Lyme Disease Support Group

By John Gever, Senior Editor, MedPage Today

Published: February 08, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

This study found that telephone support provided shortly after knee replacement surgery helped some patients gain rapid physical improvement.

The phone support was mainly beneficial for patients who were not obese or were in good emotional health prior to surgery.

SAN FRANCISCO --

Telephone support provided shortly after knee replacement surgery helped some patients gain rapid physical improvement, a researcher said here.

In a randomized trial, certain types of patients receiving weekly phone calls from a health educator for eight weeks after surgery showed substantially better improvement in physical function at their six-month evaluation compared with patients assigned to usual care, reported Patricia D. Franklin, MD, of the University of Massachusetts Medical School in Worcester, Mass.

The phone support was mainly beneficial for patients who were not obese or were in good emotional health prior to surgery, she told attendees at the American Academy of Orthopaedic Surgeons annual meeting.

Lack of comorbidities also was associated with better response to the intervention, Franklin said.

She said the findings suggested that "tailoring rehabilitation to patient subgroups" may be the best approach in perioperative care following total knee replacement.

Previous studies have demonstrated that verbal support -- delivered in person or with technology -- is helpful to people with osteoarthritis, Franklin explained. But whether such supportive care is beneficial for knee-replacement patients had been unexplored in rigorous studies.

In the current study, Franklin and colleagues sought to recruit all adult patients scheduled for primary, unilateral, total knee replacement for osteoarthritis at the University of Massachusetts joint care clinic. She said 180 patients, 73% of those eligible, agreed to participate.

They were then randomized to receive usual care or to receive the phone-based intervention, called Joint Action.

The calls focused on "self-efficacy," boosting patients' willingness to do the recommended physical therapy and exercises following surgery. Patients were encouraged to set goals and record their progress, and also to discuss barriers they encountered.

Prior to surgery, patients received four calls from the health educator, and the Short Form-36 health assessment was carried out, with separate scoring for the physical and mental component summaries.

Comorbidity burden was measured with the Charlson index, and patients also were asked to report pain in the contralateral knee, hips, or lower back.

Mean baseline SF-36 scores for physical and mental function were 32.7 and 51.3, respectively. The average patient age was 65 and about two-thirds were women. Mean body mass index was 32.

Most patients were free of major comorbidities. Only about 6% had chronic obstructive pulmonary disease, some 7% had cardiac conditions, and 3% had renal impairment.

Participants with low- or mid-level scores for the SF-36 mental component (reflecting poor or fair emotional health) obtained no physical-function benefit from the telephone intervention relative to usual care, Franklin reported. Irrespective of study arm, patients in these groups had mean increases of about 10 points in physical component scores.

But for those with high mental component scores at baseline, patients receiving the intervention saw an extra three-point gain in physical function relative to usual care (P<0.05).

The intervention was even more beneficial for most patients with BMI values below 30. In that group, participants with low or high mental component scores at baseline both had mean increases of about eight physical-function points relative to usual care (P<0.05).

Oddly, though, improvements in physical function were no higher with the intervention versus usual care for participants with a BMI below 30 who had mid-range mental component scores, which Franklin could not explain.

For all patients with BMI below 30 at baseline and no comorbidities, irrespective of emotional health at baseline, the mean gain in physical function scores was five points.

Franklin said a noteworthy finding in the baseline assessments was that women, much more than men, were likely to complain of more widespread musculoskeletal pain.

The proportion of women reporting pain in the contralateral knee was 34%, compared with 11% of men; 31% of women and 19% of men said they had lower-back pain.

This finding, as well as the variable responses to the intervention depending on baseline BMI and emotional health status, prompted Franklin to recommend against a one-size-fits-all approach to perioperative care for knee replacement patients.

She said the program's cost was still being analyzed, as were possible differences in readmission/revision rates between study arms and patient subgroups.

Session co-moderator Michael Kelly, MD, of Hackensack University Medical Center in New Jersey, said the data on readmission rates would be especially interesting, calling the issue "a big deal."

He asked Franklin about the proportion of study participants who were discharged to home versus another facility. She responded that about 30% went to a rehabilitation hospital before being sent home.

The study was supported by the National Institute of Arthritis and Musculoskeletal Diseases.

Franklin reported research funding from Zimmer.

Kelly reported consulting and other relationships with Zimmer, RTI Biologics, and Pfizer.

