Friday, May 1, 2015

What's New in Osteoarthritis?

Osteoarthritis (OA) is the most common type of arthritis affecting up to 27 million Americans.  In OA, cartilage that lines the joints breaks down.  With loss of this natural cushion, the bones begin to rub together, damaging the joint. Symptoms of osteoarthritis include pain, swelling and reduced range of motion.  OA can develop in any joint in the body, but the most common ones affected are the knees, hips, hands and spine.  Conservative treatment measures involve lifestyle changes such as exercise, weight control, and rest.  Medical treatment includes the use of non-steroidal anti-inflammatory medications (NSAIDs), acetaminophen (e.g. Tylenol), and joint injections of a joint fluid supplement (Synvisc, Hyalgan, others) or corticosteroids. With an aging population in the U.S., it is clear that more and more of us will become affected by this condition.  Fortunately, a great deal of research is being conducted to address the recognition, causes, and management of OA.  Let’s looks at some of the newest developments in this condition.
  1. Knee pain while using stairs may be first sign of arthritis.  In a new study, it was found that having pain while using stairs was one of the earliest signs for the development of OA.  When patients report this symptom to their doctor, efforts should be made to evaluate for the possibility that their knee pain could be coming from early OA. By knowing this, earlier intervention with more effective treatment may be possible.
     
  2. Drinking milk may slow knee OA progression.  It is well known that calcium-containing products, such as dairy foods, can help strengthen bones. A recent study published in Arthritis Care Research has also found that drinking milk may have a beneficial effect in slowing the progression of OA of the knee in women.  Both male and female subjects with OA were evaluated annually with x-rays over a 4 year period.  At the conclusion of the study, women who drank 7 or more glasses of milk per week were found by x-ray to have lost the least amount of cartilage and women who did not drink milk lost the most.  Cartilage loss in women who drank 1-6 glasses of milk per week was somewhere between these two groups. This suggests that, in women, the more milk that was consumed, the slower the progression of their OA. Unfortunately, these results did not hold up in men, with no differences in the amount of cartilage loss when taking milk consumption into consideration.
     
  3. Some OTC supplements for OA may be better than others.  A quick search of the internet will reveal a number of dietary supplements touted to help with OA. These include chondroitin sulfate, glucosamine, and MSM (methylsulfonylmethane).  The highly respected Cochran Collaboration conducted a review of the effects of chondroitin sulfate for people with osteoarthritis. Major findings from their review of 34 studies involving over 9,000 participants were that:
     
    • Chondroitin may improve pain slightly in the short-term (less than 6 months);
       
    • Chondroitin probably improves quality of life slightly as measured by Lequesne's index (combined measure of pain, function, and disability);
       
    • Chondroitin slightly slows down the narrowing of joint space on X-rays of the affected joint.
       
  4. When the same research group evaluated the benefits of glucosamine alone on OA, the results were much less positive.  No benefit in pain or improvement in function was found for most commercial preparations of glucosamine.  The glucosamine product from one company (Rotta), however, did show slight improvement in pain and function over placebo tablets.  When studies evaluating the use of MSM in OA were pooled, the Cochrane group found no benefit in study subjects.
       
  5. Running may help prevent knee osteoarthritis.  Controversy exists as to whether habitual running with its repetitive pounding contributes to the development of knee OA.  Recently, at a meeting of the American College of Rheumatology, researchers presented evidence that regular running does not increase a person’s risk of developing knee OA, and may even help prevent it from occurring. Their study evaluated data from 2,683 participants in a long-term study known as the Osteoarthritis Initiative.  Each participant completed questionnaires assessing their physical activity and symptoms of arthritis. Additionally, x-rays of the knee were taken 2 years apart.  After analyzing the data, runners, regardless of the age when they ran, had a lower prevalence of knee pain, x-ray evidence of OA, and symptoms of OA than non-runners. It is important to note that this study did not address the question of whether or not running is harmful to people who already have knee OA.

Monday, April 27, 2015

Dying of Loneliness

Cigarette smoking, obesity, and alcoholism are all well-known causes of premature death.  Recently, two closely related risk factors---social isolation and loneliness---have also been identified as being important in causing early mortality.  Social isolation can be characterized by living alone, having few social network ties, or having infrequent social contact. These issues are considered to be “objective” or actual, not dependent on one’s personal perception. Loneliness, on the other hand, is the perception of social isolation, or the “subjective” experience of being lonely.

Results of a Recent Study   In a published report from researchers from Brigham Young University, data from 70 separate studies involving over 3 million participants were pooled and analyzed.  Study participants were older (mean age of 66 years), but generally healthy.  Approximately one third of the participants did have a medical condition, such as heart disease or diabetes. In the analysis, an increased likelihood of dying prematurely was found in association with loneliness (26%), social isolation (29%) and living alone (32%).  This risk level is comparable with other risk factors for premature death including physical inactivity, obesity, substance abuse, lack of access to medical care, and poor mental health. The authors of this report also noted that social isolation was particularly harmful for middle-aged adults as compared to older people in a similar situation.

