CreakyJoints Survey Reveals Men Are Less Likely to Incorporate Complementary and Alternative Medicine (CAM) Into Their Arthritis Management

Turmeric Milk - a natural remedy for pain
Turmeric Milk – a natural remedy for pain


A new survey from CreakyJoints, the international digital community for millions of arthritis patients and caregivers who seek education, support, advocacy, and patient-centered research, finds that women are incorporating more complementary and alternative medicine (CAM) into their arthritis management strategy than men and that among Hispanic survey participants, more significantly reported never using CAM versus using it. Common complementary and alternative therapies for arthritis include tai chi and yoga, massage, acupuncture, meditation, vitamins, and other strategies that may help a person with arthritis cope with symptoms of the day-to-day experience of living with a chronic condition.

“At the start of a new year, many people reflect on their goals for the next 12 months. We conducted this survey to better understand how people with arthritis manage their condition going beyond prescribed medications and to start a conversation about why a holistic, patient-centered approach is key to maintaining physical, emotional, and mental wellness all year long,” said Daniel Hernandez, MD, Director of Medical Affairs and Hispanic Outreach, CreakyJoints.

In the new survey (n=847), members of the CreakyJoints community were asked questions about their condition(s), the complementary and alternative therapies they have ever used for their condition(s), and the therapies they found helpful for their symptoms based on the therapies they previously selected. Most survey respondents (89%) reported using a type of complementary or alternative therapy for their condition, with the most common therapies reportedly used being vitamins/minerals (71%), massage (48%), joint supplements (47%), relaxation/mind-body activities (38%), therapeutic herbs (34%), and yoga (33%). The therapies reported helpful by the greatest proportion of people who have ever used the therapy were massage (76%), Chi Gong (76%), yoga (74%), relaxation/mind-body activities (72%), and spiritual activities (71%). Significantly more women reported using CAM than never using it (89% vs 73%, p<0.001) while significantly more men reported never using CAM than having ever used it (27% vs 11%, p<0.001). In terms of race and ethnicity, significantly more white participants reported using CAM than never using it (82% vs 71%, p=0.007) and significantly fewer Hispanic or Latino participants reported ever using CAM than never using it (13% vs 32%, p<0.001).

“An arthritis diagnosis requires a lifetime management commitment and there will be times when a person living with arthritis feels better and worse. Our CreakyJoints survey, and other existing peer-reviewed studies, show that CAM can have a positive impact on the experience of symptoms,” said Dr. Hernandez. “However, our survey also suggests that more education is needed to encourage men and members of the Hispanic community to understand the range of CAM therapies available and to encourage them to speak with the health provider team about which therapy may offer benefit to them.”

For more information about CAM, visit: https://creakyjoints.org/alternative-medicine/

About the Survey

The 6-question survey was fielded from December 2, 2021 – December 16, 2021. Participants were recruited via email from the existing CreakyJoints and COVID-19 Patient Support Program mailing lists. Only adult participants diagnosed with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), osteoarthritis (OA), ankylosing spondylitis/axial spondyloarthritis (AS/axSpA), or psoriatic arthritis (PsA) were asked to complete the survey. The sample was primarily female (87%) and white (81%), with an average (SD) age of 61 (13). A quarter of the participants (25%) reported having a form of spondyloarthritis (SpA), 65% reported having either RA or JIA, and 10% reported having osteoarthritis without a concomitant condition of interest.

About CreakyJoints

CreakyJoints® is an international digital community for millions of arthritis patients and caregivers who seek education, support, advocacy, and patient-centered research. We represent patients in English, Spanish, and French through our popular social media channels, our websites, and the 50-State Network, which includes more than 1,700 trained volunteer patient, caregiver, and provider health care activists.

Part of the Global Healthy Living Foundation, CreakyJoints also has a patient-reported outcomes registry called ArthritisPower® (ArthritisPower.org), which includes tens of thousands of consented arthritis patients who track their disease while volunteering to participate in longitudinal and observational peer-reviewed research. In addition to online and downloadable educational resources, CreakyJoints publishes many arthritis and chronic disease podcast series, available on all major streaming platforms, that provide both patient and provider perspectives. It also hosts PainSpot (PainSpot.org), a digital risk-assessment tool for musculoskeletal conditions and injuries, and eRheum (eRheum.org), for telehealth and virtual-care support. All programming is free, always. For more information, visit CreakyJoints.org.

Virtual Exercise Effective for People with Arthritis and Helps Them Stay Socially Connected Too

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New research presented this week at ACR Convergence, the American College of Rheumatology’s annual meeting, found that a virtual exercise program can be safe for people with musculoskeletal conditions, improved their health outcomes, and helped them feel more socially connected, an important benefit during the pandemic when many people have chosen to avoid in-person exercise classes (Abstract #1451). 

