disorder.

Researchers compared the elevated risk of rheumatoid arthritis in manufacturing occupations to the risk associated with professional, administrative and technical jobs that tend to involve deskwork rather than manual labor.

Compared with men working desk jobs, electrical workers had twice the risk of rheumatoid arthritis and bricklayers and concrete workers had roughly triple the risk.

The study didnt find an increased risk of rheumatoid arthritis for women working in the manufacturing sector, but there may have been too few women in these jobs to properly analyze the impact of this work, the researchers say.

Its possible that inhaled toxins such as silica, asbestos, organic solvents and motor exhaust might have contributed to the development of rheumatoid arthritis, but the study didnt analyze which pollutants caused the condition.

One limitation of the study is that researchers assumed people in professional jobs in doing office work didnt have exposure to toxins that may increase the odds of rheumatoid arthritis. The study also wasnt a controlled experiment designed to prove whether or how certain occupations might cause rheumatoid arthritis.

They also didnt directly examine the influence of manual labor on development of rheumatoid arthritis, said Kaleb Michaud, a researcher at the University of Nebraska Medical Center and co-director of the National Data Bank for Rheumatic Diseases.

There is some evidence that greater physical labor, which can cause more stress on the body physically and mentally, can lead to rheumatoid arthritis, Michaud, who wasnt involved in the study, said by email.

Not getting enough sleep and continuous repetitive tasks can lead to added stress that can impact your immune system, Michaud added. The more triggers to the immune system just increase the chances for an irregular response by it that may lead to an autoimmune disease like rheumatoid arthritis.

SOURCE: bit.ly/2x1AdfS Arthritis Care and Research, online August 10, 2017.

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Some jobs tied to higher risk of rheumatoid arthritis - Reuters

For more than a year, Harvard researcher Ian Wallace scoured the country for skeletons. Thousands of them.

No grave-digging was involved. Wallace unearthed the bones inacademic collectionsthatranged from ancient remainsfound by archaeologists, to 19th-century bodies never claimed at morgues, to cadavers donated recently to medical schools.

His quest: to gauge the rise of osteoarthritis, the most common formof arthritis, which tends to come with age and affect hips and knees. Hechecked the knees of more than 2,000 skeletons for a telltale polished look, called eburnation, that means the bones have been rubbing against each other.

The finding: Knee osteoarthritis has doubled in prevalence since the mid-20th century, Wallace and colleagues report ina paperjust out in the journal PNAS.

Of course, everyone who pays attention knows that arthritis has been on the riseas Americanslive longer and tend to weigh more, imposing heavierloads on aging joints. Initially, Wallace says, doctors responded to the findingthat arthritis rates were up dramatically with a resounding ho-hum.

But then came the statistical kicker: Even after the researchteam adjusted for weightand age, they found thedoubling in arthritis rates.

"That's when people's eyes got big and they started scratching their heads," Wallace says. "This is a pretty major revelation for physicians, because it means that tons of cases of this disease that they encounter in the clinic might not be due to the two risk factors that receive by far the most attention old age and obesity."

And it could be a revelation for anyone who hopes to avoid the aches and pains of arthritis: If our ancestors had far less arthritis than we do roughly 8 percent of the early skeletons vs. 16 percent of the more recent ones there's hope that we could figure out what they were doing right.

"The most important message here is that we shouldn't consider arthritis a wear-and-tear disease of age," says Harvard professorDaniel E. Lieberman, senior author of the paper. "Arthritis is a disease thatbecomes more common as you age, but it's not caused by 'wear and tear'; if anything, it might be caused by the absence of physical activity," so a major way to prevent arthritis could be moving more, not less.

Though still just a hypothesis, physical inactivity is his prime suspect, he says: "It is one of the biggest differences between people who live today and people who lived in the past whose risk of arthritis was much lower" like many of our grandparents, who tended to sit much less and walk much more than we do.

When Lieberman says wear and tear does not cause arthritis, it still may seem counter-intuitive. After all, joint injuries greatly increase the risk of arthritis, andaging seems so linked to things "wearing out."

But what goes awry in arthritis is looking more complicated than just mechanical overuse, says professor David Felson of Boston University Medical School, a co-author on the paper.

"Joints biologically develop to bear a load, and bear stress across them," hesays. "When they aren't able to do it well, they break down. And that's what's going on here they're somehow not able to withstand the stress that's put across them."

