Rheumatologist says maintaining flexibility can prevent arthritis

The Pak Tribune reports findings from a study by Tim Spector, a professor of rheumatology at St. Thomas� Hospital in London, who claims his study shows that flexibility in women is associated with reduced risk of arthritis.

• It's not clear from the study if women were born with extra-flexible joints or obtained them through a lifetime of exercise and stretching, according to Tim Spector, a professor of rheumatology at St. Thomas' Hospital in London.
• "Our research suggests that both the innate or the exercise route (to flexibility) both seem to help prevent arthritis -- so exercise and stretching should be encouraged," said Spector.
• "In our study we only tested the women once and can't really separate hypermobile women who remained flexible from normal women who exercised and stretched to become more flexible than their sedentary peers," said Spector.
• It's the looseness of the structures surrounding the joint that allow it to have more motion, similar to a hinge on a door that allows it to swing open and closed.
• In some cases, hypermobility is a sign of inherited connective tissue or bone disease, and some studies had suggested it might actually increase the risk of osteoarthritis.
• Osteoarthritis occurs when the cartilage that cushions joints breaks down, often leading to pain, swelling and loss of mobility.
• In the ongoing study, predominantly middle-class white women have received regular x-rays and bone mineral density measurements since 1988.
• Spector and his colleagues found that bone mineral density was three percent higher in the hips of the hypermobile group compared with other women.
• There was no difference in spine bone mineral density between the two groups of women, according to the study in the current issue of the Journal of Rheumatology.
• The researchers also looked for osteoarthritis in the hands, knees, spine and hips of hypermobile women.
• The American Academy of Orthopedic Surgeons and the American Geriatrics Society recommend that adults engage in 30 minutes of moderate physical activity every day.

Dear Doctor: Causes, complications of neck arthritis

By Gerard Werries, M.D., Orthopedic Surgery

Q. Will I become paralyzed from my neck arthritis?

A. Arthritis of the neck is the leading cause of spinal cord dysfunction in patients 55 years and older. It affects men twice as much as women and can consist of bone spurs, disc bulges/herniations or thickened ligaments of the spine. Risk factors include frequent lifting, excessive driving and genetic and autoimmune factors.

Symptoms of neck arthritis can be neck pain, decreased motion, arm pain, numbness and weakness. Patients with significant spinal cord compression caused by severe neck arthritis often develop leg weakness, experience difficulty writing and walking and develop bowel and bladder difficulties.

If you have neck arthritis, you should have a thorough history taken and a physical done by a trained spinal surgeon. Routine X-rays of the neck should be done, after which additional imaging tests may be required to check the severity of spinal cord compression. Nerve conduction studies also may be required.

Patients with mild neck arthritis and minimal symptoms often respond well to physical therapy, anti-inflammatory medications and steroid injections. When conservative treatment fails or severe spinal cord compression from neck arthritis develops, surgery may be required to make room for the spinal cord and nerve roots. It is important for patients with severe spinal cord compression and significant neurological problems to seek immediate consultation with a spinal surgeon to avoid permanent damage to the spinal cord.

Osteoporosis drug fights knee arthritis

Risedronate preserves underlying bone to delay collapse of the joint

A drug that treats brittle bones may also help people with worn out knees.

British researchers have found that high doses of risedronate (brand name Actonel), an osteoporosis drug called a bisphosphonate, can preserve the underlying bone in the knee joints of people with osteoarthritis, the wear-and-tear form of arthritis.

"It has been known for some time within the literature that bisphosphonates could actually do this but nobody actually had the data to show it and so we are the first group to be able to do that," says Christopher Buckland-Wright, the senior study investigator and a professor of radiological anatomy at King's College London. He says the treatment slows the collapse of the joint and could potentially delay the need for knee replacement surgery.

Buckland-Wright and his colleagues studied 100 people who had knee osteoarthritis and were taking inactive pills or several different doses of risedronate. Over the next two years, X-rays showed that study participants with more advanced arthritis who were taking the higher medication doses experienced a halt or reversal in the loss of underlying bone in their knee joints.

People with advanced arthritis on the low-dose risedronate or inactive pills did not show any benefit, and those with less advanced arthritis had a modest loss of bone regardless of treatment.

Buckland-Wright says the drug was well tolerated even at high doses, and there is no reason to believe that other bisphosphonates would not also be effective.

Dr. Eric Matteson, professor of medicine at the Mayo Clinic in Rochester, Minn., says this study marks a new approach to slowing the progress of arthritis. "We now have a very good tool for slowing down this process, other than weight loss."

Arthritis patients denied drugs

By Nigel Hawkes

MANY patients with a form of arthritis that mainly affects young men are not being treated with drugs that could help them back into work. Ankylosing spondylitis (AS) affects about 60,000 people in Britain, and is most common among men in their late teens and early twenties. It impairs mobility and causes fatigue. The Arthritis Research Campaign (ARC) said that many patients were denied anti-TNF therapy, a new class of drugs that combat the inflammatory tumour necrosis factor, because of its high cost. Although it has been licensed for AS since 2003, the National Institute for Health and Clinical Excellence (NICE) is not expected to review its use in AS patients until February 2007. The ARC said that funding was patchy throughout the country and NHS trusts in England and Wales were not making the drugs available. It said that making the drugs more widely available would enable more patients to return to work. Professor Paul Wordsworth, of the ARC, said: “We urge NICE to speed up its approval process so that other people can benefit from the extraordinary transformation that these drugs can bring.”