Dr Rodrigo Megale is a Brazilian physician specialising in geriatrics , graduated from Medical School (UFMG) in 2002, with advanced training in Internal Medicine (2002-2004) followed by Geriatrics (2004-2006) through accredited residency programs (MEC). He has Masters Degree in Public Health (Epidemiology) from Fiocruz and is, currently, undertaking his PhD in The University of Sydney - Medical School.

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It is usual among older adults to think that musculoskeletal pain is a benign symptom related to the “wear and tear” of ageing. If you are in your 70s or 80s, you probably have already heard from health professionals that chronic pain is something that you should get used to, and that it is a very common age-related condition. I, myself, have said that to many of my patients. It turns out that having chronic or persistent musculoskeletal pain is not as benign as it was thought to be.
Several studies have shown an association between chronic pain and frailty, a pre-disability condition, clinically characterised by weight loss, exhaustion, weakness, slowness and low physical activity. Those who have been experiencing bothersome joint or low back pain might be worried at this moment; however, there is no reason for that. If your pain is not interfering in your daily living activities, and your doctor has already assessed it in order to rule out any serious condition, there are some tips that can help you cope with your symptoms.

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The first important thing that you need to know about chronic pain is that, in many cases, the source of pain is not only joint inflammation, cartilage damage or disc degeneration/ protrusion. Actually, it seems that our brains play a very important role in this condition. Chronic pain usually involves a problem in the so called “descending inhibitory pathway”, which is part of your body’s pain management system, and it is controlled by your brain. That is probably why some patients report less pain when they are surrounded by loved ones or when they are on a pleasant trip. Our brain is capable of modulating the pain we feel. If you focus on your pain and drive all your attention towards your suffering, your behaviour could probably “enhance” your pain. On the other hand, if you drive your attention away from your suffering and try to focus on positive aspects of your life, there is a reasonable chance of achieving pain improvement.

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Today's blog post is brought to you by Dr Helen Liang of the Sutton Arthritis Research Laboratory led by Professor Chris Jackson.

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I am a Postdoctoral Research Fellow from the Sutton Arthritis Research Laboratory, who is currently supported by the Ulysses Club Arthritis Research Fellowship, to carry out a research project that aims towards developing new medicines to provide better treatment for rheumatoid arthritis patients.

Rheumatoid arthritis is the second most common type of arthritis and one of the most damaging forms. People with this condition not only suffer severe pain, but their death rate within the first 10 years of diagnosis is also 3 times that of healthy individuals. The common clinical symptoms of arthritis include pain, swelling and stiffness of joints, inflammation, and damage to joint structures that results in joint weakness and deformity, which ultimately interferes with the most basic daily tasks such as walking and standing.

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Weight loss is very commonly spoken about when it comes to OA. Today we have a post exploring some studies about how weight loss is related to knee OA.

Today's post is written by Dr Sarah Meneses, a researcher and physiotherapist based at the Institute of Bone and Joint Research. Dr Meneses completed her PhD on laser therapy and stretching exercises at the University of Sao Paulo and takes a strong interest in conservative management of osteoarthritis.

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It is well known that being overweight or obese can lead to health issues over the time. The joints that carry this extra load suffer and it is common to see a high prevalence of osteoarthritis (OA) within overweight and obese people.

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A recent study showed that losing either 5 kg or 5% of body weight has preventive effects on both the structural and clinical signs of knee OA in middle-aged, overweight and obese women without OA.

The authors stated that is necessary to design strategies that are implementable in primary care and effective in reducing body weight of overweight and obese subjects at high-risk of developing knee OA. However, it is important to note that this was an observational study (where researcher are unable to control as much), and we cannot assume a causal relationship (where one variable results in a particular outcome), as there may have been other factors that influenced the results.

Another recent study showed the effect of bariatric surgery (to reduce the size of the stomach) prior to total knee replacement as a cost-effective option for improving outcomes in morbidly obese patients with end-stage knee osteoarthritis.

The authors advised that ideally, a team approach should be used to treat severely obese patients with knee arthritis in which various health care professionals are in place to help a patient lose weight, improve his or her health, and optimize nutrition before joint replacement to maximize its benefits. The outcomes of this study may assist physicians when counseling patients and developing an individualized treatment plan that includes optimization of overall health, nutrition and weight prior to knee replacement.