Primary source: American Academy of Orthopaedic Surgeons

Source reference:

Franklin P, et al "Telephone support to optimize patient function after total knee replacement: RCT" AAOS 2012; Abstract 1.

http://www.medpagetoday.com/MeetingCoverage/AAOS/31070? utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2012 Everyday Health, Inc. All rights reserved.

By John Gever, Senior Editor, MedPage Today

Published: February 10, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

This study found that people having total knee replacement surgery as outpatients were significantly more likely to die or need readmission within 90 days compared with inpatients remaining in the hospital for three to four days.

Rates of subsequent revision surgery were nearly doubled in patients having one-day hospital stays compared with the three-to-four-day standard.

SAN FRANCISCO --

People having total knee replacement surgery as outpatients were significantly more likely to die or need readmission within 90 days than inpatients remaining in the hospital for three to four days, Medicare data indicated.

In a study of 108,000 Medicare beneficiaries who underwent the procedure, the hazard ratio for 90-day mortality in outpatients was 1.66 relative to patients with the standard stays of three to four days; for readmission, it was 1.57 (both P<0.05), according to Scott Lovald, PhD, MPH, of Exponent, a contract research firm in Philadelphia.

Moreover, rates of subsequent revision surgery were nearly doubled in patients having one-day hospital stays compared with the three-to-four day standard, Lovald reported in a platform presentation here at the American Academy of Orthopaedic Surgeons' annual meeting.

The data came from an analysis of a 5% sample of Medicare beneficiaries undergoing total knee arthroplasty from 1997 to 2009.

The purpose, Lovald said, was to determine whether costs were really lower with shortened hospital stays, as previous studies had suggested, and whether reduced costs were offset by increased risks of complications or revision.

Lovald said the answers were yes and yes.

The data included more than 73,000 patients who had stays of three to four days, which he said was the traditional standard for patients undergoing total knee replacement.

Just over 23,500 remained in the hospital for five days or more. A total of 2,883 had outpatient procedures, 1,374 had one-day stays, and 6,756 had stays of two days.

Even counting the costs of complications and revision up to two years after the initial procedure, outpatient and overnight-stay procedures had lower average Medicare billings, Lovald said.

Total costs averaged about $30,000 for these short-stay patients, compared with about $35,000 for three-to-four-day stays and $42,000 for patients with stays of five days or more.

Reported joint pain and stiffness also was lower in the short-stay patients in the first 90 days.

But outpatients also had significantly increased risk of death and readmission within 90 days after adjusting for demographics, geographic region, and Charlson comorbidity index scores.

Revision rates were not significantly higher among outpatients, however.

Mortality risk was not increased after one or two years in the short-stay patients. The hazard ratio for revision, though, reached 1.93 at one year and 1.90 at year two in the overnight-stay patients (both P<0.05).

Patients with two-day stays had significantly higher rates of implant loosening at one year, but not after two years. Otherwise the differences between these patients and those with standard stays were negligible.

Not surprisingly, Lovald said, patients with stays of five days or more had poorer 90-day outcomes almost across the board, with significantly greater incidences of death, deep vein thrombosis, infection, and readmission. Longer-term outcomes were also generally worse, although revision rates were similar to those seen in the standard-stay patients.

Lovald noted that the Medicare data do not capture all the risk factors for poor outcomes, many of which may have been more prevalent in patients with longer hospital stays. A common problem with the data is "undercoding" of comorbidities, he said.

Medicare data also do not include important risk factors such as body mass index and smoking status.

Session co-moderator David Dalury, MD, an orthopedic surgeon in Towson, Md., pointed to another finding in the study that also may cast doubt on the data's reliability -- that 27% of outpatients were discharged to skilled nursing facilities.

Such a pattern would make no sense for a hospital, Dalury argued, since it would lose the Medicare payments it would otherwise realize from keeping the patient for several days. He wondered whether the finding reflected errors in the Medicare data.

Lovald said that was possible and that he and his colleagues were currently trying to find out.

During the question-and-answer period following Lovald's presentation, an audience member highlighted the greater risk of complications that seems to accompany the reduced financial cost associated with short stays.

He asked Lovald whether he would consider a short-stay procedure for himself.

"I would do even more research than I have at this point," Lovald replied.

The study was funded by Stryker.