What's making them vulnerable like that is the central question, Felson says. The paper found such a large difference over time that it's likely due to more than one factor, he says, butit's plausible that inactivity is having an effect.

Exercise makes joints more stress-resistant, he says: "Their cartilage gets thicker; the muscles that support and protect the joints get stronger. And joints are hardier when you're active, so the absence of activity isn't necessarily good for our joints."

But is it ever too late for exercise? Say, after arthritis has already hit hard?

"Ithink probably it can always help," Felson says. "The issue is: When your joint is already far gone, is it a good idea to suddenly engage in physical activity? And the answer is probably no. So it depends on where you are, the stage of disease."

Not to over-promise: Physical activity by no meansguarantees arthritis prevention. Felson notes that arthritis has been found in Egyptian mummies; it has also been found in Neanderthals.

But the skeleton findings do point the way toward additional research to pinpoint exactly which factors are at work in the rise of arthritis, and how to counteract them.

"Your probability of having arthritis today is more than double at a given age what your probability of having arthritis was if you had been born before World War II," Lieberman says. "And obviously, genes for arthritis haven't swept the population since World War II. It's something about the way we're living today that's changed. And those are factors that we can shift."

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Harvard Study Of Skeletons Suggests Much Age-Related Arthritis May Be Preventable - WBUR

A new study found osteoarthritis of the knee is more than twice as common as it was just a few generations ago. It's estimated that the lifetime risk of developing this condition is 46 percent.

However, it is possible to protect your knees and even reverse some of the symptoms. Dr. Jordan Metzl, a sports medicine physician at New York's Hospital for Special Surgery, joined "CBS This Morning" to discuss what might be causing the increase and what you can do to reduce arthritic symptoms.

Asked what people are doing wrong when it comes to arthritis, Metzl said, "They're not recognizing the symptoms of arthritis."

The first thing to do if you are having symptoms, Metzl said, is to get an X-ray, which will show if there is a "narrowing between the bones."

Metzl also credits the inactivity of modern life. "If you were alive 100 years ago, you walked more, you were much more active," Metzl said.

"As this study shows us, the incidence of arthritis, the prevalence has more than doubled in the past hundred years and there are some different reasons for why that may be including people living longer and having higher weights but also related to activity," Metzl said.

X-rays of what a healthy knee versus an arthritic knee looks like.

CBS News

To reduce symptoms, he says the best thing to do is strengthen your muscles with exercises like squats and lunges instead of saying off of the knee and, in effect, becoming more inactive.

"We want them to be very active. When they get arthritis I get them started on exercise, strengthening," Metzl said.

While he says the wrong shoes can play a part in making symptoms worse, they don't necessarily cause arthritis.

"I think the shoes may be part of making the symptoms worse. I don't think it really has a lot to do with the reasons people get arthritis which are probably genetic, longevity, body index and then maybe inactivity but once you have arthritis we do a lot to control your symptoms," Metzl said.

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Sports medicine doctor on how to combat knee arthritis symptoms - CBS News

Meningitis is an infection of the protective membranes that surround the brain and spinal cord.

If untreated, it can turn serious very quickly - one in ten cases of bacterial meningitis are fatal, according to the NHS.

For this reason the meningitis ACWY jab is offered for free to everyone aged 17 and 18 in England.

However, there are concerns that not enough school leavers are having it, with only a third vaccinated against the condition last year.

The Royal College of Nursing this week warned that people are risking loss of limbs, arthritis and even death by not having it.

Older teenagers and university students are thought to be particularly at risk since they are mixing with lots of new people.

This vaccine is different from other meningitis jabs often giving to babies including the meningitis B vaccine, 6-in-1 vaccine, pneumococcal vaccine, meningitis C vaccine and MMR vaccine.

It can be spread by coughs, sneezes and kisses.

A classic symptom of the condition is a blotchy rash, where small red, pinpricks spread quickly over the body before turning into red or purple blotches.

According to the NHS, if you press the side of a clear glass firmly against the skin and the rash doesn't fade, it's a sign of blood poisoning - or septicaemia - which requires urgent medical attention.

Other signs of the condition include a high temperature, feeling and being sick, lack of energy, a headache, achieving muscles, breathing quickly and cold hands or feet.

Additionally, sufferers may experience pale and mottled skin, a stiff neck, confusion, dislike of bright lights, drowsiness and seizures.

It is possible to make a full recovery, but the condition can lead to long-term or life-threatening problems.

