Use of alternative therapies by older adults with osteoarthritis

Objective

To examine the rates of use and expenditures on alternative therapies by adults with osteoarthritis (OA).

Methods

Adults with OA recruited from the community to participate in a randomized clinical trial recorded alternative and traditional health care use on postcard diaries. General and arthritis‐specific quality of life was assessed by questionnaires.

Results

More than 47% of participants reported using at least one type of alternative care during the 20‐week intervention period. Among alternative care consumers, the most commonly used treatments were massage therapy (57%), chiropractic services (20.7%), and nonprescribed alternative medications (17.2%). Four percent of subjects reported using only alternative care during the study period. Expenditures for alternative therapy averaged $1,127 per year, compared with $1,148 for traditional therapies.

Conclusion

Use of and expenditures for alternative care were high among this cohort of older adults with OA. Clinicians may want to inquire about use of these therapies before recommending treatments for this condition.

     

Self-management of osteoarthritis

Osteoarthritis is the most prevalent activity-limiting condition among older persons. In addition to, or instead of, taking nonsteroidal anti-inflammatory drugs, people use a variety of activities to manage their osteoarthritis. This study describesthe self-management methods reported by 61 participants aged 60 years or older assessed on two occasions 8 months apart. A questionnaire was developed to assess levels of use of 10 self-management methods including low-impact activity, rest, range-of-motion exercises, relaxation, heat (or cold), taking medication, jointprotection, massage, splints, and any other activity. On a typical day, participants usedabout four of these activities to manage Osteoarthritis symptoms, and significantly more on a day that their arthritis was worse than usual. Three self-management scales were formed from groups of activities suggested by factor analysis (medication taking, typical management, and worse-day passive management) that demonstrated adequate internal consistency and stability across the two assessments. The findings are discussed in terms of the importance of developing a brief measure of Osteoarthritis self-management, and the substantial individual variation in subsets of methods used.     

Quality of osteoarthritis care for community‐dwelling older adults

Objective

To describe the quality of osteoarthritis care provided to community‐dwelling elderly patients and to characterize arthritis‐related function in these patients.

Methods

Two medical groups in the western United States participated in a practice‐redesign intervention targeted at falls and mobility disorders, incontinence, and cognitive impairment, but not osteoarthritis. From 339 individuals reporting a diagnosis of arthritis, we collected information on demographics, functional status, and quality of care via patient interviews and mailed questionnaires. Eight quality indicators measured osteoarthritis care: 4 indicators measuring the provision of effective osteoarthritis care (osteoarthritis treatment indicators) and 4 measuring the provision of safe osteoarthritis care (medication safety indicators).

Results

The mean ± SD Short Form 12 physical component summary score was 35 ± 11 points, indicating a physically frail population. The overall indicator pass rate was 57.0% (95% confidence interval [95% CI] 53.9–60.2). Pass rates were higher for indicators of osteoarthritis treatment (63.5%, 95% CI 59.8–67.2) than for indicators of medication safety (43.8%, 95% CI 38.2–49.4). Patients with hip or knee pain had mean ± SD Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and function scores of 6.0 ± 4.0, 3.1 ± 1.7, and 25 ± 12 points, respectively.

Conclusion

Quality of osteoarthritis care for older adults is suboptimal, particularly with regard to medication safety. Given the high prevalence of osteoarthritis in older age groups, the population impact of any improvement in quality would be substantial. Quality improvement efforts for osteoarthritis should target appropriate use of and counseling regarding medications, as well as underuse of efficacious therapy for osteoarthritis.

     

