The Birth Control Pill Might Help Rheumatoid Arthritis

By Steven ReinbergHealthDay Reporter

FRIDAY, Aug. 28, 2015 (HealthDay News) — Oral contraceptives — also known as birth control pills — may ease pain and improve functioning in women with rheumatoid arthritis, a small German study suggests.

“Women with inflammatory arthritis who were currently using oral contraceptives or who had used them in the past, presented with better patient-reported outcomes within the first two years of arthritis,” the study authors wrote.

Rheumatoid arthritis is an autoimmune disorder in which the body’s immune system attacks the joints, resulting in pain and swelling. About 1.3 million people in the United States have rheumatoid arthritis, and of these, nearly 75 percent are women, according to the American College of Rheumatology.

Dr. Waseem Mir, a rheumatologist at Lenox Hill Hospital in New York City, noted, “We have to take the findings of the study with great caution.” Mir was not involved in the current study, but reviewed its findings.

One reason he cited for the note of caution is that all of the data were self-reported by patients, so it’s not clear that all the participants in the study actually had rheumatoid arthritis. Researchers only saw an association, not a cause-and-effect link, between birth control pill use and lessened rheumatoid arthritis symptoms.

Mir also pointed out the potential risks of oral contraceptives. “Certain patients with inflammatory arthritis may increase their risk of blood clots by going on oral contraceptives,” Mir said.

The report was published Aug. 20 in Arthritis Care & Research.

The researchers, led by Dr. Katinka Albrecht from the German Rheumatism Research Centre in Berlin, reviewed data on 273 women with rheumatoid arthritis. The women were between 18 and 60 years old, the study said.

The researchers found that 18 percent had never used the birth control pill, 63 percent had used it in the past, and 19 percent were taking it at the time of the study. None of the women had taken hormone replacement therapy, the study noted.

The progression of the disease was not affected by birth control use, the study found. But women who had used or were using the pill had better scores on standard measures of rheumatoid arthritis than women who had never used the pill, the researchers said.

Albrecht’s group also found that women who had used or were using oral contraceptives — especially those with impaired function — relied less on steroid treatment than women who hadn’t used the pill.

The researchers speculated that the beneficial effect of oral contraceptives may be due to increasing the levels of estrogen, which may have a positive effect on mood. Whether boosting estrogen levels also helps reduce the inflammation associated with rheumatoid arthritis isn’t clear, they said.

Dr. Jennifer Wu, an obstetrician-gynecologist from Lenox Hill Hospital in New York City, said, “Oral contraceptives are known to reduce the risk of ovarian and uterine cancer, and reducing the toll of rheumatoid arthritis may be another benefit.”

However, she doesn’t think women should be taking oral contraceptives to try to reduce or prevent rheumatoid arthritis.

“When young women are diagnosed with rheumatoid arthritis and if they need birth control, they should think about using the birth control pill instead of other forms of birth control,” Wu said.

“Older women with rheumatoid arthritis, however, shouldn’t go on birth control pills to try to treat their inflammatory arthritis,” she said.

Mir agreed. “Although oral contraceptives are important in society for what they offer, one should not be using it to treat inflammatory arthritis,” he said.

The study authors also noted that their results should be interpreted carefully. “This association needs to be confirmed in further studies before any clinical conclusion can be drawn,” they wrote.

More information

For more information on rheumatoid arthritis, visit the American College of Rheumatology.


3 Conditions That Make Your Joints Hurt

 

You know how it goes: a creaky hip here, a popped knee there. Though you may have thought that your joints wouldn’t ache until you reached old age, the truth is, a woman who has been active most of her life may feel the first twinge in her 30s. And if you’re one of the 300,000 unlucky people to contract lyme disease annually, that may also affect your joint health. Figure out what may be causing your aches by spotting your symptoms on this chart.

Knee Pain: Arthritis Study Suggests Some Surgery Useless

Painful knees? You’re not alone. Half of the people in the United States have knee arthritis by the time they hit their mid-80s, including nearly 65% of those who are obese.

Now a new study suggests that a type of minimally invasive knee procedure, known as arthroscopic surgery, is essentially useless for many with knee arthritis.

If that sounds like bad news, it’s not—it’s good news.