These two studies had different subtypes of overweight or obese participants. In the first were included people without OA and in the other were included people in the end-stage of the disease. However, both studies showed a positive effect of weight reduction in the prevention or management of OA. So, keep track of your weight! Speak with your GP and find a real weight loss target for yourself. A weight reduction of 5% already promotes benefits to your health!

Runhaar J, de Vos BC, van Middelkoop M, Vroegindeweij D, Oei EH, Bierma-Zeinstra SM. Moderate weight loss prevents incident knee osteoarthritis in overweight and obese female. Arthritis Care Res (Hoboken). 2016 Feb 11. doi: 10.1002/acr.22854. [Epub ahead of print]

McLawhorn AS, Southren D, Wang YC, Marx RG, Dodwell ER. Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation. J Bone Joint Surg Am. 2016 Jan 20;98(2):e6. doi: 10.2106/JBJS.N.00416.

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Welcome to the very first post of 2016! We have writing for us today, Mrs Jillian Eyles, a researcher and physiotherapist at the Institute of Bone and Joint Research. Jill has had many years of experience in clinical physiotherapy at the Royal North Shore Hospital and has recently taken a strong interest in research about knee and hip osteoarthritis.

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We all know we should exercise for our general health, what you may not know is why exercise is so important in the management of knee osteoarthritis and which type of exercise is best.

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How will exercise help my knee osteoarthritis?
People are often concerned that exercise will cause further damage to their osteoarthritic knee. Rest assured this is a myth! In fact, clinical research has proven that exercise is an effective treatment for knee osteoarthritis and the benefits include:

- Reduction in knee pain
- Improved ability to move around normally
- Improved quality of life
- Reduction in the knee feeling like it is ‘giving way'
- Improved mood
- May assist in weight loss (if required)
- May even help slow down the disease process

So, what is the right type of exercise for my knee osteoarthritis?

Strength training:
Muscles around the knee and hip stabilize the knee and help maintain normal postural alignment during walking and other activities. Muscle weakness is common in knee osteoarthritis. Some muscles become so disused they fail to fire altogether. Strengthening exercises help to build up weak muscles around the hip and knee to protect the knee from forces that load and stress the cartilage.

Strengthening exercises need not require a gym or fancy equipment; some exercises can be performed using your bodyweight alone. You may even prefer to complete your strengthening program in the pool (hydrotherapy or aquatic physiotherapy). The effects of an intensive strengthening program may be felt for up to 6 months, but an ongoing strength maintenance program is recommended for lasting effects.

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Neuromuscular control:
Neuromuscular control is a form strengthening exercise based around everyday movement. People with knee osteoarthritis often adapt their movement patterns to compensate for their knee symptoms. These abnormal movement patterns can cause further weakening of key muscles leading to pain and disability. Exercises that improve the control of the knee during movement also strengthen the muscles around the knee joint and thus help to reduce symptoms of knee osteoarthritis. These exercises are particularly important for those people with osteoarthritis behind the knee-cap.

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Flexibility training:
Often osteoarthritic knees feel stiff. However the loss of movement in the knee is not caused by the joint alone but also often involves the muscles. Stretching exercises aim to improve the flexibility of the body by stretching out tight muscles, joints and other tissues. This may lead to improvements in pain. Stretching can be incorporated into any exercise program, or you may want to take a class that focusses on flexibility such as yoga.

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Fitness training:
We all know that aerobic exercise is good for our heart health; research shows that it is also good for our knees and mental well-being! Aerobic exercise may also help us to shift unwanted kilos that make the pain from knee osteoarthritis a whole lot worse. Low impact activities such as walking, swimming, cycling, aerobic exercise classes and aquafitness are good choices. Aim to include at least 30 minutes of physical activity (at the level of a brisk walk) every day.

There seem to be so many types of exercise I can do- which is the best choice?
Current research suggests that a combination of strength, fitness and flexibility training is the most effective way to reduced pain and improve your ability to move around (and do the things you enjoy!). You may want to mix up the type of training that you do so that it doesn’t become a chore. The best choices of exercise type are the ones that you enjoy, and if you exercise with a friend or two it may double up as a social activity- anyone for coffee after?

How do I start exercising for my knee osteoarthritis?
It is important to seek advice from a health professional before you start an exercise program. Ask your physiotherapist or GP to help get you started with an exercise program that is right for you!

