<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_455"
                     title="Low Vitamin D Linked to Hip OA (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/Rheumatology/Arthritis/tb/18379?impressionId=1265753963954"
                     
      &lt;p&gt;Elderly men with low serum levels of vitamin D are at increased risk for developing hip osteoarthritis, a prospective cohort study found.&lt;/p&gt;
&lt;p&gt;Men whose levels of 25-hydroxyvitamin (OH)D were between 15.1 to 30 ng/mL had twice the likelihood of prevalent radiographic hip osteoarthritis than those whose levels were normal (OR 2.19, 95% CI 1.21 to 3.97), according to R. Krishna Chaganti, MD, of the University of California at San Francisco, and colleagues.&lt;/p&gt;
&lt;p&gt;Conversely, after adjusting for age, season at blood draw, and clinic site, higher vitamin D levels were associated with a lower prevalence of hip osteoarthritis (OR 1.39 per 1 SD decrease in 25(OH)D level, 95% CI 1.11 to 1.74), the researchers reported in the February issue of &lt;em&gt;Arthritis &amp;amp; Rheumatism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Because the role vitamin D may play in the pathogenesis and progression of osteoarthritis is unclear, Chaganti and colleagues analyzed data from the Osteoporotic Fractures in Men Study, which enrolled a large cohort of elderly men between 2000 and 2002 from six centers across the U.S.&lt;/p&gt;
&lt;p&gt;A total of 1,104 men whose mean age was 77.2 years had baseline measurements of serum vitamin D, and about 4.5 years later pelvic radiographs were obtained.&lt;/p&gt;
&lt;p&gt;Radiographs were scored to reflect joint space narrowing, osteophyte formation, cysts, subchondral sclerosis, and femoral head deformity.&lt;/p&gt;
&lt;p&gt;Vitamin D levels were categorized as deficiency (&amp;#8804;15 ng/mL), insufficiency (15.1 to 30 ng/mL), and sufficiency (&amp;gt;30 ng/mL).&lt;/p&gt;
&lt;p&gt;Mean vitamin D level was 23.38 ng/mL in men who had radiographic hip osteoarthritis, compared with 26.04 ng/mL in men without radiographic abnormalities (&lt;em&gt;P&lt;/em&gt;=0.0002).&lt;/p&gt;
&lt;p&gt;Men with hip osteoarthritis had a higher prevalence of both vitamin D insufficiency (77% versus 65%, &lt;em&gt;P&lt;/em&gt;=0.002) and deficiency (10.2% versus 7.5%, &lt;em&gt;P&lt;/em&gt;=0.012).&lt;/p&gt;
&lt;p&gt;Moreover, they had slower six-meter walking speed (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) and reported more hip pain (&lt;em&gt;P&lt;/em&gt;=0.0001).&lt;/p&gt;
&lt;p&gt;Men who were vitamin D deficient also tended to have an increased likelihood of hip osteoarthritis (OR 1.99, 95% CI 0.83 to 4.74), but after adjustment in multivariate models, statistical significance was lost with this level of the vitamin.&lt;/p&gt;
&lt;p&gt;&quot;The association of low 25(OH)D levels with prevalent radiographic hip [osteoarthritis] underscores the potentially important role of vitamin D in the pathogenesis of [osteoarthritis]. Vitamin D metabolites have been found to be associated with the regulation of the Wnt pathway, products of which play important roles in the development and maintenance of bone and cartilage,&quot; the investigators explained.&lt;/p&gt;
&lt;p&gt;Furthermore, in vitro studies have suggested that serum levels of 25-hydroxyvitamin D&lt;sub&gt;3&lt;/sub&gt; can affect the ratio of RANKL to osteoprotegerin and thereby influence bone deterioration and repair.&lt;/p&gt;
&lt;p&gt;Previous investigations have yielded conflicting results. One study found that low levels of vitamin D were not associated with worsening of knee osteoarthritis, as reflected in loss of articular cartilage on MRI.&lt;/p&gt;
&lt;p&gt;Another study, however, linked knee osteoarthritis with low vitamin D levels, particularly in patients who also had decreased bone mineral density in the lumbar spine.&lt;/p&gt;
&lt;p&gt;&quot;Vitamin D influences the mineralization of bone matrix, and low serum levels of vitamin D may result in poorly mineralized bone that might alter forces across the joint and reduce joint deterioration,&quot; the authors suggested.&lt;/p&gt;
&lt;p&gt;On the other hand, low levels may interfere with chondrocyte metabolism and thereby increase degeneration.&lt;/p&gt;
&lt;p&gt;Further studies will be needed to more fully clarify the effects of the vitamin on the development and progression of osteoarthritis, the investigators cautioned.&lt;/p&gt;
&lt;p&gt;Strengths of the study include the large cohort of participants, careful classification of radiographic osteoarthritis, and reliance on the gold standard of vitamin D measurement, the 25(OH)D level.&lt;/p&gt;
&lt;p&gt;Limitations include the cross-sectional design, precluding the inference of causality, and the gap in time between measurement of serum vitamin D and radiography.&lt;/p&gt;
&lt;p&gt;The authors concluded that therapeutic interventions to increase vitamin D serum levels in the elderly &quot;are warranted,&quot; with the goal of improving skeletal health in this vulnerable age group.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, the National Center for Research Resources, and the NIH Roadmap for Medical Research.&lt;/p&gt;&lt;p&gt;The lead author was supported by a grant from the American College of Rheumatology Research and Education Foundation.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_268"
                     title="No Meds Needed for Two Effective OA Regimens (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/tb/18119?impressionId=1265753963954"
                     
      &lt;p&gt;Middle-aged patients with early knee osteoarthritis can benefit from either a self-managment program or strength training, but a combination of the two did not provide additional gains, a study found.&lt;/p&gt;
