RESEARCH SNIPPETS


Ankylosing spondylitis | Arthritis | Chronic pain | FibromyalgiaGout | Inflammatory bowel syndrome | Juvenile arthritis | Osteoarthritis | Osteopenia | Osteoporosis | Psoriatic arthritis | Rheumatoid arthritis

Ankylosing spondylitis

What effect does living with ankylosing spondylitis or undifferentiated spondyloarthritis have on a person’s psychological well‐being?

People who have ankylosing spondylitis (AS) or undifferentiated spondyloarthritis live with chronic pain, and this can have an effect on many aspects of their life. They often will have had symptoms for many years, however it takes on average three years for people to seek help and nine years to receive a diagnosis.

This study used an online survey to gain information from people who have (AS) or undifferentiated spondyloarthritis. They received 161 responses.

Participants pain levels were measures at 24 hours and over the last week using a Brief Pain Inventory. At both time points pain levels of participants was high. These high levels of chronic pain in AS and undifferentiated spondyloarthritis interfered with participants daily living activities more than 50% of the time for all categories including work, relationships, walking and sleep.

People also reported extreme levels of psychological distress as assessed by Depression, Anxiety and Stress Scale Short Form‐21 (DASS-21) scores. There was a significant relationship between average chronic pain levels and depression, anxiety and stress scores.

In conclusion the findings confirm that delays in diagnosis and serious emotional distress should not be overlooked in people with AS and undifferentiated spondyloarthritis. Also health professionals should be aware and take this into account when treating people as well as offering support options.

Read the full abstract here. 
Kelly K. Ankylosing spondylitis and undifferentiated spondyloarthritis: The relationship between living with these diseases and psychological well-being. Musculoskeletal Care. 2020 Sep 18. doi: 10.1002/msc.1513. Epub ahead of print. PMID: 32949095.

Arthritis

Exercise helps prevent cartilage damage caused by arthritis

We’ve known for a long time that exercise is an important tool for managing your arthritis. But we weren’t sure of precisely how exercise prevents damage to our cartilage.

Researchers in London have demonstrated that during exercise the cartilage in joints such as the hip and knee is squashed. Cells in the cartilage detect this and react by blocking inflammatory molecules. They discovered that it all came down to a specific protein – HDAC6 – being activated during exercise.

Researchers hope that this knowledge will aid in the discovery of new treatments for people with arthritis, including medications that simulate the anti-inflammatory effect of physical activity on the joints.

Read more about this research in Science Daily.
Read the full article here.
Fu Su, et al. Mechanical loading inhibits cartilage inflammatory signalling via an HDAC6 and IFT-dependent mechanism regulating primary cilia elongation. Osteoarthritis and Cartilage, 2019; DOI: 10.1016/j.joca.2019.03.003.

Chronic pain

Exercising through pain – is it worth it?

This literature search compared the effect of exercises where pain is allowed or encouraged compared with non-painful exercises. They specifically were looking at the effects on pain, function or disability in patients with chronic musculoskeletal pain.

Out of more than 9,000 research articles they discovered, 9 papers met the inclusion criteria for this study.

With the available evidence, researchers concluded that using painful exercises provided a small but significant benefit over pain-free exercises, however this was only a short term benefit. In the medium and long term there was no clear advantage of one treatment over another.

Read the full article here.
Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(23):1679-1687. doi: 10.1136/bjsports-2016-097383. Epub 2017 Jun 8. PMID: 28596288; PMCID: PMC5739826.

Are psychological therapies helpful for managing chronic pain (excluding headache) in adults?

Chronic non-cancer pain is a common problem for many adults around the world. Psychological treatments/therapies are one of the treatment options used to reduce pain, disability and distress. This study aimed to determine how effective these treatments are when delivered by a trained psychologist and whether they had any adverse/unwanted effects.

This systematic review analysed a large body of evidence that included over 5,000 participants from 59 studies. The data compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or treatment as usual, and at six month to 12 month follow‐up.