Co-investigators had relationships with Stryker, Medtronic, Amgen, Alcon, and Kyphon.

Several co-investigators, in addition to Lovald, were employees of Exponent.

Dalury reported consulting and speaking fees from DePuy.

Primary source: American Academy of Orthopaedic Surgeons

Source reference:

Lovald S, et al "Outpatient total knee arthroplasty: a cost and outcomes analysis" AAOS 2012; Abstract 411.

http://www.medpagetoday.com/MeetingCoverage/AAOS/31113? utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2012 Everyday Health, Inc. All rights reserved.

By John Gever, Senior Editor, MedPage Today

Published: February 13, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that it is estimated that about 1.5 million U.S. adults younger than 70 may require a revision of a prior knee replacement.

Point out that the study estimated that the lifetime risks of knee replacement were about 10% for women and 7% for men.

SAN FRANCISCO --

As more Americans in their 50s have knee replacement surgery, the nation can look forward to dramatically higher numbers of revision procedures as time goes on, a researcher warned here.

The conclusion follows almost inexorably from a new estimate of the prevalence of knee replacement in the U.S., which included a finding that 2% of women and more than 1% of men in their 50s have already undergone such procedures.

On the basis of this estimate and the finite lifetime of total knee replacement implants, about 1.5 million U.S. adults younger than 70 are "likely to live long enough to be at risk for revision," said Elena Losina, PhD, of Boston University.

During a platform presentation at the American Academy of Orthopaedic Surgeons' annual meeting, she added, "TKR [total knee replacement] prevalence data should be used in planning health services, including anticipated volume of revision TKR."

In the absence of a national registry for knee replacement procedures or other comprehensive data, Losina said, estimates of the population-level prevalence must be cobbled together from disparate, surrogate data sources.

The estimates she reported were based on annual TKR incidence data developed in the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative.

These were extrapolated to the entire population on the basis of osteoarthritis prevalences established in the National Health and Nutrition examination survey.

These numbers were then fed into a validated, published model called OAPoI that uses Monte Carlo simulations to estimate population-level TKR prevalence by age and sex, progression of symptomatic osteoarthritis, and likelihood of revision.

The age-level TKR prevalence results were as follows:

50 to 59: 1% of men, 2% of women

60 to 69: 3% of men, 4% of women

70 to 79: 6% of men, 8% of women

80 to 89: 9%of men, 11% of women

90 plus: 10% of men, 12% of women

Overall, Losina said, the model indicated that 4.2% of all adults 50 and older -- about 4 million people in the U.S. -- have undergone knee replacements.

It also showed that roughly one-sixth of the implants in Americans age 90 and older were revisions.

When osteoarthritis progression and demographic trends were included, Losina and colleagues estimated lifetime risks of knee replacement of about 10% for women and 7% for men.

And about 1% of men and 2% of women in the population will have had serial procedures on the same joint by the time they die.

The estimates Losina reported did not include breakouts of unilateral versus bilateral replacements.

She noted that these estimates suggest that knee replacement "is considerably more prevalent than rheumatoid arthritis and nearly as prevalent as congestive heart failure."

Moreover, she said, because knee replacements are being performed more commonly in the middle-aged, there is an "urgent need for studying longer-term outcomes in younger persons undergoing TKR."

The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Losina declared that she had no relevant financial interests.

Primary source: American Academy of Orthopaedic Surgeons

Source reference:

Weinstein A, et al "How many Americans are currently living with total knee replacement?" AAOS 2012; Abstract 797.

http://www.medpagetoday.com/MeetingCoverage/AAOS/31147? utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2012 Everyday Health, Inc. All rights reserved.

A recent study found that a 60-minute “dose” of Swedish massage therapy delivered once a week for pain due to osteoarthritis of the knee was both optimal and practical, establishing a standard for use in future research.

This trial, funded by NCCAM and published in the journal PLoS One, builds on an earlier pilot study of massage for knee osteoarthritis pain, which had promising results but provided no data to determine whether the dose was optimal.

(The researchers defined an optimal, practical dose as producing the greatest ratio of desired effect compared to costs in time, labor, and convenience.)

Osteoarthritis, a degenerative disease of the joints, is the most common type of arthritis, affecting approximately 27 million Americans.

Researchers randomly assigned 125 participants with osteoarthritis of the knee to receive one of four 8-week doses of Swedish massage (30 or 60 minutes weekly or twice weekly) or usual care.

