Brain and Joints May Share Similar Inflammatory Mediators in Rheumatoid Arthritis

PainRelief.com Interview with:
Dr. Woojin Won
KU-KIST Graduate School of Converging Science and Technology
Korea University, Seoul
Center for Cognition and Sociality, Institute for Basic Science (IBS), Daejeon
Republic of Korea

PainRelief.com: What is the background for this study?

Response: Rheumatoid arthritis is a chronic systemic autoimmune disease that mainly affects the joint, and 30-70% of patients have complained of psychiatric disorders such as depression and cognitive impairment. It was suggested that inflammation of the brain was the cause, but the detailed mechanism was unknown. Based on the previous studies, I hypothesized that neuroinflammation will affect astrocytes (star-shaped brain cells) and induce psychiatric disorders.

In addition, there have been clinical reports that inhibition of monoamine oxidases (MAOs), enzymes that catalyze the oxidation of monoamine, relieves pain and mood disorder symptoms of rheumatoid arthritis. However, it is difficult to find a study on MAO inhibitors and rheumatoid arthritis. The reason may be that although MAO consists of two types (MAO-A and MAO-B), several studies have used them without distinction.

Over Half of Older Adults Use OTC Pain Relievers for Joint Pain Relief

PainRelief.com Interview with:
Beth Wallace, M.D. M.Sc
Associate Investigator, Center for Clinical Management Research
Staff Physician, Rheumatology
VA Ann Arbor Healthcare System
Assistant Professor, Division of Rheumatology
University of Michigan

Dr. Wallace

PainRelief.com: What is the background for this study?

Response: Arthritis and joint pain are common among older adults. We used data from the University of Michigan National Poll on Healthy Aging to understand how a national sample of older adults experiences and manages joint pain.

PainRelief.com: What are the main findings?

Response: Seventy percent of adults aged 50-80 report that they have joint pain. Three in five have a diagnosis of arthritis, including 30% who have a diagnosis of osteoarthritis (also called “wear and tear” or “bone on bone” arthritis).

Of those with joint pain, half said that it limited their usual activities, but about three in four said that they saw arthritis and joint pain as a normal part of aging that they could manage on their own.

More than half of all adults use over-the-counter pain relievers like non-steroidal anti-inflammatory drugs (Advil, Motrin, Aleve) for joint pain. One in ten used a prescription oral steroid, like prednisone. This is important because these medications can cause or worsen health conditions common in older people, such as high blood pressure and heart disease. More than a quarter of adults who used oral steroids for joint pain did not remember discussing the risks of these medications with their health care provider.

Ninety percent of those with joint pain used non-medication treatments, like exercise, massage, and splints and braces, to manage their symptoms. Most people who used these treatments found them to be very helpful.

University of Pittsburgh Study Finds Durable Pain Relief in Obese Patients Following Bariatric Surgery

PainRelief.com Interview with:
Wendy C. King, PhD
Epidemiology Data Center
School of Public Health
University of Pittsburgh
Pittsburgh, PA

Dr. King

PainRelief.com: What is the background for this study?

Response: Previous studies had provided evidence that bariatric surgical procedures are associated with improvements in pain, physical function and work productivity. However, most prior studies only followed participants 1-2 years, at which point participants were at the peak of their weight loss. 

Among a large cohort of US adults, we wanted to evaluate how much initial improvements in pain, physical function and work productivity declined during long-term follow-up, when some degree of weight regain is not uncommon. We limited our study to adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), the two most common bariatric surgical procedures done today.

Experimental Hydrogel Improved Chronic Pain from Degenerative Disc Disease

PainRelief.com Interview with:
Douglas P. Beall, MD, FSIR
Chief of Radiology Services
Clinical Radiology of Oklahoma

Dr. Bealll

PainRelief.com:  What is the background for this study? 

Response: Degenerative disc disease (DDD) is the leading cause of chronic low back pain and one of the world’s most common medical conditions contributing to high medical and disability costs. Healthy spinal discs act aids spine movement and distributes force which allows for spine flexibility and even distribution of the load that is placed on the spine. Each has a firm outer layer and a soft, jelly-like core. With normal aging, discs tend to become dry, thin, cracked or torn, which can cause pain and abnormal motion.

Substances called hydrogels, with biochemical similarities to the intervertebral disc designed to augment both the core and outer layer, have been used for years to help repair degenerated discs. First-generation hydrogels are placed as a soft solid, through a surgical incision, but were not simple to place and had a tendency to migrate from where they were originally placed.

For a first-in-human trial, our team conducted a prospective, single-arm feasibility study to evaluate an experimental, injectable hydrogel for safety and performance in relieving chronic low back pain caused by DDD. We used a second-generation hydrogel (Hydrafil™) developed by ReGelTec, Inc.. Unlike earlier hydrogels, it can be temporarily modified into a liquid and injected rather than placed through a small incision. In 2020, this product received FDA’s breakthrough device designation, allowing expedited review based on promising early evidence.

