Arthritis Impact on African-Americans and Hispanics

Arthritis causes more pain and limitations for African-Americans and Hispanics than for whites, according to a study released today by the Centers for Disease Control and Prevention.

African-Americans were 17 percent less likely to report having arthritis than whites, and Hispanics were 46 percent less likely to report the condition than whites, the study said. However, African-Americans and Hispanics with arthritis were almost twice as likely to report severe joint pain and work limitations attributed to their arthritis when compared to whites, it said.

The study, “Difference in the Prevalence and Impact of Arthritis among Racial/Ethnic Groups,” was published in the journal Preventing Chronic Disease.

Arthritis is the leading cause of disability in the United States, affecting 20% of adults. It interferes with work and other daily activities and can complicate the management of other chronic diseases. Arthritis encompasses more than 100 diseases and conditions that affect joints and other connective tissue.

The reason for the racial and ethnic differences, while unknown, may result from a lack of access to health care, language barriers and cultural differences, the report says.

“We must address these stark differences in arthritis impact by using what we know,” said Jennifer Hootman, an epidemiologist for the CDC National Center for Chronic Disease Prevention and Health Promotion and co-author of the report. “We can educate those with arthritis about increasing physical activity and self-management and reducing obesity, especially those in groups bearing a disproportionate burden from arthritis.”

The data, collected from the CDC National Health Interview Survey, are the first to estimate the national prevalence of arthritis and assess its impact among smaller racial and ethnic groups that are usually grouped together when reporting health statistics.

Source: CDC, April 15, 2010

Regular Drinking May Reduce the Risk of Rheumatoid Arthritis

Drinking alcohol regularly may reduce the risk of developing rheumatoid arthritis by up to 50%, according to recent research.

Scandinavian researchers conducted two studies, involving 2,750 people, assessing environmental and genetic risk factors for rheumatoid arthritis. 1,650 participants had the disease, and were questioned about their smoking and drinking habits, while blood samples were taken to check for genetic risk factors.

Findings showed that drinking alcohol was linked to a reduced risk of developing rheumatoid arthritis; in fact, the more the subject drank, the lower the risk of rheumatoid arthritis.

Among regular drinkers, the quartile drinking the most were up to 50% less likely to develop the disease than the half who drank the least. Findings were the same for both men and women. In addition, alcohol cut the risk most in smokers with genetic risk factors for rheumatoid arthritis.

The authors conclude that their research reinforces the importance of lifestyle factors in the development of the disease, and that giving up smoking remains the single most important preventive measure.

They point to recent experimental research by other authors, which shows that alcohol protects against the development and severity of rheumatoid arthritis, although it is not clear exactly how it does this. The study also draws parallels with the links between moderate alcohol consumption and a reduced risk of other inflammatory processes, such as cardiovascular disease.

The study was published in the Annals of the Rheumatic Diseases.

Source: First Ann Rheum Dis 10.1136/ard.2007.086314

X-Ray Often Better and Cheaper than MRI in Knee Diagnostics

A weight-bearing X-ray is a better diagnostic tool and much less expensive than the MRI typically prescribed for patients with knees affected by osteoarthritis, according to a recent study. A patient’s medical history and a routine physical should be the starting point for a primary-care physician, followed by basic diagnostics.

"MRIs are being used in excess. Many doctors no longer talk to or examine their patients. Instead, they are going right for the technology," said Wayne Goldstein, MD. Dr. Goldstein, lead author on the study, is a clinical professor of orthopedics at the University of Illinois at Chicago College of Medicine and chairman of the Illinois Bone and Joint Institute.

"This is another example of over-utilization of the health-care system. It has become easier to go for the high-cost imaging. On average, an X-ray can cost less than $150, while an MRI can cost around $2,500". Medical imaging now accounts for 10%-15% of Medicare payments to physicians, compares with less than 5% only 10 years ago.

In 2008, Medicare will reimburse doctors more than $400 per MRI. By contrast, a 4-view X-ray which effectively reveals osteoarthritis and is routinely used by most orthopaedic surgeons, reimburses doctors just over $43. It is estimated that these MRI costs will continue to row at an annual rate of 20% or more in 2008. In the United States more than 533,000 total knee replacements were performed in 2005, primarily because of severe pain, swelling of stiffness of the knee caused by osteoarthritis.

A random sample of 50 knee arthroplasty patients found that 32 of the 50 had had a knee MRI within 2 years before surgery, ordered by their primary-care or orthopedic physician. The MRI did not produce any diagnostic information which could not have been provided by an X-ray, and more than 50% did not have any X-rays before surgical consultation.

"There are some indications for MRI, such as suspicion of avascular necrosis [in which blood loss to the area causes bones to break down, something which may not be seen on early X-rays], but that is not a common condition," Dr. Goldstein said. Dr. Goldstein and his co-authors believe that the main reason for this over-utilization of the MRI is a lack of education on this diagnostic technique, especially with family and primary-care physicians.

Dr. Goldstein added, "We fix this problem through educating physicians on the appropriate use of MRIs. We also need to educate our patients. Virtually every adult experiencing a knee problem should first have an appropriate set of X-rays before considering an MRI, which has been marketed as the premier diagnostic tool, so patients often come into the office expecting, even demanding, an MRI. Physicians need to look at why they are ordering an MRI and consider whether it is truly necessary."

The study was presented at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in March, 2008.

Rheumatoid Arthritis Patients at Risk for Cardiovascular Disease

Mayo Clinic researchers have created a simple approach for the prediction of heart disease in rheumatoid arthritis patients within ten years of their initial diagnosis.

Mayo researchers had already identified a connection between rheumatoid arthritis patients and increased risk for heart disease. The problem was to detect and prevent heart disease in these patients who showed no symptoms of it.

"Rheumatoid arthritis sufferers are dealing with pain and stress, therefore cardiovascular disease prevention may be delayed," says Hilal Maradit Kremers, M.D., lead study investigator and research associate in the Mayo Clinic Department of Health Sciences Research. "Our findings indicate that evaluation of cardiovascular risk based on risk factor profiles of individual patients can help physicians identify high risk rheumatoid arthritis patients and assist with decisions concerning cardiovascular prevention."

The 10 year absolute risk of cardiovascular disease in 553 patients diagnosed with rheumatoid arthritis was estimated by Mayo Clinic researchers and compared with 574 patients of the same age and gender who did not have rheumatoid arthritis. The researchers also collected subjects’ other risk factors—diabetes, blood pressure, cholesterol, body mass index and smoking.

It was discovered that 85 percent of 60 to 69 year olds newly diagnosed with rheumatoid arthritis had a 1 in 5 chance of developing a serious cardiovascular condition, compared with 40 percent who did not have rheumatoid arthritis.

In each age group, cardiovascular risk to rheumatoid arthritis patients was similar to that of non rheumatoid arthritis subjects aged 7 to 10 years older. "These results emphasize the importance of performing a comprehensive cardiovascular risk assessment for all newly diagnosed rheumatoid arthritis patients," says Sherine Gabriel, M.D., the study’s senior author and Mayo Clinic rheumatologist and epidemiologist.

Members of the Mayo Clinic study team include: Hilal Maradit-Kremers, M.D., Cynthia Crowson, Terry Therneau, Ph.D; Veronique Roger, M.D., and Sherine Gabriel, M.D. Their work was supported by grants from the National Institutes of Health; in particular, the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The findings were presented at the American College of Rheumatology Annual Scientific Meeting in Boston, November 6-11, 2007.

Source: Mayo Clinic