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.
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.
Acupuncture, Alexander technique may be effective for long-term relief of chronic neck pain
Reported in ACP Internist, researchers conducted a 3-group, randomized controlled trial in the U.K. primary care setting.
Researchers recruited 517 patients from 33 general practices in 4 cities. Patients had neck pain lasting at least 3 months and no serious underlying pathology. The study population was predominantly female (69%) and white British (90%) patients, with a mean age of 53.2 years. Median duration of prior neck pain was 72 months.
Patients were randomized to 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total).
Acupuncture sessions and Alexander technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months.
Comment: chronic neck pain is awful so this study provides some hope.
Vitamin D… what’s the real scoop when it comes to arthritis… next
Vitamin D As Treatment for Rheumatoid Arthritis
Deborah Mitchell writing in EMax Health reported a high dose of vitamin D taken by people who have rheumatoid arthritis and vitamin D deficiency can result in a significant improvement in their symptoms within a short time. That’s the consensus of a new study published in the International Journal of Rheumatic Diseases.
The randomized, open-label study involved 150 adults who with rheumatoid arthritis who had been taking disease-modifying anti-rheumatic drugs (DMARDs) for a mean of more than three years. At the beginning of the study, nearly half (49%, 73 individuals) were found to be deficient in vitamin D. The participants were given 60,000 IU vitamin D per week for six weeks, followed by 60,000 IU per month for a total duration of three months. Investigators evaluated vitamin D levels and disease activity among 59 (80.8%) of the vitamin D deficient patients who completed the 12 weeks of treatment and observed the following:
Significant improvement in disease activity score
Significant improvement in serum vitamin D levels from a mean of 10.05 ng/mL to 57.21 ng/mL.
Comment: RA is a risk factor for vitamin D deficiency. It appears that replenishing vitamin D may help the arthritis.
Here’s an interesting tidbit for those who are interested in getting a facelift…
Study suggests a face-lift won’t improve self-esteem
Rebecca Adams writing for the Huffington Post reported Dr. Andrew Jacono, a New York City-based plastic surgeon, “partnered with Ryan P. Chastant, MD, and Greg Dibelius, MD, to perform” the study. They had “50 patients between the ages of 37 and 73 (48 of whom were women) fill out the Rosenberg Self-Esteem Scale, a questionnaire social scientists use to measure self-esteem, just before they had the procedure done and again six months after the procedure.” The findings after they concluded the study…“a face-lift may make you look younger, but it won’t necessarily improve your self-esteem.”
Comment: Maxwell Maltz, a plastic surgeon who first noticed this phenomenon has had his observation confirmed many times.
This routine activity might be hazardous to your health… next
Excessive TV-watching may be linked to increased risk of mortality
Alice G. Walton writing for Forbes reported that a new study published in the American Journal of Preventive Medicine found that “excessive TV-watching is linked to mortality from diseases researchers already knew to be linked to it, like cancer and heart disease, but also to some new ones, like COPD and Parkinson’s disease.” The study, “which was carried out by a team at the National Cancer Institute,” found that “people who watched 3-4 hours of TV had a 15% greater risk of mortality overall.”
U.S. Pays 10 Times More for Prescription Drugs than Other Countries
Reported in Rheum Now, prescription drugs may cost up to 10 times more in the United States than they do in other countries, according to a 2013 Comparative Price Report was released last month by the International Federation of Health Plans (IFHP). Results are based on surveys of the prices of prescription drugs from member plans.
The US has the highest drug prices and costs associated with medical care that bears no relation to health outcomes.
Comment: Drug costs are out of control. The U.S. is supporting the rest of the world. Between pharmaceutical companies and insurance companies, the average consumer is taking a beating.
Forget counting sheep — Therapy could help chronic pain sufferers get a good night’s sleep
Research conducted at the University of Warwick indicates that chronic pain sufferers could benefit from therapy to help them sleep better.
The University of Warwick academics found that cognitive behavioural therapies (CBT) were either moderately or strongly effective in tackling insomnia in patients with long-term pain. They also discovered that chronic pain sufferers didn’t just benefit from improved sleep but also experienced a wider positive impact on pain, fatigue and depression. However they also concluded that therapies only worked when delivered in person.
The study has been published in the journal Sleep.
Comment: I like this method because it’s safer than pills
Electricity… it’s not just for breakfast anymore… next
NIH, pharmaceutical companies fund research on “electroceuticals”
Sharon Begley writing in the Boston Globe reported that scientists across the world “are exploring the potential of devices dubbed electroceuticals to treat conditions from heart failure and asthma to diabetes, incontinence, and arthritis.” The first of the new class of devices, “to treat obesity, reached the market this year, and the US government and drug companies are pouring tens of millions of dollars into further research.” This fall, the National Institutes of Health will announce “the first funding from its $248 million Stimulating Peripheral Activity to Relieve Conditions, or SPARC, program.”
Comment: Looks like we’ve come full circle. Electricity has been touted for its healing powers since the days of the medicine show charlatans.
Is there a particular area that seems to be involved early in patients with rheumatoid arthritis… and I’m not talking about the usual places…
Shoulder Injury Happens Earlier Than Expected in Patients with Rheumatoid Arthritis
Bill Schu writing for MD reported that study in Arthritis Research & Therapy found that patients with rheumatoid arthritis (RA) experience shoulder pain early in the course of the disease, suggesting that screening of shoulder function should become a larger focus for maintenance and treatment of RA.
Comment: This is surprising because rheumatoid arthritis is a small joint disease early on.