Surprise! Omega 3 May Trump Fat in OA Patients
Are you obese and dealing with osteoarthritis (OA)? Watch the quality of what you eat, says new research from Duke University. Specifically, says Farshid Guilak, Ph.D., director of Orthopaedic Research, get your omega 3s. Dr. Guilak, the vice-chair of Orthopaedic Surgery, tells OTW, “Obesity is the number one preventable risk factor for OA, but the connection hasn’t been sufficiently researched as most people believe the disease comes from joint loading that wears out the cartilage. The data say otherwise, however. Obese people have more OA in their hands, but obesity would not be expected to increase loading in the hands…and if someone loses a mere 5-10 pounds they will experience a decrease in OA pain.”
“My team and I took note of the growing literature showing that obese patients show signs of low grade, chronic inflammation, and hypothesized that OA in obese patients may be related to systemic and metabolic factors. The cytokines involved in obesity were the same ones that people have been investigating in OA for years; however, to date, no one had thought that the problem was emanating from the fat and not just mechanical load.”
“In this study, we used lard in order to study what saturated fats do to mice with OA caused by a knee injury. We gave the first group a diet of 60% saturated fats (either lard or an omega 6 rich diet); these mice got much worse than those on a normal diet. The second group had a diet of 60% saturated fat, but also received a small supplement of omega 3. We found that just adding this small supplement completely eliminated the deleterious effect of having all these other fats in the diet. Our goal is to find the mechanism by which this occurs. We have thus far shown that it’s probably not the increased weight, but the inflammation caused by a unhealthy diet.”
“Now, we are working on a study to determine what effects weight loss will have on inflammation, knee pain, and OA severity. We have a number of overweight patients who are on a weight loss program; we will follow them closely and see how these changes affect their metabolic disease and OA pain. We will also assess how they walk and the biomechanics of their knees. Upon completion of this study we hope to conduct a study where we have one group that receives a diet rich in omega 3s and one group on a ‘normal’ diet.”
Diagnose Scoliosis With Light…and Other Innovations in Scoliosis Treatment
Spine surgeons now have a diagnostic tool that is healthier and more nuanced than traditional X-rays. Baron S. Lonner, M.D. is the chief of the Division of Spine Surgery at Mount Sinai Beth Israel Hospital in New York. Dr. Lonner, the chair of the Advocacy Committee for the Scoliosis Research Society tells OTW, “There are currently about eight medical facilities in the U.S. that have this wonderful new capability of doing non X-ray diagnostic evaluations of patients through surface topography that uses harmless light rays. This technology allows us to follow pediatric patients and adults over time and detect subtle changes in spine curvature and body shape. The surgeon typically takes an X-ray at the first visit and combines it with the surface topography; approximately six months later—how long depends on skeletal maturity and curvature size—the patient will return for a repeat surface topography. If there has been no change in his or her condition then we will continue to follow this person using only surface topography.”
“This is a novel technology and although it is widely used in Europe, as of yet it has not gained traction in the U.S. I believe that will change as we complete prospective, multicenter studies, however. We are currently involved in such a study, and to date we have found a reliable correlation between the magnitude of the curve and the 3-D spinal deformity of the patient as measured on X-ray. Also, even if the X-ray and the surface topography don’t give an equivalent number, we are using multiple parameters on the surface topography such as waistline alignment, shoulder symmetry, prominences on the back, etc. That way we can determine over time whether there are significant changes in those parameters. If that is the case then we would obtain an X-ray. We combine all of this information with a physical exam, thus there are multiple levels of checks and balances involved.”
“Another addition to the non-operative armamentarium of the scoliosis specialist, is Schroth Method. This set of exercises and physical modalities for scoliosis patients emanated from Europe and has received a lot of lay press in the United States. This method may help decrease back pain associated with scoliosis…and it may be of some benefit in combination with bracing for prevention of curve progression, but more studies are needed. Some advocate using this method in skeletally immature (growing) patients with curves that are small in order to prevent curve progression. A prospective-randomized study on those who have undergone Schroth versus those who have not is needed.”