In conclusion, they found that CBT had beneficial effects (albeit small) for reducing pain, disability, and distress in chronic pain. Due to insufficient or low-quality evidence, they were unable to assess any potential adverse events or determine any benefits from trials of BT and ACT.

Read the full article here. 
Williams ACC, et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020;8(8):CD007407. Published 2020 Aug 12. doi:10.1002/14651858.CD007407.pub4.

Fibromyalgia

Fibromyalgia pain and fatigue can be eased with a TENS machine  New!

Fibromyalgia is a complex condition that involves widespread pain and fatigue. Most people with fibromyalgia continue to experience activity-limiting pain despite taking multiple pain-relieving medications. They also report that pain caused by movement, limits their participation in physical activities.

While there’s strong evidence that identifies exercise as an effective treatment for fibromyalgia, pain remains a significant barrier to undertaking it. Researchers set out to investigate if using transcutaneous electrical nerve stimulation (TENS) during activity would improve pain associated with movement and other patient‐reported outcomes in women with fibromyalgia.

This randomised controlled trial took place over a four week period and involved 352 women with fibromyalgia using TENS for up to two hours per day. Results showed that 44% of women achieved a clinically significant benefit in pain (greater than 30% reduction in pain) and 45% had a clinically significant improvement in fatigue (greater than 20% less fatigue), compared to rates of 22% and 26% with placebo TENS.

The researchers concluded that the use of TENS can relieve the movement-related pain experienced by people with fibromyalgia. This may provide a window of opportunity for people with fibromyalgia to participate in exercise as a recommended evidence-based non-drug treatment.

Read the full article here. 
Dailey DL et al. Transcutaneous electrical nerve stimulation reduces movement-evoked pain and fatigue: A randomized, controlled trial. Arthritis Rheumatol. 2020 May;72(5):824-836. doi: 10.1002/art.41170. Epub 2020 Mar 18. PMID: 31738014; PMCID: PMC7188591.

Are mindfulness and acceptance-based therapies effective for people with fibromyalgia?

Researchers wanted to know if mindfulness and acceptance-based interventions, such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT) were safe and effective treatments for people living with fibromyalgia.

They performed a literature search covering the period 1990 – 2019. From this search, they discovered more than 4,000 articles, of which 9 were selected after meeting their research criteria.

The researchers found that mindfulness and acceptance-based interventions had a small to moderate positive effect on pain, depression, anxiety, mindfulness, sleep quality and health-related quality of life when compared to the control group. They concluded that these results were promising, but more research is needed.

Read the full article here. 
Haugmark T, et al. Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses. PLoS One. 2019 Sep 3;14(9):e0221897. doi: 10.1371/journal.pone.0221897. PMID: 31479478; PMCID: PMC6719827.

Is mixed exercise training effective for adults with fibromyalgia?

Exercise training is commonly recommended for people with fibromyalgia. Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed, tired, and stiff, and have difficulty sleeping.

Mixed exercise is defined as regular sessions of two or more types of exercise including aerobic (walking or cycling), strengthening (lifting weights or pulling against resistance bands), or flexibility (stretching) exercise.

Reviewers looked at 29 randomised controlled trials (RCTs) that compared mixed exercise interventions with other or no exercise interventions. The studies involved more than 2,000 adults with fibromyalgia from 12 different countries. The average age of study participants was 51 years, and 98% were female. The average exercise programme was 14 weeks long with three sessions of 50 to 60 minutes per week. Major outcomes were health‐related quality of life (HRQL), pain, stiffness, fatigue, physical function, withdrawals, and adverse events.

Researchers concluded that mixed exercise may improve health‐related quality of life and the ability to do daily activities, may decrease pain and tiredness, and may be acceptable to individuals with fibromyalgia. Low‐quality evidence suggests that mixed exercise may slightly improve stiffness.

When compared to other exercise or non‐exercise interventions, researchers were uncertain about the effects of mixed exercise. Although mixed exercise appears to be well tolerated, evidence on harms was scarce, so they couldn’t make any conclusions about its safety. Reviewers considered the quality of evidence to be low to moderate because of small numbers of people in the studies, some issues involving study design, and the low quality of results.