These include hearing loss, problems with memory, vision loss, loss of limbs to stop the infection spreading arthritis and kidney problems.

Helen Donovan, from the Royal College of Nursing, said: "Meningitis can be fatal, and can leave those who survive with life-changing disabilities. Vaccination is quick, easy and free, and offers protection against most strains of the disease, but reaching young people is not easy.

"Many will have been away over the summer travelling or working before university. But the risk is real and getting vaccinated saves lives.

"We are urging people to contact their surgeries now and book an appointment with the practice nurse."

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Arthritis warning: Going without THIS vaccine puts you at risk of joint damage - Express.co.uk

Rheumatoid arthritisis a painful disease where a person's immune system attacks the joints, causing chronic inflammation in the peripheral joints of the hands, feet, elbows, shoulders, knees, hips and feet. According to Health24, the symptoms of rheumatoid arthritis are stiffness early in the morning, pain and swelling of the joints.

The cause of rheumatoid arthritis is not known and is usually linked to a genetic predisposition.

But new research shows that rheumatoid arthritis appears to be more common among people in certain types of jobs.

The findings "indicate that work-related factors, such as airborne harmful exposures, may contribute to disease development," study author Anna Ilar said. She is a doctoral student in epidemiology at the Karolinska Institute in Stockholm.

Some more at risk than others

The study looked at more than 3 500 people in Sweden with rheumatoid arthritis, and nearly 5 600 people without the disease.

Among men, those in manufacturing jobs had a higher risk of rheumatoid arthritis than those in the professional, administrative and technical sectors, the findings showed. The risk was twice as high for electrical and electronics workers, and three times higher for bricklayers and concrete workers.

The risk for rheumatoid arthritis is high in men who work in jobs such as construction and electronics.

Among women, assistant nurses and attendants had a slightly higher risk, but women in manufacturing jobs did not. The researchers suspect that's because fewer women than men work in manufacturing.

Assistant nurses had a slightly higher risk to develop rheumatoid arthritis.

More study is needed to zero in on the exposures that may be involved, Ilar noted. Potential culprits include silica, asbestos, organic solvents and engine exhaust.

The report was published online in the journal Arthritis Care & Research.

"It is important that findings on preventable risk factors are spread to employees, employers, and decision-makers in order to prevent disease by reducing or eliminating known risk factors," Ilar said in a journal news release.

The researchers said they accounted for lifestyle factors associated with rheumatoid arthritis, such as body fat, smoking, alcohol use and education level. However, while the study found an association between certain occupations and rheumatoid arthritis risk, it didn't prove a cause-and-effect relationship.

Managing rheumatoid arthritis

Here are a few practical tips to manage your arthritis:

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Got arthritis? Your job might be the problem... - Health24

Experts have, perhaps unexpectedly, said the condition is not due to people living longer and an ageing society.

They have even gone as far as to suggest the condition is as preventable as heart disease.

Scientists have said there are a number of environmental factors which could be causing the condition - but living longer and being overweight are not reasons why, according to experts.

Instead, the scientists suggested it could be as a result of being less active than our ancestors and have even said it could be as a result of wider environmental factors.

The team analysed over 2,000 skeletons from archaeological collections spanning more than 6,000 years to show how cases have soared in the last seven decades.

Professor Daniel Lieberman, of Harvard University in Boston, said: "The most important comparison is between the early industrial (1800s) and modern samples.

"Because we had data on each individual's age, sex, body weight, ethnicity and in many cases, their occupation and cause of death, we were able to correct for a number of factors that we considered important co-variates.

"Using careful statistical methods, we are able to say that if you were born after World War II you have approximately twice the likelihood of getting knee osteoarthritis at a given age or BMI than if you were born earlier."

It also exposed the idea knee osteoarthritis is now widespread because of more obesity and longevity as a myth.

Dr Ian Wallace, of Harvard University in Boston, said: "Before this study it was assumed without having been tested the prevalence of knee osteoarthritis has changed over time.

"We were able to show - for the first time - this pervasive cause of pain is actually twice as common today than even in the recent past.

"But the even bigger surprise is it's not just because people are living longer or getting fatter, but for other reasons likely related to our modern environments."

Experts said the condition is responsible for more disability than almost any other musculoskeletal disorder.

