Golf is acknowledged as a sport allowing players to blow off steam and enjoy the outdoors, but a new study led by the University of South Australia shows it may also have significant benefits for people with chronic disease osteoarthritis.

UniSA researcher Dr Brad Stenner from the Alliance for Research in Exercise, Nutrition and Activity (ARENA) and a team of academics from Australia and the UK found that golfers with the degenerative condition experience lower psychological distress and better general health compared to the general population.

The same was found with golfers without osteoarthritis.

The findings are reported in the Journal of Science and Medicine in Sport.

Osteoarthritis affects more than two million Australians who suffer joint pain and stiffness most commonly in their hands, neck, lower back, knees, or hips, contributing to a lower likelihood of meeting physical exercise guidelines.

Osteoarthritis is the most common form of arthritis, the leading cause of chronic pain and the second most common cause of disability.

In a survey of 459 golfers with osteoarthritis more than 90% of participants rated their health as good, very good or excellent, compared to just 64% of the general population with the condition.

Almost three times as many non-golfers (22%) reported high to very high levels of psychological distress compared to golfers with osteoarthritis (8%).

Dr Stenner, a lecturer and occupational therapist, says regular golfers are kept active due to the amount of walking required and they can also experience a range of social benefits.

“People who play golf are often walking 8-10km per round and, as such, are regularly meeting or exceeding recommended physical activity guidelines, which is known to reduce the risk of cardiovascular disease, diabetes, obesity and improve metabolic and respiratory health,” he says.

“There are also significant benefits to mental health and wellbeing.

“Our research has highlighted the important role that golf has in building friendships, contributing to community, and bringing a sense of belonging, all of which are known to contribute to mental health and wellbeing.”

Staying active and exercising regularly is one of the most important aspects of managing osteoarthritis.

“Lower impact activity such as golf can assist in maintaining activity whereas higher impact activities such as running, jogging and gym may place significant stress on the joints, contributing to increased symptoms and pain,” Dr Stenner says.

“There is a growing body of evidence that golf reduces the risk of many chronic conditions such as obesity, diabetes, and cardiovascular disease, and may contribute to the management of these illnesses, which in turn may lower the longer term health and medical costs.

“From a mental health point of view, playing golf is associated with improved wellbeing and lower levels of psychological distress, and this is an important consideration for older adults.”

Dr Stenner says there is a gap in the known literature on the topic despite it being one of the most popular sporting activities for older adults.

“Very little is known about the relationship between golf and health and there is so much more we need to find out,” he says.

A study by Swansea University has revealed how machine learning can help early detect Ankylosing Spondylitis (AS) inflammatory arthritis and revolutionise how people are detected and diagnosed by their GPs.

Published in the open-access journal PLOS ONE, the study, funded by UCB Pharma and Health and Care Research Wales, has been carried out by data analysts and researchers from the National Centre for Population Health & Wellbeing Research (NCPHWR).

The team used machine learning methods to develop a profile of the characteristics of people likely to be diagnosed with AS, the second most common cause of inflammatory arthritis. 

Machine learning, a type of artificial intelligence, is a method of data analysis that automates model building to improve performance and accuracy. Its algorithms build a model based on sample data to make predictions or decisions without being explicitly programmed to do so.

Using the Secure Anonymised Information Linkage (SAIL) Databank based at Swansea University Medical School, a national data repository allowing anonymised person-based data linkage across datasets, patients with AS were identified and matched with those with no record of a condition diagnosis.

The data was analysed separately for men and women, with a model developed using feature/variable selection and principal component analysis to build decision trees.

The findings revealed:

• In men, lower back pain, uveitis (inflammation of the eye’s middle layer), and non-steroidal anti-inflammatory drug (NSAID) use under age 20 are associated with AS development.
• Women showed an older age of symptom presentation compared to men with back pain and multiple pain relief medications.
• The test data had a good prediction rate of around 70%-80%; however, when applying the model to a general population, the team felt multiple models might be needed to narrow down the population over time to improve the predictive value and reduce the time to diagnose AS.

Sandra Purdy, lives with ankylosing spondylitis, a type of arthritis in which the spine and other body areas become inflamed. CREDIT Sandra Purdy

The typical person living with arthritis in the UK is 20% less likely to be in work than their equivalent without the condition, new research shows.

And the most striking finding was that non-university-educated women aged 60-plus are at least 37% less likely to be in work if they have arthritis compared to matched individuals without the condition.

The study, published today by the University of Leeds, matched a group of 18,000 people with arthritis to another group of 18,000 who were the most similar to the first group regarding various characteristics but had not been diagnosed with arthritis. These characteristics included age, gender, level of education, ethnicity and where they lived.