Read the full article here.
Bidonde J, et al. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2019;5(5):CD013340. Published 2019 May 24. doi:10.1002/14651858.CD013340

If you have fibromyalgia could tai chi improve your mood, pain and sleep?

This study randomly enrolled 66 people with fibromyalgia in a trial evaluating the effectiveness of tai chi when compared with wellness education and stretching. Half of the group were given 60 minute sessions of Yang-style tai chi twice a week for 12 weeks, and the other half (the control group) were given education and stretching to perform over the same period.

Researchers were looking for any changes in a person’s Fibromyalgia Impact Questionnaire (FIQ) score. The FIQ is a set of questions that ask people to rate the impact fibromyalgia has on things such as their ability to do usual daily activities, their mood, pain and sleep quality. At the end of the questions, people are given a score – ranging from 0 to 100 – with higher scores indicating more severe symptoms.

At the end of the twelve weeks, those in the tai chi group had greater improvements in their FIQ score and quality of life when compared to the control group.

Researchers concluded by saying that tai chi may be an effective treatment for fibromyalgia, however further study in larger groups of people should be carried out.

Read the full article here. 
Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363(8):743-754. doi:10.1056/NEJMoa0912611 

Gout

Gout and diet

It’s generally accepted that diet plays an important role in the treatment of gout and hyperuricaemia. However there’s still some debate about specific food selection, as well as conflicting advice as to what foods will increase your risk of gout or hyperuricemia.

This meta-analysis and systematic review identified newer studies for analysis and evaluated the associations between dietary factors and the risk of gout and hyperuricemia. Nineteen cohort or cross-sectional studies were included, all of which analysed the effects of red meat, seafoods, alcohol, fructose, dairy products, soy foods, high-purine vegetables and coffee.

Researchers concluded that the evidence indicated that red meat, seafoods, fructose and alcohol were likely to increase the risk of hyperuricemia and gout. However consumption of dairy products or soy foods were likely to decrease the risk of hyperuricemia and gout. Similarly coffee consumption was likely to decrease the risk of gout and decrease the risk of hyperuricemia in men, however it increased the risk of hyperuricemia in women. Finally they found that purine rich vegetables (e.g. (cauliflower, spinach, peas, beans, mushrooms) may not predispose people to gout, and they may even exert protecting effects on the risk of hyperuricemia.

Read the full article here. 
Li R, et al. Dietary factors and risk of gout and hyperuricemia: a meta-analysis and systematic review. Asia Pac J Clin Nutr. 2018;27(6):1344-1356. doi: 10.6133/apjcn.201811_27(6).0022. PMID: 30485934.

Does nurse-led care improve outcomes for people with gout?

Gout is the most common inflammatory arthritis in the world, but it’s poorly treated and managed, with around 70% of people experiencing frequent, painful flares.

This study looks at the effectiveness of nurse-led care of people with gout compared to usual GP-care. About 500 people were included in the study, with approximately half assigned to the nurse-led group and the other half assigned to usual care.

In the nurse-led group, people received individualised treatment and were included in decision making. At the end of the trial, people who were in the nurse-led group had better outcomes in terms of being prescribed (and continuing to take) medication to lower their blood urate levels to prevent flares and improve their quality of life.

Read the full article here. 
Doherty M, Jenkins W, Richardson H, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet. 2018;392(10156):1403-1412. doi:10.1016/S0140-6736(18)32158-5.  

Inflammatory bowel syndrome

Is there a risk of developing inflammatory bowel syndrome from taking an interleukin 17 antagonists such as secukinumab or ixekizuma?

With some inflammatory conditions such as psoriatic arthritis, ankylosing spondylitis and psoriasis the body produces too much of the inflammatory protein interleukin 17 (IL-17). This results in swollen, painful joints and other symptoms. To manage these symptoms, specialists may prescribe drugs known as interleukin 17 antagonists. These drugs work by binding to IL-17, reducing the inflammation it causes.

Inflammatory bowel diseases (IBD) are a group of chronic conditions that cause inflammation in the digestive tract. The most common forms are Crohn’s disease and ulcerative colitis. Symptoms typically include diarrhoea, abdominal pain and fever.

