JustCare

Tag: Arthritis

  • In winter, expect more chronic conditions

    In winter, expect more chronic conditions

    We all know there are foods and behaviors we need to avoid in order to feel healthy. We might lose sleep or get stomach upset if we eat foods with gluten or drink wine. We might mess up our backs if we lift items that are heavy. Similarly, if we spend too much time in the cold, we might experience symptoms of psoriasis, asthma, arthritis and raynaud’s disease. Heidi Godman reports for Harvard Health on how winter exacerbates chronic conditions.

    Psoriasis causes your skin to grow quickly, developing red patches as a result of dry skin or excess indoor heat. A virus or strep throat in the winter can also lead to psoriasis.

    What can you do to reduce your risk of psoriasis? Don’t spend a lot of time in the shower and avoid using hot water. Humidifiers help, as does a moisturizer on your skin each day immediately after a shower. It’s also helpful to go out into the sun for at least 10 minutes a day, of course, with sunscreen.

    Asthma is a chronic lung condition that results from breathing in pollen or pollution. Your lungs inflame and your airways narrow. Cold air is a trigger, causing your airways to tighten. (NB: If you use an inhaler and you have Medicare, your out-of-pocket costs should come down soon.)

    What can you do to reduce your risk of asthma? Avoid going outside when it’s super cold. And, before you go out, take a precautionary puff of an inhaler. Wear a mask outside to keep your lungs warm. Avoid being near firepit smoke. And, wash your hands frequently when you are around others.

    Raynaud’s disease constricts your blood vessels in cold weather. As a result, your fingers and toes might turn white from lack of blood flow. It can be painful! Raynaud’s disease is particularly common among thin women.

    What can you do to reduce your risk of Raynaud’s disease? Don’t go outside in the very cold unless necessary and wear lots of warm clothing, including a hat, coat, gloves. If possible, use foot and hand warmers. The symptoms tend to fade once you’re back in a warm environment.

    Arthritis tends to flare up in cold weather, causing joint pain. It’s not clear why, the evidence is scanty.

    What can you do to avoid arthritis? Stay warm! Use a heating pad or take a hot shower. Consider wearing a brace on your joint to lower the risk of inflammation. Exercise also can help a lot, reducing inflammation and getting your blood flowing. That should ease your pain. If not, speak to your physician.

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  • Have arthritis? Beware of corticosteroid injections

    Have arthritis? Beware of corticosteroid injections

    New studies reveal that getting corticosteroid injections to relieve the pain of arthritis might actually cause your arthritis to worsen. NBC news reports on two small studies which found that people with arthritis who skipped the corticosteroid injections saw their arthritis progress more slowly than those who had the injections.

    Some 32 million adults in the US have arthritis in their hands, hips and/or knees. People with osteoarthritis, which is the most common arthritis, lose some of the cartilage that surrounds their joints. Their joints become inflamed and stiff.  Arthritis cannot be cured, but it can be treated to ease the pain.

    Most people get corticosteroid injections to treat their pain. Others get hyaluronic acid injections. The studies found that hyaluronic acid injections or no injections led to slower progressing of people’s arthritis, slower deterioration of their cartilage, than corticosteroid injections.

    An earlier study also found that corticosteroid injections in knees and hips could speed up the deterioration of cartilage and sometimes also accelerate the need for joint replacements. And, yet another study confirmed this finding for people receiving corticosteroid injections as well as people receiving hyaluronic acid injections. But, the study sizes were small. So, what precisely causes the speeding up of cartilage deterioration is not 100 percent clear; it might not be the injections.

    Experts are of several minds about these findings. For example, it could be that the people who receive the steroid injections exercise more, aggravating their arthritis. Also, the findings were based on images taken of people’s joints. They did not indicate that the people who received the steroid injections experienced more pain.

    And, not all the experts interviewed believed that steroid injections should be avoided. They believe steroid injections could have value because they can minimize people’s pain. Other experts thought that steroids and hyaluronic acid injections should be avoided, and there should be good alternatives, though none were identified!