The usual care group continued with their current treatment and did not receive massage therapy.

The researchers assessed participants’ pain, function, joint flexibility, and other measures at the start of the study and then at 8, 16, and 24 weeks thereafter.

At 8 weeks, participants in the 60-minute massage groups (i.e., both once- and twice-per-week) had significant improvements in pain, function, and global response compared with participants in the usual care group.

Pain intensity had the greatest reduction in the 60-minute, once-per-week group and was significantly reduced compared to both the usual care and 30-minute groups.

There was no significant difference in outcomes between the 60-minute groups, which led to the conclusion that the optimal dose of massage was, on average, 60-minutes once per week.

Compared to usual care, all the massage groups had similar reductions in stiffness, though range-of-motion was not significantly affected by usual care or massage.

At 24 weeks, the clinical benefits had reduced for all groups (i.e., usual care and massage groups) and were not significantly different between the groups, though they were still improved compared to the start of the study.

The researchers noted that there is promising potential for the use of massage therapy for osteoarthritis of the knee and that future, larger trials should use this dose as a standard. Further, they suggest that more definitive research is needed on massage for osteoarthritis of the knee, in terms of efficacy, how it may work in the body, and its cost-effectiveness for patients.

References

Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One.

2012; 7(2):e30248.

Publication Date: February 8, 2012

http://nccam.nih.gov/research/results/spotlight/020812.htm

By Julie Appleby, Kaiser Health News

Published: March 02, 2012

The federal government spends 14 percent less than private insurers for knee replacement surgery and its related costs, even though Medicare patients are older and twice as likely to be readmitted to the hospital, a research paper released this week shows.

Sharp differences in what Medicare pays for hospital care -- on average, $6,400 less than what is paid by commercial insurers -- accounted for a large part of the cost difference, found researchers from the Health Care Incentives Institute, a nonprofit that studies quality of care and backs the idea of "bundling" payments for medical services.

The finding comes amid calls by conservative lawmakers in Congress and the states to hand over more authority to private insurers in hopes they would prove more efficient at curbing costs.

In recent years, hospital prices charged to commercial insurers have gone up rapidly, while Medicare has been more successful in moderating such increases, says Francois de Brantes, study co-author and executive director of the Newtown, Conn.-based group.

"Every single commercial payer and employer ought to ask themselves why is it that we're paying $1.50 for something the government pays $1 for," says de Brantes.

Medicare sets the amounts it will pay for the surgeries, while commercial insurers negotiate with hospitals that have varying clout:

in some areas, insurers are powerful enough to drive prices, while in others, hospitals have large market share or must be included in networks, and therefore have a negotiating advantage.

Hospitals accept lower rates from Medicare because the program represents such a large share of their revenue.

The American Hospital Association says the study's results are not surprising given that Medicare pays less on average than it costs to care for its beneficiaries, says Caroline Steinberg, vice president of trends analysis for the association.

And Medicaid -- the government program for the poor -- pays even less, so hospitals must compensate for the lower government payments by shifting more costs to private insurers, she says.

Hospitals lost money on Medicare patients overall in 2011, according to the Medicare Payment Advisory Commission in its most recent report.

The knee replacement study, published on the institute's website, used data from 19,000 Medicare surgeries and 32,000 commercial ones, finding the average cost of care provided during 180 days surrounding the surgery was $22,611 for Medicare patients, and $25,872 for those covered by commercial insurers.

De Brantes agrees that Medicare payments fall short of covering hospital costs for some treatments, but says knee replacements are profitable for hospitals, even at Medicare rates.

He says hospitals could afford to shave several percentage points off their charges to both Medicare and private insurers for total knee replacement.

The best way to do that, he says, could be for Medicare and private insurers to seek "bundled" payments that cover the entire cost of the procedure, including post-surgery rehabilitation services.

Proponents of bundling, like de Brantes, say that incentivizes hospitals and doctors to work together to provide the most efficient care.

An additional cost driver for really expensive cases -- for both commercial insurers and Medicare -- is potentially avoidable complications, such as infections, bleeding, and blood clots, although such problems were relatively rare, says de Brantes.

Other studies have shown differences in what commercial payers shell out for doctor office visits and hospital care versus government programs.