Cases of IBD have been reported during trials with IL-17 antagonists. Researchers wanted to find out the overall risk of developing an IBD when using these drugs.

They concluded from their systematic review and meta-analysis of 10s of thousands of patients, that the risk of developing IBD was not increased. However they did recommend that more research be carried out, due to certain limitations in the studies included in the review.

Read the full article here. 
Burisch J, Eigner W, Schreiber S, et al. Risk for development of inflammatory bowel disease under inhibition of interleukin 17: A systematic review and meta-analysis. PLoS One. 2020;15(5):e0233781. Published 2020 May 27. doi:10.1371/journal.pone.0233781.

Juvenile arthritis

New genomic testing can help early diagnosis and targeted treatment of juvenile idiopathic arthritis  New!

Juvenile idiopathic arthritis (JIA) is an autoimmune disease that can lead to chronic pain and disability in children. At present the diagnosis of JIA is based purely on clinical symptoms, which can be very variable, leading to diagnosis and treatment delays.

This Australian-led study set out to explore whether genomic testing can help diagnose and treat JIA more quickly by using hereditary components to construct genomic risk scores.

They examined three case control cohorts from the UK, US and Australia, and analysed the data for subtype-specific genes.

Following analysis, the researchers constructed seven subtype-specific genomic risk scores for systemic arthritis, oligoarthritis, rheumatoid-factor-positive polyarthritis (RF-positive), rheumatoid-factor-negative polyarthritis (RF-negative), enthesitis-related arthritis (ERA), psoriatic arthritis and undifferentiated arthritis.

The study concluded that these genomic risk scores could improve current JIA diagnosis, prioritising higher-risk individuals for follow-up and treatment and reducing delays.

The authors stated that this is a cost-effective, non-invasive test that has the potential to be used at the primary care level to screen out children who don’t have inflammatory disease - so that those requiring treatment receive it earlier.

Read the full article here.
Cánovas R et al. Genomic risk scores for juvenile idiopathic arthritis and its subtypes. Ann Rheum Dis. 2020 Dec;79(12):1572-1579. doi: 10.1136/annrheumdis-2020-217421. Epub 2020 Sep 4. PMID: 32887683; PMCID: PMC7677485.

Vaccinations don’t increase arthritis flares in juvenile arthritis

There’s long been concern that routine childhood vaccinations, along with medications and infections, may act as a trigger for some flares in children with juvenile idiopathic arthritis (JIA). These concerns affect clinician’s behaviour in immunising children with JIA and can lead to inconsistency in vaccination practice – where some children have vaccinations delayed and others are vaccinated regardless.

A recent study from the Royal Children’s Hospital in Melbourne set out to investigate the proposed link between routine childhood vaccinations and flares in children with JIA. The study analysed data from the Rheumatology Clinical Database at the Royal Children’s Hospital of 138 Victorian children under the age of six.

The findings concluded that there’s no association between vaccination and the occurrence of flares in JIA. This was true for any of the vaccines in the Australian National Immunisation Program. Data revealed that flare activity was actually lower in the three months after receiving a vaccine, with children 40% less likely to experience an arthritis flare than in the ‘baseline’ control period before vaccination.

The researchers stated that these results should provide reassurance to families and health professionals about the safety of routine childhood vaccinations in children with JIA - even in the setting of the COVID-19 pandemic.

Read the full article. 
Alfayadh NM et al. Vaccinations do not increase arthritis flares in juvenile idiopathic arthritis: A study of the relationship between routine childhood vaccinations on the Australian immunisation schedule and arthritis activity in children with juvenile idiopathic arthritis. Int J Rheumatol. 2020 Aug 4;2020:1078914. doi: 10.1155/2020/1078914. PMID: 32831849; PMCID: PMC7424527.

Osteoarthritis

Are stem cell injections beneficial for osteoarthritis?

Osteoarthritis is the most common type of arthritis in Australia and is a major cause of disability and chronic pain. The current treatment for osteoarthritis is focused on controlling symptoms and pain, however there’s growing interest around the potential benefits of stem cell therapy.