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  • One in seven older adults experience harmful drug side effects

    One in seven older adults experience harmful drug side effects

    More than nine in ten older adults take at least one prescription drug; And, half of all older adults take four or more prescription drugs, some of which they may not need. On top of that, many take over-the-counter medications and supplements. Kaiser Health News reports that more than one in seven older adults experience harmful drug side effects. Talk to your doctor about all the drugs you’re taking, why you need them, and whether you can stop taking one or more of them.

    Good primary care doctors and geriatricians oversee their patients’ drug use and try to “deprescribe,” reduce the number of prescriptions their patients are using, eliminating those that are unnecessary or inappropriate. Often, with drugs, less is more. Hundreds of new drugs are harmful or ineffective. And, one in three recently approved drugs may have harmful side effects.

    The most common side effects from multiple medications are dizziness, confusion and falls. But, some side effects are life-threatening. Here is a roundup of Just Care posts on commonly used prescription and over-the-counter drugs, as well as supplements, that have been linked with serious side effects.

    Keep in mind that FDA approval of a drug does not mean that it is safe, only that the clinical trials pre-FDA approval showed that the drug offered a clinical benefit. If possible, stay away from drugs that have been on the market fewer than ten years. Typically, it takes 4.2 years from FDA approval for detection of a new risk for a novel drug. But, it could take ten years after FDA approval for popular drugs to be pulled from the market.

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  • Seven lifestyle changes for managing rheumatoid arthritis

    Seven lifestyle changes for managing rheumatoid arthritis

    Jeannette Moninger writes for Medshadow.org on seven lifestyle changes for managing rheumatoid arthritis. I excerpt her article below. To learn more about rheumatoid arthritis on JustCare, click here. You can read Moninger’s full post on Medshadow.org here.

    1. Stay Active

    Exercising may be the last thing you want to do when your joints ache, yet research shows that physical activity alleviates joint pain and stiffness, increases joint mobility, strengthens muscles and improves mental health. “Water exercises and those that improve flexibility like yoga and tai chi are particularly good for achy joints,” says Dr. Wei.. .. It’s natural to experience some muscle soreness after a workout. But increased joint pain may be a sign that you’re exercising too hard or too much and need to ease up….

    A 2016 meta-analysis of nine randomized controlled trials and one cohort were reviewed to determine the impact of exercise on arthritic symptoms of patients with JIA. Exercises included aquatic, strengthening, proprioceptive, aerobic, and pilates. Based on descriptive summaries on activity capacity, body function, pain, muscle strength, and quality of life, 95% of patients in the trials showed significant improvement…

    2. Maintain a Healthy Weight

    Every pound of excess weight puts about four extra pounds of pressure on joints. This extra pressure worsens aches and pains. Plus, fat tissue spurs chronic inflammation and exacerbates existing swelling and tenderness in arthritic joints. A 2017 study in the British Medical Journal found that women with body mass index values of 25 or higher have a 35% greater risk of getting RA.

    3. Eat a Balanced Diet

    According to Harvard Health Publishing, certain foods have been shown to fight inflammation, strengthen bones and boost the immune system. These include foods rich in inflammatory-fighting omega-3 fatty acids like salmon, tuna, olive oil and soybeans; antioxidant-rich green tea; fiber-rich whole grains and beans; and vitamin C-rich citrus fruits. Findings from the Nurses’ Health Study (NHS) and NHS 2, published in the American Journal of Clinical Nutrition, suggest it’s also a good idea to avoid sugary soft drinks because they may contribute to the onset of rheumatoid arthritis. Sugary drinks are considered to be a major contributor to obesity — and excess weight is known to increase the risk of RA….

    4. Don’t Smoke

    Rheumatoid arthritis is an inflammatory disease able to produce severe disability due to pain. Smokers with RA are likely to experience more pain and fatigue compared to non smokers. A 2016 study from the University of Manchester conducted a meta analysis measuring the effects of smoking cessation on a population based cohort of 5,677 patients to measure the association of smoking on patients with RA. Of this cohort, 40% have never smoked, 34 are former smokers, and 26% are current smokers. Due to the increased inflammation that smoking causes, smokers and reformed smokers experienced 73% more frequent flare ups and pain compared to non-smokers with RA. There was also a significant increase (1.5 fold) in premature mortality also associated with inflammation such as cardiovascular disease and respiratory diseases.