We recruited 20 patients, aged 22 to 69, who each described their pain as four or higher on a zero to 10 scale. None had found more than mild relief from non-surgical management, which includes rest, analgesics, physical therapy, and back braces. Patients were sedated for the procedure, and the gel was heated to become a thick liquid. Guided by fluoroscopic imaging, an interventional radiologist used a 17-gauge needle to inject the gel directly into the affected disc(s). The gel filled in cracks and tears and adhered to the disc’s core and outer layer.

Barriers to Implementation of Patient Education in Inflammatory Arthritis

PainRelief.com Interview with:
Mwidimi Ndosi PhD MSc BSc PGCert (Clin Ed) FHEA RN 
Sarah Bennet and Beth Jones
Associate Professor in Rheumatology Nursing
University of the West of England, Bristol  
Honorary Researcher
University Hospitals Bristol and Weston NHS Trust  

Dr. Ndosi

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Patient education is seen as an essential part of managing long-term conditions like inflammatory arthritis. Chronic inflammatory arthritis includes rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. We define patient education as a planned interactive learning process designed to support and enable people to manage their life with a disease and optimise their health and wellbeing.[1]

There are variations across Europe in the way patient education is delivered to people with inflammatory arthritis. In 2015, an international group of professionals and patients with inflammatory arthritis developed evidence-based recommendations for patient education [1]. This initiative was supported by the European Alliance of Associations for Rheumatology (EULAR), an organisation representing people with arthritis, health professionals in rheumatology and scientific societies of rheumatology in Europe.

In this study, we wanted to find out whether the recommendations were acceptable to patients and healthcare professionals. We also needed to know what helped people to follow these recommendations and what were barriers to putting them into practice. We surveyed health professionals in 20 countries in Europe, and 3 in Asia (India, Hong Kong and Japan) [2]

Cooled Radiofrequency Ablation for Pain Relief After Total Knee Replacement

PainRelief.com Interview with:

Felix Gonzalez, M.D.
Assistant professor, Division of Musculoskeletal Imaging
Department of Radiology and Imaging Scienc
Emory University School of Medicine
Atlanta, Georgia

Dr. Gonzalez

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Total knee arthroplasty is a common procedure performed worldwide for the treatment of symptomatic knee arthritis. Unfortunately, approximately 20% of those patients develop chronic pain after the surgical intervention in the setting of no complications such as infection or hardware loosening. The reason for this is not known at this point although theories exist.

The new study focused on 21 patients who were experiencing persistent chronic pain after total knee replacement, without underlying hardware complications. The patients had all failed conservative care. They filled out clinically validated questionnaires to assess pain severity, stiffness, functional activities of daily living and use of pain medication before and after the procedure. Follow-up outcome scores were collected up to one year after the C-RFA procedure.

In the end, the study found, patients with knee arthritis reported an 70% drop in their pain ratings approximately, on average.

Study Compares PRP to Placebo For Pain Relief in Knee Arthritis

PainRelief.com Interview with:

Professor Kim Bennell FAHM
Barry Distinguished Professor | NHMRC Leadership Fellow
Dame Kate Campbell Fellow
Centre for Health Exercise and Sports Medicine
Department of Physiotherapy
Melbourne School of Health Sciences
The University of Melbourne, Victoria Australia

Prof. Bennell

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis is a common chronic painful joint condition with no cure that often leads to costly joint replacement surgery. Treatments are needed that can not only reduce symptoms but also slow structural progression of the disease in order to reduce the burden of knee OA.  There are no approved disease-modifying treatments available at present. 

Platelet-rich plasma (PRP) injections have become a widely used treatment for knee osteoarthritis (OA) in recent years despite the fact that the evidence to support their effects is limited and not of high quality. For this reason, clinical guidelines currently do not recommend PRP for the management of knee osteoarthritis.

To address this gap in knowledge, our study aimed to compare the effectiveness of PRP injections to reduce knee pain and slow loss of medial tibial cartilage volume over a 12-month period. We did this by conducting a clinical trial of 288 people with mild to moderate knee OA. The study included a placebo group where participants were injected with saline into the knee. Participants and the injecting doctors were blind as to whether PRP or saline was injected into the knee.

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Caution Should Be Taken with Hip Steroid Injections For Arthritis Pain Relief

PainRelief.com Interview with:
Kanu M. Okike, MD
Orthopedic Surgeon
The Hawaii Permanente Medical Group

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Hip corticosteroid injections are a common treatment for osteoarthritis and other hip conditions.  Recently, isolated case reports have raised the question of whether hip corticosteroid injections could be associated with rapid progression of the arthritis process – a condition known as rapidly destructive hip disease (RDHD).

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Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

PainRelief.com:  What is the background for this study?

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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Synovial Stem Cells Injected into Knee Repaired Meniscus without Tumor Formation

PainRelief.com Interview with:
Mitsuru Mizuno, DVM, Ph.D.
Assistant professor at CSCRM,
Principal investigator for this study
and Ichiro Sekiya, M.D., Ph.D..

PainRelief.com:  What is the background for this study?  What are the main findings? How are the stem cells obtained?

Response: We have developed a cell therapy for treating difficult-to-heal meniscus injury using mesenchymal stem cells (MSCs) derived from the synovium of the knee. However, trisomy 7 is often found in synovial cells obtained from patients with osteoarthritis, a disease that occurs with aging.

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