Investigating Racial Differences in Coping with Chronic Osteoarthritis Pain

Osteoarthritis is a prevalent disease in older patients of all racial groups, and it is known to cause significant pain and functional disability. Racial differences in how patients cope with the chronic pain of knee or hip osteoarthritis may have implications for utilization of treatment modalities such as joint replacement. Therefore, we examined the relationships between patient race and pain coping strategies (diverting attention, reinterpreting pain, catastrophizing, ignoring sensations, hoping and praying, coping self-statements, and increasing behavior activities) for hip and knee osteoarthritis. This is a cross-sectional survey of 939 veterans 50 to 79 years old with chronic hip or knee osteoarthritis pain recruited from VA primary care clinics in Philadelphia and Pittsburgh. Patients had to have moderate to severe hip or knee osteoarthritis symptoms as measured by the WOMAC index. Standard, validated instruments were used to obtain information on attitudes and use of prayer, pain coping strategies, and arthritis self-efficacy. Analysis included separate multivariable models adjusting for demographic and clinical characteristics. Attitudes on prayer differed, with African Americans being more likely to perceive prayer as helpful (adjusted OR = 3.38, 95% CI 2.35 to 4.86) and to have tried prayer (adjusted OR = 2.28, 95% 1.66 to 3.13) to manage their osteoarthritis pain. Upon evaluating the coping strategies, we found that, compared to whites, African Americans had greater use of the hoping and praying method (β = 0.74, 95% CI 0.50 to 0.99). Race was not associated with arthritis pain self-efficacy, arthritis function self-efficacy, or any other coping strategies. This increased use of the hoping and praying coping strategy by African Americans may play a role in the decreased utilization of total joint arthroplasty among African Americans compared to whites. Further investigation of the role this coping strategy has on the decision making process for total joint arthroplasty should be explored.     

Exercise,self‐efficacy,and mobility performance in overweight and obese older adults with knee osteoarthritis

Objective

To examine changes in mobility‐related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis (OA), and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance.

Methods

The Arthritis, Diet, and Activity Promotion Trial was an 18‐month, single‐blind, randomized, controlled trial comparing the effects of exercise alone, dietary weight loss alone, a combination of exercise plus dietary weight loss, and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA. Participants completed measures of stair‐climb time and 6‐minute walk distance, self efficacy for completing each mobility task, and self‐reported pain at baseline, 6 months, and 18 months during the trial.

Results

Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility‐related self efficacy (P = 0.0035), stair climb (P = 0.0249) and 6‐minute walk performance (P = 0.00031), and pain (P = 0.09) when compared with the healthy lifestyle control intervention. Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair‐climb time.

Conclusion

Exercise + dietary weight loss results in improved mobility‐related self efficacy; changes in these task‐specific control beliefs and self‐reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair‐climb performance.

     

Coping with pain in the hip or knee in relation to physical disability in community-living elderly people

Objective . To investigate the use of pain coping strategies by community-living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability. Methods . A group of 157 people with pain “in the last month” was identified. Coping with pain was assessed with the Pain Coping Inventory, physical disability with the Sickness Impact Profile, and household and sport activities with a validated structured interview method. Results . People with chronic pain used relatively more “resting,” and “reducing demands” as pain coping strategies. Pain chronicity made a significant contribution to physical disability; however, when corrected for other variables in a regression model, no significant partial correlation was found. Conclusion . We conclude that pain coping has a mediating role in the relationship between pain chronicity and physical disability. Less use of “resting” and a physically active lifestyle are independently associated with less physical disability.     

Use of alternative therapies by older adults with osteoarthritis.

OBJECTIVE: To examine the rates of use and expenditures on alternative therapies by adults with osteoarthritis (OA). METHODS: Adults with OA recruited from the community to participate in a randomized clinical trial recorded alternative and traditional health care use on postcard diaries. General and arthritis-specific quality of life was assessed by questionnaires. RESULTS: More than 47% of participants reported using at least one type of alternative care during the 20-week intervention period. Among alternative care consumers, the most commonly used treatments were massage therapy (57%), chiropractic services (20.7%), and nonprescribed alternative medications (17.2%). Four percent of subjects reported using only alternative care during the study period. Expenditures for alternative therapy averaged $1,127 per year, compared with $1,148 for traditional therapies. CONCLUSION: Use of and expenditures for alternative care were high among this cohort of older adults with OA. Clinicians may want to inquire about use of these therapies before recommending treatments for this condition.     

Changes in barometric pressure and ambient temperature influence osteoarthritis pain

Purpose

Individuals with osteoarthritis often assert that change in the weather influences their pain, but the evidence is inconclusive. Our objective was to determine if short-term weather parameters influence knee osteoarthritis pain.

