Whitney Palmer

Healthcare. Politics. Family.

It’s Not Enough to “Tell” RA Patients to Exercise: They Need a Challenge

Published on the Nov. 11, 2015, Rheumatology Network website

By Whitney L.J. Howell

Improving physical activity could be an effective tool in decreasing fatigue associated with rheumatoid arthritis, according to a small study.
Fatigue is universally associated with rheumatoid arthritis, as well as depression, poor sleep and obesity. Physical activity can mitigate these problems, meaning increased movement could positively impact rheumatoid arthritis-associated fatigue.
In a presentation given on Nov. 11 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Patricia Katz, MD, professor of medicine at the University of California at San Francisco, discussed how increased walking is enough to be beneficial. At study’s end, participants experienced no increase in rheumatoid-arthritis activity, but they did see a marked decreased in tiredness.
“For years, people with rheumatoid arthritis experiencing fatigue have been told they should rest more,” Katz said. “This research flies in the face of that advice. Resting more is probably the opposite of what they need to do.”
Ninety-six participants were divided into three groups: (1) education-only (2) pedometer and (3) pedometer with step targets. Group 1 received only a Centers for Disease Control and Prevention booklet about incorporating exercise into daily routines. Group 2 monitored their steps, and Group 3 was challenged to increase their steps by 10 percent each week for 21 weeks. Both groups received phone call follow-ups at 10 weeks and 21 weeks.
Overall, the median baseline step count was 3,710, fewer than 5,000 daily steps is considered sedentary. At the study’s end, Group 1 saw virtually no change in their number of steps, but experienced a 38 percent drop in fatigue. Group 2 increased their steps by 87 percent and decreased their fatigue 54 percent. Group 3 augmented their steps by 159 percent and saw their fatigue dip by 48 percent. The PROMIS Fatigue short-form was used to assess fatigue levels.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/it%E2%80%99s-not-enough-%E2%80%9Ctell%E2%80%9D-ra-patients-exercise-they-need-challenge

November 11, 2015 Posted by | Healthcare | , , , , | Leave a comment

How Do Your Patients Perceive Pain?

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

A significant portion of patients with rheumatoid arthritis don’t feel they have effective communication with their rheumatologists, according to a small qualitative study.
Patient perceptions of pain and fatigue can differ from clinical markers. Knowing this can encourage rheumatologists to take patient responses into account when designing treatment plans.

In a presentation given on Nov. 10 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Mayo Clinic rheumatologist John M. Davis III, discussed how frequently patients report severe rheumatoid arthritis symptoms that exceed the objective markers their rheumatologists observe.

Results suggest patients experience a disconnect with their doctors, friends and family members that contributes to the psycho-social burden of disease. The findings can help providers recognize patients who feel their concerns aren’t being heard, he said, as well as open the door to more transparent patient-physician discussions.

“The sense is if we engage with patients and are attentive to their unmet needs, in terms of complaints and coping with symptoms,” he said, “we’ll have a better sense of what’s going on with patients.”

Based on patient responses through the Clinical Disease Activity Index, the pain visual analog scale, and the Patient Health Questionnaire-9, patient-physician discordance appears in 33 percent of clinical encounters even though not all patients are dissatisfied with their doctors. Patient-physician concordance is defined by a >25-mm absolute difference in these global assessments of their disease activity during the patient’s most recent rheumatology appointment within the previous four weeks.

Patients who report discordance also report high levels of fatigue, pain and difficulty with activities, he said, even though the number of swollen joints and CRP protein levels don’t indicate the same level of disease activity.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/how-do-your-patients-perceive-pain

November 9, 2015 Posted by | Healthcare | , , , , | Leave a comment

Physical Therapy in Knee Osteoarthritis Relieves Physical and Financial Pain

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

Individuals with knee osteoarthritis can benefit more from intensive physical therapy paired with subsequent booster sessions than from a shorter period of concentrated physical therapy, according to a recent study.

While this strategy is a deviation from current practices, it has been shown to improve outcomes, as well as lower costs. Longer periods of face-to-face work with a physical therapist could also encourage patients to exercise more, helping them maintain health benefits.

In a presentation given on Nov. 8 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., University of Pittsburg physical therapy assistant professor Allyn Bove, discussed the comparative differences between treating knee osteoarthritis patients with short, concentrated periods of physical therapy or with extended physical therapy services augmented by booster session.

“A lot of physical therapists would like to have regular follow-ups with patients to adjust home exercise programs and talk about best strategies to manage knee osteoarthritis,” she said. “It would be much like having a conversation about chronic disease with a primary physician or scheduling regular dental appointments.”

Three hundred participants completed a two-year study and were divided into four groups: 12 exercise-only visits; 9 exercise-only visits with three boosters, spread over 12 months; 12 exercise-only session, plus manual therapy; and, 9 exercise-only therapy, plus manual therapy, plus three booster sessions.

Based on patient-reported outcomes, Healthcare Utilization Project data, and the Medicare physician fee schedule, physical therapy with booster session produced the greatest effectiveness at the lower cost, Bove said. Exercise, manual therapy and booster session cost the least, and exercise-plus-booster cost $1,061 more with a gain of 0.082 Quality-Adjusted Life Years.

According to study results, she said, it would cost $13,000 in medication costs, follow-up visits, and additional services to achieve the same healthcare benefits seen with physical therapy sessions that include booster sessions spread out over a 12-month period.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/physical-therapy-knee-osteoarthritis-relieves-physical-and-financial-pain

November 9, 2015 Posted by | Healthcare | , , , , | Leave a comment

Lung Scarring Systemic Sclerosis

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

Patients with systemic sclerosis who take cyclophosphamide or mycophenolate mofitil both experience nearly the same decrease in lung scarring, according to a small study.