One Possible Explanation   Other researchers have suggested that the physiologic basis for this increased death rate occurs because loneliness triggers a stress response in the brain which affects certain endocrine glands (hypothalamic-pituitary-adrenal axis) in the body.  High levels of stress hormones are produced that can bring about a number of health problems including depression, high blood pressure, and autoimmune disease.

A Growing Problem   In the U.S., more people are living alone or reporting being lonely than ever before. The Census Bureau reports that 27% of households are single-person households, a figure that is up significantly over the past few decades. With social isolation on the rise, an “epidemic” in loneliness has been predicted by the study’s authors.  They contend that social isolation and loneliness should receive greater attention by health care organizations since this will become an increasingly serious public health issue.

A (not so simple) Solution?  Based on the results of the Brigham Young study, it appears that reaching out to family members or neighbors who are socially isolated or lonely may be one of the most effective actions that we can take to improve their well-being and longevity.  While social isolation has been shown to present an added risk to health, there is also evidence that the existence of social ties can provide a protective effect on health.

Friday, April 17, 2015

Listeria in the News Again

Listeria monocytogenes, or Listeria for short, is a bacterium that causes an infection called listeriosis. Recently, Sabra Dipping Co. voluntarily recalled 30,000 cases of its Classic Hummus because of possible Listeria contamination.  Just prior to that, several people became infected with Listeria due to contamination of Blue Bell ice cream.   As of this writing, no one has become infected due to a contaminated Sabra product.  Due to infections linked to contaminated Blue Bell products, however, the CDC has recommended that consumers avoid any Blue Bell brand products made at their Oklahoma production facility.

How does someone contract listeriosis?  Listeria bacteria are found in soil and surface water, as well as in animals that do not appear to be infected.  Food can become contaminated when it is handled by an asymptomatic carrier or if it comes in contact with Listeria bacteria in fertilizer or animal waste.  The great majority of people who develop listeriosis get it through contaminated foods.  Foods that have most commonly been associated with Listeria contamination include processed meats (hot dogs, deli meats, etc.), cheeses (particularly those made with non-pasteurized milk), raw milk, and smoked seafood.  Thus far, contamination of fresh produce has been uncommon.  Infections that occur in pregnant women are particularly troubling since they can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn.

What are the symptoms of listeriosis? Most people that are infected have few or no symptoms. When symptoms are present, they are usually flu-like in nature, including fever, muscle aches, nausea and/or diarrhea. In severe cases, nervous system involvement including meningitis and brain abscesses can occur.

Who is at risk for developing listeriosis? In the United States, an estimated 1,600 persons become seriously ill with listeriosis each year. Some groups of people are at higher risk of becoming infected and developing complications than others. Those at increased risk include:
  • Individuals with immune system weakness due to AIDS, cancer, or from taking immune-suppressing medications.
     
  • Pregnant women, who are approximately 20 times more likely to contract listeriosis than other healthy adults.
     
  • People with chronic illness, such as diabetes, alcoholism, liver or kidney disease.
     
  • Older individuals.

  • Newborns, particularly if their mother is infected at the time of delivery.
How is listeriosis diagnosed?  The diagnosis is often suspected based on typical symptoms occurring during a Listeria outbreak. With the first cases of an outbreak, or when the diagnosis is uncertain, culturing the bacteria from the subject’s blood or spinal fluid can be performed.
 
How can you reduce your risk for listeriosis? Some of the most important ways to reduce your risk of developing listeriosis are as follows:
  • Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature.
     
  • Rinse raw fruits and vegetables thoroughly under running tap water before eating (even if the peel is not eaten).
     
  • Keep uncooked meats and poultry separate from vegetables and from cooked foods and ready-to-eat foods.
     
  • Do not drink raw (unpasteurized) milk, and do not eat foods that have unpasteurized milk in them.
     
  • Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
     
  • Consume perishable and ready-to-eat foods as soon as possible.
Persons at high risk, such as pregnant women and those with weakened immune systems, need to take additional precautions. These include: (1) avoiding soft cheeses (brie, feta, blue, etc.) unless made with pasteurized milk, (2) refrigerated smoked seafood (which may be labeled as "nova-style," "lox," "kippered," "smoked," or "jerky”), and (3) refrigerated pâté or meat spreads from a deli or from the refrigerated section of a store.
 
What should you do if you’ve eaten food that could have been contaminated with Listeria?  Even if the food contained Listeria, the risk of developing listeriosis is very small. No tests or treatment is necessary if symptoms do not occur after eating food suspected of being contaminated.  If the person is in a high-risk group, the CDC recommends seeking medical attention if fever or signs of listeriosis occur, even if this develops several weeks after eating the suspect food.
 
Can Listeriosis be treated?  In healthy individuals, Listeria bacteria are cleared by the body in about a week without specific treatment.  For high-risk patients with symptoms, antibiotics delivered through an intravenous line, are usually required. Ampicillin and Bactrim (trimethoprim-sulfamethoxazole) are two of the antibiotics that are typically used.  Treatment with antibiotics is particularly important in pregnant women due to the risk to the fetus.