    5. Get More of the ‘Sunshine Vitamin’

    A June 2019 report from the University of Birmingham suggests that low levels of vitamin D up one’s risk of developing autoimmune disorders including rheumatoid arthritis. This vitamin deficiency also may worsen existing arthritis symptoms. Not having sufficient vitamin D can lead to a pro-inflammatory result and can cause symptoms to arise or worsen. A blood test can determine vitamin D levels….

    [Vitamin D supplements also seem to be over-rated as far as bone health, as supplements do not lower fracture risk for those living in the community. For those living in nursing homes on the other hand, they do lower the risk of fractures from falls.]

    6. Manage Stress

    Recognize what causes you stress and change what you can….[I]ncorporate into your daily routine relaxation exercises including meditation, deep breathing and guided imagery — there are free apps that will start you off. Releasing muscle tension eases arthritis pain…

    7. Try Alternative Treatments

    Acupuncture helps some people with rheumatoid arthritis by releasing pain-blocking endorphins and interfering with the transmission of pain signals to the brain via the nervous system. Another alternative treatment that shows promise is transcutaneous electrical nerve stimulation (TENS) therapy. With TENS therapy, a wearable device sends painless electrical currents to nerve fibers. This causes the release of pain-killing endorphins, as well as the generation of heat that relieves stiffness and pain…

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  • Think twice before getting a knee replacement

    Think twice before getting a knee replacement

    Liz Szabo reports for Kaiser Health News about the high proportion of people who get knee replacements and wonder whether they should have. For about one third of people, knee replacements do not ease arthritis pain. Better treatments include pain relievers, diet changes, and physical therapy.

    Knee replacements are fairly common procedures, considered safe and effective. More than 750,000 people receive them each year. But, in some cases, they may cause more harm than good. Doctors and hospitals make money from knee replacements and may not warn you about their risks.

    People get knee replacements to address chronic pain, But, a knee replacement is not always a cure for pain. Indeed, it can bring on more knee pain, which can spread to your hips and back.

    Knee replacement surgery has serious risks. The data suggests that as many as one in three people suffer chronic pain as a result of a knee replacement. About twenty percent of people who have the procedure are unhappy with the result.

    People who get knee replacements are far more likely to develop complications than people who use non-surgical treatments such as pain relievers and physical therapy to relieve their pain. Infections, blood clots and knee stiffness are all too common side effects of surgery and may lead to the need for another medical procedure. Between one and two percent of people who get knee replacements die within three months.

    You may not want to get a knee replacement if  you have mild arthritis. A BMJ study found that quality of life does not tend to improve for people with mild arthritis.

    And, you probably do not want to get a knee replacement in order to be able to engage in heavy duty sports, such as basketball. Artificial knees tend not to be meant for heavy duty exercise.

    Finally, if you are relatively young and believe you would benefit from a knee replacement, keep in mind that artificial knees only last about 20 years before they must be replaced. They can wear out and leave particles that inflame the knee area. They also can loosen and separate from the bone. If you need to replace an artificial knee, the risk of complications is higher.

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  • Drugmaker charged with paying kickbacks to sell more Humira

    Drugmaker charged with paying kickbacks to sell more Humira

    Humira is one of the top-selling drugs in the US. But, it may be in part because its drugmaker, AbbVie, has paid kickbacks to doctors and nurses to sell more Humira. The California insurance commissioner has filed a lawsuit alleging that AbbVie engaged in a range of illegal activities to promote the sale of Humira, which cost the state $1.2 billion.

    To get doctors to write more prescriptions for Humira, a drug that treats rheumatoid arthritis, the California insurance commissioner claims that AbbVie paid doctors cash and gave them gifts and patient referrals. According to the commissioner, AbbVie also hired nurse “ambassadors,” who claimed to be patient advocates, to make sure patients were taking the Humira their doctors prescribed and refilling their prescriptions. These same nurses also made visits to doctors’ offices with Humira sales reps.

