$87 Billion For Total Knee Replacements by 2030?

An epidemic that will break the bank… next
$87 Billion Dollars For Total Knee Replacements by 2030?
Reported in Blood Cure… We have an epidemic of knee arthritis in the United States with over 10 million affected Americans. Many treatments are prescribed with variable efficacy for this common problem. When all else fails, knee replacement is often recommended. This procedure is overall highly successful but also expensive.

In 2009, the CDC reported the estimated costs of knee replacement in the US to be $28.5 billion dollars. Published reports suggest there will be a need for almost 3.5 million knee replacements in the United States by 2030. At a conservative total cost of $25,000 per surgery, that translates into $87 billion dollars. So, the projections suggest the costs will triple over the next 15 years.

That is $87 Billion Dollars just in the United States to treat end-stage knee arthritis. That is just the cost of knee replacements. It does not include other surgical or non-operative costs. It also doesn’t include treatment of other potentially arthritic joints such as the hip or shoulder.
Comment: Obviously there is the need to find a better solution. Biotherapies such as stem cells are the areas where we need more progress.

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Arthritis: Self-directed Exercise Program Shows Benefits

An overlooked arthritis medicine…next
Arthritis: Self-directed Exercise Program Shows Benefits
Laird Harrison writing in Medscape Medical News reported a self-directed exercise program can improve the symptoms of arthritis, a new study shows.
After 12 weeks, participants in the First Step to Active Health program showed significant improvements in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy.
“This program adds a more flexible format to the existing list of evidence-based programs, and it may appeal to subgroups of the arthritis population with less access to community programs,” write Sara Wilcox, PhD, from the Department of Exercise Science, University of South Carolina, Columbia, and colleagues in a report published in the American Journal of Preventive Medicine.
Comment: I tell my patients that they should view exercise as an effective medicine.

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RA Therapy: Study Supports Early Treatment Window

Delaying treatment in RA can make a big difference… next
RA Therapy: Study Supports Early Treatment Window
Neil Osterweil writing in Medscape Today reported a study of more than 1200 patients treated with disease-modifying anti-rheumatic drugs (DMARDs) suggests that patients started on therapy within a few months of symptom onset will have more durable DMARD-free remissions than patients for whom therapy was delayed.
The curve of the relationship is nonlinear, indicating the presence of a “window of opportunity” for ameliorating joint erosion, dampening inflammation, and reducing the need for orthopedic surgery, report Jessica A. B. van Nies, MD, from the Department of Rheumatology, Leiden University Medical Center, the Netherlands, and colleagues. The study was published in the Annals of the Rheumatic Diseases.
Comment: Early treatment means remission.

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The surprising dangers of CT scans and X-rays

A potential life threatening hazard you should know about next…
The surprising dangers of CT scans and X-rays
Reported in Consumer Reports, this eye-opening article… the introduction of computed tomography, or CT scans, in the 1970s, was revolutionary. The new tests, which use multiple X-ray images, allowed doctors to see with unprecedented precision the inner workings of the human body. Use of the tests grew quickly, rising from fewer than 3 million per year in 1980 to more than 80 million now.
But recent research shows that about one-third of those scans serve little if any medical purpose. And even when CT scans or other radiology tests are necessary, doctors and technicians don’t always take steps to limit radiation exposure.
All of that exposure poses serious health threats. Researchers estimate that at least 2 percent of all future cancers in the U.S.—approximately 29,000 cases and 15,000 deaths per year—will stem from CT scans alone. Even some standard X-rays, which expose you to much smaller amounts of radiation, can pose risks if you undergo multiple ones.
Comment: The full article reveals other disturbing facts and everyone should be aware of this danger.

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Genetic Factors May Play Role In Development Of Knee OA-Related Pain

Here’s a risk for knee pain you might not know about…
Genetic Factors May Play Role In Development Of Knee OA-Related Pain.
Nancy Walsh writing in MedPage Today reported that according to the results of a 219-patient study published in the Annals of the Rheumatic Diseases, “genetic factors appear to play a role in the development of osteoarthritis (OA)-related knee pain, with higher rates of worsening knee pain being identified in the offspring of parents who had knee arthroplasty.” Meaning knee replacement.

