Clinical trials reveal the best shoes to manage osteoarthritis pain

From independent.co.uk 

Kade Paterson The Conversation & Rana Hinman

• New research challenges the common belief that stable, supportive shoes are always the best option for people with osteoarthritis.
• A recent clinical trial found that for hip osteoarthritis, flat flexible shoes were no more effective than stable supportive shoes in reducing pain.

• People with hip and knee osteoarthritis are advised to wear “appropriate footwear” to minimise their pain.

  Does that mean heels are out? Does it matter if you wear runners or something a little stiffer? How about using insoles?

  Our research, including our latest clinical trial published today in Annals of Internal Medicine, provides some answers.

• We show that stable, more supportive shoes aren’t necessarily the best option, despite what you might have heard.

  What is osteoarthritis?

  Osteoarthritis is a condition that affects the tissues in and around a joint, including bone, cartilage, ligaments and muscles. It is more common in older people, and people with excess body weight. It causes joint pain and stiffness, and can lead to disability.

• About 2.35 million Australians have osteoarthritis and this number is predicted to increase as the population ages and obesity rates rise.

  

  Osteoarthritis is a condition that affects the tissues in and around a joint (PA)

  Osteoarthritis commonly affects the hip and knee joints, making it difficult to walk. There is no cure, so self-management is important.

  That includes wearing the right type of shoes.

  How can shoes affect symptoms?

  There are many causes of osteoarthritis, but excessive force inside the joint when someone is walking is thought to play a role. Excessive joint forces can also increase the chance of osteoarthritis worsening over time.

• Shoes are our connection to the ground and can influence how forces are transmitted up the leg during every step. Some shoe features are particularly important.

  Shoes with higher heels increase joint forces. For example, shoes with six-centimetre heels increase knee forces by an average 23% compared to walking barefoot.

• Some shoes come with supportive features, such as insoles that support the arches. Other supportive features include being made with a stiffer material in the sole or heel.

  Many people, and clinicians, think these stable and supportive shoe features are best for people with osteoarthritis.

  But biomechanical research shows shoes with these supportive features actually increase knee force by up to 15% compared to shoes without them. Arch-supporting insoles also increase knee force by up to 6% when added to shoes.

  So, are flatter, flexible shoes without stable supportive features – such as ballet flats – better for knee and hip osteoarthritis?

  Not necessarily. We also need to look at people’s pain.

  What we found

  Our biomechanical research from 2017 in people with knee osteoarthritis showed flat flexible shoes reduced knee forces by an average 9% compared to stable supportive shoe styles.

  This suggests flat flexible shoes could be better for osteoarthritis. To find out, we conducted two clinical trials to look at people’s pain levels.

  Our new clinical trial involved 120 people with hip osteoarthritis.

  They were randomised to wear different types of flat flexible shoes, such as flexible ballet flats, or different types of stable supportive shoes, such as supportive runners. People were asked to wear their shoes for at least six hours a day. After six months we measured the change in hip pain when they walked.

• We found that flat flexible shoes were no better than stable supportive shoes for reducing hip pain.

  These findings differ to those from our 2021 clinical trial in 164 people with knee osteoarthritis. In that trial, we found wearing stable supportive shoes for six months reduced knee pain when walking by an average 63% more than wearing flat flexible shoes.

  It’s unclear why findings differed between the knee and hip. But it might be because joint forces are higher in knee compared to hip osteoarthritis, and so there may be greater potential for stable supportive shoes to reduce knee forces, and therefore knee pain.

  In both trials, more complications, such as foot pain, were reported by people who wore flat flexible shoes. This might be because these shoe styles provide less protection for the feet.

  So which shoes should I wear?

  For people with knee osteoarthritis, stable, supportive shoes are likely to be more beneficial than flat, flexible ones.

  For people with hip osteoarthritis, neither shoe type is better than the other for improving hip pain.

  But for all older people – including those with hip and knee osteoarthritis – it is sensible to avoid ill-fitting shoes, as well as shoes with high or narrow heels, due to an increased risk of falls.

  For younger people with knee or hip osteoarthritis but who are not at risk of falls, it may still be advisable to avoid high heels given their potential to increase joint forces.

• Who should you talk to?