Methods

We performed a longitudinal analysis of pain reports from a 3-month clinical trial among individuals with knee osteoarthritis dispersed across the United States. Daily values for temperature, barometric pressure, dew point, precipitation, and relative humidity were obtained from the weather station closest to each participant. We used a longitudinal mixed-model random effects analysis with a first-order autoregressive error structure to test for associations while accounting for within-patient correlation.

Results

The study included 200 participants with knee osteoarthritis. Their mean age was 60 years (standard deviation [SD] 9.4), 64% were female, and 10.5% were African American or Hispanic. They had a mean body mass index of 32.5 kg/m² (SD 8.4) and a baseline WOMAC pain score of 9.0 (SD 3.4). There were consistent associations of pressure change and ambient temperature with pain severity (change in barometric pressure, coefficient = 1.14, P = .02, ambient temperature = −0.01, P = .004; adjusted mutually and for age, gender, body mass index, nonsteroidal anti-inflammatory drug use, opiate use, and prior pain score). Interaction terms between change in barometric pressure and ambient temperature had no influence in the models.

Conclusions

Changes in barometric pressure and ambient temperature are independently associated with osteoarthritis knee pain severity.     

Effects of total hip replacement on quality of life in patients with osteoarthritis and in patients with rheumatoid arthritis

Summary The effects of total hip replacement (THR) on quality of life were investigated in 62 patients with osteoarthrosis (OA) and 35 patients with rheumatoid arthritis (RA). Patients eligible for a first hip joint replacement were enrolled consecutively and examined at home before the operation and 3, 6, and 12 months after surgery.The IRGL (Influence of Rheumatic Diseases on Health and Lifestyle), a Dutch version of the AIMS (Arthritis Impact Measurement Scales), was used to operationalize quality of life in a questionnaire.Pain and mobility scores showed significant improvement among both OA and RA patients. The general mood of the OA patients also improved significantly, but the RA group showed only a favourable tendency in this respect. The interference of OA in several areas of life almost disappeared, whereas the impact of RA was only slightly reduced. There was no discernible effect on the social dimension in either group. A single THR apparently solves the main problem of most OA patients, but only one of a number of joint problems for most RA patients. The IRGL is complex and time-consuming and contains irrelevant scales. Its multidimensional evaluation of the quality of life is more informative than a purely somatic evaluation.     

The effect of ranitidine on NSAID related dyspeptic symptoms with and without peptic ulcer disease of patients with rheumatoid arthritis and osteoarthritis

Summary The efficacy of ranitidine in the treatment of NSAID-related dyspeptic symptoms with and without peptic ulcer disease (PUD) was investigated in 124 patients with rheumatoid arthritis (RA) and osteoarthritis (OA). The patients, who continued the use of NSAIDs were investigated by gastroduodenoscopy. Patients with PUD received open label ranitidine 150 mg b.i.d. and the patients without PUD were randomly allocated to receive ranitidine 150 mg b.i.d. or placebo for 4 weeks. PUD was found in 36 (26%) consecutive patients who presented with dyspeptic symptoms. Of these patients dyspeptic symptoms had disappeared in 8 (26%) of 31 evaluable patients and PUD was healed in 18 (56%) patients after 4 weeks of treatment. After 8 weeks of treatment PUD was healed in 27 (87%) patients. Of the remaining patients without PUD dyspeptic symptoms had disappeared in 24 (26%) of the ranitidine-treated patients which was significantly better (p<0.02) than the 5 (6%) placebo-treated patients. The minor mucosal lesions found in this patient group improved to a similar extent in the ranitidine and placebo-treated patients although 1 placebo-treated patient deteriorated and 2 placebo-treated patients developed PUD during the 4 weeks of study. The results of this study show that oral ranitidine 150 mg b.i.d. is effective in the treatment of both dyspeptic symptoms and mucosal lesions in RA and OA patient who continue the use of NSAIDs.     