No one wants to undergo a pricey ($5,000 and up) procedure unnecessarily. And the study, published this week in The New England Journal of Medicine, found that relatively noninvasive treatments—physical therapy, acetaminophen (Tylenol), anti-inflammatories, and injections that fight inflammation or lubricate the joint—are effective for knee arthritis.

If those stop working, patients can still go on to have a total joint replacement, which is also a very effective form of therapy, says study coauthor Brian Feagan, MD, a professor of medicine and the director of the clinical trials unit at the Robarts Research Institute at the University of Western Ontario in Canada.

Next page: Why it doesn’t work for arthritis

Why it doesn’t work for arthritis

Arthroscopic surgery is used as a way station on the road to total knee replacement. When painkillers or injections stop working, surgeons sometimes try—or at least they used to try—arthroscopic surgery.

During the procedure, surgical instruments are inserted through the skin via tiny incisions and used to repair damage, smooth the cartilage’s surface, and remove cartilage fragments and calcium crystals.

In the new study, the researchers randomly assigned 86 patients with moderate-to-severe knee arthritis to undergo arthroscopic surgery, and 86 to make do with physical therapy and medication.

After two years, the surgery-treated patients had no advantages over the other group in terms of joint pain, stiffness, or health-related quality of life.

That’s not to say that arthroscopic knee surgery doesn’t benefit some people with knee pain, says Frederick Azar, MD, spokesperson for the American Academy of Orthopaedic Surgeons (AAOS), who was not involved in the new study.

The study did not include patients with major tears in the meniscus, which is a C-shaped disk of cartilage that cushions the knee (there are two in each knee joint).

People who have knee pain due to a torn meniscus, which is more likely to occur in younger patients who hurt their knees during sports, can still benefit from arthroscopy, says Dr. Azar, of the Campbell Clinic in Memphis, Tenn.

“I worry that arthroscopy is going to get a bad name,” he says. “Hopefully it won’t, because it’s a great technology for the right patients.”

One type of major meniscus tear that can be fixed via arthroscopy is known as a “bucket handle” tear, says Dr. Azar.

“If they tear completely in the back, they will flip over like the handle of a bucket, from the back of the knee to the front,” he says. This particular injury can prevent patients from extending their leg fully.

Next page: Do you need a second opinion?

Do you need a second opinion?

However, Dr. Feagan thinks too many orthopedic surgeons are doing arthroscopic surgery on run-of-the-mill arthritis patients who don’t have these major tears.

Some doctors perform arthroscopy surgery on patients who have symptoms such as “locking” or “freezing” of the joint. Dr. Feagan says his study found the minimally invasive surgery was no more helpful for those patients (who didn’t have major tears) than others without knee locking.

A second study in the journal found that minor meniscal tears are common—in those who have achy knees and those who don’t. So that means if you have a magnetic resonance imaging (MRI) scan of the knee, the minor meniscal tears may not be the cause of the pain.

“A lot of the people will have microscopic tears—not like the bucket handle tears—but as part of the degenerative process,” says Dr. Feagan. “These micro-tears develop that can be seen on an MRI, but they don’t correlate with symptoms so they really are not very useful.”

So how do you know if you are a candidate for arthroscopy or not? About one million of these surgeries are performed every year, according to the AAOS, but it’s not clear exactly which patients are getting the procedures.

Dr. Azar says that most surgeons have already moved away from performing the procedure for the treatment of arthritis.

“The vast majority of orthopedic surgeons agree with this study, and I think that’s the take-home message,” he says. If you’re not sure if your doctor is recommending an appropriate surgery, then Dr. Azar suggests that you “go get another opinion—that’s always a good thing to do.”

Dr. Feagan says there was a similar study in 2002, but many doctors continued to do arthroscopies on arthritis patients after it came out.

“There was a lot of resistance to that finding—it really didn’t change practice,” he says. “[Surgeons] weren’t prepared to change their minds on the basis of a single study.”

However, that may change.

“Taken together, the two studies are very consistent and give a very clear message,” says Dr. Feagan. “Most reasonable orthopedic surgeons are going to stop doing this surgery if they haven’t already.”By Theresa Tamkins

(PHOTO MAGNUSMEDICINE.EU)

 


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Blood Test May Predict Rheumatoid Arthritis

(Getty Images)

By Denise Mann

THURSDAY, Jan. 28, 2010 (Health.com) — A simple blood test may allow doctors to identify a debilitating form of arthritis years before any symptoms appear, which may help to stop the disease in its tracks, new research suggests.