A February report by the Center for Studying Health System Change found wide variation between what insurers covering unionized autoworkers and Medicare paid for various services, including doctor office visits and hospital care.

Differences in overall health among the workers explained much of the variation, but doctor and hospital prices also played a key role.

For example, the study found that prices paid for hospital care were, on average, 55% higher for the autoworkers' insurers than what Medicare paid.

"We know that one of the reasons private insurers pay more is hospitals insist on it, but whether they are simply making up for the shortfall in Medicare and Medicaid, or whether they are aggressively gaining additional margin is a question that different people will answer in different ways," says Paul Ginsburg, president of the center.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation.

Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

http://www.medpagetoday.com/Orthopedics/Orthopedics/31451? utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2012 Everyday Health, Inc. All rights reserved.

Hyaluronic acid has little effect on pain, none on function, new review states

Tuesday, June 12, 2012

MONDAY, June 11 (HealthDay News) --

It's not good news for baby boomers with arthritic knees:

Injections of hyaluronic acid have little effect on pain and no effect on function, according to a new analysis.

Worse, the injections may cause serious harm, Swiss researchers found.

Hyaluronic acid -- a lubricant in joint fluid that acts as a shock absorber -- declines with the wear-and-tear type of arthritis known as osteoarthritis.

When nonsteroidal anti-inflammatory drugs don't provide relief, doctors sometimes prescribe injections of hyaluronic acid, also called viscosupplementation.

"Unfortunately, there is no evidence to suggest that viscosupplementation results in any relevant reduction in symptoms in patients with knee osteoarthritis," said study co-author Dr. Peter Juni, professor of clinical epidemiology at the University of Bern in Switzerland.

Moreover, his research suggested the injections could cause gastrointestinal and cardiovascular problems and other harmful side effects. As a result, Juni said he sees no role for the therapy.

"There is a concerning increase in adverse events, which should prevent patients and physicians from using this approach," he said.

The analysis is scheduled to be published online June 12 in the journal Annals of Internal Medicine.

The U.S. Food and Drug Administration in 1997 approved the injections, which are commercially available from several companies and much more costly than pain relievers.

In 2006, injections for a six-month period ranged from $850 to $1,840, according to a pharmaceutical report.

For the study, Juni's team reviewed 89 studies that compared injections with either a placebo treatment or no treatment. In all, the studies involved more than 12,000 adults aged 50 to 72.

The effect on pain was minimal, and the injections had no effect on functioning, the researchers found.

In some of the studies, the injections reached peak effectiveness at eight weeks, then declined.

Looking at safety, the researchers detected a 40 percent increased risk for serious side effects, such as gastrointestinal problems, with the injections.

Flare-ups -- typically a hot, swollen knee 24 to 72 hours

after injection -- were noted, but not in statistically significant numbers. Less strong evidence suggested associations -- but not cause-and-effect relationships -- with cardiovascular events and cancer.

Despite these findings, a surgeon not involved in the study said he still sees a possible role for the injections in certain patients.

"Viscosupplementation therapy for the knee appears to have some transient improvement in a relatively small number of patients for variable periods of time -- most often less than six to 12 months," said Dr. William Robb, III, chairman of ort

hopedic surgery at North Shore University Health System in Evanston, Ill. "In some patients -- particularly patients who have received previous viscosupplements -- acute adverse reactions have been seen and may persist for several weeks, occasionally months."

However, "in none of these cases did the adverse reaction require surgical treatment," he added.

Robb said he looks at the pros and cons from a patient's perspective. Many turn to the injections to avoid surgery or medications, which can have their own harmful side effects, he said.

"Some patients, however -- particularly patients with earlier stage arthritis -- benefitted from viscosupplementation for periods of time sufficient to continue the use of this therapy," he said.

Further research would help determine which patients benefit so doctors could tailor the therapy effectively, he said.

The authors pointed out several study limitations, saying the methodology of some of the studies was flawed and the overall quality generally low. Also, many provided no information on safety.

SOURCES:

Peter Juni, M.D., professor of clinical epidemiology, University of Bern, Switzerland;

William Robb III, chairman, orthopedic surgery, North Shore University Health System, Evanston, Ill.; June 12, 2012, Annals of Internal Medicine

HealthDay

Copyright (c) 2012 HealthDay. All rights reserved.