Neither medication is superior in reducing lung scarring and improving skin tightness. Rheumatologists can now better understand the agents’ safety profiles and know more about how to prescribe them and monitor results to help patients live longer with better lives.

In a presentation given on Nov. 8, at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., University of California-Los Angeles rheumatologist Philip Clements, MD, revealed patients with systemic sclerosis experienced equivalent improvement with interstitial lung disease when taking both cyclophosphamide and mycophenolate mofitil.

“Both medications have now been shown to be effective in slowing down the scarring of the lungs in fibrosis,” Clements said. “Hopefully, this will leave patients with less breathlessness, less new fibrosis, more functionality, and longer lives. That’s what we’d really like to see happen.”

Overall, Clements said, 70 percent of patients achieved improved vital capacity in lung function, and 70 percent with thick skin experienced skin softening and thinning for improved joint function.

All total, 106 participants were divided into two groups: (1) oral cyclophosphamide 2kg/mg/day for a year, followed by a placebo and (2) oral mycophenolate mofitial 2kg/mg/day up to 1,500 mg BID for two years. Baseline characteristics for both groups were the same.

At study’s end, improvements in forced vital capacity were roughly the same. In the transition dyspnea index, there was an increase of 2.24 with cyclophosphamide versus 1.86 with mycophenolate mofitil. With modified Rodnan skin scoring, there was a decline of 6.1 with cyclophosphamide versus 2.9 with mycophenolate mofitil.

Nearly twice as many participants taking cyclophosphamide came off the medication for intolerance versus those taking mycophenolate mofitil.

To read the story at its original location: http://www.rheumatologynetwork.com/acr2015-rn/lung-scarring-systemic-sclerosis

November 9, 2015 Posted by | Healthcare | , , , , | Leave a comment

Tai Chi Leads to 167-Point Drop in Pain in Knee Osteoarthritis

Published on the Nov. 8, 2015, Rheumatology Network website

By Whitney L.J. Howell

For individuals with knee osteoarthritis, practicing classical tai chi on a weekly basis can be as effective in treating associated pain as engaging in weekly physical therapy, according to a small study.

According to the Centers for Disease Control and Prevention, nearly 27 percent of Americans live with knee osteoarthritis, and there’s, currently, no effective treatment for it. Identifying effective strategies to reduce the associated pain can improve quality of life and overall functionality.

In a presentation given on Nov. 8 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Tufts Medical Center rheumatologist Chenchen Wang, MD, discussed the comparative effectiveness of classical Yang-style Tai Chi and traditional physical therapy in improving pain and quality of life. Previous research has shown both methods are effective, but this is the first study to compare the two directly.

In total, 204 patients participated in the study, and they were randomized into two groups: (1) 12 weeks of classical Yang-style Tai chi, twice weekly and (2) traditional physical therapy twice weekly for six weeks, followed by six weeks of vigorous at-home physical therapy.

“In addition to decreasing pain, we found tai chi offers benefits against depression and improved self-efficacy and quality of life,” she said. “This study exactly identifies what we found before. We’ve replicated our previous results.”

The primary outcome, Wang said, was a reduction in pain. Based on the WOMAC pain scale, participants practicing tai chi experienced a 167-point drop in pain. Physical therapy patients reported a 143-point pain drop. Although researchers had anticipated tai chi would be the superior pain-reduction strategy, she said, in essence, the results were equivalent. Neither method produced any adverse effects, and both led to reduced medication use.

To see the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/tai-chi-leads-167-point-drop-pain-knee-osteoarthritis#sthash.QmpCGugq.dpuf

November 9, 2015 Posted by | Healthcare | , | Leave a comment

Patients with Osteoarthritis Show Improvements after Weight Loss

Published on the Nov. 8, 2015 Rheumatology Network website

By Whitney L.J. Howell

Massive weight loss due to bariatric surgery could greatly improve the quality of life for osteoarthritis patients, according to a small pilot study.

Approximately 27 million Americans have osteoarthritis, a condition of significant public health concern because it directly impacts an affected adult’s functioning. There have been no new treatments within the past two decades, and the most effective therapy remains joint replacement.

In a presentation given on Nov. 8 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Cleveland Clinic rheumatologist and immunologist Elaine Husni, MD, discussed the impact of significant weight loss on quality of life, presenting the surgery as a potential strategy for osteoarthritis-symptom reduction. Recent research indicates fat cells could be metabolically active, contributing to inflammatory cytokine development.

“We wanted to see if massive weight loss in patients with osteoarthritis would make a difference beyond reducing the mechanical load on joints,” she said.

Three years post-bariatric surgery, she said, osteoarthritis patients reported, using the SF-36 self-assessment health survey, greater positive feelings about their overall health than those who didn’t undergo surgery. Patients did, however, during the same time, lose some walking and stair-climbing stamina.

Of the 67 study participants, 49 underwent surgery and 18 received medical intervention alone, such as calorie reduction, behavioral modification, or lifestyle changes. Individuals either had physician-documented osteoarthritis; radiographic evidence of degenerative changes in the hip, knee, ankle, foot, or spine; or they met the American College of Rheumatology’s criteria for knee or hip osteoarthritis.

The pilot study is part of the larger STAMPEDE trial – a randomized, controlled trial, evaluating the efficacy of medical therapy alone versus medical therapy combined with bariatric surgery in patients with uncontrolled Type 2 diabetes.

Additional study into activity level, weight-loss maintenance, and metabolic cytokines is needed to understand how to maintain bariatric-surgery impact, she said.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/patients-osteoarthritis-show-improvements-after-weight-loss#sthash.tBFdbwMr.dpuf

November 8, 2015 Posted by | Healthcare | , , , | Leave a comment


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