Professor Lieberman added: "Understanding the origins of knee osteoarthritis is an urgent challenge because the disease is almost entirely untreatable apart from joint replacement - and once someone has knee osteoarthritis it creates a vicious circle.

"People become less active which can lead to a host of other problems - and their health ends up declining at a more rapid rate."

"Knee osteoarthritis is not a necessary consequence of old age.

We should think of this as a partly preventable disease.

"Wouldn't it be great if people could live to be 60, 70 or 80 and never get knee osteoarthritis in the first place?

"Right now, our society is barely focusing on prevention in any way, shape or form, so we need to redirect more interest toward preventing this and other so-called diseases of ageing."

The researchers hope their study inspires new research to prevent knee osteoarthritis.

The study was published in the Proceedings of the National Academy of Sciences.

Arthritis cure? Woman hails miracle device used on horses

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Knee osteoarthritis symptoms: Obesity is not to blame for rise, say experts - Express.co.uk

Aging and obesity alone cannot explain it.

Arthritis is an inflammation of the joints (or another area where the bones come together). Its often a chronic condition which typically starts off in the hands or feet, and most often ends up affecting the knees. Its estimated that one in five Americans over 45 suffer from knee arthritis, and similar figures are reported in many parts of the world.

Initially, this was thought to be a consequence of aging people lived to older ages, and therefore started suffering more from old age diseases. Obesity is also thought to play a role the more you weigh, the more pressure you put on your joints. But a new study found that these factors alone cannot explain the rise in knee arthritis prevalence.

Image credits: BruceBlaus.

Ian Wallaceis a paleoanthropologist at Harvard University who studies how human health and diseases have changed over time. He was aware that knee arthritis is often associated with obesity and aging, but wanted to see how these and other factors affected the prevalence of obesity through the years. So he and his colleagues studied several thousand American skeletons, frompre-industrial, early industrial, and post-industrial periods. They were specifically looking at the wear and tear in the skeletons knees. The age and body mass index were also assessed and through statistical processing, the impact of obesity and age was removed.

Wallace and colleagues found that18 percent of the skeletons from the post-industrial ages (1950) had signs of advanced arthritis, compared tosix and eight percent of the early industrial and prehistoric bones, respectively. The statistical model showed that neither aging nor obesity can explain the phenomenon.

It points to this mysterious conclusion: A lot of cases of osteoarthritis, which we thought might be inevitable, may be preventable and are due to unknown factors, Wallace says.

Of course, both obesity and aging take their toll no ones saying they just dont matter. But what this study shows is that theres something else were missing.

The study didnt attempt to explain the findings, but its not very difficult to speculate. Wallace too says that lack of physical activity is a very likely culprit. Since the 1950s, office jobs have multiplied dramatically, more and more cars flood the streets, and physical activity has declined accordingly. Sitting down is also a possible culprit.David Felson, study co-author, a renowned arthritis expert and physician at Boston University comments:

Our joints dont do well when they arent active much of the time, Felson says.

But that might not tell the whole story. Inflammation might also be at blame. Arthritis itself is an inflammation, but different inflammations, while a natural reaction, promote injury and prevent proper healing.Francis Berenbaum, a researcher and physician at Pierre and Marie Curie University and AP-HP hospital in Paris, France, who wasnt involved in the study, believesan unhealthy diet might also be at blame. The same diet (high in processed foods and sugars) thats favoring diabetes and heart diseases might also be contributing to arthritis. Other factors, such as walking more on hard surfaces such as concrete or asphalt or concrete might also contribute, but at the moment, the truth is we dont really know.

I study this, and I dont know what [more] can be done to prevent it, Felson adds.

For now, your best bet is to keep a healthy diet and be physically active.

Journal Reference:Ian J. Wallace, Steven Worthington, David T. Felson, Robert D. Jurmain, Kimberly T. Wren, Heli Maijanen, Robert J. Woods, and Daniel E. Lieberman Knee osteoarthritis has doubled in prevalence since the mid-20th century.doi: 10.1073/pnas.1703856114

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Knee arthritis has doubled since 1950, and we don't really know why - ZME Science

The majority of rheumatologists indicate that "ideal" Cosentyx patients have previously failed at least one TNF agent, a group representing nearly half of all biologic-treated PsA patients, so what is at the source of Cosentyx's apparent plateau? Just under one-third of rheumatologists report high satisfaction with the IL-17 inhibitor, a lower percent compared to the leading TNF agents and Janssen's Stelara. Furthermore, despite Cosentyx's association with strong efficacy in skin clearance, more rheumatologists prefer AbbVie's Humira over Cosentyx for patients with severe psoriasis. Finally, use of Cosentyx continues to be hampered by rheumatologists' perceptions of inferior market access compared to more established biologic brands.