The research shows significant differences in how arthritis affects people’s working lives, depending on their age, level of education and gender.

The team is now suggesting that workplaces provide more support for people living with the condition, so they can keep working as long as they wish.

Principal Investigator Dr Adam Martin, Associate Professor in Health Economics at the University of Leeds’ School of Medicine, said:

“We already know that arthritis is more common amongst women and people from lower socio-economic backgrounds. Our new findings show that substantial inequalities also exist in terms of how the work outcomes of these groups are affected by arthritis.

 “Government and employers should consider how interventions in workplaces could better support people living with arthritis and improve their health and employment prospects, whilst also potentially tackling inequalities and address the need to support people in their 50s and 60s to stay in work for longer if they want to.

“Given the increasing prevalence of arthritis and the trend towards older retirement ages, this need for better support represents a substantial and growing challenge for society.”

Deborah Alsina MBE, Chief Executive of Versus Arthritis, said:
“This is a vital and important study and reinforces what we have heard from people with arthritis about how the condition robs them of their health, independence, and careers.

“We know work matters to people with arthritis, benefitting health and wellbeing as well as their finances, yet this evidence demonstrates how arthritis is truly an unfair and unequal condition.

“We as a country need to tackle these health inequalities. Arthritis should no longer disproportionately and unfairly impact women and those less well served in our society, potentially driving millions into disability and unemployment.”

Patient experience

Sandra Purdy, 61, from Churwell in Leeds, had to retrain due to chronic pain caused by ankylosing spondylitis, a type of arthritis in which the spine and other body areas become inflamed.

She said: “I had problems with pain since my late teens and was misdiagnosed several times.

“When I was younger, I had manual jobs, but the pain meant I often couldn’t work. There’s a stigma in saying you have back pain at work, so I tried to hide it, but it got more difficult as the pain worsened.

“Eventually, I started looking for an office job which I thought would be more manageable. I got a job in a bank but sitting down all day was worse. Due to morning stiffness, I needed to get up at 4.30 am to be ready for 7.30 am. I needed crutches and sticks to walk at the start of the day. I wouldn’t need them by the end of the day, so I’d worry that people thought I was making it up. But during a bad flare-up, the pain would last all day, and I couldn’t move.

“When I was 45, I developed iritis, a painful eye condition which causes swelling and irritation in the iris. I was referred to a rheumatologist and had an MRI scan, and they diagnosed me with ankylosing spondylitis.

“I took part in a trial for a drug called infliximab, which was liquid gold. It changed my life – but at the end of the trial, I had a severe flare-up. Because of this, I was moved onto a drug called adalimumab, which I still take now. However, it lowers my immune system, so I pick up many bugs.

“I found a new job with a more understanding employer, where I could move about during the day. I now have a management role so I’m less customer-facing and can work from home.

“I hear a lot of people at my hospital patient participation group talking about how they have been treated and their employers aren’t great.

“I have always worried about losing my job, especially at first. I left school with no qualifications, so I had to sit exams in English and maths to get work in an office. I’ve had to adapt, but not everyone can do this.

“Patients need better access to diagnostics, and more joined-up thinking between employers and the health service.”

Research findings

The Nuffield Foundation-funded research used two decades of data about people aged 18-80. The team compared 18,000 people with arthritis to 18,000 people without the condition to better understand how it affects people’s lives.

The study showed that as people with arthritis reach middle age, their likelihood of being in work diminishes at a faster rate than those who do not have the condition. Many of these will have taken early retirement. This effect is more pronounced for people without a university-level education, possibly as symptoms may be easier to manage in professional jobs than in manual roles.

And once both men and women reach 60, their chances of being in work when living with arthritis are markedly more reduced compared to people without the condition.

The chart below shows the percentage reduction in the likelihood of being in work for each group compared to their counterparts without arthritis.

Age:	30	40	50	60
Men with a degree	6.3%	2.0%	2.0%	14.1%
Men without a degree	12.6%	5.3%	5.3%	25.0%
Women with a degree	12.8%	5.3%	5.3%	25.4%
Women without a degree	24.3%	14.0%	12.6%	37.2%

People with a history of working in routine (such as lorry drivers or bar staff) and intermediate (such as paramedics or bank staff) occupational groups were also much less likely to work if they had arthritis. However, this was not the case for people in professional work (such as lawyers or architects). For them, arthritis did not seem to affect the likelihood of being in work, although some people with arthritis in this group did work fewer hours and had lower earnings if they had arthritis. This was especially true for working women aged over 40.

Among people living with arthritis, those with a history of working at small private companies were also generally less likely to be in work than people with arthritis who had worked in larger companies or the public sector. The team’s discussions with people living with arthritis indicated that this might be due to smaller firms having fewer resources available or less scope for them to adjust work patterns or take on alternative roles.