Rheumatoid arthritis (RA), which affects an estimated 1.3 million Americans, is an autoimmune disease that attacks the joints, causing inflammation, pain, and swelling. Early diagnosis and treatment are key to preventing long-term joint damage, but the warning signs of rheumatoid arthritis are often easily confused with those of other diseases and conditions.

Now, a new study reports that markers of inflammation that can be detected in the bloodstream rise long before symptoms of the disease. This finding holds out the possibility that doctors can one day treat rheumatoid arthritis before it starts to take a toll on the patient. Treating rheumatoid arthritis early and aggressively with a combination of drugs provides the best odds of preventing joint damage.

The study “moves the whole field along,” says rheumatologist Lionel Ivashkiv, MD, an associate chief scientific officer at the Hospital for Special Surgery, in New York City. “In the future, in combination with other tests and risk factors—such as genetics, smoking, and family history—we can maybe predict who is at high risk for developing RA.”

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In the new study, which appears in the February issue of Arthritis & Rheumatism, researchers in Sweden analyzed the blood samples of 342 people, 86 of whom went on to develop rheumatoid arthritis up to five years after giving blood. Overall, the people who ultimately developed rheumatoid arthritis had higher levels of proteins and other substances involved in inflammation in their blood compared to those who didn’t develop the disease.

Rheumatoid arthritis drugs target some of the inflammatory markers that were elevated, such as tumor necrosis factor (TNF).

When all 30 of the markers that the researchers measured are taken into account, the test would correctly predict 86% of the time the individuals who would ultimately develop rheumatoid arthritis, according to the study.

Next page: More research needed to create a practical test

“When a patient with RA comes in now, their immune system is on fire,” says Richard Keating, MD, a professor of rheumatology at the University of Chicago. “The researchers are working backwards and trying to figure out what started the fire. This will help unlock the pathway involved in how this disease occurs, and may open up new early treatment opportunities.”

Eric Matteson, MD, the chairman of the rheumatology department at the Mayo Clinic College of Medicine, in Rochester, Minn., calls the new findings “a step in the right direction,” but says that it is premature to conclude that a blood test can predict who will develop rheumatoid arthritis with any degree of certainty.

Many of the inflammatory markers measured in the study are not specific to rheumatoid arthritis, Dr. Matteson points out. They reflect “general immune system activation,” he explains, and could indicate a host of other inflammatory autoimmune diseases (such as lupus or psoriasis), or even a viral infection.

Still, he says, “It is exciting to think that…we could be alerted to the fact that [people] may go on to develop RA or another autoimmune disease.”

Blood tests that accurately identify the warning signs of rheumatoid arthritis could eventually help doctors tailor treatment plans to individual patients, Dr. Matteson adds. If researchers are able to pinpoint the blood markers of rheumatoid arthritis, doctors could use that information to assess the severity of individual cases and predict which medications are likely to be most effective for which patients, he says. (This approach is already used to treat other diseases, including some types of cancer.)

However, Dr. Ivashkiv stresses, the blood testing used in the study is not likely to be used by arthritis doctors in the near term. “It is another way of trying to identify patients with early RA, but it is not practical yet,” he says.

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CDC: Achy Joints on the Rise in U.S.

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By Ray Hainer

THURSDAY, October 7 (Health.com) — More than 1 in 5 adults in the U.S. have arthritis or other joint-damaging conditions, and the ongoing obesity epidemic may be partly to blame, according to a report issued today by the Centers for Disease Control and Prevention (CDC).

Roughly 50 million U.S. adults have some form of arthritis, the report estimates. That number includes people with osteoarthritis, which is typically caused by aging, as well as those with other, less common conditions such as rheumatoid arthritis, gout, lupus, and fibromyalgia.

The report was based on a national survey conducted between 2007 and 2009. Overall, 9.4% of adults said that arthritis prevented them from doing everyday activities. That’s up from 8.8% four years earlier—an increase that’s outpacing forecasts made by CDC researchers in 2006.