Stem cells have the unique ability to make copies of themselves (self-renew) and therefore have the potential to repair a joint damaged by osteoarthritis. However, there’s still a great deal of uncertainty around the safety and effectiveness of this treatment.

This study set out to see if mesenchymal stem cell (MSC) injections had a positive effect on the joint cartilage and the bone directly under the cartilage (subchondral bone). It identified 13 high quality randomised controlled trials analysing groups of people with osteoarthritis, or at risk of developing it. The outcomes measured included cartilage volume/thickness, cartilage defects, quality and repair, meniscal volume and pathology, tibial bone area, bone marrow lesions, subchondral bone sclerosis and osteophyte formation, composite MRI scores and joint space width.

They found that there was consistent evidence for the beneficial effects of MSC injections on joint cartilage and subchondral bone, but not enough evidence to recommend its use in the management of osteoarthritis. It’s also important to note that these studies did not look at functional outcomes like walking or moving and whether there was any improvement in people’s quality of life

Rheumatologists have noted that while this is an area of promise, current research makes it impossible to recommend stem cell therapy until more rigorous research is conducted.

Read the abstract here.     
Gong J et al. Effect of stem cell injections on osteoarthritis-related structural outcomes – a systematic review. J Rheumatol. 2020 Oct 1:jrheum.200021. doi: 10.3899/jrheum.200021. Epub ahead of print. PMID: 33004537. 

Can steroid injections speed up the progression of knee OA?  New!

From the American College of Rheumatology virtual congress 2020.   

Corticosteroid injections, which are used to help with osteoarthritis (OA) knee pain, does not increase the risk of getting a total knee replacement.

Some recent studies have suggested corticosteroid injections increase progression of knee OA by as much as 3-4 times.

Two cohort studies of knee OA – the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI) - were used to look at rates of x-ray progression and total knee replacement among patients having a corticosteroid joint injection or a hyaluronic acid injection. Visits were performed every 12 and 30 months and included knee x-rays and questions about hyaluronic acid injections and corticosteroid injections in the previous six months.

Researchers found that use of corticosteroid joint injections for knee OA was not associated with higher rate of radiographic progression or progression to total knee replacement than hyaluronic acid injection.

They suggested that the risk of disease progression attributed to corticosteroid joint injections in earlier studies may reflect the presence of more severe OA in those undergoing injections.

Read the full abstract here.  
Bucci J et al. Progression of knee OA with use of intra-articular corticosteroids (CS) vs hyaluronic acid (HA) [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10).  Accessed November 29, 2020. 

Can we ‘stun’ shoulder and hip pain away?

While it sounds like something straight out of a science fiction movie, researchers in Atlanta (USA) believe this may be an option for people with osteoarthritis in the shoulder and hip when other treatments are no longer an option.

This small study included 23 people with osteoarthritis – 12 with shoulder pain, 11 with hip pain. The procedure involves placing needles in the main sensory nerves around the shoulder and hip joints. The nerves were then given a low-grade current that “stuns” them, slowing the transmission of pain messages to the brain.

There were no side effects from the procedure, and people reported decreases in pain and increases in the function of the joint.

While these results are very promising, this was a very small study, so more research is needed. But it does provide some hope for alternatives to the way osteoarthritis is treated beyond medication and joint replacement surgery.

Read more about this research in Science Daily. 

Does weather increase the risk of pain in people with hip osteoarthritis?

It’s long been reported by people with osteoarthritis (OA) that changes in the weather affects their pain. This Australian study set out to evaluate the association of such weather factors with the risk of increased pain in people with hip osteoarthritis.

The study followed 129 people with hip OA who self-reported hip pain on most days of the week.

Participants were mostly women, with an average age of 63 and a Body Mass Index (BMI) of 29. Every 10 days, and whenever they experienced worsening pain, participants were required to complete an online questionnaire.

Weather variables were obtained from the Bureau of Meteorology for the person’s location or postcode on the days of the survey completion.