  If you are concerned about your hip or knee osteoarthritis, talk to your GP or other health-care provider, such as a podiatrist or physiotherapist.

  Other non-surgical treatments, such as exercise, weight management, nutrition and some pain medicines can help.

• https://www.independent.co.uk/life-style/arthritis-best-shoes-knee-osteoarthritis-b2926484.html
  

Psoriatic Arthritis: Hand Strength, Dexterity, and Fine Motor Control

From everydayhealth.com

If you have psoriatic arthritis (PsA), you may be familiar with sore fingers, stiff wrists, and the frustration of struggling with formerly simple tasks like buttoning a shirt or chopping vegetables. Psoriatic arthritis is an inflammatory form of arthritis that causes painful, swollen joints. It frequently affects the hands.

When PsA impacts your hands, this can reduce strength, dexterity, and fine motor skills, all of which can interfere with your daily life.

“In severe cases, it may be almost impossible to open and close the hand or make a fist,” says Norman Gaylis, MD, a rheumatologist and board member of the American College of Rheumatology in Miami. “This drastically reduces the quality of life when people are unable to complete household chores, pursue hobbies they enjoy, or take care of their daily hygiene needs because they are unable to use their hands.”

How PsA Takes a Toll on Hand Function

In the most basic terms, psoriatic arthritis affects hand function through chronic inflammation. This can degrade cartilage and bone over time.

These are the ways that PsA can change your hands:

• Reduced Strength and Muscle Atrophy When your hands are painful, swollen, or stiff, you might use them less. This can lead to a loss of strength and muscle mass.
• Stiffness Inflammation from psoriatic arthritis can make your hands feel stiff. This is due to synovitis (inflammation of the joint capsule) and enthesitis (inflammation where your tendons and ligaments attach to your bones).
• Difficulty Gripping Grip strength decreases as the severity of psoriatic arthritis increases. This affects the ability to both grasp an object with your whole hand, like when you pick up a water bottle, and pick up small items with your thumb and index finger.
• Swelling Psoriatic arthritis can cause severe swelling in the fingers, called dactylitis. You might also hear this called “sausage fingers.”
• Nail Changes Up to 80 percent of people with PsA experience changes in their fingernails. “With some patients, nails start to look broken, become brittle, and even separate from the nail bed,” says Dr. Gaylis. Not only can this feel embarrassing but it can be painful and make it difficult to use the tips of your fingers (like you do when typing on a computer or phone).
• Deformities Actual deformities in the hands are rare these days, thanks to better treatment. However, they can still develop if psoriatic arthritis isn’t treated. “In the most severe cases, arthritis mutilans develops and dissolves tissue and bones in the fingers,” says Gaylis. This occurs in about 5 percent of psoriatic arthritis cases.
• Loss of Fine Motor Skills Hand swelling, pain, and stiffness can all make it challenging to perform tasks that require precision, dexterity, and coordination. You might find it increasingly difficult to manipulate small objects like zippers or buttons.

All these symptoms add up to real difficulty completing functional tasks in your everyday life.

Who Can Help Restore Hand Function

There are a few health professionals you can reach out to if psoriatic arthritis is affecting your hands. The primary ones are rheumatologists and certified hand therapists (CHTs).

Rheumatologists are doctors who specialize in autoimmune diseases and inflammatory diseases that affect the joints, bones, and muscles. If you’re diagnosed with PsA, you’ve most likely already seen a rheumatologist.

“Fortunately, rheumatologists can treat psoriatic arthritis with many new biologics and medicines that are very effective,” says Gaylis. These medications help manage inflammation and swelling from psoriatic arthritis, which can noticeably improve hand function.

CHTs are also an essential part of the team for anyone with psoriatic arthritis affecting their hands. These health professionals can either be occupational therapists or physical therapists who’ve gone through extra training to specialize in treating hand conditions like psoriatic arthritis.

A CHT will assess your mobility and function and give you tailored treatment that might include splints, exercises, and assistive devices. You can ask your doctor to refer you to a CHT, or depending on your health insurance, you may be able to make your own appointment.

Strategies to Improve Strength and Control

We use our hands constantly, from turning on the tap at a sink to sliding a credit card out of a wallet. Bringing back strength and control to your hands can improve your quality of life.