Although the glut of aging baby boomers is likely responsible for much of the increase in arthritis-related disability, researchers say that obesity also plays a role. More than two-thirds of Americans are now obese or overweight, according to the most recent government data.

“Any extra weight on the joint—it doesn’t matter what kind of joint arthritis you have—is not good,” says one of the report’s authors, Jennifer Hootman, PhD, an epidemiologist in the CDC’s arthritis program. “Extra weight adds stress, whether you have rheumatoid [arthritis] or gout or osteoarthritis.”

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Nearly 30% of the obese people in the survey had some form of arthritis, compared to just 20% of overweight people and 17% of normal-weight people. (Overweight and obesity are defined as having a body mass index above 25 and 30, respectively.) Among the most obese individuals, those with a body mass index of 40 or above, the arthritis rate was 38%.

Overall, 45% of people who were obese said their arthritis limited their everyday activities, compared to 35% of normal-weight people.

“Being obese, having multiple chronic conditions, and low fitness and physical activity increase your risk for having activity limitations,” Hootman says. “All of those things are probably contributing.”

The CDC report highlights several other potential risk factors for arthritis. The condition is more prevalent among women (24%) than among men (18%), among people who live a sedentary lifestyle (24%) versus those who are physically active (18%), and among smokers (24%) versus nonsmokers (19%).

Public health officials expect arthritis rates to rise as the population continues to age. At just under 37 years, the median age in the U.S. is higher than ever before and is expected to increase through 2035, according to U.S. Census Bureau projections.

Not much can be done about those demographic trends. On the other hand, obesity and other factors that contribute to arthritis-related disability can—and should—be addressed by individuals and doctors, Hootman says.

“Activity limitation is preventable, and if you already have some limitation, that can be changed through exercise, physical therapy, appropriate medical management, [and] losing weight,” she says. “We don’t want people with arthritis who are currently limited in their activities to think it has to be that way. There are things they can do.”

Soda and OJ May Increase Risk of Gout

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By Amanda Gardner

WEDNESDAY, November 10 (Health.com) — Drinking too much soda, orange juice, or other sugary drinks appears to increase the risk of developing gout, an especially painful form of arthritis, according to a new study in the Journal of the American Medical Association.

Women who consumed two cans or more of non-diet soda per day were more than twice as likely to develop gout as women who rarely drank soda, the study found. (Diet soda had no apparent effect on risk.) Drinking 12 ounces or more of orange juice per day increased risk by roughly the same amount.

Women who had just one soda or 6-ounce glass of OJ per day were at 74% and 41% greater risk, respectively, compared to women who rarely drank either.

The culprit appears to be fructose, says the lead author of the study, Hyon Choi, MD, a professor of medicine at Boston University School of Medicine. A sugar found in oranges as well as the high-fructose corn syrup used to make many non-diet sodas, fructose increases levels of the chemical uric acid, which causes gout. When uric acid levels in the body get too high, the acid hardens into sharp crystals that are deposited in joints.

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Cutting back on sugary drinks “would help you, particularly for gout patients or if you have high levels of uric acid,” says Dr. Choi, who presented his findings today at the annual meeting of the American College of Rheumatology, in Atlanta. (The findings corroborate a similar 2008 study in men, also led by Dr. Choi.)

The overall risk of developing gout is very low, however. Over a 22-year period, just 1% of the nearly 79,000 women included in the study developed gout, and the increased risk linked to soda and juice consumption was confined almost exclusively to women who had gone through menopause.

Estrogen appears to protect against gout, Dr. Choi says. As many as 98% of gout cases in women occur after menopause, when estrogen levels decline, he adds.

The study participants, who were part of a long-running, government-funded trial known as the Nurses’ Health Study, were mostly white and between the ages of 30 to 55. Gout rates tend to be higher among men and blacks than among white women, so the increased risk of gout associated with sugary drinks may be slightly higher in the population at large than in the study, the authors note.

Still, fructose may play a relatively small role in the development of gout. Although the researchers controlled for body mass index and a number of dietary factors that have been linked to gout (such as alcohol, meat, seafood, and dairy intake), fructose consumption is difficult to untangle from other factors that can contribute to the disease, says Karen Congro, RN, director of the Wellness for Life Program at the Brooklyn Hospital Center, in New York City.