    Over a five-year period, commercial insurers paid 274,000 claims for Humira prescriptions. And, the price for Humira is high in part because AbbVie has been able to get new patents approved for the prescription drug and extend its monopoly pricing power; it has 247 patent applications for this drug alone. So, Humira’s price has more than doubled (increasing 144 percent) in six years.

    AbbVie denies any wrongdoing, claiming that it was simply helping patients, providing “support services,” to them. It claims no interference between patients and health care providers. However, the lawsuit alleges that these nurses placed themselves between patients and their doctors, with a responsibility of keeping patients on Humira and reporting complaints to AbbVie, not the patients’ doctors.

    AbbVie contends that it provided professional services to help doctors with insurance processing, prior authorization, and more, in order to save them time and money. It also takes the position that several of the allegations in the lawsuit included proprietary information that should not be publicly disclosed so that, for now, the lawsuit has been substantially redacted.

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  • Tips for driving safely

    Tips for driving safely

    As you get older, it can become increasingly challenging to drive. A variety of health conditions can affect your ability to drive. If you are concerned about whether you or someone you love is a safe driver, talk to your doctor. Don’t risk hurting yourself or others. Here are tips for driving safely from the National Institutes of Health.

    If your joint and muscles are stiff, you may have difficulty turning your head to see oncoming cars or responding to a situation where you need to turn the steering wheel or brake quickly. In these situations, you are likely better off driving an automatic car with power steering and brakes and big mirrors. And, you should exercise so that you are as strong and flexible as possible.

    If your vision is not what it used to be, you may have trouble seeing people and things in front of you as you drive. You also might struggle to see at night. Visit the eye doctor to ensure your vision is as good as possible. You also might consider stopping driving at night.

    If your hearing is failing, you may not hear horns and sirens and may not be warned when you need to get out of the way. Make sure to have your doctor check your hearing. Also, consider keeping the radio off while you are driving so that you are better able to hear outside noises.

    If you have mild dementia, you may continue to drive. But, you want to stop when your memory weakens and you are unable to remember where you need to go. You may not appreciate the challenges of driving.

    As your reflexes slow down, you may not be able to respond as quickly as needed while you are driving. Try to not to get too close to the car in front of you, brake sooner, and, if possible, stay out of rush-hour traffic. If you need to drive when the roads are busy, try to keep to the right lane.

    If you are taking medicines, be sure to note whether the warning label includes side effects like drowsiness or lightheadedness.  If so, driving can be unsafe, and you should not be driving. Be sure to check the warning labels on your medicines and discuss them with your doctor to see whether you should be driving while taking them.

    To be safe, try not to drive when the weather is bad and at night and avoid highways, if possible. Here are helpful tips on how to help someone you love decide when to stop driving.

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  • Out-of-pocket costs for Part D brand drugs way up

    Out-of-pocket costs for Part D brand drugs way up

    The Department of Health and Human Services Office of the Inspector General (OIG) just released a report revealing a steep increase in out-of-pocket costs for people with Medicare Part D prescription drug coverage needing brand-name drugs. The findings are particularly disturbing given that people with Medicare filled fewer brand-name prescriptions and still spent more. The OIG blames pharmaceutical companies for increasing their prices on these drugs substantially.

    During the five-year period between 2011 and 2015, the OIG found that people with Medicare filled 17 percent fewer prescriptions than in the prior period. But, their out-of-pocket costs for these drugs rose 40 percent, from $161 to $225. Part D drug plans simply shifted more costs for brand-name diabetes, cholesterol and asthma drugs, among others, onto their enrollees because pharmaceutical companies charged them significantly more for these drugs.

    Taxpayers were also hit hard by the steep increase in the prices pharmaceutical companies charged Medicare Part D plans for their drugs. The brand-drug price increases amounted to a 77 percent increase in Part D reimbursements to pharmaceutical companies, up to $102 billion in 2015 from $58 billion in 2011.

    Not surprisingly, in 2015, 7.3 percent of people with Medicare in a Part D plan spent $2,000 per year in out-of-pocket costs for brand-name drugs, almost twice the 3.7 percent in 2011. Until Congress steps in to negotiate drug prices, as every other nation does, you should expect this trend to continue.