Results showed that high daily temperature variation during the previous 72 hours was associated with a higher risk of hip pain exacerbations. However there was no significant association found between maximum daily temperature, minimum daily temperature, relative humidity, precipitation, or barometric pressure and hip pain exacerbations.

The authors suggested that there may be physiological or psychological mechanisms at play, however any relationship between temperature variability and pain required further exploration.

Despite this the researchers suggested that such associations could help people with hip OA better manage their pain by choosing an air-conditioned environment or avoiding outdoor activities during days with high daily temperature variation.

Read the abstract here. 
Fu K et al. Association of weather factors with the risk of pain exacerbations in people with hip osteoarthritis. Scand J Rheumatol. 2020 Jul 2:1-6. doi: 10.1080/03009742.2020.1760929. Epub ahead of print. PMID: 32614268.

Is turmeric an effective treatment for knee osteoarthritis?

Osteoarthritis is the most common joint disorder, however there are currently no medications that work on the actual disease process, only medications that help people manage their joint pain and stiffness.

There has long been interest in the use of turmeric as a treatment for knee osteoarthritis, however the jury is still out on the effectiveness of curcumin (turmeric supplements) in reducing symptoms.

This study used a randomised, double-blind, placebo-controlled trial with 70 people from Tasmania, with symptomatic knee osteoarthritis and effusion synovitis. They were given two capsules of Curcuma longa extract (CL) – or placebo – every day for 12 weeks.

Researchers found knee pain improved in people taking the curcumin supplement as reported on a visual analogue scale but there was no significant difference between the groups for effusion-synovitis volume or cartilage composition as measures on MRI.

They concluded that the small pain reduction may not be of clinical importance and that larger trials, run over a longer period of time and at several different locations are needed to access the clinical significance of the study findings.

Read the full abstract here. 
Wang Z, et al. Effectiveness of curcuma longa extract for the treatment of symptoms and effusion-synovitis of knee osteoarthritis : A randomized trial. Ann Intern Med. 2020 Sep 15. doi: 10.7326/M20-0990. Epub ahead of print. PMID: 32926799.

Is tramadol an effective and and safe treatment for osteoarthritis?

is an opioid medication often prescribed to treat the pain and physical disability associated with osteoarthritis. Compared to non‐steroidal anti‐inflammatory drugs (NSAIDs), it offers less gastrointestinal side effects (bleeding in the stomach) and is therefore suggested as a potential alternative for people who can’t tolerate NSAIDs.

This systematic review critically analysed 22 randomised controlled trials concerned with taking tramadol for osteoarthritis symptoms. It aimed to determine any potential harms or benefits for people with osteoarthritis taking oral tramadol or tramadol combined with paracetamol or non-steroidal anti-inflammatory (NSAIDs).

The review concluded that compared to a placebo, tramadol alone or combined with paracetamol probably has no important benefit on the average pain levels or function of people with osteoarthritis. Moderate quality evidence also suggested that a substantial number of participants probably stopped taking tramadol because of unpleasant side effects. The three most common adverse side effects reported were nausea, dizziness and tiredness.

Read the full article here. 
Toupin April K, et al. Tramadol for osteoarthritis. Cochrane Database Syst Rev. 2019;5(5):CD005522. Published 2019 May 27. doi:10.1002/14651858.CD005522.pub3.

What’s better – yoga or aerobic/strengthening exercises for people with knee osteoarthritis?

Exercise is an important and effective part of any osteoarthritis (OA) management plan. Regular exercise can help reduce some of the symptoms (e.g. pain, stiffness) caused by your condition and improve your joint mobility and strength.

In this study researchers wanted to compare the effectiveness of three different programs for knee OA in older adults – Hatha yoga, aerobic/strengthening exercises and an education only program.  People were randonly assigned to one of these three groups.

In total, 83 people completed the study: yoga – 32, aerobic/strengthening exercise – 28 and education only group – 23.

Both the yoga and aerobic/strengthening groups involved 45 minute group classes, 2-4 times a week for 8 weeks. The education group received printed brochures about knee OA and weekly calls from study staff.