Therapeutic Exercises

Therapeutic exercises can reduce pain and improve coordination, strength, and function. Common exercises for PsA include the following:

• Isometric Exercises These are static exercises during which your muscles stay the same length. “Isometric exercises are safer for the arthritic hand to perform because the joints are not moving,” says Kristin Valdes, a certified hand therapist and professor at Touro University Nevada, in Henderson, Nevada. In this type of exercise, you squeeze an immovable object, and your joints are supported by the object you’re holding. Valdes suggests squeezing a firm racquetball or tennis ball to improve grip strength.
• Passive Range of Motion With psoriatic arthritis, the fingers can flex (or “claw” inward) over time as the skin contracts. Anyone experiencing this “should use the other hand or pull their fingertips over the edge of the table to try to straighten out the fingers daily,” says Valdes.
• Tendon Gliding This set of exercises encourages smooth movement of your finger tendons within their sheath.

Be cautious when starting hand exercises with psoriatic arthritis. “If treatment is too aggressive, it can increase hand pain and cause skin breakdown,” says Valdes.

Consider seeing a CHT for a personalized program of exercises, since everyone’s psoriatic arthritis is different.

Assistive Tools

When your wrist is sore, twisting open a jar can be very painful. And when your fingers are stiff, it can feel near impossible to pick up small items. Assistive devices can help you achieve these everyday tasks with less effort and therefore less pain.

Assistive devices for psoriatic arthritis include these examples:

• Wide-grip pens or utensils
• Electronic jar or can openers
• Ergonomic kitchen tools
• Button hooks
• Elastic shoelaces
• Electric toothbrushes
• Gripping materials (to hold a mixing bowl in place, for example, or grip a lid)
• Tap turners or lever handles (to avoid twisting)
• Tongs
• Adaptive cutting boards
• Motion sensor dish soap or shampoo dispensers

Orthoses

For those seeing a hand therapist for treatment, “The therapist can also fabricate a custom orthosis to rest the joints,” says Valdes. This might look like a ring to keep your finger joint straight or a brace that wraps around your thumb.

You can also get premade orthoses like wrist splints online or in pharmacies, but talk to your hand therapist or doctor first to ensure that you’re getting the right one.

Joint Protection and Skin Protection

Joint protection techniques, which are usually taught by a CHT, are ways to perform daily tasks so that less stress is applied to your joints. The following techniques are common:

• Practice the large joint rule. Use larger and stronger joints for tasks instead of smaller ones. Valdes gives the examples of pushing instead of pulling, carrying bags with your forearm instead of hands, and using a shoulder bag rather than a handbag.
• Limit repetitive hand movements. For example, use an electric can opener instead of a hand-operated one. You can still knit or do hobbies involving your hands, but Valdes recommends limiting these to no more than 30 minutes at a time.
• Use a light grip. “Try not to grip so forcefully that the hand fatigues easily,” says Valdes. One way to achieve this is to bulk up the handles of tools or utensils. For example, when cooking, wrap a potholder around a pot handle to make it larger; that reduces the pressure on your hand.
• Don’t forget skin protection. Applying cream to tight skin can help protect both the skin and joints.

Heat and Cold Therapy: Using Paraffin Baths for Stiffness vs. Ice for Acute Inflammation

If your fingers are swollen, try cold therapy with a cold cloth or ice pack. This can help reduce inflammation in the affected joints.

Heat therapy can’t bring down acute inflammation, but it can provide pain relief. If your hands are stiff or painful, consider applying a warm cloth or heating pad.

Warm paraffin, or wax, baths, which a CHT can perform, can also be soothing. A hand therapist might do this to loosen up your joints before exercising them. However, you’ll want to avoid paraffin baths if you have any open cuts or inflamed skin on your hands.

Lifestyle and Daily Habits

Breaking tasks into smaller, more manageable steps can help you conserve energy and manage pain. Be sure to take frequent breaks to rest your hands. “For example, when making a meal, break up cutting or chopping tasks throughout the day,” says Valdes.

You’ll also want to make a daily habit out of your therapeutic exercises, particularly stretching and range of motion exercises. However, avoid strengthening exercises when your hands are painful, says Valdes.

