Knee Replacement Often Beneficial for Rheumatoid Arthritis: Study

Patients did as well as those with osteoarthritis, but same did not hold true for hip replacement

By Maureen Salamon

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- The common belief that rheumatoid arthritis patients don't benefit from knee replacement surgery as much as those with the more common osteoarthritis has been challenged by the findings from a pair of studies by New York City scientists.

Researchers from the Hospital for Special Surgery also found, however, that rheumatoid arthritis patients who underwent a total hip replacement didn't fare as well as those with osteoarthritis, though they did experience improvements in pain and function.

"One thing that we can clearly pull out of this research is that the levels of pain and function among those with rheumatoid arthritis were so much worse preoperatively at the point they approached joint replacement," explained rheumatologist Dr. Susan Goodman, the lead author of both studies. "They may be postponing or not getting to surgery until they're really in a much worse state. Perhaps that's one of the explanations for the results . . . perhaps it's their generalized disease. We really just don't know yet."

Goodman presented the research last week at the European League Against Rheumatism's annual meeting in Madrid, Spain. Research presented at scientific conferences has typically not been peer-reviewed or published and is considered preliminary.

Affecting one of every five adults, along with 300,000 children, arthritis is the leading cause of disability in the United States, according to the Arthritis Foundation. Osteoarthritis, the most prevalent form, progressively breaks down cartilage in the joints due to wear and tear, while rheumatoid arthritis is an autoimmune disease marked by inflammation of the membranes surrounding joints. Along with bringing chronic pain, both types can result in joint destruction.

Historically, rheumatoid arthritis patients have had worse outcomes after joint replacement surgeries than osteoarthritis patients, according to the study authors, but more effective drugs developed over the last two decades have helped them to better control their disease.

In the first study, Goodman and her team analyzed joint replacement registry data to identify 178 rheumatoid arthritis patients and more than 5,200 osteoarthritis patients who underwent knee replacement surgery. Though rheumatoid arthritis patients had worse pain and function before surgery, patients in both groups had similar satisfaction rates after surgery.

The second study compared outcomes of 202 rheumatoid arthritis patients and more than 5,800 osteoarthritis patients who underwent hip replacement, finding that those with rheumatoid arthritis started out with worse function before surgery and also had worse pain and function scores after surgery. However, rheumatoid arthritis patients were as likely as those with osteoarthritis to experience an overall improvement after hip replacement, though the gains didn't erase the disparity between the two groups.

"The advice to rheumatoid arthritis patients is, really, that you will have significant pain relief [from joint replacement surgery]," Goodman said. "It is an area that needs more study. We're looking forward to assessing more rheumatoid-specific factors."

The research, which looked at participants with active rheumatoid arthritis, is consistent with what Dr. Olivia Ghaw, an assistant professor of medicine in rheumatology at Mount Sinai Medical Center in New York City, sees in her practice.

But Ghaw said she felt the study's two-year follow-up period was perhaps not long enough to confirm if the joint replacement outcomes remained positive for rheumatoid arthritis patients.

"For some of my patients, if their joint is severely destructed, I still do recommend joint replacement," she said. "Ideally, we would love to get their underlying disease under better control. If we can bring their inflammation down, perhaps they can have better results with joint replacement."

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Jared Leto and mystery woman out in Paris

Is this your new girlfriend, Jared Leto? We snapped the star with a mystery lady out in the Le Marais area of Paris over the weekend. 

ELIGIBLE BACHELORS 

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swimming and weight loss

Someone told me that you can't lose weight from swimming but couldn't explain further.  I don't think it makes any sense-- you're moving, how can you not be burning calories?  My friend responded, "Oh yes! I've heard that too!" and even though it seems ridiculous, I'm worried. 

I often swim a kilometer and a half in 40 minutes and used to do two and a half in a session. Did she think that because I'm obese, I just splash around and call that swimming?

Is there any truth to this?

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How to Talk to Your Child About ADHD

Talking with your child about his ADHD isn't always easy. But it's important to do, and it goes better if you keep it productive and positive.

"I have two children with ADHD, so I can speak from experience here," says Terry Dickson, MD, director of the Behavioral Medicine Clinic of NW Michigan, and an ADHD coach. "The reason why you need to talk about your child's ADHD with him directly is because you want them to be involved, to understand, and to be on board."

These eight tips will help you talk about it.

When you find out your child has ADHD, that's the time to start communicating with them about it.

"It's never too early to start talking with your child about his ADHD," says Patricia Collins, PhD, director of the Psychoeducational Clinic at North Carolina State University.

You'll talk about it many times as your child grows and develops. Start having those talks as early as possible.

A good approach is to help your child understand what ADHD means, what it doesn't mean, and how to be successful at school and in life. What you say should be appropriate for their age.

"You need to help your child feel special, and like he is part of the plan," Dickinson says. "He should feel like he is involved."

Help him understand that ADHD has nothing to do with his intelligence or his ability, and it's not a flaw, Dickson says.

"It should be a time when you are unlikely to be interrupted," Collins says.