Researchers measured OA symptoms, physical function, mood, spiritual health, fear of falling, and quality of life at the beginning of the study, at 4 weeks and at the end of the study at 8 weeks.

They found that people in the yoga group had greater improvements in pain and self-reported function, lower extremity strength, anxiety, and fear of falling compared with those in the aerobic/strengthening and education groups.

While this was a small study and the participants were mostly well-educated women, researchers say their study suggests yoga is a safe and effective way for people to manage knee OA.

More research is needed, with larger, more diverse groups of people.

Read the full article here.
Cheung C, Wyman JF, Bronas U, McCarthy T, Rudser K, Mathiason MA. Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int. 2017;37(3):389-398. doi:10.1007/s00296-016-3620-2

Osteopenia

For women with osteopenia can mini-trampoline training improve balance?

This randomized controlled trial aimed to evaluate if a combined balance, strength, and jumping-exercise program on a mini-trampoline was effective for older women with osteopenia. They were specifically looking at improvements in balance and functional mobility, walking speed, strength of the upper and lower limbs, fear of falling, and the effect on bone mineral density.

Forty women were assigned to two groups – one group of 20 were given the exercise program to perform twice a week for 12 weeks. The second group of 20 were given no exercise program and continued with their usual osteopenia treatment for the same time period. This was the control group.

Researchers found that after 12 weeks, the women who took part in the exercise program had improvements in balance and functional mobility, strength and walking and had less fear of falling.

Read the full article here.
Posch M, Schranz A, Lener M, et al. Effectiveness of a mini-trampoline training program on balance and functional mobility, gait performance, strength, fear of falling and bone mineral density in older women with osteopenia. Clin Interv Aging. 2019;14:2281-2293. Published 2019 Dec 20. doi:10.2147/CIA.S230008.

Osteoporosis

Effects of combination denosumab and high‐dose teriparatide on bone microarchitecture and strength

Post-menopausal women are at higher risk of developing osteoporosis. The drop in oestrogen levels around the time of menopause leads to increased bone loss, and as a result an increased risk of fracture. It’s estimated that on average women lose up to 10% of their bone mass in the first five years after menopause, and that half of all women over the age of 60 years will have at least one fracture due to osteoporosis.

Recent research has been investigating the best treatment options for increasing bone density in high-risk post-menopausal women.

This randomised controlled study recruited 69 patients to receive either standard or high dose teriparatide (daily subcutaneous injection) for nine months, overlapped with denosumab (60 mg subcutaneous injection) at three, nine and 15 months.

Results identified that the combination therapy of high-dose (versus standard dose) teriparatide and denosumab is most likely to help prevent fractures in postmenopausal women. The combination therapy improved the very small scale structures (microarchitectures) inside the bone (trabecular bone) and the outer layer of bone (cortical bone), as well as the estimated bone strength.

Researchers explained that short-term treatment with this high-dose combination therapy has been shown to improve measures of bone density, microstructure, estimated strength, and greater gains in total bone density. Such treatment may be of benefit in postmenopausal women with severe osteoporosis.

Read the abstract here. 
Ramchand et al. Effects of combination denosumab and high-dose teriparatide administration on bone microarchitecture and estimated strength: The DATA-HD HR-pQCT Study. J Bone Miner Res. 2020 Aug 13. doi: 10.1002/jbmr.4161. Epub ahead of print. PMID: 32790196.

Psoriatic arthritis

Key discovery in psoriatic arthritis points to developing targeted treatments

Psoriatic arthritis is an inflammatory arthritis that affects some people with the skin condition psoriasis. We don’t know what causes it or why it affects some people and not others.

However researchers from the University of Oxford (UK) have taken a step closer to unravelling this mystery. By analysing the fluid drained from the knees of people with psoriatic arthritis, they found that many T cells in the joint fluid shared an identical T cell receptor.