Overall, do your best to maintain an active lifestyle and keep up with the activities that bring you joy and meaning. You can also try new hobbies that don’t tax your hands as much, such as singing, line dancing, learning a language, or hiking.

If you’re struggling with hand pain or stiffness, talk to your rheumatologist or CHT. Your rheumatologist may adjust your medication, and your CHT can strategize personalized solutions, whether that’s a new hand splint or exercise program.

The Takeaway

• A rheumatologist can help you manage psoriatic arthritis hand symptoms with newer biologics and medications that control inflammation.
• Certified hand therapists can tailor exercises to your specific hand symptoms, recommend assistive tools, and educate you on joint protection to preserve and restore hand function.
• Therapeutic hand exercises can help enhance grip strength, dexterity, and control for performing daily tasks.

https://www.everydayhealth.com/rheumatic-conditions/psoriatic-arthritis-hand-strength-and-dexterity/

Workplace Air May Up Your Risk for Rheumatoid Arthritis

From healthcentral.com 

New research says exposure to certain inhalants could increase the odds of autoimmune conditions

You might not suspect that the air you breathe in could affect your joints or your immune system. But inhaling dust, fumes, and chemical vapours on the job may impact your health in ways far beyond irritating your lungs or causing respiratory issues. Breathing in bad air could also raise your risk of developing rheumatoid arthritis (RA), new research suggests.

A large research review recently published in Arthritis & Rheumatology found that people whose jobs expose them to certain occupational inhalants are at significantly higher risk of developing RA compared to people who aren’t regularly exposed. This new study adds to the growing pile of evidence that inhaling certain substances into the lungs—including silica, asbestos, solvents, pesticides, animal dust, and engine exhaust—may play a key role in triggering RA and other autoimmune diseases.

An Emerging Picture of RA Risk

Scientists don’t fully understand why only some people develop RA, an autoimmune disease in which the immune system attacks the body’s own joints—leading to inflammation, pain, stiffness, and joint damage over time. They do know it involves a combination of genetic, environmental, and lifestyle risk factors, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD).

One known risk factor for RA is smoking, according to NIAMSD. This suggests a lung-joint connection that has led researchers to investigate whether breathing in other kinds of harmful particles could also help trigger RA. “There are theories that things we inhale, either work-related or pollution-related, or with smoking cigarettes, may prompt an immune reaction,” says Julianna Desmarais, M.D., an associate professor of medicine in the division of arthritis and rheumatic diseases at the Oregon Health & Science University School of Medicine in Portland, OR.

Some studies have previously suggested a link between RA and breathing in certain types of dust and chemicals—with the most evidence for silica, commonly released into the air in industries like construction and mining. But the results haven’t been conclusive. For this paper, researchers wanted to evaluate the existing body of evidence on a variety of workplace inhalants to get a clear picture of whether they are truly a significant environmental risk factor for RA.

A Clear Signal in the Data

“Our study pulled together decades of global research,” says genetic epidemiologist and study co-author Xia Jiang, Ph.D, an assistant professor in the department of clinical neuroscience at the Karolinska Institute in Stockholm, Sweden, and full professor of epidemiology at the West China School of Public Health at Sichuan University in Chengdu.

The team systematically reviewed 31 studies in total and analysed data pooled from 25 different studies to look at how being exposed to 10 different types of chemicals impacted RA risk. Some of the studies were cohorts (meaning they followed people over time to see who developed RA), while others were case-control studies (comparing inhalant exposures among people with and without RA). The authors also accounted for other known risk factors, like smoking and age.

The results were clear. The review “found strong evidence that breathing in certain dusts and chemicals at work increases a person’s risk of developing rheumatoid arthritis,” says Dr. Jiang.

For seven of the 10 inhalants researchers looked at, there was a significant effect—increasing somebody’s risk of RA anywhere from 20% to 49%, depending on the substance:

• Fertilizer: 49% higher risk

• Engine exhaust: 45% higher risk

• Asbestos: 39% higher risk

• Silica: 36% higher risk

• Pesticides: 32% higher risk

• Solvents: 24% higher risk

• Animal dust: 20% higher risk

For many of these agents, there appeared to be a dose effect—meaning that a longer duration or higher intensity of exposure correlated with a greater increase in RA risk. (But the authors note that exposure measurement varied widely across studies).