Comment: Not a surprising finding since knee OA does tend to run in families.

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Surgery, More Conservative Treatments Similar Outcomes Spinal Stenosis Patients

Which works better for spinal stenosis…. Conservative treatment or surgery… the answer next…
Surgery, More Conservative Treatments May Provide Similar Long-Term Outcomes Spinal Stenosis Patients.
Robert Preidt writing in Healthday reported that research published in Spine suggests that “surgery and more conservative treatments provide similar long-term outcomes for people with spinal stenosis.” The research “included more than 650 spinal stenosis patients who had surgery or received nonsurgical treatment such as physical therapy or medications.” Investigators found that “after eight years of follow-up, there were no significant differences between the two groups in terms of pain, functioning or disability.”
Comment: Surgery has its place but only after conservative management has failed.

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Joint Replacement Not Recommended for Patients With Fibromyalgia Symptoms

Which patients should be extra cautious about getting joint replacement? Next…
Total Hip or Knee Replacement Not Recommended for Some Patients With Fibromyalgia-Like Symptoms
Rosemary Frei writing in Pain Medicine News reported total hip or knee replacement is not advisable for some patients with both severe hip or knee pain and fibromyalgia-like symptoms, according to a new analysis of predictors of pain outcomes after total knee and hip arthroplasty.
Researchers focused on the pain scores of 635 patients with fibromyalgia-like symptoms—but not necessarily a clinical diagnosis of fibromyalgia—before arthroplasty and six months after. The study indicated that a patient self-report survey for the assessment of fibromyalgia was the only statistically significant predictor of patients who had long-term postoperative pain as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and other tools.
Comment: This is a phenomenon reported by others and comes as no surprise.

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Joint Inflammation In Patients With Early RA Still Present After Two Years Of Therapy

Should RA patients who are in renmission go on a drug holiday? The answer might surprise you.
Study: Joint Inflammation In Patients With Early RA Still Present After Two Years Of Therapy.
Pam Harrison writing in MedPage Today reported that “MRI evidence of joint inflammation was still present in patients with early rheumatoid arthritis (RA) despite clinical remission, according to a sub-study of the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) trial.” Investigators found that “a couple years of triple therapy, or the combination of a tumor necrosis factor (TNF) inhibitor plus methotrexate, did not eliminate signs of joint inflammation, with all 118 patients in the TEAR sub-study showing evidence of residual MRI inflammation, including patients who met stringent definitions of remission at the same follow-up point.” The research was published in Arthritis Care & Research.

Comment: These are surprising and disturbing findings since remission doesn’t seem to be as good as we think it is and certainly negates the thought we ought to give a drug holiday. It would be a bad idea.

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Glucosamine And Chondroitin May Benefit Patients With Knee OA

Glucosamine… the debate rages on

Glucosamine And Chondroitin May Benefit Certain Patients With Knee OA.
Nancy Walsh writing in MedPage Today reported that “evidence has been increasing in favor of the use of glucosamine and chondroitin in osteoarthritis (OA) of the knee, with a new noninferiority study” published in Annals of the Rheumatic Diseases “showing equivalent significant benefits for the supplement combination as for the COX-2 inhibitor Celebrex.” Researchers found, “in a clinical trial known as MOVES that included 606 patients with moderate-to-severe pain,” that “6 months of treatment with the dietary supplements was associated with a 50.1% decrease in pain as measured on the Western Ontario and McMaster osteoarthritis index (WOMAC), compared with a 50.2% decrease among patients given Celebrex.” Walsh pointed out that “MOVES becomes the third major trial to show a benefit for the supplement combination in OA.”

Comment: Next week, another negative study. Oh well…

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A predictor for treatment success in rheumatoid arthritis

A predictor for treatment success in rheumatoid arthritis

Diana Swift writing in MedPage Today reported in early rheumatoid arthritis (RA) the most important single predictor of achieving an absolute or a relative patient-perceived pain improvement (PPSI) after 6 months of treatment is baseline symmetrical arthritis, according to a Dutch study published online in the journal Rheumatology.

Comment: I’ve actually noticed the same phenomenon in my practice.

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