“My team and I are beginning to study the psychosocial aspects of scoliosis. I am the principal investigator on a study looking at body image disturbance in those with scoliosis. We just published a validation of the body image disturbance questionnaire in the Journal of Bone and Joint Surgery that gets to the root of what these patients may be experiencing emotionally. With this questionnaire, which we have validated in adolescent idiopathic scoliosis, we initially looked at surgical patients. Not surprisingly, we found that the larger the curve, the more body image disturbance. Interestingly, there were some people with significant curvatures who have no body image disturbance and may be more resilient than other patients with large curvatures. If you spend enough time with our adult patients they will tell you about their emotional pain from having a spinal deformity…how it embarrasses them and makes them feel so different. We intend to study these issues further in the adult scoliosis patient in a prospective study that we hope to embark upon in the coming months. We have also recently validated a new questionnaire that my research team and I have validated, called the TAASQ, Truncal Anterior Asymmetry Scoliosis Questionnaire that is designed to assess the impact of scoliosis on the patient’s frontal appearance—that is what the patient sees in the mirror. We are studying how well surgery and bracing correct the anterior or frontal appearance of the patient’s torso.”
Massive, 40, 000 Patient Global Trauma Study Launched
The need for such a massive study could not be greater. While orthopedic surgeons in the West are mulling over whether to install a fluoroscopy-based navigation system or a computed tomography–based navigation system, orthopedic surgeons in India or Morocco may be telling a patient with an open fracture to wait two to four days for treatment. These and other such glaring access discrepancies didn’t sit well with one famed researcher and his colleagues, who decided to organize a massive international study involving 40, 000 patients. Mohit Bhandari, M.D., professor and research chair in Orthopaedic Surgery at McMaster University in Canada, tells OTW, “In 2011 the United Nations kicked off a program on Road Safety with the goal of cutting traffic deaths by 50% over 10 years. The sad truth, however, is that the needle hasn’t moved at all in the first three years of this program—there has been NO reduction in global traffic deaths.”
“Fortunately, the Canadian Institutes of Health Research provided us with a $500, 000 grant for our study, known as INORMUS (International Orthopaedic Multi-centre Study in Fracture Care), so that we might begin to assess the burden of trauma in developing nations. To date we have recruited 6, 000 patients in India and hope to reach 40, 000 patients worldwide within the next two years; we are looking specifically at fractures and dislocations. Our goal of this observational study is to assess what patient and institutional factors are predictive of complications within 30 days of a major traffic accident. In developing nations data collection isn’t a top priority, and when looked at how they get their records we saw that there was a disconnect with how the government gets its data. Many hospitals don’t have what we would call records. When there is a traffic accident, a police officer writes up a report and that goes into the files and essentially becomes the medical record. You might say that the cops are diagnosing fractures, etc.”
“From the data on our initial 6, 000 patients we found that some people wait up to four days to have an open fracture treated. In rural India 70% of people traveling to a hospital for care arrive in something other than an emergency vehicle—even rickshaws. Within 30 days, 18% of these patients have major complications. And amazingly, 59% of patients experienced a delay in irrigation and debridement (between 7-48 hours). Mortality is 2% in 30 days, but we are not capturing those who already died on the street. And while 2% may not sound shocking, imagine that many people coming into a U.S. hospital with a only a fracture and being dead within 30 days.”
“The fact that the U.N. program has shown no reduction in mortality in the first three years is a good indication that this issue is more complex than it may appear (there are issues corruption, for example). The prevention idea isn’t working so well…lots of people will get hit no matter what we do. So our focus is now, ‘What can we do at the point of the broken bone?’ Once the patient arrives at the hospital there is a better opportunity to optimize care.”
“So what we have learned from these first patients is that we can do research like this—fast with good quality data. We have also confirmed that the burden of severe injuries in these countries is high. This initial work will provide important insight towards the development of clinical trials to test simple, life and limb saving interventions that will come to the aid of countless people worldwide.”