By Nancy Walsh, Staff Writer, MedPage Today

Published: July 07, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Take Posttest

Action Points

A longitudinal cohort study of predominantly white women in the U.K. found a fairly low cumulative incidence of knee osteoarthritis over a 15-year period as measured by plain radiography.

Note, however, that women with even just possible osteophytes at baseline had more than a four-fold increased risk for definitive and progressive osteoarthritis over time.

The annual rate at which middle-age women develop knee osteoarthritis (OA) is fairly low, but progression is common when x-ray changes in the joint are already present, a community-based cohort study found.

During 15 years of follow-up, the annual incidence of radiographic knee arthritis was 2.3%, according to Nigel K. Arden, MD, of the University of Oxford in England, and colleagues.

However, those with possible – not even definitive -- changes visible on x-rays at baseline were 4.5-fold more likely to have worsening of the disease at year 15 (95% CI 2.7 to 7.4), the researchers reported in the July Arthritis & Rheumatism.

"Because of the increasing health burden due to the aging population and a projected 45% lifetime risk of symptomatic knee OA developing, there is an urgent need to understand the natural course of knee OA in order to target preventative therapies and reduce known risk factors for both the incidence and progression of knee OA," they observed.

To address this need, they analyzed data from the Chingford Women's Study, which included more than 1,000 women in a North London general practice.

Among the entire cohort, 561 had undergone knee radiography at baseline and then at years 5, 10, and 15.

Participants' median age was 53 and median body mass index was 24.7.

At baseline, 80.9% had no radiographic evidence of knee OA, while 5.4% had grade 1 Kellgren/Lawrence (K/L) scores, indicating the possible presence of an osteophyte, or bone spur, but no joint space narrowing.

Grade 2 and higher scores represent definitive OA, and were seen in 13.7% of the women at baseline.

By year 5, 23.9% of the women had developed OA, as had 36.4% by year 10 and 47.8% after 15 years.

Among the women who had no evidence of disease at baseline, 60.5% were still disease-free at year 15.

A total of 51.3% of all knees remained free of radiographic changes throughout the study, but worsening by a full grade was seen in 41.5%.

Worsening of at least one radiographic grade occurred in 12% of knees by year 5, in 23.4% between years 5 and 10, and in 23.8% between years 10 and 15.

Stratification by age found a significant difference, with 42.2% of women older than 60 at baseline having developed OA by year 15, compared with 26% of those younger than 50 (P<0.01).

High body mass index also was associated with an increased incidence, with a nearly 20% greater incidence by year 10 among obese women.

At baseline, 8.6% of women had unilateral OA and 5.2% had bilateral disease, and by year 15 these proportions had risen to 18.4% and 29.4%, respectively.

The rate of total knee replacement by year 15 increased according to baseline radiographic scores, ranging from 1.1% for grade 0 knees to 6.7% for grade 3.

However, compared with knees scoring 0, the odds of having a total replacement were similar for all other radiographic scores:

Grade 1, OR 4.7 (95% CI 1 to 22.2)

Grade 2, OR 5.9 (95% CI 1.9 to 18.2)

Grade 3, OR 4.6 (95% CI 0.3 to 65.3)

In discussing their findings, the researchers stressed the importance of the high likelihood – a 4.5-fold increase – of progression to definite radiographic OA in patients who had only "possible osteophytes" present at baseline.

This "suggests that grades of 1 are an important indicator of longitudinal incidence," Arden and colleagues noted.

They also explained that there may be both genetic and environmental influences on progression, radiographic worsening, and unilateral versus bilateral disease.

A limitation of the study was reliance on the Kellgren/Lawrence grading system for scoring the radiographs, which has been criticized as being "osteophyte-centric," and has several variations.

"Although the relationship between K/L grades and pain is by no means perfect, other imaging modalities, such as MRI, have not yet demonstrated a better specificity than plain film radiography," they wrote.

Other limitations were the inclusion of women only, a predominantly white population, and considerable numbers of participants being lost to follow-up.

The study was funded by the University of Oxford and Arthritis Research U.K.

The authors had no financial disclosures.

Primary source: Arthritis & Rheumatism

Source reference:

Leyland K, et al "The natural history of radiographic knee osteoarthritis" Arthritis Rheum 2012; 64: 2243-2251.

http://www.medpagetoday.com/Rheumatology/Arthritis/33648? utm_content=&

utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2012 Everyday Health, Inc. All rights reserved.

