Back pain unrelieved by rest may indicate systemic problem

Back pain unrelieved by rest… listen up

Back pain unrelieved by rest may indicate systemic problem

Bruce Jancin writing in Rheumatology News reported that night time back pain or pain unrelieved by rest is a red flag for systemic illness according to Dr. Robert Janson at a symposium sponsored at the University of Colorado. Other red flags include weight loss, fever, sweats, age over 50, low back pain lasting longer than 6 weeks or pain unresponsive to treatment.

Comment: Most low back pain is mechanical in nature and improves over time with proper therapy but 5% of patients have a more serious problem that needs to be identified.

Salt… an unsuspected villain… next

High Sodium Intake Linked to Risk of RA

Reported in Rheum Now, diet has long been considered a potential risk factor for the onset or pathogenesis of rheumatoid arthritis. Now a group of Spanish investigators have reported a study of 18,555 persons from the general population who were enrolled in the SUN (Seguimiento Universidad de Navarra) cohort launched in 1999. Participants returned questionnaires regarding medical history, physician-diagnosed health conditions, diet, lifestyle and sociodemographic data, BMI, and physical activity.

The amount of dietary sodium consumed per day was associated with an increase in the odds for self-reported RA. The investigators concluded, high sodium intake may be associated with a diagnosis of rheumatoid arthritis.

Comment: 3 white poisons… sugar, flour, salt.

Swollen knee. No apparent cause. Watch next…

Spontaneous knee effusion may be a symptom of Lyme disease

Reported in Healio, a study published in the J Am Acad Orthop Surg… Spontaneous knee effusion can be a primary symptom of Lyme disease, even without the presence of other primary symptoms, according to results of a literature review.

Researchers of the review noted knee effusion in patients with Lyme disease may appear in the early disseminating stage or in the late disseminating stage as part of Lyme arthritis. Lyme arthritis is developed by 60% of patients with untreated Lyme disease and can lead to permanent joint damage.

Comment: In our area, Maryland, Lyme disease is pretty common.

More good news about stem cells…

Stem cell transplants improve knee function

M. Alexander Otto writing in rheumatology news reported that mesenchymal stem cell transplants appeared to regenerate cartilage and improve clinical outcomes at 2 years in patients with knee osteoarthritis in a South Korean study.

The study involved 24 treated knees. Cells from fat liposuction were delivered in a thrombin gel under arthroscopic guidance. Knees were immobilized for 2 weeks and weight-bearing was allowed at 4 weeks. MRI follow up on the knees was performed at 2 years. At baseline, 23 cartilage lesions were grade 2 to 3. At follow up, only 5 lesions were grade 2 or 3. The study was published in Osteoarthritis Cartilage.

Comment: More evidence that stem cells work in osteoarthritis.


Placebo… it’s pretty powerful… next

Increasing Placebo Responses in the USA

Reported in Rheum Now, a recent analysis of randomized clinical trials (RCT) for the treatment of neuropathic pain has shown in increase in placebo responses. Published data from RCTs done between 1990-2013, finds that placebo responses have increased considerably, but drug responses have remained stable, thus leading to diminished treatment advantage for the active drug.

These findings are germane to rheumatology where it appears the same phenomenon has evolved.  In recent years it has become harder to prove clinical efficacy and x-ray benefit, largely because of an unexpectedly high placebo response.

The data is fairly clear. The only real question is what is causing this trend. Is this due to changing trial design?  Or the influence of direct-to-consumer advertising on patient expectations?  Lastly, such trends underscore the problems inherent in RCT comparisons over time.

Comment: Placebo response can soar as high as 60 % in arthritis trials.

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