Additional pressure on Cosentyx is ahead in the form of pipeline PsA agents which will offer even more options for non-TNF treatment. Among those is the second IL-17 inhibitor, Eli Lilly's Taltz. Although nearly one-third of respondents see Cosentyx's first-to-market status as a significant advantage over Taltz, over the past year there has been a significant increase in Taltz familiarity and a growing percent of rheumatologists anticipate routine use of Taltz once approved.

Taltz is expected to have a competitive position in the PsA treatment paradigm if available, however most rheumatologists agree that there is a higher unmet need for new, oral, small molecule agents for PsA than for any additional alternate MOA biologics. Indeed, when asked directly which agent they would most like to see gain the PsA indication, 61% selected a JAK inhibitor, such as Pfizer's Xeljanz, whereas the remaining respondents were split between BMS' Orencia, an additional IL-17 such as Taltz, and an IL-23 inhibitor.According to RealWorld Dynamix: Biologic and Otezla Switching in PsA, which evaluated over 1000 PsA patients recently switched from one biologic or Otezla to a different brand, Xeljanz has already captured 2% of the switch population and one in five recently switched patients are considered by the treating rheumatologist to be good candidates for future treatment with Xeljanz.

RealTime Dynamix: Psoriatic Arthritis is an independent report series published on a quarterly basis. The series tracks the evolution of the PsA market, provides a deep dive on launch effectiveness, and highlights opportunities for pipeline agents. The next wave of research will be published in September 2017.

About Spherix Global Insights Spherix Global Insights is a business intelligence and market research company specializing in renal, autoimmune, neurologic and rare disease markets. We provide clients with strategic insights leveraged from our independent studies conducted with healthcare providers and other stakeholders.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact: Lynn Price, Immunology Franchise Head Email: info@spherixglobalinsights.com

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Novartis' Cosentyx Beginning to Plateau in Psoriatic Arthritis, as US Rheumatologists Prepare for an Influx of Non ... - PR Newswire (press release)

Arthritis is a joint disease that can cause cartilage destruction and erosion of the bone, as well as tendon inflammation and rupture. Affected areas are highlighted in red in this enhanced X-ray.

American doctors have been noticing an increase in osteoarthritis of the knee. They have suspected two driving forces: more old people and more people who are overweight.

A study published in this week's Proceedings of the National Academy of Sciences argues that's far from the whole story. Even correcting for body mass index and age, osteoarthritis of the knee is twice as common now as it was before the 1950s.

"That's an incredible difference," says Daniel Lieberman, a professor of human evolutionary biology at Harvard University and co-author of the study.

Lieberman started wondering about arthritis a few years ago as he was compiling a list of diseases that modern humans aren't well adapted to cope with such as heart disease, lower back pain and nearsightedness.

"I wanted to include arthritis in the list, but realized that there wasn't any good data," he tells NPR.

So Lieberman asked Ian Wallace, a post doctoral research fellow in his lab, to fly around the country and study human skeletons that had ended up in museums or had been donated to medical schools for scientific research. The skeletons were from people who died as long ago as 4,000 B.C..

"The oldest specimens that we looked at were some skeletons from prehistoric Inuit hunter-gatherers from Alaska," Wallace says. The most recent were the remains of people who died in Tennessee in 2015.

Conventional wisdom is that osteoarthritis of the knee results mostly from wear and tear, which is why, these days, it's more common among older people and those whose excess body weight puts extra stress on those joints..

"So, going into it, I suppose my expectation was that people in the past, especially early hunter-gatherers and early farmers, would have had a much higher prevalence of osteoarthritis than people do today," Wallace says. Surely all that running around, squatting, twisting and other activity in the days before cars and couches would have worn out joints quickly.

But that's not what the evidence showed.

"I was actually extremely surprised to find that [osteoarthritis] is much more common today" than it was in Americans long ago, says Wallace.

That higher rate held true even after scientists corrected for body mass and age. So there's apparently something else driving the increase in knee arthritis. The current study doesn't pinpoint that cause.

"If I were a betting man, I would guess physical activity is especially important," Lieberman says. "One of the things that's really shifted in our world today is that we sit all the time, and kids sit all the time. And that may be affecting how our joints are forming and how our joints are aging."

