New pain relief remedies for achy joints

The number of people with arthritis is increasing, as are the ways to provide help. Botox injections and quad strengthening, anyone?

By Susan J. Landers — Posted Dec. 11, 2006

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Pain relief can be just a few lost pounds away for people with arthritis of the knee -- the most common site for this very common affliction, said researchers at a mid-November gathering of rheumatologists in Washington, D.C.

People with stiff, achy knees can find relief if they shed as little as 15 pounds, according to findings from the Johns Hopkins Arthritis Center in Baltimore.

What's more, the reduction in pain apparently motivated 30 trial participants to keep most of the weight off when researchers checked back in a year, said Project Director Steffany Haaz, a doctoral candidate at Hopkins' Bloomberg School of Public Health and a dancer with an interest in movement and health. Haaz presented the findings last month at the Annual Scientific Meeting of the American College of Rheumatology/Assn. of Rheumatology Health Professionals.

For every five pounds lost, Haaz said, patients experienced an improvement in quality of life.

With the aging population of boomers facing the double whammy of increasing obesity and joint pain, any additional ammunition to convince patients that less is more when it comes to weight is a very good thing.

The Centers for Disease Control and Prevention reports that the number of Americans with arthritis or chronic joint symptoms has been creeping up over the years. In 1985 the tally was 35 million, in 1998 it was nearly 43 million and, in 2006, it hit 46 million. So it's no surprise that arthritis takes a huge toll on the nation's health, nor is it a shock that providing all patients risk-free relief from pain has proven elusive. But advances in understanding the disease and in helping patients in surprising ways were in evidence at the meeting.

In addition to weight loss, exercises to strengthen quadriceps are another effective remedy, said researchers. Although a 2003 study questioned the value of stronger quads for patients with misaligned leg bones or loose knee joints, researchers at the Mayo Clinic in Rochester, Minn., found that strengthened quads actually prevented the deterioration of cartilage behind the knee cap -- even in those with malalignments.

The Mayo study followed 265 men and women who had knee arthritis for 30 months. The strength of their quadriceps was measured at the outset of the study, and MRIs of the knee were taken at the beginning as well as at 15 months and at 30 months. Cartilage loss based on the MRIs was determined at both the tibiofemoral and the patellofemoral joints.

"We found that men and women with more strength in their quadriceps had less cartilage loss," said principal investigator Shreyasee Amin, MD, MPH, assistant professor of medicine at the Mayo Clinic. "This makes sense, as stronger quadriceps would be better able to keep the knee cap from moving laterally and tracking abnormally with joint movement."

Botox for pain

Another more unusual therapy -- injections with intra-articular botulinum toxin type A, or Botox -- one day could be offered to patients who might not be able to exercise, are thought to be poor candidates for joint reconstruction or face harm from oral medications.

Injections of neurotoxins, which target the pain nerves within the joint, provided significant relief for most of the 36 men and one woman in the study, according to the findings.

"If this novel approach to local treatment for refractory joint pain continues to prove beneficial, it offers a very welcome solution for fragile patients," said Maren Mahowald, MD, chief of rheumatology at the Minneapolis Veterans Administration Medical Center and professor of medicine at the University of Minnesota Medical School.

The idea for the study arose from the observation that patients who had some form of paralysis, whether from a stroke or disease, no longer had arthritis pain.

The conclusion drawn from the study was that the nervous system had a major role to play in the pain scenario, Dr. Mahowald said. "Local joint treatment with injection could replace oral medications that carry the risk of systemic side effects and may negate or delay the need for joint surgery."

The data were taken from a one-month interim analysis of the ongoing study, which is scheduled for completion next August.

Meanwhile, the theory that wear and tear causes most knee arthritis took a hit during another research presentation. Although the influence of heredity on the development of hand and hip arthritis had been well documented, researchers from King's College in London found a genetic link for knee arthritis in a study of 228 identical and 390 fraternal twins, all women.

Each participant was examined for radiographic knee arthritis and for knee alignment, and the results were compared with knee x-rays taken seven years earlier.

Researchers found that genes accounted for nearly half of the risk for developing knee arthritis and also explained the rate of progression of the disease in a majority of cases.

A separate research study showed that leg length differences of as little as two centimeters, another possibly inherited trait, is associated with knee and hip arthritis.

Studies to test whether correction of leg length inequalities with orthotics or shoe lifts can prevent the onset of arthritis or its progression is a logical next step, concluded the researchers from the University of North Carolina's Thurston Arthritis Research Center in Chapel Hill.

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CDC warns of another major risk -- arthritis of the hip

In addition to the sobering assessment that 46 million people in the nation already have arthritis, new Centers for Disease Control and Prevention data reveal that one in four will develop symptomatic hip arthritis by age 85.

Researchers took a closer look at this condition because it can be even more disabling than the more frequently occurring knee arthritis, said Louise Murphy, PhD, a CDC epidemiologist who presented the findings Nov. 13 at the American College of Rheumatology/Assn. of Rheumatology Health Professionals' Scientific Meeting. Plus, the $8 million annual cost of hip replacements, of which there are about 26,000 a year in the nation, provided another reason to examine the numbers, she said.

The risk estimates were derived from data collected for the Johnston County (N.C.) Osteoarthritis Project, a long-term effort by the CDC and the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill. The data also were used to determine the lifetime risk of symptomatic knee arthritis, which is one out of every two people.

Of the more than 3,000 people followed, women were found to be at higher risk of symptomatic hip arthritis than men, 28% compared with 18%, and risks for blacks and whites were similar. The greatest difference emerged when body mass index was calculated. Those of normal weight had a 20% risk compared with those who were overweight, a 25% risk, or obese, a 39% risk.

"Our results show another major public health problem associated with the aging population, one that may be aggravated by overweight and obesity," Dr. Murphy said.

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External links

American College of Rheumatology (link)

Centers for Disease Control and Prevention's arthritis program (link)

Arthritis Foundation (link)

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