Detection of stromelysin in synovial fluid and serum from patients with rheumatoid arthritis and osteoarthritis

Summary Stromelysin levels were measured using a one-step sandwich immunoassay in synovial fluid (SF) obtained from 31 patients with rheumatoid arthritis (RA) (31 samples) and 13 patients with osteoarthritis (OA) (13 samples) and in serum from 81 patients with RA (106 samples), 12 with OA (14 samples), 12 with gouty arthritis (gout) (14 samples), and 8 with osteoporosis (OP) (14 samples) to identify differences in the levels in these diseases as well as correlations with clinical parameters in RA. SF stromelysin levels were significantly higher in RA than in OA, and rose with increasing joint destruction in the former. No significant correlations were found between the SF stromelysin level in RA and various clinical parameters, except for the volume of SF which showed a correlation. Serum levels of stromelysin were highest in RA, gout, OA, and osteoporosis in decreasing order, and in RA were correlated with the Steinbrocker Stage. A significant correlation was also found between the serum stromelysin level and number of swollen joints, and correlations with the Lansbury index, ESR, CRP, WBC and Plt. The stromelysin level in SF was thought to be a useful parameter of local joint involvement and that in serum of the severity of systemic joint inflammation.     

An assessment of tenoxicam,a nonsteroidal anti-inflammatory drug of long half-life,in patients with impaired renal function suffering from osteoarthritis or rheumatoid arthritis

Summary Fifty-eight patients, aged 48–87 years, with impaired renal function and mean initial creatinine clearance of 52.1 mls/min were recruited to a 12-week open study of tenoxicam 20 mg/day for osteoarthrosis or rheumatoid arthritis. Renal function was mea sured before and after a brief run-in period when patients discontinued all nonsteroidal anti-inflammatory drugs, taking paracetamol alone, prior to monthly monitoring thereafter. Fifty-four% of patients completed the study, the others being withdrawn from lack of efficacy (17%), adverse events (24%) or both (5%). During the run-in period the mean creatinine clearance of 28 patients completing the trial improved to 64.7 mls/min and then dropped to 57.9 mls/min during the course of 12 weeks treatment with tenoxicam. Serial analysis of haematological and biochemical safety parameters showed no drug-induced change of significance. Twenty-three% of patients felt worse and 45% better at the end of treatment. Seventeen patients withdrew because of adverse events. These were normally gastrointestinal and always unrelated to further deterioration in renal function. Tenoxicam, 20 mg/day, can be given safely for a period of at least three months in patients with mild or moderate renal impairment.     

Recruiting adults with osteoarthritis into an aquatic exercise class: Strategies for a statewide intervention

Objective. Although research suggests that regular exercise can be helpful in reducing the dysfunction and discomfort of osteoarthritis, promoting exercise among older adults within this population is neither straightforward nor easily accomplished. This article describes the various methods, and their relative success rates, that were employed to recruit older adults throughout the state of Washington into an aquatic exercise program. Methods. Strategies included a recruitment letter distributed to Arthritis Foundation (AF) members in Washington state, local media news coverage, physician referrals, and advertisements in local papers and newsletters. Results. The most successful methods for enrolling participants were through the AF recruitment letters and local television coverage. The AF recruitment letter was the most expensive method of generating responses, while the television coverage was the least expensive. Conclusions. Collaborating with a well-reputed community-based organization and capitalizing on available publicity resources are important strategies researchers can use to gain access to a difficult and geographically dispersed population.     

Appraisal of and coping with arthritis-related problems in household activities,leisure activities,and pain management

Purpose. We examined whether or not there are systematic differences in how people appraise different types of illness-related problems and in how they cope with these problems. Methods. Two hundred thirty-five adults with recently diagnosed rheumatoid arthritis completed a mailed questionnaire followed by a telephone interview. A series of stress appraisal and coping variables were assessed in relation to three areas: household activities, leisure activities, and pain management. Results. Pain Differed significantly from household and leisure activities with regard to several appraisal and coping variables. Participants reported the least control over problems with pain, while attaching the most importance to pain control. Leisure activities also stood out as unique on several variables. Participants perceived greater ability and were more satisfied with their ability in relation to leisure activities. Conclusion. These findings show that, at least early in the disease, appraisal and coping strategies differ across the areas of household activities, leisure activities, and pain management.     