“We can’t prove 100% that [fructose] is the one item that is causing gout when there are so many other issues,” Congro says. “Is it drinking beverages with high-fructose corn syrup, or is it the whole diet?”

Gout is a growing problem in the U.S. The percentage of adults affected by the condition rose from 2.7% in the late 80s and early ’90s to almost 4% in 2008, according to other research presented at the meeting.

Oxycontin and Similar Drugs Up Fracture, Heart Attack Risk

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By Denise Mann

MONDAY, December 13 (Health.com) — Doctors are increasingly turning to Oxycontin and similar painkillers to treat arthritis and other conditions in older people, but the drugs may not be as safe as once thought. A new study suggests that elderly arthritis patients who take these drugs—known as opioids—are 4.5 times more likely to break their hip, pelvis, wrist, or upper arm than those taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

In a given year, about 1 in 10 older people who take an opioid will break a bone, compared to about 1 in 50 people taking COX-2 inhibitors, a more targeted form of NSAID, the study found.

What’s more, the risk of dying from any cause during the study period was 87% higher in people taking opioids than it was in people taking NSAIDs.

“Opioids are not as safe as people had hoped,” says the lead author of the study, Daniel H. Solomon, MD, a rheumatologist and epidemiologist at Brigham and Women’s Hospital, in Boston. “We need to recognize that opioids are not without risk.”

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The study, which was published in the Archives of Internal Medicine, looked at nearly 13,000 low-income Medicare patients with osteoarthritis or rheumatoid arthritis who received a prescription for NSAIDs (such as ibuprofen), COX-2 inhibitors (such as Vioxx and Celebrex), or opioids (such as oxycodone and hydrocodone) over a six-year period.

In addition to the increased risk of fracture, people who took opioids were more than twice as likely to have a heart attack than their counterparts who took NSAIDs. Surprisingly, the risk of heart attack associated with opioids was even higher than that seen with Vioxx and other COX-2 inhibitors, a class of drugs that has been plagued by concerns about heart problems, including heart attack. (Vioxx and Bextra were withdrawn from the market for this reason, and Celebrex is now the only COX-2 inhibitor sold in the U.S.)

It’s not clear from the study why opioids might increase the risk of fracture and heart attack. Opioid-related wooziness may contribute to falls, Dr. Solomon says, and the drugs may also affect bone mass. Even less is known about the link between opioids and heart attack, which the authors called an “unexpected finding.”

The use of opioids has risen dramatically in recent years, as doctors and patients have sought to avoid the gastrointestinal problems that can occur with long-term NSAID use and the heart risks associated with some COX-2 inhibitors. “Over the past eight or 10 years, we have moved away from NSAIDs because of all the concerns around Vioxx and cardiovascular risks, so we moved toward opioids,” Dr. Solomon says. “This is a tremendous increase based on not a lot of information.”

Next page: Time to reconsider opioid use

Although the study findings should not discourage doctors from prescribing opioids to older people altogether, they do suggest that it may be time for the pendulum to swing back toward traditional NSAIDs and nondrug pain-relief methods, Dr. Solomon says. “As an arthritis specialist, I will still use opioids, but I will do so in an informed manner and make sure the patients are aware of the risks.”

Joseph S. Ross, MD, an assistant professor of internal medicine at the Yale University School of Medicine, in New Haven, Conn., says that the “broad brush conclusion” of the study is that doctors should first prescribe NSAIDs—such as aspirin or naproxen (Aleve)—before starting patients on other painkillers. “They seem on the whole to be safer than the COX-2 drugs, and now opiates,” says Dr. Ross, who led a study on Vioxx that appears in the same issue of the journal.

The study had some important limitations. Though Dr. Solomon and his colleagues used statistical techniques to divide the participants into three closely matched groups, they did not explicitly control for characteristics such as alcohol consumption, smoking, and over-the-counter medication use, which could skew the results. (Over-the-counter medicines are especially important, as many pain patients take nonprescription NSAIDs in addition to opioids.)

The participants, whose average age was 80, were also overwhelmingly female and white, so it’s not clear how the results may translate to other demographic groups.

