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.

The groundbreaking study from Hebrew University has turned our understanding of how Tylenol works on its head. For decades, scientists believed that acetaminophen (also known as paracetamol or Panadol) relieved pain by working only in the brain and spinal cord. However, this new research reveals a previously unknown peripheral mechanism by which the world’s most common painkiller actually works.

Led by Professors Alexander Binshtok from Hebrew University’s Faculty of Medicine and Avi Priel from its School of Pharmacy, the study published in the prestigious journal PNAS has uncovered a surprising new way that acetaminophen works. They found that the drug’s active metabolite, AM404, is produced right in the pain-sensing nerve endings and works by shutting off specific sodium channels that help transmit pain signals.

By blocking these channels, AM404 stops the pain message before it even starts. This breakthrough discovery not only reshapes our understanding of how Tylenol fights pain but also opens the door to developing safer, more targeted pain treatments.

Imagine a new generation of painkillers that avoid the numbness, muscle weakness, and side effects that come with traditional local anesthetics. The potential for these innovative treatments is vast, and researchers are excited about the possibilities.

According to Prof. Binshtok, “This is the first time we’ve shown that AM404 works directly on the nerves outside the brain. It changes our entire understanding of how acetaminophen fights pain.” And Prof. Priel added, “If we can develop new drugs based on AM404, we might finally have pain treatments that are highly effective but also safer and more precise.”

This remarkable discovery has far-reaching implications for pain management, offering hope to millions of people worldwide who suffer from chronic pain. As research continues to unlock the secrets of how Tylenol works, we may be on the cusp of a new era in pain relief.

The COSMOS-Web field, a vast map of the universe, has been released to the public, and it’s a game-changer. The largest-ever map of the cosmos, built with data collected by the James Webb Space Telescope (JWST), consists of imaging and a catalog of nearly 800,000 galaxies spanning nearly all of cosmic time.

The goal of the COSMOS-Web collaboration was to create this deep field of space on a physical scale that far exceeded anything that had been done before. “If you had a printout of the Hubble Ultra Deep Field on a standard piece of paper,” said UC Santa Barbara physics professor Caitlin Casey, “our image would be slightly larger than a 13-foot by 13-foot-wide mural, at the same depth.” That’s what we’re looking at here – a cosmic neighborhood that’s truly breathtaking.

The COSMOS-Web composite image reaches back about 13.5 billion years, covering about 98% of all cosmic time. The researchers wanted to see not just some of the most interesting galaxies at the beginning of time but also to get a wider view of cosmic environments that existed during the early universe, when the first stars, galaxies, and black holes formed.

And what a big surprise it turned out to be! Before JWST turned on, Casey said they made their best predictions about how many more galaxies the space telescope would see. But the best measurements from Hubble suggested that galaxies within the first 500 million years would be incredibly rare. “It makes sense,” she explained – “the Big Bang happens and things take time to gravitationally collapse and form, and for stars to turn on.”

But with JWST, they see roughly 10 times more galaxies than expected at these incredible distances. And it’s not just seeing more; they’re also seeing different types of galaxies and black holes that were previously invisible.

While the COSMOS-Web images and catalog answer many questions astronomers have had about the early universe, they also spark more questions. “Since the telescope turned on we’ve been wondering ‘Are these JWST datasets breaking the cosmological model?'” Casey said. “Because the universe was producing too much light too early; it had only about 400 million years to form something like a billion solar masses of stars.”

In releasing the data to the public, the hope is that other astronomers from all over the world will use it to further refine our understanding of how the early universe was populated and how everything evolved to the present day. The dataset may also provide clues to other outstanding mysteries of the cosmos, such as dark matter and physics of the early universe that may be different from what we know today.

“A big part of this project is the democratization of science and making tools and data from the best telescopes accessible to the broader community,” Casey said. The data was made public almost immediately after it was gathered, but only in its raw form, useful only to those with specialized technical knowledge and supercomputer access to process and interpret it.

The COSMOS collaboration has worked tirelessly for the past two years to convert raw data into broadly usable images and catalogs. In creating these products and releasing them, the researchers hope that even undergraduate astronomers could dig into the material and learn something new.

“Because the best science is really done when everyone thinks about the same data set differently,” Casey said. “It’s not just for one group of people to figure out the mysteries.”

For the COSMOS collaboration, the exploration continues. They’ve headed back to the deep field to further map and study it. “We have more data collection coming up,” she said. “We think we have identified the earliest galaxies in the image, but we need to verify that.”