This makes sense to Dr. Richard Loeser a rheumatologist who directs the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill.

"Your joints aren't just like your automobile tires that wear out as you use them," he says. In fact, exercise helps nutrients diffuse into cartilage in the knee and keep it strong and healthy.

If cartilage "is formed and more healthy when you're younger, then your joints are more likely to be functioning better and have less osteoarthritis when you get older," Loeser says. And exercise also helps fully grown people.

"By strengthening your muscles and by stimulating your cartilage you can still improve the health of your joint," Loeser says.

That's not to say that exercise fully explains the trend that the Harvard researchers have noted.

"There may be dietary factors that may be important," Loeser suggests And sports injuries, which he says "have become more and more common" may be contributing to arthritis, too.

As Lieberman and his colleagues try to figure out exactly what's behind the problem, they're hopeful that a lot of what's driving it may be preventable.

You can contact Richard Harris at rharris@npr.org.

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6000-Year-Old Knee Joints Suggest Osteoarthritis Isn't Just Wear And Tear - NPR

(Reuters Health) - Oral glucosamine, a natural supplement often marketed for joint pain, has no more effect than a dummy pill, according to a new review of available research.

The analysis of randomized controlled trials from which data have been made public found that at both three-month and 24-month follow-up points, the supplement had no effect on either hip or knee pain from arthritis.

Even analyses of the results for sub-groups of study participants, such as overweight people or those with high inflammation, found no benefit with the supplements.

Most recent guidelines conclude there is an overall lack of efficacy of glucosamine, however, we knew that osteoarthritis could affect subgroups differently, said senior study author Sita Bierma-Zeinstra of Erasmus University Medical Center in Rotterdam, the Netherlands.

The most recent report from the U.S. National Center for Health Statistics found that Americans spent nearly $13 billion in 2012 on natural product supplements, and glucosamine was one of the most popular.

The Osteoarthritis Research Society International and the U.S. National Institute for Health and Care Excellence recently issued guidance about the lack of evidence for glucosamine as a cure for joint pain.

Before we threw the baby out with the bathwater, however, it was important to know whether different subgroups could have some effect, Bierma-Zeinstra told Reuters Health by email.

The researchers analyzed data from randomized, controlled trials conducted between 1994 and 2014. Of the 21 studies they found on the subject, only six shared data through the OA Trial Bank, an international collection of data from trials conducted worldwide. None of the trials included in the analysis was funded by industry, the authors note.

Five of the trials, which altogether included more than 1,600 patients, compared glucosamine with a placebo. Five of the six studies investigated knee osteoarthritis, and one looked at hip osteoarthritis.

Overall, the effects of glucosamine and the placebo on pain and physical functioning didnt differ, either in the short-term or one or two years later. The supplement was also no better than placebo among subgroups based on pain severity, severity of osteoarthritis, age, body mass index, gender or signs of inflammation.

Of course, the most striking thing in this study is that when a commercial party funded the source, data sharing became difficult, Bierma-Zeinstra said. Open access to data from clinical studies, although propagated by many research organizations worldwide, is still far from common practice.

In addition, the researchers found that data for a study published in 2006 was no longer available. Although data from older studies may disappear, that doesnt often happen with recent ones, she added.

The research team plans to update subgroup data in the OA Trial Bank every five years. Theyll continue to contact clinical trial researchers to encourage them to contribute data to the project.

Future studies should look more closely at knee versus hip osteoarthritis and specific supplement types such as glucosamine sulfate versus glucosamine hydrochloride, the Bierma-Zeinstras team writes in the Annals of the Rheumatic Diseases.

Consumers should be cautious about spending money on unproven treatments, said Dr. C. Kent Kwoh, director of the University of Arizona Arthritis Center in Tucson.

For instance, side effects of glucosamine include heartburn, drowsiness, headaches, allergic reactions, weight gain, diarrhea and abdominal pain, said Kwoh, who wasnt involved in the study.

Most consumers believe that, as a natural product, glucosamine is safe, but there are potential side effects, he told Reuters Health by email. There is very little evidence that oral glucosamine is beneficial for pain.

SOURCE: bit.ly/2vTqE5h Annals of the Rheumatic Diseases, online July 28, 2017.

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Glucosamine supplements don't help knee or hip arthritis pain - Reuters