Try to pick a time when your child isn't eager to do something else, like playing outside or before dinner or bed. 

Leave some time for follow-up, so you're available to the child after the conversation is over if he has extra questions.

Many other people have ADHD, too, and everyone with ADHD can be successful. 

Give your child examples of people who have or had ADHD that they might know, like Walt Disney, Michael Phelps, and designer Tommy Hilfiger. 

Let your child know they are special and they can succeed as well as anyone else.

Talk to your doctor, reach out to advocacy groups, and find support groups in your area. 

"One of the best things you can do is talk to other parents who already have experience with ADHD about what they've learned," Collins says.

"Focus on their strengths, what they do well, and praise their accomplishments," Dickinson says. 

"Whether its sports, arts, or dance, they can pursue their interests and do well with your support."

"Kids can't take the easy way out by blaming their setbacks on their ADHD," Collins says. 

"Parents need to help their child understand that ADHD is not a reason to not turn in homework, to not try their hardest, or to give up."

Don't be surprised if your child doesn't respond immediately or seems uninterested, Collins says. 

It takes some children, particularly younger ones, some time for new information to make sense, or for them to know what questions to ask.

"One conversation is just the beginning," Dickinson says. 

"Keep the dialogue going, talk about school, their friends, homework, extracurricular activities, and keep a positive attitude."

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Rachel Zoe at a park with Rodger and Skyler Berman in Los Angeles

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Health Highlights: June 19, 2013

Natura Pet Products is recalling a wide range of dry pet foods and treats due to possible salmonella contamination.

The recall covers all of the following products with expiration dates prior to June 10, 2014: Innova Dry dog and cat food and biscuits/bars/treats; EVO dry dog, cat and ferret food and biscuits/bars/treats; California Natural dry dog and cat foods and biscuits/bars/treats; Healthwise dry dog and cat foods; Karma dry dog foods; Mother Nature biscuits/bars/treats.

Salmonella can cause illness in pets that eat contaminated products and in people who handle the products, the U.S. Food and Drug Administration said. There haven't been any reports of pet or human illnesses related to the recalled products.

The Natura pet food and treats were sold in bags at veterinary clinics, select pet stores, and online in the United States and Canada. People with the recalled products should throw them out.

For more information or to ask for a product replacement or refund, call Natura toll-free at 800-224-6123.

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Most Americans Oppose Soda, Candy Taxes

They say it's not government's role to try to influence what people eat, drink, Harris Interactive/HealthDay poll finds

By Amy Norton

HealthDay Reporter

THURSDAY, April 25 (HealthDay News) -- Most U.S. adults aren't sweet on the idea of soda and candy taxes, and many doubt the bigger price tags would trim the national waistline.

That's the finding of a new Harris Interactive/HealthDay poll released Thursday. In the online survey of more than 2,100 adults, respondents were opposed to government taxes on sugary drinks and candy by a more than 2-to-1 margin.

Between 56 percent and 58 percent said no to such taxes, while only 21 to 23 percent were in favor.

"This is a strong vote against the 'nanny state,'" said Humphrey Taylor, chairman of The Harris Poll.

"The idea of taxing calorie-rich candies and sodas may be popular with some public health advocates, who see them as major causes of the nation's obesity epidemic, but it is very unpopular with the public," Taylor said.

The poll results come at a time of rising debate over the potential health impact of taxing "junk food." Many U.S. states do have sales taxes on soda, but they are small -- and not aimed at driving down Americans' thirst for sugary drinks, said Kelly Brownell, a professor of psychology at Yale University and co-founder of the school's Rudd Center for Food Policy and Obesity.

"Sales taxes were intentionally kept small so they wouldn't affect consumption," said Brownell, a long-time advocate of a bigger tax that would make consumers think twice about that sugary drink.

For several years, Brownell and his colleagues have pushed for a penny-per-ounce excise tax on sweetened beverages (not just soda). That would ultimately boost the cost of sweet drinks by about 20 percent. And unlike sales taxes, which consumers do not see until they get to the cash register, excise taxes show up on the sticker price -- when people are making the decision to buy or not.

In a 2011 study, Brownell's team estimated that a national penny-per-ounce tax would cut Americans' sugary drink intake by one-quarter. The researchers also projected that the tax could generate $79 billion in revenue over five years.

A number of states and local governments have proposed such a tax, but they've gone nowhere.

The proposals have popped up in states like Vermont and Texas, big cities like New York and Philadelphia, and in smaller communities. Last year, voters in two California cities, Richmond and El Monte, rejected ballot initiatives that would have levied sugary-drink taxes.

The respondents in the Harris Interactive/HealthDay poll echoed those voters. Besides disliking the taxes, many doubted the potential health benefits -- 51 percent disagreed with the statement, "Sales taxes on candies and sodas would help to reduce obesity." Only 26 percent agreed.

A bigger percentage seemed to have a philosophical opposition to such taxes: Two-thirds agreed with the statement, "It should not be the role of government to influence what we eat and drink to make healthier choices."

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