Osteoarthritis (OA) is the most common musculoskeletal condition, that causes pain, limited mobility and loss of physical function, which can affect an individual’s quality of life. OA often affects middle aged to older individuals. It is commonly referred to as “wear and tear” of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone. OA development and progression can be affected by genetics, mechanical stress, body weight, diet, and physical activity. About 26% of U.S. adults are physically inactive, and this is more common among people 65 and older.

Nearly 75% of seniors have a musculoskeletal condition, and when coupled with physical inactivity, they are more likely to have poor health outcomes, such as lower pain tolerance, weak muscles and stiff joints. The COVID-19 pandemic added another wrinkle: older adults who stayed home to avoid exposure to the coronavirus may have felt more socially isolated and less likely to get the exercise they need at local gyms or classes. To reach these older adults, Hospital for Special Surgery (HSS) switched their Pilates, yoga and tai chi exercise programs from onsite to the virtual platform Zoom in March 2020.

This study measured the health outcomes and social connectedness of older adults who participated. “The pandemic disrupted many aspects of daily living, such as engaging in physical activity and interacting with friends and family. Unfortunately, older adults were the most vulnerable to greater health risks during this period, leading to potential worsening of musculoskeletal conditions and emotional distress,” says Titilayo Ologhobo, MPH, Director, Outcomes and Data Analytics at HSS and the study’s author. “Healthcare delivery is constantly changing, but considering the impacts of the lockdown, there was a need to quickly adapt to virtual programming, especially for vulnerable older adults. We need to know if virtual exercise classes are effective for older adults, because it provides continued access to these services, keeps them physically active from the comfort of their homes, and reduces isolation.” All classes were 60 minutes long and low intensity. Participants were able to talk and socialize before the guided exercises began. The researchers evaluated the programs’ effectiveness based on pre- and post-course online surveys. They assessed the socio-demographics of the participants, as well as self-reported health outcomes like pain intensity, pain interference with daily life, physical function, stiffness, fatigue, physical activity, and self-efficacy. The virtual exercise programs reached 6,779 people. Out of 355 people assessed, there were 161 who self-reported a musculoskeletal condition, mostly female, 60 or older, and white.

Overall, these participants reported a 5% decrease in pain intensity, a 7% decrease in pain interference in their walking ability, an 8% decrease in fatigue, and a 5% decrease in joint stiffness with every six-week virtual exercise session. People who participated in online exercise courses more frequently had improved pain, fatigue, stiffness and improvement in their ability to carry out their activities of daily living. Thirty-three people who participated in virtual exercise classes at least twice a week reported an 11% decrease in pain intensity, a 12% decrease in stiffness, a 9% decrease in fatigue and decreased pain interference with all aspects of daily living, including general activity levels, mood, walking ability, normal work, relations with others, sleep and enjoyment of life with every six-week virtual session. 

“Amid the uncertainties caused by the pandemic, shifting to virtual programming provided older adults with musculoskeletal conditions continued access to effective community programs and reduced the negative impact of isolation,” says Ms. Ologhobo. “Implementation of virtual online exercise programs can be successful when assessing the needs of your target audience, considering potential barriers to program participation, and tailoring virtual programs to meet patients’ specific needs.”

What Americans Don’t Know About Arthritis May Surprise You

Arthritis Is Tough When You're Missing Out On These Great Tips
Arthritis Is Tough When You’re Missing Out On These Great Tips


More than 4 in 5 Americans (81 percent) have arthritis and/or know someone with arthritis* and 85 percent of Americans believe that arthritis needs more public attention.* However, the disease is still widely misunderstood by the general public. Committed to supporting the one in four Americans with arthritis**, the Arthritis Foundation commissioned The Harris Poll to conduct an online survey of 2,016 U.S. adults ages 18 and older to gauge Americans’ understanding and perceptions of arthritis. Here are some highlights from the Arthritis Foundation/Harris Poll survey:

Less than 1 in 10 Americans (7 percent) know that arthritis is the No. 1 cause of long-term disability in the U.S.
Nearly 3 in 5 Americans (59 percent) would be uncomfortable requesting time off work each month to manage an illness.  (However, an estimated 172 million work days are lost annually due to arthritis and other rheumatic conditions**.)
More than half of Americans (57 percent) don’t know that people with arthritis are at an increased risk for developing other diseases like heart disease. (However, almost half of all adults with heart disease (49.3 percent) or diabetes (47.1 percent) also have arthritis**.)