Self-efficacy mediates walking performance in older adults with knee osteoarthritis

BACKGROUND: Self-efficacy is a determinant of walking performance in older adults with knee osteoarthritis. We examined whether self-efficacy mediated the effect of age, psychosocial, impairment, and mechanical factors on walking performance. METHODS: Fifty-four participants with knee osteoarthritis completed the Six Minute Walk test and Arthritis Self-Efficacy Scale. Independent variables reflected age, psychosocial (depressive symptoms), impairment (pain, stiffness), and mechanical (strength, obesity) factors. RESULTS: Self-efficacy fully mediated the effect of age and impairments on walking. The effects of strength were only partially mediated by self-efficacy. Depressive symptoms and obesity were not mediated by self-efficacy. CONCLUSIONS: These findings are consistent with Social Cognitive Theory, according to which age may alter outcome expectations, and impairments like pain and stiffness provide negative physiological feedback to influence performance. Mechanical factors like strength and obesity may better represent a person's capabilities and interact with other variables to influence physical performance in older adults with knee osteoarthritis.     

Measurement of pain threshold in patients with rheumatoid arthritis,osteoarthritis, ankylosing spondylitis,and healthy controls

Summary Pain threshold was measured using a pressure algometer in 126 subjects, of whom 54 were females and 72 males. These subjects included 18 males and 18 females with rheumatoid arthritis, 18 males and 18 females with osteoarthritis, 18 males with ankylosing spondylitis, and 18 male and 18 female healthy control volunteers. Six points were studied on each side of the body: 2 cm above the eyebrow on the forehead, lateral aspect of the arm at the insertion of the deltoid muscle, midpoint of the ulna, hypothenar eminence in the palm, midpoint of the quadriceps muscle, and midpoint of the anteromedial aspect of the tibia. None of these points corresponded to the trigger points in fibromyalgia. The pain threshold was statistically significantly higher in patients with ankylosing spondylitis than in patients with osteoarthritis, and these in turn were statistically higher than in the normal subjects. Patients with rheumatoid arthritis had significantly lower pain thresholds than the normal subjects. No laterality in pain threshold was identified, but females had in general a lower pain threshold.     

Quality of well‐being in older people with osteoarthritis

Objective

To examine the sensitivity of the Quality of Well‐Being Scale (QWB) as a measure of health‐related quality of life (HRQOL) in people with osteoarthritis (OA).

Methods

The QWB was administered, along with the Arthritis Impact Measurement Scale (AIMS) and other health measures. Health care utilization data were also obtained.

Results

People with OA had a mean QWB score of 0.643. The QWB scores were significantly correlated with total AIMS scores, self‐rated health status, health care costs, depression scores, and most AIMS subscales. In addition, changes in QWB scores after 1 year were significantly correlated with changes in total AIMS scores and some AIMS subscales.

Conclusion

The QWB appears to be a useful and sensitive generic, utility‐based measure of HRQOL in people with OA.

     

Comparison of blood and synovial fluid lymphocyte subsets in rheumatoid arthritis and osteoarthritis

Summary Immunoregulatory T-cell deficiency is thought to underlie pathogenesis of rheumatoid arthritis (RA) as a systemic autoimmunopathy. The aim of this study was a simultaneous analysis of peripheral blood and synovial lymphocyte subsets (Ly-SS) of RA patients as compared to patients with locally active osteoarthritis (OA). Peripheral blood Ly-SS and paired synovial fluid Ly-SS from 87 RA patients were analysed by two dimensional flow cytometry (Simulset Becton Dickinson) as compared to 15 OA patients. The control group consisted of 32 healthy subjects. The peripheral blood analysis from RA and OA patients revealed a significant decrease of CD8+T-cells and increase of CD4+:CD8+ ratio when compared to the control group. The blood of RA patients showed a significant increase of HLA DR+ and IL 2R+T cells as compared to OA group. The synovial fluid from RA and OA patients showed a significant increase of CD3+, CD8+, HLA DR+ T-cells and decrease of CD4+:CD8+ ratio and CD19+ cells in comparison to the peripheral blood. This study shows, that the OA T-cell system seems not to be activated in peripheral blood in opposition to RA patients. Synovial fluid Ly-SS in OA, however, showed only quantitative but not qualitative differences. OA seems to be mainly a local inflammatory response depending on T-cells, when lymphocyte T activity in blood is diminished.