Arthritis

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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.”

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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.

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New approach against chronic inflammation

Graphics


ASC specks – shown here in different colors – are large complexes of many copies of the ASC protein. They can cause immense damage in the tissue. CREDIT © Franklin Lab / University of Bonn

Not only the villas of the rich and famous have a direct line to the police. The cells in our body also have a sophisticated alarm system, the inflammasome. Its central component is the so-called ASC protein. In the event of danger, such as an attack by a pathogen, many of these molecules join together to form a large complex, the ASC speck. This ensures two things: First, its activity causes the cell to accumulate large quantities of messenger substances, which can be used to summon the help of the immune system. And secondly, numerous pores are formed in the cell membrane through which these alarm molecules can reach the outside and fulfill their task.

Last cry for help from the dying cell

These holes ultimately lead to the demise of the cell: “At some point, the cell basically explodes and empties its entire contents into the tissue,” explains Prof. Dr. Bernardo Franklin of the Institute of Innate Immunity at the University Hospital Bonn. “The messenger substances that are now abruptly released then act like a last great cry for help. This triggers the immune system to mount a strong inflammatory response that contains the infection.” That is why this mechanism of innate immune defense is hugely important.

However, in this process, ASC specks also accumulate in the tissue and may persist there for a long time. “We have now been able to show in mice that their activity activates the immune system even after the threat has been averted,” Franklin says. “This can result in chronic inflammation, which severely damages the tissue.” Together with researchers from the University of Sao Paulo, Franklin’s team has succeeded in preventing this undesirable effect. They used so-called nanobodies for this purpose.

These agents are antibody fragments with a very simple structure. “In collaboration with Prof. Dr. Florian Schmidt from the Institute of Innate Immunity, we generated nanobodies that specifically target ASC and can dissolve the specks,” explains Franklin’s collaborator Dr. Damien Bertheloot. The researchers got help from an alpaca: They injected the animal with the ASC protein so that it developed matching antibodies. Some of the alpaca antibodies have a very simple structure. This makes it possible to produce and test fragments of these antibodies as so-called nanobodies.

Rheumatism and gout symptoms alleviated in mice

The researchers were able to obtain the genetic information for the ASC nanobodies from blood samples of the animal using a complex technique. “We then incorporated this genetic makeup into bacteria so that we could have them produce the nanobody in large quantities,” Bertheloot explains. The team demonstrated that the compound can dissolve ASC specks using human cell cultures as well as mice. “The mice in our experiments have rheumatoid and gout-like symptoms,” Bertheloot explains. “After administration of the nanobody, the inflammation and also the general health of the rodents improved significantly.”

Nanobodies are very small compared to normal antibodies. They are therefore excellent for breaking up such molecular complexes. This is because they can still reach sites that would be too cramped for large agents. Moreover, normal antibodies provide additional stimulation to the immune system and can therefore exacerbate inflammation – a property that nanobodies lack.

The results are also interesting for another reason: Studies indicate that ASC specks can also cause significant damage to the brain. There, they seem to serve as a kind of “crystallization nucleus” for the Aß protein. In the brains of Alzheimer’s patients, Aß clumps together to form large protein complexes called plaques. Presumably, ASC specks can trigger this clumping. “So perhaps it’s possible to slow down this process with the help of our nanobodies,” Franklin hopes. “We now plan to investigate this possibility in a follow-up study.” Bernardo Franklin is a member of the ImmunoSensation2 Cluster of Excellence at the University of Bonn.

At the same time, however, he warns against overly high expectations: Even in the ideal case, it will be years before the results might translate into new drugs.

Posted on Arthritis, Diet, Pain Management

Vegan diet eases arthritis pain, finds new study

Veganism and Fibromyalgia

A low-fat vegan diet, without calorie restrictions, improves joint pain in patients with rheumatoid arthritis, according to a new study conducted by researchers at the Physicians Committee for Responsible Medicine and published in the American Journal of Lifestyle Medicine. Study participants also experienced weight loss and improved cholesterol levels.

“A plant-based diet could be the prescription to alleviate joint pain for millions of people suffering from rheumatoid arthritis,” says Neal Barnard, MD, lead author of the study and president of the Physicians Committee. “And all of the side effects, including weight loss and lower cholesterol, are only beneficial.”

Rheumatoid arthritis is a common autoimmune disease that typically causes joint pain, swelling, and eventually permanent joint damage.

At the outset of the Physicians Committee’s study, participants were asked to use a visual analog scale (VAS) to rate the severity of their worst joint pain in the preceding two weeks, from “no pain” to “pain as bad as it could possibly be.” Each participant’s Disease Activity Score-28 (DAS28) was also calculated based on tender joints, swollen joints, and C-reactive protein values, which indicate inflammation in the body. DAS28 increases with rheumatoid arthritis severity.

During the study, 44 adults previously diagnosed with rheumatoid arthritis were assigned to one of two groups for 16 weeks. The first group followed a vegan diet for four weeks, with the elimination of additional foods for three weeks, then reintroduction of the eliminated foods individually over nine weeks. No meals were provided, and participants handled their own food preparation and purchases, with guidance from the research team. The second group followed an unrestricted diet but were asked to take a daily placebo capsule, which had no effect in the study. Then the groups switched diets for 16 weeks.

During the vegan phase of the study, DAS28 decreased 2 points on average, indicating a greater reduction in joint pain, compared to a decrease of 0.3 points in the placebo phase. The average number of swollen joints decreased from 7.0 to 3.3 in the vegan phase, while that number actually increased from 4.7 to 5 in the placebo phase. For those who completed the study, VAS ratings also improved significantly in the vegan phase, compared with the placebo phase.

The vegan diet also led to greater decreases in DAS28 in a subanalysis that excluded individuals who increased medications during the study and another subanalysis limited to participants making no medication changes.

In addition to reductions in pain and swelling, body weight decreased by about 14 pounds on average on the vegan diet, compared with a gain of about 2 pounds on the placebo diet. There were also greater reductions in total, LDL, and HDL cholesterol during the vegan phase.