    The unit price increase for covered Medicare Part D brand-name drugs averaged 29 percent, nearly six times more than inflation, which was 5 percent. And, some drugs saw far greater price increases. The price of Valeant’s rheumatoid arthritis drug, Cuprimine (250 milligram oral capsule), increased 2,143 percent, from $6 in 2011 to $135 in 2015. How could this and other extreme price increases be? Because Valeant and every other brand-name drug manufacturer can raise the price of their drugs as much as they want with little effect on demand.

    Had we been in the room with the Valeant people deciding to raise Cuprimine’s price, we might have heard them debating how far they should push the price increase. “Let’s raise the price to $270. We still can get the PBMs to put it on the insurers’ formularies, if we pay the PBMs a generous fee,” one of them might have suggested. “But, our manufacturing and marketing costs aren’t up. Cuprimine is only costing us pennies to produce,” another might have replied. “OK. We’ll split the difference. That seems entirely reasonable. And, we can raise the price again next year. Congress hasn’t stopped us yet.” Sadly, Congress seems not to care. This is what our lawmakers understand to be pricing in a competitive free market.

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  • Rheumatoid arthritis drug has dangerous side effects

    Rheumatoid arthritis drug has dangerous side effects

    If you think drugs approved by the FDA can’t kill you, think again. A recent article in Stat News explains that Actemra, a rheumatoid arthritis drug, has dangerous side effects, possibly killing hundreds of patients who took it. But, the FDA warning label made no mention of its risks of stroke, heart and lung disease, or pancreatitis. And, the FDA seems to be incapable of determining the drug’s safety or of acting to warn patients now that the drug shows signs of having dangerous side effects.

    Somehow Actemra’s manufacturer, Genentech, a subsidiary of Roche, was able to persuade the FDA that, unlike other treatments for rheumatoid arthritis, Actemra did not have serious side effects. As it turns out, just like other drugs for rheumatoid arthritis, the data suggests that Actemra can cause stroke, heart disease, heart attack, lung disease and pancreatitis.

    In fact Stat, which studied more than 500,000 reports of Actemra’s side effects, found that patients taking Actemra may be more likely to suffer a heart attack or a stroke than patients taking a competitor drug. Stat further reports that the FDA has been notified of 1,128 people taking Actemra who subsequently died.

    The FDA doesn’t have the capability to determine whether Actemra was the cause of death, and the FDA is not responsible for determining the accuracy of Actemra’s side effects, as reported by Genentech. But, Stat learned through a Freedom of Information Act (FOIA) request that several doctors ascribe their patients’ deaths to Actemra. Experts Stat enlisted to review the FOIA information say that the evidence suggests that the Actemra warning should include risk of heart failure and pancreatitis.

    Stat quotes oncologist and medical ethicist Vinay Prasad, Oregon Science University: “We’ve done a very good job of making it easier to approve drugs, often based on very preliminary evidence. But we haven’t ramped up the standards of post-marketing surveillance to make sure that what’s been out there for several years is safe and effective.” Prasad continues: “The system is broken, and all the financial incentives are lined up to keep it broken.”

    Psychiatrist, Jean Roiphe M.D., says: “It is safest to assume, until proven otherwise, that a new drug, from a given class of medication, is likely to have similar side effects and risks as other members of its class, even if there is no specific warning to that effect. Before deciding to take a newly approved drug, I recommend that patients consider taking a drug that has been around for a longer period of time, whose side effects are more well known.”

    About 1.5 million Americans have rheumatoid arthritis. It causes swelling of the joints and, sometimes, physical disabilities. It can be extremely painful. (Click here for a post on managing arthritis pain.) There is no cure for the disease, but there are several types of treatments, including therapy and a range of medications.

    You can watch Mike Papantonio, a trial lawyer, describe the dangerous side effects of Actemra here.

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  • The Zen of swimming

    The Zen of swimming

    “It’s a wonderful world out there, swimming back and forth in the calming waters. Instead of running on a treadmill, I brace my feet against the side of a pool and glide off into the bright blue buoyant world, swimming back and forth at whatever relaxing or invigorating pace I feel like taking that day..”