“I wish I could say I was surprised by these stats and the lack of understanding about arthritis, but I’m not,” said Anna Legassie, 2018 National Adult Honoree for Walk to Cure Arthritis who was diagnosed with arthritis at age 11. “There are so many people with arthritis, yet the general public doesn’t fully grasp how devasting this disease can be for so many people. People need to be educated about the disease, so they can help us fight this disease and one day find a cure.”

“People with arthritis are more likely than the general public to feel isolated, because many people, including loved ones, don’t understand how challenging arthritis can be,” said Cindy McDaniel, senior vice president of consumer health, Arthritis Foundation. “Our goal is to raise awareness and ensure that people with arthritis feel supported. This survey helps us understand the gaps in education and raise awareness so that we can support and better serve the more than 54 million Americans with arthritis.”

The Arthritis Foundation has programs to combat isolation, such as local meetups and online tools and resources, as well as is working tirelessly to increase the public’s understanding of arthritis through its first-ever cause campaign, “Let’s Get a Grip on Arthritis.” To learn more, visit https://www.arthritis.org/letsgriparthritis. 

*According to a survey commissioned by the Arthritis Foundation and conducted by The Harris Poll. See below for the methodology.

**According to the Arthritis Foundation Arthritis by the Numbers: Book of Trusted Facts and Figures.

New evidence of how exercise can counter diabetes damage

New evidence of how exercise can counter diabetes damage


Drs. Masuko Ushio-Fukai and Tohru Fukai CREDIT Michael Holahan, Augusta University

One way exercise can counter the damage of diabetes is by enabling activation of a natural system we have to grow new blood vessels when existing ones are ravaged by this disease, scientists report. 

Angiogenesis is the ability to form new blood vessels, and diabetes not only damages existing blood vessels, it hinders this innate ability to grow new ones in the face of disease and injury, say experts at the Vascular Biology Center at the Medical College of Georgia.

Endothelial cells line our blood vessels and are essential to that new blood vessel growth.

Now the MCG scientists have the first evidence that in the face of diabetes, even one 45-minute session of moderate intensity exercise enables more exosomes, submicroscopic packages filled with biologically active cargo, to deliver directly to those cells more of the protein, ATP7A, which can set angiogenesis in motion, they report in The FASEB Journal.

Not unlike the most sophisticated and efficient delivery services we have all come to rely upon, particularly during the pandemic, what exosomes carry depends on where they come from and where they are headed, says Dr. Tohru Fukai, MCG vascular biologist and cardiologist.

While he and co-corresponding author MCG vascular biologist Dr. Masuko Ushio-Fukai are not yet certain of the origin of these helpful exosomes, it’s clear that one place they deliver is to endothelial cells, Fukai says.

In both an animal model of type 2 diabetes and a handful of healthy 50-something-year-olds, two weeks of volunteer running on a wheel for the mice and that one cardio session for the humans increased levels of ATP7A in the exosomes that attached to endothelial cells.

At that point, the activity did not significantly impact the weight of the mice, the scientists note, but it did also increase a marker of endothelial function and factors like, vascular endothelial growth factor, needed for angiogenesis.

Exercise also increased the amount of the powerful, natural antioxidant extracellular superoxide dismutase, or SOD3, but it’s the heavier payload of ATP7A, which is also known to deliver the essential mineral copper to cells, that is key to making good use of the SOD3 present, Ushio-Fukai says.

SOD3, is an important natural antioxidant produced by vascular smooth muscle cells in the walls of blood vessels as well as skeletal muscle cells, which helps us maintain healthy levels of reactive oxygen species, or ROS. ROS is a natural byproduct of our use of oxygen that is an important cell signal, enabling a variety of functions. But in diabetes, high blood sugar levels result in high ROS levels that instead hinder important normal functions.

The Fukais have shown that ATP7A levels are reduced in diabetes. They also now have some of the first evidence that exosomes circulating in the plasma of sedentary animal models of type 2 diabetes actually impair angiogenesis when placed in a dish with human endothelial cells, as well as in an animal model of wound healing.

The scientists suggest that synthetic exosomes, already under study as drug-delivery mechanisms, could one day work as an “exercise mimetic” to improve patients’ ability to grow new blood vessels when diabetes has damaged their innate ability.

In fact, they have already generated exosomes in which SOD3 is overexpressed and found improved angiogenesis and healing in a mouse model of diabetes.

The way it’s supposed to work is SOD3 is naturally silenced in endothelial cells, so they must get it from other cells, notes Ushio-Fukai, hence the importance of exosome delivery. SOD3 must then bind to endothelial cells at its natural spot called the heparin-binding domain, and the copper transporter ATP7A must be present to enable SOD3 to be active there, Fukai says. Both ATP7A and the binding site are key, Fukai notes. For example, when they removed the binding site from the endothelial cells, which can happen in nature, the benefits were lost.  