Dr Martin said: “In light of this research, people with arthritis told us that potential interventions could involve making appropriate adjustments to the working environment, tackling workplace discrimination and supporting changes in people’s roles.

“Existing evidence suggests that providing personalised case management by an occupational health practitioner could help to encourage constructive dialogue between employees, healthcare practitioners and employers.

“Our study indicates that such support could be especially cost-effective if designed for and targeted for the people we identified who are most at risk of poor work outcomes.”

Notes to Editors
The 18,000 people aged 18-80 in the data who said they had been diagnosed with arthritis were collected between 2001 and 2019. This group was compared with 18,000 selected people from the same datasets who were similar in terms of age, gender, ethnicity, education level and where they live but who had not been diagnosed with the condition.

Using statistical models, comparisons were made between the two groups based on the likelihood that each individual had a job, what their earnings were and their weekly working hours. The team then looked at differences in age, gender, degree status, occupation (professional, administrative, technical or routine) and employer characteristics (size of the organisation; public or private sector).

The team expected that some people with arthritis might experience poorer work outcomes than those without the condition, such as job loss or slower career progression. Their study set out to determine how significant the differences in work outcomes were and if particular age groups or genders doing specific jobs were especially at risk.

The fat pad adjacent to the kneecap (Hoffa’s fat pad, infrapatellar fat pad) can change in signal on MRI when the knee is inflamed. (A) Normal knee without signs of inflammation. (B) Arrow pointing on a circumscribed area with higher signal (bright lines) in the area of the fat pad (normally dark), which is indicative of a beginning inflammatory reaction. (C) The whole fat pad has a higher signal (light grey color with white lines), which is a sign of progressive inflammation of the knee joint. CREDIT RSNA and Johanna Luitjens

Taking anti-inflammatory pain relievers like ibuprofen and naproxen for osteoarthritis may worsen inflammation in the knee joint over time, according to a new study being presented next week at the annual meeting of the Radiological Society of North America (RSNA).

Osteoarthritis is the most common form of arthritis, affecting more than 32 million adults in the U.S. and more than 500 million people worldwide. It occurs most frequently in the hands, hips and knees. In people with osteoarthritis, the cartilage that cushions the joint gradually wears away. Arthritis is often accompanied by inflammation, or swelling, of the joint, which can be painful.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for osteoarthritis pain and inflammation. But little is known of the long-term effects of these drugs on disease progression.

“To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis,” said the study’s lead author, Johanna Luitjens, postdoctoral scholar in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “NSAIDs are frequently used to treat pain, but it is still an open discussion of how NSAID use influences outcomes for osteoarthritis patients. In particular, the impact of NSAIDs on synovitis, or the inflammation of the membrane lining the joint, has never been analyzed using MRI-based structural biomarkers.”

Dr. Luitjens and colleagues set out to analyze the association between NSAID use and synovitis in patients with osteoarthritis of the knee and to assess how treatment with NSAIDs affects joint structure over time.

“Synovitis mediates development and progression of osteoarthritis and may be a therapeutic target,” Dr. Luitjens said. “Therefore, the goal of our study was to analyze whether NSAID treatment influences the development or progression of synovitis and to investigate whether cartilage imaging biomarkers, which reflect changes in osteoarthritis, are impacted by NSAID treatment.”

For the study, 277 participants from the Osteoarthritis Initiative cohort with moderate to severe osteoarthritis and sustained NSAID treatment for at least one year between baseline and four-year follow-up were included in the study and compared with a group of 793 control participants who were not treated with NSAIDs. All participants underwent 3T MRI of the knee initially and after four years. Images were scored for biomarkers of inflammation.

Cartilage thickness, composition and other MRI measurements served as noninvasive biomarkers for evaluating arthritis progression.

The results showed no long-term benefit of NSAID use. Joint inflammation and cartilage quality were worse at baseline in the participants taking NSAIDs, compared to the control group, and worsened at four-year follow-up.

“In this large group of participants, we were able to show that there were no protective mechanisms from NSAIDs in reducing inflammation or slowing down progression of osteoarthritis of the knee joint,” Dr. Luitjens said. “The use of NSAIDs for their anti-inflammatory function has been frequently propagated in patients with osteoarthritis in recent years and should be revisited, since a positive impact on joint inflammation could not be demonstrated.”

According to Dr. Luitjens, there are several possible reasons why NSAID use increases synovitis.

“On the one hand, the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative change resulting in worsening of synovitis over time,” she said. “On the other hand, patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis, although we adjusted for physical activity in our model.”

Dr. Luitjens noted that prospective, randomized studies should be performed in the future to provide conclusive evidence of the anti-inflammatory impact of NSAIDs.