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The researchers here at the Institute of Bone and Joint Research (IBJR) are pleased to bring you summaries of the latest research in the musculoskeletal research arena. We will summarise recently published research from around the world and within the IBJR. We’re starting the series off with an in-house research study about an online OA management resource from Australia.
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Today we will be talking about an original research paper titled “The Web-based Osteoarthritis Resource My Joint Pain Improves Quality of Care: A Quasi Experimental Study” which was published earlier this year in the Journal of Medical Internet Research.

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Osteoarthritis (OA) is the leading cause of chronic pain and is estimated to affect 1 in 8 adults. Due to the aging population and the increasing rates of obesity in developed countries, it is expected that the incidence of OA will double by the year 2020! Current clinical practice for OA management is often centred on pain relief and eventually surgery despite numerous evidence based guidelines advocating conservative treatment options. The lack of efficiency in practice highlights the need for patients to receive evidence based information about OA outside the clinical encounter. While this is already regularly done in self-management programs to allow patients to play an active role in improving their condition, the use of online platform to distribute the information will have a much wider reach. Hence, the My Joint Pain website was developed.

The research was carried out over 12 months with participants from all over Australia in what is called a quasi-experimental study. This means that instead of being randomised to a group of the study, participants could choose for themselves. Participants filled out an online survey to assess eligibility and if eligible, the questionnaires used in this study. Once the My Joint Pain website was available, participants were informed and were only contacted again after 12 months to fill out the same questionnaires and to provide details of their website usage (to divide them into users and non-users).

The two questionnaires used for this study were the Health Evaluation Impact Questionnaire (heiQ) and the Osteoarthritis Quality Indicator (OAQI).

The heiQ was designed to evaluate the effects of self-management programs in 8 different categories that include health directed activity, emotional distress and health service navigation. This study found that over 12 months, users of the website had greatly improved in most categories where non-users didn’t change. Most interestingly, the only change in the non-users was emotional distress. It appears that by using the website, participants were able to protect their emotional wellbeing by preventing it from deteriorating as is usually seen in people with worsening OA and in our non-users.

The OAQI assessed the appropriateness of care received by patients and evaluates 17 different aspects including disease development, weight reduction, and surgery. Comparing user and non- users showed significant differences in self-management and weight reduction. Many of the significant changes seen (even just within the group) were centred on the more conservative options which suggested that the website was effective in dispersing information about conservative options

To read the full paper and more about the results use this link:http://www.jmir.org/2015/7/e167/

My Joint Pain is free and available at this link https://www.myjointpain.org.au/.

You can also support the research carried out the Institute of Bone and Joint Research here: https://donateplanet.com/charities/read/institute-of-bone-and-joint-research/
All donations above $2 are tax deductible.

Umapathy H, Bennell K, Dickson C, Dobson F, Fransen M, Jones G, Hunter DJ
The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study
J Med Internet Res 2015;17(7):e167
URL: http://www.jmir.org/2015/7/e167
DOI: 10.2196/jmir.4376
PMID: 26154022
PMCID: 4526979

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We have a special message all the way from Scandinavia from Professor Ewa Roos!

Here from the IBJR we wish everyone a very Happy Holiday season!
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At this time of the year, as you all well know, it is time for Santa to fill up his sack with presents for everyone, including those middle‐aged and elderly suffering from pain due to knee and hip osteoarthritis. And wow, there seem to be more and more of them every year! And they complain. They complain they can no longer dance around the Christmas tree. Neither can they sit for as long as the Christmas dinner lasts, without feeling stiffness. Santa thought about his own painful knees for a while, sighed, and then contemplated what treatments to put in his sack.....

Click Here to download the rest of the message

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Here is Professor Hunter's final post about how he went while stepping up in September.
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The month of Stepping UP in September for osteoarthritis research is now over. For all those wondering how I fared I exceeded the target of 300,000 steps and took 378, 450 steps or 12,615 steps per day (about 10km). I lost a couple of kilos along the way and will try to keep on stepping.

For all those that have supported me-your encouragement is greatly appreciated. Thank-you.

For those who would like to, it is not too late. Go to the fundraising link on donate planet https://donateplanet.com/charities/read/institute-of-bone-and-joint-research/ and commit some funds (all donations over $2 are tax deductible (Au)).

Thanks for your support and keep on STEPPING.

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