What surprised the researchers was the variety of inhalants linked to RA. “We expected silica and asbestos to show an effect,” Dr. Jiang says, but “the strength of the connection for some less-studied exposures was striking.” This means that working in industries we might not traditionally think of as particularly dusty or high-risk—like farming and transportation—may increase RA risk, Dr. Jiang explains.

The researchers also identified 25 other inhalants that were associated with an increased risk for RA (such as fungicides, carbon monoxide, welding fumes, and pulp or paper dust). But there weren’t enough studies to include these substances in the analysis.

                                                                                            GettyImages/skynesher

How Inhalants Might Trigger RA

How could what’s going on in your lungs end up affecting your joints? Scientists think that the lungs may act as a sort of gateway where autoimmune disease begins. “The lung interacts with the outside world in a unique way,” Dr. Desmarais says. Inflammatory dusts and vapours “may lead to an immune reaction that starts in the lungs, but later causes symptoms elsewhere, such as the joints,” Dr. Desmarais says.

“It’s a case of the immune system ‘misfiring’ after being repeatedly triggered in the airways,” Dr. Jiang elaborates. “When you inhale irritating particles, they can cause mild, ongoing inflammation in the lung. In some people, this may confuse the immune system, causing it to attack the body’s own tissues—like the joints—instead of just dealing with the dust.” This may be more likely to happen in people who are already genetically predisposed to RA, Dr. Desmarais adds.

There’s a decent chance that this same process could play a role in other autoimmune diseases. “We already know that smoking is a risk factor for lupus, multiple sclerosis, myositis, and scleroderma,” Dr. Jiang points out. “If inhaled substances can disrupt immune regulation and trigger one autoimmune disease like RA…[they] may provide risk also for these other autoimmune diseases.”

Looking Ahead

Experts would like to see more research into what “dose” of exposure seems to trigger immune responses that lead to RA or other autoimmune diseases. “We need to understand how much and how long exposure is needed to increase risk. Is there a threshold?” says Dr. Jiang. Another big question is how breathing in more than one of these substances could impact RA risk, Dr. Desmarais says, given that people often encounter several dusts or chemicals at once in their workplace.

Researchers also hope to learn how different populations might be affected differently. Future studies could look into whether this exposure threshold varies based on the age or ethnicity of the patient, Dr. Desmarais says—as well as sex, adds Dr. Jiang. “And we need to know how [inhalant exposure] interacts with genetics and lifestyle factors, like smoking,” Dr. Jiang says.

Ultimately, the research into the effects of workplace inhalants will likely expand beyond rheumatoid arthritis—and potentially help answer bigger questions about autoimmunity. “The exposures that we found to be risk factors for RA should also be investigated in other autoimmune diseases,” Dr. Jiang says. And if that turns out to be the case, “workplace air quality might be a broader health concern than previously recognized,” Dr. Jiang says.

https://www.healthcentral.com/news/rheumatoid-arthritis/workplace-air-and-rheumatoid-arthritis-risk

Can Psoriatic Arthritis Cause Hair Loss?

From everydayhealth.com

Psoriatic arthritis (PsA) is an autoimmune disease that causes inflammation of the joints, tendons, and nails. It usually occurs in people with psoriasis, an inflammatory condition causing rashes on the skin.

Symptoms can include joint pain, swelling, stiffness, and fatigue. Hair loss (alopecia) isn’t typically a sign of the disease, but it can affect some people with PsA in a roundabout way. 

“Psoriatic arthritis and hair loss are not directly linked,” explains Jennifer E. Yeh, MD, PhD, a clinical assistant professor of dermatology at Stanford University School of Medicine in California. “However, having psoriatic arthritis may predispose one to hair loss from psoriatic arthritis inflammation, from psoriatic arthritis treatment, or from an increased likelihood of having another type of autoimmune condition.” 