Gurkirpal Singh, MD, an adjunct clinical professor of gastroenterology and hepatology at the Stanford University School of Medicine, in Palo Alto, Calif., stresses that the study does not show that opioid use directly causes heart attacks or bone fractures. “I would consider this hypothesis-generating and intriguing,” he says. “We can’t say that opioids cause these toxicities and [that] we shouldn’t use them. We are nowhere near the level of proof we would need to say that.”

Opioids remain a good option in the right patient, Dr. Singh adds.

Some opioids may be safer than others, however. In a separate study published in the same issue of the Archives of Internal Medicine, Dr. Solomon and his colleagues looked at the rates of cardiovascular events and fracture among people taking five types of opioids for non-cancer pain.

People taking codeine appeared to have a higher risk of heart attack and other cardiovascular events compared to those taking hydrocodone, the study found. Two other opioids, tramadol and propoxyphene, appeared to decrease the risk of bone fracture compared to hydrocodone. (In November, propoxyphene was pulled from the U.S. market over concerns about increased risk of heart rhythm abnormalities.)

Dr. Solomon says that more research will be needed in order to pinpoint which pain medication is safest for any given patient. “There is no one answer,” he says.

Arthritis Impacts Physical, Mental Health

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By Amanda Gardner

THURSDAY, April 28, 2011 (Health.com) — Arthritis can limit mobility and make everyday tasks painful, and it can also take a toll on your mental health and overall quality of life, a new study suggests.

Researchers analyzed data from several national health surveys conducted by the Centers for Disease Control and Prevention (CDC) and found that people with arthritis—which includes those with aging-related osteoarthritis and similar conditions such as rheumatoid arthritis and gout—tend to rate lower than their peers on measures of overall health.

Twenty-seven percent of the survey respondents with some form of arthritis described their health as “fair” or “poor,” versus just 12% of those without arthritis Those with arthritis also reported having more than twice as many “physically unhealthy days” in the previous month.

The surveys showed a similar pattern for mental health. People with arthritis experienced an average of five “mentally unhealthy days” per month, compared to three per month among those who were arthritis free, according to the study, which appears in Arthritis Care & Research.

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“People who have arthritis, particularly rheumatoid arthritis, have significant rates of depression,” says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic, in Rochester, Minn., who was not involved with the study. “And there’s no question that when you feel depressed, it influences your general sense of well-being and how arthritis affects you.”

Moreover, when arthritis is acting up, metabolic and other changes in the body can increase levels of inflammation, which can worsen depression, Dr. Matteson says. “That highlights the importance of not only controlling the disease or managing the disease but also getting depression under control, too.”

More than one-fifth of the U.S. population has some form of arthritis, according to the CDC. The rate has been rising, partly because of the aging of the baby-boom generation. But the obesity epidemic is also partly to blame, since excess weight can strain inflamed joints.

Physical activity was linked to a higher quality of life, the researchers found. People who managed to exercise in spite of their arthritis were 53% less likely to be in fair or poor health than were inactive arthritis patients, says the lead author of the study, Sylvia Furner, PhD, an epidemiologist at the University of Illinois at Chicago.

“Physical activity does a lot to strengthen and support the joints, and there’s a lot of pain relief that comes along with exercise,” says rheumatologist Allyson McDonough, MD, assistant professor of internal medicine at the Texas A&M Health Science Center College of Medicine, in Temple. Low-impact exercise—such as walking, swimming, yoga, or tai chi—is “extremely important to improve quality of life,” she says.

“There’s a significant perception that there’s nothing that can be done about arthritis,” says Dr. McDonough, who was not involved in the research. “That’s inaccurate. Seeking care and looking for avenues of self-help will help improve quality of life.”

Does Smoking Help Protect the Joints?

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By Ella Quittner

FRIDAY, July 8, 2011 (Health.com) — Smoking will increase your risk of cancer, emphysema, heart disease, stroke, and dying young, but if you manage to dodge all those bullets, it may actually reduce your need for joint-replacement surgery later in life.

Curious as it may sound, a new study of nearly 11,000 older men in Australia has found that the longer the men smoked, the less likely they were to undergo surgery to replace hips and knees damaged by arthritis or other conditions.

Those who smoked for 48 years or more—the bulk of their adult lives—were 42% to 51% less likely (depending on their age) to need the surgeries than men who had never smoked, according to the study, which appears in the journal Arthritis & Rheumatism.