Researchers found aerobic, water exercise reduced pain, boosted function in patients

Tuesday, November 6, 2012

TUESDAY, Nov. 6 (HealthDay News) --

Adults with painful osteoarthritis of the knee should turn to exercise -- aerobic, aquatic or strength training -- as a good nonsurgical way to ease their pain and improve their functioning, a new review suggests.

To reach this conclusion, Dr. Tatyana Shamliyan, a senior research associate at the University of Minnesota, and her colleagues reviewed 193 studies that were published between 1970 and 2012.

"Several guidelines recommend nondrug treatment, including exercise, electrical stimulation, tai chi and esthetics," Shamliyan said. Her team analyzed the evidence and came up with results that were sometimes at odds with those guidelines.

They looked at how the therapies affected pain, functioning and disability.

"Based on the analysis, we can't conclude sustained benefit with tai chi, manual therapy or massage, or transcutaneous electrical [nerve] stimulation," she said.

The electrical stimulation reduced pain, she found, for very short time periods, less than six weeks. Over time, the pain actually got worse, she noted.

The investigators found few physical therapy interventions worked to reduce pain or improve functioning or levels of disability.

Shamliyan said it's important for those with knee pain from osteoarthritis -- the "wear-and-tear" form -- get a prescriptive exercise program of aerobics, aquatics or strength training from a physical therapist.

The research is published in the Nov. 6 issue of the Annals of Internal Medicine.

In the analysis, the researchers also found that perseverance counted. "We found some evidence that adherence, compliance with the exercise recommended was associated with better outcomes," she said.

However, the study authors did not find good evidence that more intense exercise was any better than moderate exercise.

The U.S. Agency for Healthcare Research and Quality funded the research.

Osteoarthritis of the knee affects about 28 percent of those older than 45 in the United States, the study authors said, and 37 percent of those over 65.

Nonsurgical treatments are aimed at reducing or controlling pain, helping physical functioning, preventing disability and improving quality of life.

The findings are no surprise to Dr. Benjamin Bengs, an assistant professor of orthopedic surgery at UCLA Medical Center, Santa Monica, and the University of California, Los Angeles, David Geffen School of Medicine.

"There is evidence to show that physical therapy, aerobic and aquatic exercise and strength training all improve quality of life," he said.

The researchers also showed that certain therapies were not effective, Bengs noted, although he would not discount them so quickly. "Given the potential for placebo effect, I would not rule out these [other treatments]," he added.

Often, Bengs said, his patients will be convinced a treatment that has no science to back it up is helping them. If it does, and it's not harmful, he doesn't see a problem.

He did suggest that some of the nonsurgical treatments work better when done in tandem with surgery.

And, Bengs agreed that people do better when they adhere to the exercise program prescribed for them.

Both Bengs and Shamliyan also advised maintaining a healthy weight to improve knee pain.

SOURCES:

Benjamin Bengs, M.D., assistant professor, orthopedic surgery, UCLA Medical Center, Santa Monica, University of California, Los Angeles, David Geffen School of Medicine;

Tatyana Shamliyan, M.D., M.S., senior research associate, Minnesota Evidence-Based Practice Center, division of health policy and management, University of Minnesota, Minneapolis; Nov. 6, 2012, Annals of Internal Medicine

http://www.nlm.nih.gov/medlineplus/news/ fullstory_131050.html

Copyright (c) 2012 HealthDay. All rights reserved.

In fact, experts now predict 1 in 2 people may develop knee osteoarthritis in their lifetime.

A new study in the Annals of Internal Medicine compared treatments for knee osteoarthritis to see what effect they had on pain, physical function and disability.

Researchers reviewed 193 trials conducted from 1970 through February of 2012.

Among the therapies included were strength training, massage, tai chi, aerobic exercise, electrical stimulation and ultrasound.

After analyzing the data, the team found evidence that aerobic and aquatic exercise improved disability and that aerobic exercise, strength training and ultrasound lessened pain and improved function.

Patients who stuck with their exercise programs experienced more relief suggesting, according to researchers, that adherence was more important than amount or intensity.

I'm Dr. Cindy Haines of HealthDay TV, with news from today that can lead to healthy tomorrows.

http://www.nlm.nih.gov/medlineplus/videos/news/ Knocking_Knee_110612-1.html

Page last updated on 09 November 2012