Physical or Psychological Stress Can Lead to Hair Loss

Psoriatic arthritis can significantly impact your emotional well-being, leading to anxiety, depression, diminished self-esteem — and particularly, stress. Chronic stress can worsen inflammation and immune dysregulation, leading to increased disease activity and more severe symptoms. Researchers note that stress may also disrupt neuroendocrine pathways, affecting cortisol levels and further dysregulating the immune system in PsA. According to the American Academy of Dermatology, stress is linked to hair loss and thinning hair.

Dr. Yeh says that both the physical and psychological stress associated with PsA can trigger a temporary type of hair loss called telogen effluvium. 

With telogen effluvium, more hairs than normal are forced into their resting phase. When this happens, they fall out at once. Most people lose about 100 strands of hair a day. But if you have telogen effluvium, you may lose up to 300 strands a day.

“While telogen effluvium is characterized by an increase in daily hair shedding, it usually reverses, and hair regrows once the underlying stressor is removed,” Yeh says.

                                                             iStock

Medications for PsA May Cause Thinning Hair

Treatments for PsA can contribute to hair loss. Some common culprits are: 

• Methotrexate It stops cells from growing — including hair follicles. About 1 to 3 percent of people who use it experience hair loss.
• Leflunomide This medicine works like methotrexate and causes hair loss in about 10 percent of people.
• Anti-TNF Therapy Research has shown that “a sizable minority” of people on TNF inhibitors develop alopecia areata, the most common inflammatory hair loss disease, at a higher prevalence than the general population, though it’s not clear why this happens.

“Treatment-related alopecia typically improves with discontinuation of the offending medicine,” says Yeh.

Comorbid Psoriasis and Hair Loss

Most, but not all, people with PsA also have psoriasis. And, if you have psoriasis, you have a 45 to 56 percent chance of developing scalp psoriasis.

Scalp psoriasis causes a dry, itchy, and inflamed scalp. “Scalp psoriasis that is not controlled irritates the hair follicles, disrupting normal hair follicle function, and thereby causing hair shedding,” says Yeh. 

If you scratch or pick at the lesions, you can also damage hair follicles. This can result in additional hair loss.

The good news is that hair loss due to scalp psoriasis is usually temporary. “Most cases show complete hair regrowth after treatment,” says Yeh.

If you have severe psoriasis plaques, you should be aware that the oral medication acitretin, occasionally used to treat persistent psoriasis, can cause hair loss.

What to Do About Hair Loss

If you have PsA and experience hair loss, talk to your doctor. If you’re not already seeing a dermatologist to manage your condition, your rheumatologist can refer you to one who may be able to determine the underlying cause of your hair loss.

Getting your symptoms under control can also help preserve your hair. “Hair loss from uncontrolled PsA reverses once the inflammation is well-controlled,” says Yeh. “It’s critical to treat concomitant scalp psoriasis so that local inflammation surrounding hair follicles on the scalp does not contribute to increased hair shedding.”

Here are some ways you can help prevent hair loss caused by scalp psoriasis.

• Try not to touch, pick, or scratch your scalp.
• Keep your fingernails short.
• Be gentle when brushing, combing, washing, or drying your hair.
• Wear a hat when you’re outside.
• Use a medicated shampoo that contains salicylic acid and follow with a moisturizing conditioner. 
• Don’t take extremely hot showers.
• Ask your doctor about a prescription treatment that can help your symptoms.
• Avoid blow-drying your hair. If you do, use a low-heat setting.
• Try to keep stress levels low.
• Follow a healthy diet.
• Avoid heavy drinking.

While hair loss associated with PsA can be frustrating, the right treatments and lifestyle habits can help you minimize shedding — and protect the hair you have.

The Takeaway

• If you have psoriatic arthritis and you’re experiencing hair loss, consult your doctor to determine the underlying cause and effective treatment strategies.
• Medications such as methotrexate and leflunomide, commonly used to manage PsA, might contribute to hair thinning, so discuss potential side effects with your healthcare provider to explore any necessary adjustments.
• Emotional and physical stress linked to PsA can cause temporary hair loss; reducing stress levels and effectively managing the disease can lead to regrowth and a healthier scalp condition.
• If you’re dealing with scalp psoriasis, measures such as medicated shampoos and avoiding scalp irritation can prevent additional hair loss and support recovery.

https://www.everydayhealth.com/rheumatic-conditions/can-psoriatic-arthritis-cause-hair-loss/