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Previous studies have hinted at a similar link, but this is the first to show a clear relationship between the number of years spent smoking and the likelihood of joint-replacement surgery, says George Mnatzaganian, the lead researcher and a PhD candidate in public health at the University of Adelaide.

Mnatzaganian and his colleagues can’t fully explain the findings. Obesity and habitual vigorous exercise both increase the risk of arthritis and also tend to be less common among smokers, but the link between smoking and joint replacement remained even when the researchers took those factors into account. (They also adjusted the data to account for medical conditions besides arthritis—and the fact that the smokers survived into old age in the first place.)

Nicotine may play a role, however. Lab experiments using animals and human tissue have suggested that nicotine may stimulate the activity of the cells found in joint cartilage, which could help lessen the severity of osteoarthritis, the study notes.

“What we would like to see now is increased research by laboratory and clinical scientists, so we can clarify the exact mechanisms by which smoking confers protection on weight-bearing joints,” Mnatzaganian says. “If this led to development of new preventative or treatment strategies then, eventually, we might reasonably expect to see a fall in the need for major joint replacement.”

But he is quick to point out that smoking is not the answer to joint health. “Whatever new preventative or treatment strategies may be developed in the future,” he says, “they will certainly not include smoking.”

Leigh Callahan, PhD, an arthritis researcher and professor of medicine at the University of North Carolina at Chapel Hill, says the findings are likely to spur scientists to explore the relationship between smoking and arthritis more closely.

The study “makes you want to understand the mechanism underlying the association,” she says.

I Had Arthritis—For an Hour

Products carrying the Arthritis Foundation’s Ease-of-Use Commendation logo, like these Fiskars Titanium Easy Action Scissors, are easier to use for people living with arthritis.Health.comTwisting off the top of a bottle of aspirin. Using scissors. Gripping a pen. These are the little tasks that most of us take for granted because we perform them hundreds of times each day without thinking. But for someone with arthritis, it’s often the little tasks that become the most difficult.

Georgia Tech Research Institute’s arthritis simulation gloves are designed to reduce the ability to grasp, pull, and rotate something.Health.com

I learned this recently when I tried out a pair of arthritis simulation gloves designed at the Georgia Tech Research Institute (GTRI). Each glove resembles an average snow glove, but the fingers are contorted and stiff. Metal wires sandwiched between layers of neoprene and other fabrics reduce the wearer’s ability to hold, pull, or rotate objects by as much as 50%. Simply making a fist or extending my fingers took considerable effort—and that was before I really got to work.

I tried using scissors and couldn’t fit my twisted fingers into the handles. I tried writing my name and it came out looking like the work of a kindergartner. I tried, unsuccessfully, to open a child-proof bottle of pain relievers. I tried drinking from my water bottle and just barely missed spilling on myself. I couldn’t even pick these items up off the table; I was forced to slide each one to the end of the table so it would fall into my other hand.

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After this, trying a range of products that had earned the stamp of approval from the Arthritis Foundation’s Ease-of-Use program felt like a relief. And that’s exactly what the gloves are for, says Brad Fain, PhD, principal research scientist and branch head at GTRI.

The mission of the Ease-of-Use program is to encourage product manufacturers to consider the needs of people living with arthritis. Companies purchase the simulation gloves to test out their own wares, and then apply to have their products reviewed by the Arthritis Foundation, a nonprofit advocacy organization based in Atlanta.

Health.com

After an initial evaluation by scientists, people with arthritis test each product in real-life situations. A spatula isn’t just picked up and held, it’s actually baked with. Testing out a pillow usually requires an overnight stay in a sleep lab, and all aspects are tested out, including putting on the pillowcase. A coffee canister should not only be easy to open, but also easy to hold and pour. As much as 30% of the products fail the test, Fain says.

More than 100 products have been approved so far, many of which would make thoughtful gifts for people with arthritis this holiday season. For anyone, actually: That tough-to-open water bottle doesn’t serve you so well when you’re pounding the treadmill and your hands are slippery with sweat, right? A water bottle with the Ease-of-Use Commendation logo from the Arthritis Foundation would open in a cinch. What’s easy for people with arthritis is easy for all of us.