The Alarming Impact of Routine X-Rays on Arthritis Patients’ Decisions

Osteoarthritis is a leading cause of chronic pain and disability, affecting millions worldwide. While routine x-rays are not recommended for diagnosing knee osteoarthritis, nearly half of new patients visiting a general practitioner in Australia are referred for imaging. This unnecessary use of x-rays not only wastes the health system A$104.7 million each year but also affects how people think about their knee pain and may prompt them to consider potentially unnecessary knee replacement surgery.

Our study reveals that using x-rays to diagnose knee osteoarthritis can lead patients to believe they need knee replacement surgery more than those who receive a clinical diagnosis without x-ray images. In fact, people who received an x-ray-based diagnosis were 36% more likely to think they needed surgery compared to those with a clinical diagnosis.

But what happens when you get osteoarthritis? It arises from joint changes and the joint working hard to repair itself, affecting the entire joint, including bones, cartilage, ligaments, and muscles. Many people experience persistent pain and difficulties with everyday activities like walking and climbing stairs.

While knee replacement surgery is often viewed as inevitable for osteoarthritis, it should only be considered for those with severe symptoms who have already tried appropriate non-surgical treatments. Surgery carries risks of serious adverse events, such as blood clot or infection, and not everyone makes a full recovery.

Most people with knee osteoarthritis can manage it effectively with:

1. Pain relief medication
2. Exercise and physical activity
3. Weight management
4. Assistive devices

Debunking a common misconception, research shows that the extent of structural changes seen in a joint on an x-ray does not reflect the level of pain or disability a person experiences. Some people with minimal joint changes have very bad symptoms, while others with more joint changes have only mild symptoms.

In our study, we found that people who received an x-ray-based diagnosis and were shown their x-ray images had a higher perceived need for knee replacement surgery than those who received a clinical diagnosis without x-ray. They also believed exercise and physical activity could be more harmful to their joint, were more worried about their condition worsening, and were more fearful of movement.

What does this mean for people with osteoarthritis? Our findings show why it’s essential to avoid unnecessary x-rays when diagnosing knee osteoarthritis. By reducing unnecessary x-rays, we can ease patient anxiety, prevent unnecessary concern about joint damage, and reduce demand for costly and potentially unnecessary joint replacement surgery.
In conclusion, while changing clinical practice can be challenging, reducing unnecessary x-rays could help improve patient outcomes and reduce healthcare costs.

So, if you have knee osteoarthritis, know that routine x-rays aren’t needed for diagnosis or to determine the best treatment for you. Getting an x-ray can make you more concerned and more open to surgery. But there are a range of non-surgical options that could reduce pain, improve mobility, and are less invasive.

A groundbreaking study has shed light on why more women are diagnosed with Alzheimer’s disease than men. Researchers from King’s College London and Queen Mary University London analyzed blood samples from over 800 participants and discovered a startling omega-3 deficiency in women with Alzheimer’s, compared to healthy women. This finding could explain the disparity in Alzheimer’s diagnosis rates between the sexes.

The study, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, analyzed lipids (fat molecules) in the blood and found that women with Alzheimer’s had significantly lower levels of unsaturated fats, such as those containing omega-3 fatty acids. This is significant because unsaturated fats play a crucial role in maintaining brain health.

In contrast, men with Alzheimer’s showed no significant difference in lipid composition compared to healthy men. Senior author Dr Cristina Legido-Quigley noted that this finding suggests Alzheimer’s lipid biology may be different between the sexes, opening new avenues for research.

The researchers took plasma samples from participants with Alzheimer’s disease, mild cognitive impairment, and cognitively healthy controls. Using mass spectrometry, they analyzed over 700 individual lipids in the blood. The results showed a steep increase in saturated lipids (considered “unhealthy”) in women with Alzheimer’s compared to the healthy group.

Dr Legido-Quigley emphasized that while there is a statistical indication of a causal link between Alzheimer’s disease and fatty acids, a clinical trial is necessary to confirm this association. She also suggested that women should ensure they are getting enough omega-3 fatty acids through their diet or supplements.

The study’s lead author, Dr Asger Wretlind, added that scientists have known for some time that more women than men are diagnosed with Alzheimer’s disease. This research provides valuable insights into the biological differences in lipids between the sexes and highlights the importance of unsaturated fats containing omega-3s.

Alzheimer’s Research UK’s Head of Research, Dr Julia Dudley, welcomed this study as a step towards understanding how the disease works differently in women. She emphasized that future research should be carried out in a more ethnically diverse population to see if the same effect is seen and to understand the mechanisms behind this difference.

Overall, this groundbreaking study has shed light on the potential role of omega-3 deficiency in explaining the higher risk of Alzheimer’s disease in women. Further research and clinical trials are necessary to confirm these findings and explore their implications for prevention and treatment strategies.

The article discusses a groundbreaking study that demonstrates the potential for a small walking adjustment to delay knee surgery for years. Researchers from the University of Utah, New York University, and Stanford University conducted a year-long randomized control trial that showed participants who made a small adjustment to the angle of their foot while walking experienced pain relief equivalent to medication. Critically, those participants also showed less knee cartilage degradation over that period as compared to a group that received a placebo treatment.

The study, published in The Lancet Rheumatology, was co-led by Scott Uhlrich of Utah’s John and Marcia Price College of Engineering. The researchers specifically looked at patients with mild-to-moderate osteoarthritis in the medial compartment of the knee, which tends to bear more weight than the lateral compartment. This form of osteoarthritis is the most common, but the ideal foot angle for reducing load in the medial side of the knee differs from person to person depending on their natural gait and how it changes when they adopt the new walking pattern.

The researchers used a personalized approach to selecting each individual’s new walking pattern, which improved how much individuals could offload their knee and likely contributed to the positive effect on pain and cartilage that they saw. In the first two visits, participants received a baseline MRI and practiced walking on a pressure-sensitive treadmill while motion-capture cameras recorded the mechanics of their gait.

This allowed the researchers to determine whether turning the patient’s toe inward or outward would reduce load more, and whether a 5° or 10° adjustment would be ideal. The personalized analysis also screened out potential participants who could not benefit from the intervention, as none of the foot angle changes could decrease loading in their knees.

The study found that participants in the intervention group reported a significant decrease in pain over the placebo group, which was comparable to what would be expected from an over-the-counter medication like ibuprofen or a narcotic like oxycontin. The MRIs also showed slower degradation of knee cartilage health in the intervention group.

Beyond the quantitative measures of effectiveness, participants expressed enthusiasm for both the approach and the results. One participant said they were thrilled with their new gait, which would be with them for the rest of their days.

The researchers believe that this intervention could help fill the large treatment gap for people with osteoarthritis, who may experience decades of pain management before being recommended for a joint replacement. The study’s findings have significant implications for the treatment and management of knee osteoarthritis, and future studies are needed to further develop and refine this approach.