    I want to break the record for longest living human. I also want to keep feeling as strong and pain-free as possible. So when I turned 50, I started walking everywhere I needed to go instead of taking public transportation, and I joined a gym. Walking was a pleasure, but the gym was not.

    At 55, I joined a different gym—one that had a pool. I hadn’t been swimming for 35 years, but doing laps sounded a lot more fun than push-ups and treadmills.

    As soon as I joined, I panicked.

    – Which lock should I buy?
    – How cold is the water going to be?
    – Will I have to wear a stupid bathing cap?
    – Ugh. Group showers.
    – Ohmygod, what do I look like in a bathing suit these days??

    I worried that everyone would swim faster than me, that I would jam up my lane and they’d all hate me. Would I swim half a lap and then feel like I was going to die and give up?

    But the image of my 70, 80, 90-plus-year-old self thump, thump, thumping along on a treadmill drove me to deal with the fears and give swimming a try. It turns out, science is on my side.

    What Science Says About Swimming and Aging

    A 32 year study of men ages 20 to 90 found that swimmers had the lowest mortality rate, beating walkers and even runners.

    Swimming peels off the pounds. Even a slow crawl burns more calories than walking or cycling, and you’d have to run six miles per hour or more to beat it.

    Swimming is the ideal exercise for arthritis pain management and for keeping your joints flexible.

    “The most prevalent heart disease risk factor for older people is high blood pressure,” Dr. Hirofumi Tanaka, director of the Cardiovascular Aging Research Laboratory at the University of Texas at Austin points out, and swimming, he says, is very effective in reducing blood pressure.

    According to Joel M Stager, director of the Counsilman Center for the Science of Swimming (really!) at Indiana University’s School of Public Health, “Older swimmers maintain their muscle mass better than those who don’t swim, have much lower cardiovascular risk factors than non-swimmers… and score higher on all the various facets of ‘wellness.’ ” But one of the most important benefits, Stager says, is the fact that swimmers have much better balance than their non-swimming contemporaries. “This is a critical issue with aging. Bad balance leads to falls, falls lead to decreased activity and that leads to poor quality of life and a loss of independence. So, swim.”

    The Art of Being a Novice

    I did. The first time I swam a lap, I was so out of breath that I was ready to quit on the spot. As I clung to the far side of the pool, huffing and puffing, a very kind lifeguard walked over and said, “Take your time. Swim a lap, rest, then maybe swim another.” He assured me that I would build up my stamina. By taking a lot of rests, I swam an incredible 14 laps that day. Today, I swim anywhere from one to 10 miles a week.

    Swimming also has turned out to be a surprisingly social activity. In New York City, where I live, I’ve found swimming groups to join and activities to engage in, including an annual lap swim contest with a dinner and party hosted by NYC Parks & Recreation. Swimming is also wonderfully intergenerational. At my pool I regularly swim with people from their 20s to their 90s.

    As far as my other fears and concerns go:

    I found a simple and inexpensive Master Lock at my local drugstore.

    I’m fortunate enough to swim in a heated pool, but it’s still cold sometimes. I won’t lie: On those days, I hate that first minute.

    I don’t have to wear a stupid bathing cap, but I choose to, because it saves my hair. A tip for women: If you’re worried about the effect of chlorine on your locks, wet your hair, lather in some conditioner and cover it with your bathing cap while you swim.

    Group showers equal girl talk, and sharing swimming tips and stories.

    How do I look in a bathing suit? Better than I would have had if I not been swimming for the past six years. For the record, I wear tankini tops and men’s square-leg bottoms. It’s a flattering combination for the self-conscious.

    If you’re tempted to try, Google “public pools near me” and pick one that fits your budget. Or maybe you’re lucky enough to have a lake or ocean nearby. Just remember my friendly lifeguard’s advice: Start slowly.

    It’s a wonderful world out there, swimming back and forth in the calming waters. Joel Stager describes it as “almost meditative in nature,” and I agree. Instead of running on a treadmill, I brace my feet against the side of a pool and glide off into the bright blue buoyant world, swimming back and forth at whatever relaxing or invigorating pace I feel like taking that day.

    Try it.

    This article was first published on Senior Planet.

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