&lt;p&gt;During a two-year trial, roughly two-thirds of participants randomized to one of three groups achieved clinically meaningful improvements in functioning, defined as a 26% change from baseline, according to a new report in the Jan. 15 &lt;em&gt;Arthritis Care &amp;amp; Research&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Patients also achieved clinically meaningful improvements in pain -- defined as a 40% change from baseline -- regardless of treatment group, wrote Patrick E. McKnight, PhD, of George Mason University in Fairfax, Va., and colleagues.&lt;/p&gt;
&lt;p&gt;The functional improvements were 70% for patients in the strength training group, 64% for those in the self-management group, and a 66% improvement in the combined treatment group. For pain, the breakdown was as follows: &lt;ul&gt; &lt;li&gt;Strength training, 65%&lt;/li&gt; &lt;li&gt;Self-management, 56%&lt;/li&gt; &lt;li&gt;Combined treatment, 65%&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;McKnight and colleagues wrote that studies in older patients have reported positive changes for both strength training and self-management.&lt;/p&gt;
&lt;p&gt;To see if these modalities also could benefit younger patients with milder disease, and whether combining the two would lead to additional benefits, the investigators recruited 273 subjects ages 35 to 64 years.&lt;/p&gt;
&lt;p&gt;Participants all had pain on most days in at least one knee, had symptoms for less than five years, had radiographic evidence of osteoarthritis, and had self-reported disability.&lt;/p&gt;
&lt;p&gt;The strength training program consisted of two phases, the first being nine months focused on stretching and balance, range of motion and flexibility, and isotonic muscle strengthening in three sessions each week.&lt;/p&gt;
&lt;p&gt;Phase two involved the development of self-directed long-term exercising habits, following the guidance and advice of trainers.&lt;/p&gt;
&lt;p&gt;The self-management program also included two phases. During the first nine-month phase, participants attended 12 weekly 90-minute classroom sessions addressing coping and self-efficacy skills, promoting active adaptive strategies and increasing perception of control for physical function and pain management.&lt;/p&gt;
&lt;p&gt;Phase two consisted of telephone calls from instructors and problem-solving discussions.&lt;/p&gt;
&lt;p&gt;The combined treatment group concurrently participated in both strength training and self-management programs, adjusted to maintain equivalent contact time with the other two groups.&lt;/p&gt;
&lt;p&gt;Overall compliance was modest, with 55.8% of those in the strength training group completing the study, along with 69.1% and 59.6% of the self-management and combined groups, respectively.&lt;/p&gt;
&lt;p&gt;Objective measures of physical functioning consisted of five physical performance tests measured at baseline and at months nine and 24. Pain and disability were self-reported.&lt;/p&gt;
&lt;p&gt;All of these outcomes showed significant changes over time in all three treatment groups, with effect sizes computed using the standard Cohen&apos;s d units: &lt;ul&gt; &lt;li&gt;Leg press, d=0.85&lt;/li&gt; &lt;li&gt;Range of motion, d=1.00&lt;/li&gt; &lt;li&gt;Work capacity, d=0.60&lt;/li&gt; &lt;li&gt;Balance, d=0.59&lt;/li&gt; &lt;li&gt;Stair climbing, d=0.59&lt;/li&gt; &lt;li&gt;Pain, d= &amp;#8722;0.51&lt;/li&gt; &lt;li&gt;Disability, d= &amp;#8722;0.55&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Both men and women improved, although benefits were greater among men, who gained more large muscle mass strength. Study-related adverse effects included accident, injury, or increased pain with strength training.&lt;/p&gt;
&lt;p&gt;Within-group and between-group effect sizes were also computed. All within-group effect sizes differed significantly from zero, with the exception of the pain outcome in the strength training group, but none of the between-group effects were significant.&lt;/p&gt;
&lt;p&gt;&quot;The logic behind the combined treatment was that the different factors addressed in physical and psychological treatments might produce an additive effect if administered together. These results suggest otherwise,&quot; the investigators conceded.&lt;/p&gt;
&lt;p&gt;As to why there were no differences between the three treatment arms, the length of the study and the relative youth of the participants may have contributed.&lt;/p&gt;
&lt;p&gt;The sample was younger than are included in typical osteoarthritis studies and were higher functioning at baseline, which could mean that there was less opportunity to produce a significant effect, the investigators suggested.&lt;/p&gt;
&lt;p&gt;Also, the increased burden of the combined treatment may have diluted the effects of the two programs.&lt;/p&gt;
&lt;p&gt;Despite the fact that combined treatment in this study had negligible benefits beyond that seen with strength training and self-management, other long-term outcomes such as physical activity level might show a greater response. This remains speculative, but deserves further study, according to the investigators.&lt;/p&gt;
&lt;p&gt;Limitations of the study include the fact that the researchers did not assess effects of the treatment on articular cartilage or inflammation, and they did not include a no-treatment arm.&lt;/p&gt;
&lt;p&gt;Also, there may have been differences in self-medication practices between the groups.&lt;/p&gt;
&lt;p&gt;Nonetheless, the study findings suggest that the two nonpharmacologic approaches can produce gains in middle-age patients with osteoarthritis, and both can be recommended.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.&lt;/p&gt;&lt;p&gt;One co-author is an employee of Bristol-Myers Squibb and holds stock and/or stock options in the company.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_3_936"
                     title="If Genes Spell RA, Smoking Doesn&apos;t Punctuate the Problem"
                     score="-0.005"
                     href="