Dr Hussein Al-Mossawi, from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford, said: “Our data suggest that psoriatic arthritis doesn’t just appear out of nowhere. Each receptor is like a unique lock that recognises a molecular key and we discovered, that across the patients, they are recognising a common molecule. This gives the first evidence that the T cells are seeing and reacting to the same molecule, which acts as a trigger for the disease. We don’t know the exact culprit yet, but this a great step forward in understanding the disease.” *

*
University of Oxford. “Key discovery in psoriatic arthritis points way for developing targeted treatments.” ScienceDaily. 21 September 2020. 

Read the full article here. 
Penkava F et al. Single-cell sequencing reveals clonal expansions of pro-inflammatory synovial CD8 T cells expressing tissue-homing receptors in psoriatic arthritis. Nat Commun. 2020 Sep 21;11(1):4767. doi: 10.1038/s41467-020-18513-6. PMID: 32958743; PMCID: PMC7505844.

Rheumatoid arthritis

Rheumatoid arthritis and diet

Being able to treat or manage rheumatoid arthritis (RA) with changes to diet is very appealing. It’s affordable, accessible and it has the potential to help manage RA symptoms. However there’s still uncertainty about the therapeutic benefits of diet in the management of RA and its effects on symptoms such as pain, joint stiffness, swelling, tenderness and associated disability.

This literature review analysed the outcomes of published randomised clinical trials involving people with RA to observe the effect of various dietary interventions on the management of their condition. The discussion highlights clinically and statistically significant outcomes that identify beneficial long-term effects for relieving symptoms and delaying RA progression.

The researchers concluded that dietary interventions can assist in the symptomatic control of RA and should ideally be used as a tool that can both supplement and complement present treatment strategies.

Based on the findings of this review, an anti-inflammatory food chart was compiled (available within full text article) that may have the potential to aid people in reducing their disease activity, delay disease progression and reduce joint damage for a better health outcome.

Read the full article here. 
Khanna S et al. Managing rheumatoid arthritis with dietary interventions. Front Nutr. 2017 Nov 8;4:52. doi: 10.3389/fnut.2017.00052. PMID: 29167795; PMCID: PMC5682732.

Rheumatoid arthritis drugs help improve the early stages of heart disease

Having rheumatoid arthritis increases a person’s risk of developing cardiovascular disease, or diseases of the heart and blood vessels.

In this study researchers wanted to find out if people with early rheumatoid arthritis have cardiovascular disease. And if so, if it may be affected by disease-modifying antirheumatic drug (DMARD) therapies used to treat RA.

Before the trial began, heart scans were taken of the participants. They had no history of heart disease, however these scans found evidence of damage to the heart including scarring and vascular stiffness of the aorta (the largest blood vessel in the body).

After one year of treatment, they found that in the 71 people who had completed the trial, there were improvements to their cardiovascular disease.

Read more about this research in News Medical.  
Read the research abstract here.
Plein S, et al. Cardiovascular effects of biological versus conventional synthetic disease-modifying antirheumatic drug therapy in treatment-naïve, early rheumatoid arthritis [published online ahead of print, 2020 Aug 28]. Ann Rheum Dis. 2020; annrheumdis-2020-217653. doi:10.1136/annrheumdis-2020-217653.

Mindfulness for people with rheumatoid arthritis – what does the research say?

There are few studies studying the effectiveness of mindfulness-based interventions for people with rheumatoid arthritis (RA).

In this study, researchers reviewed the literature to determine if mindfulness-based interventions improve the mental and/or physical health of people living with RA.

They found that the outcomes – both physical and mental – varied across the different studies in their review. Studies also used a range of different types of mindfulness-based interventions. Because of this they could not make any conclusions about the effect of mindfulness-based interventions on disease activity and pain. However they do state that preliminary findings suggest that these “interventions may be a useful strategy to improve psychological distress in those with RA”.

Read the full article here.
DiRenzo D, Crespo-Bosque M, Gould N, Finan P, Nanavati J, Bingham CO 3rd. Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis. Curr Rheumatol Rep. 2018;20(12):75. Published 2018 Oct 18. doi:10.1007/s11926-018-0787-4.



Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

Useful Links


Key Conditions

Copyright by Musculoskeletal Australia 2020. All rights reserved

ABN: 26 811 336 442ACN: 607 996 921