Once on the scene and active, SOD3 converts the ROS superoxide into hydrogen peroxide, or H2O2, another signaling ROS that helps support normal endothelial cell function. The Fukais have reported that in human endothelial cells, overexpressing SOD3 promotes angiogenesis by increasing H2O2. 

A copper connection also runs throughout this process as endothelial cells regularly use a lot of copper, and ATP7A, known to transport the essential mineral that we consume in foods like nuts and whole grains, is dependent on copper itself.

Physical exercise, like running or walking on treadmill, prompts muscles to contract which in turn prompts release of exosomes into the blood.

When Fukai was a postdoc in the Emory University Section of Cardiology he was part of the research group that was the first to show that exercise increases SOD3 activity. SOD3 levels decrease with age and with some disease states like diabetes and hypertension.

Exosomes are being studied as biomarkers for a wide range of diseases like cancer and diabetes as well as precise treatment delivery tools. For example, exosomes produced by a cancer cell will hone right back to a cancer cell.

About 1 in 10 Americans have diabetes, according to the Centers for Disease Control and Prevention.

Social behaviour differs in children with a family history of autism

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Baby wearing an ERP cap at UC San Diego’s Developmental Cognitive and Social Neuroscience Lab. CREDIT Photo courtesy of Leslie Carver, UC San Diego.

The baby brothers and sisters of autistic children do not seek emotional cues from adults, or respond to them, as often as other toddlers do, suggests new research from the University of California, San Diego.

The study is the first to investigate “social referencing” behavior in children from families at high risk for autism and also points to profound differences in related measurements of brain activity, said lead researcher Leslie Carver.

Carver, an assistant professor of psychology and director of the Developmental Cognitive and Social Neuroscience Lab at UC San Diego, is presenting the findings at the 2007 International Meeting for Autism Research in Seattle, Wash.

“Our results,” Carver said, “support two important ideas about autism: That those behaviors that are diagnostic of the disorder fall on one end of a broad behavioral spectrum and also that there is a strong genetic component to autism, evidenced by the behavioral resemblances in close family members.”

The heritability of autism has been estimated as high as 90 percent, Carver noted, and siblings are at increased risk of receiving the diagnosis themselves: About 8 percent will go on to develop the disorder, as compared to about .5 percent of the general population.

Social referencing involves checking in with the emotional displays of others (especially those we expect to be knowledgeable about a novel situation) and regulating our own emotions and behavior in response. It is something most of us do and do without thinking. On spying a new caterpillar in the park, a young child might turn to find a parent’s smile before toddling over to take a closer look. And an adult, startled by a sudden jolt on an airborne plane, might seek out the expression of a flight attendant to determine whether that was just a nasty bit of turbulence or something really worth worrying about.

Typically, social referencing begins to emerge toward the end of the first year of life. But in individuals with autism, this behavior, along with several other aspects of social cognition, is characteristically impaired.

The current research is in line with earlier work demonstrating that first-degree relatives of autistic children often display milder, or subclinical, features of the disorder.

Carver and her colleagues, UC San Diego psychology professor Karen Dobkins, doctoral student Lauren Cornew and post-doctoral researcher Joseph McCleery, tested 18 high-risk toddlers (18-month-old siblings of children diagnosed with autism) and compared their results to those of 28 age-matched counterparts who had no family history of the disorder.

In the behavioral portion of the experiments, the children were presented with three novel and ambiguous toys – toys that could be taken as either good or bad, scary or fun, or neither – and their caregivers were trained to react with facial expressions and vocal signals that were positive, negative and neutral. The interactions were videotaped and later analyzed.

After the behavioral testing, the children were shown pictures of the same toys and their brain responses were measured – specifically by tracking ERP (event-related potential) activity, or the electrical activity of groups of neurons firing in synchrony in response to a specific event.

The high-risk toddlers differed in almost every element of social referencing, the researchers found: Though they sought emotional information from adults as quickly as the low-risk toddlers, they did so about 30 percent less frequently, and they did not respond to the adult’s information in ways that were consistent with the adult’s reaction.

Brain-activity measurements told a similar story: Where low-risk children showed the expected magnitude of neural response to emotionally tagged objects, the high-risk ones did not. And where the brain activity of low-risk children correlated with their behavior regulation, this pattern was not observed in the high-risk.

“It’s as if the high-risk children do not have as clear an understanding of the meaning of an emotion and don’t connect it to the object in the same way,” Carver said.

Data from children who would later go on to a diagnosis of autism are not included in the study results.