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ACR Coverage: OA Management, Telehealth, Medical Marijuana and More

Our team of Patient Representatives and staff hit the ground running Monday to take in a range of sessions at the 2017 Annual Meeting of the ACR/AHRP (Annual Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals).

Donna Dernier sat in on a session titled “Moving Toward Better Osteoarthritis Management.” In it, Kelli Allen, a research professor of medicine from the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill, said there is plenty of good evidence that certain behavioral therapies can work to better manage osteoarthritis (OA), but the message is getting lost in translation to the patient. Dernier reports, “The good news is there are agreed-upon strategies that work well to reduce pain and increase mobility. These include weight loss, better sleep patterns, judicious use of pain meds, increased exercise. Unfortunately, compliance isn’t always as high as doctors would like. Causes for this could be: non-shared decision making, a patient’s lack of confidence in the recommendation, or perhaps difficulty in actually getting to [physical therapy] sessions.”

Carol Oatis, a physical therapist and professor at Arcadia University in Glenside, Pennsylvania, also attended the lecture. She was asked about the bottom line for patients. 

Dernier also attended a session on telehealth and how it can expand access to care for many patients. “The main point is that there are fewer and fewer doctors, including rheumatologists, to serve a large (and growing) aging population. The goal of telehealth is to provide the right medical care at the right time for the right patient pathology.… There are many administrative issues in practicing medicine across state lines, but the government recognizes that this is an upcoming and necessary technology.”

A session on “Physical Activity and Psychosocial Aspects of Arthritis” caught the attention of both Dernier and Stacy Courtnay. Writes Dernier, “Good news is studies show no bad effects [of exercise] on either OA or [rheumatoid arthritis] RA. The recommendation is for 150 minutes of moderate activity per week. When people are less active, they are more prone to depression. Thus, physical activity intervention lowers depression. Turns out physical activity has positive impact on all aspects of rheumatic disease: function, pain, sleep, etc. Physical activity delays the onset of ‘disability,’ defined as the loss of valued life activities.”

Courtnay reports, “Interesting session on exercise and psychosocial aspects in rheumatic patients by Patricia Katz [professor of medicine at University of California, San Francisco]. Feeling validated by information presented. Patients with RA are more sensitive than general population to sleep disturbances, which explains why I need naps when I don’t get enough sleep or have a bad night’s sleep. Most people can push through, but it’s much harder for RA patients.”

Courtnay concludes, “Prevalent theme throughout all sessions is ‘Sit less, move more!’”

Another session of note was a presentation by Mayo Clinic cardiologist Rekha Mankad, called “Getting to the Heart of the Matter.” In it, she reminded the rheumatology community that people with autoimmune inflammatory rheumatic diseases – including RA, lupus, psoriatic arthritis and ankylosing spondylitis – are at higher risk for developing all types of cardiovascular problems, from atrial fibrillation and atherosclerosis to heart attack and stroke. While traditional risk factors (like high blood pressure and diabetes) play a role, this risk is increased because of constant, low-level inflammation – but just how much it is increased has not been agreed upon.

“Cannabis in Society and Medical Practice” explored the impact on society and the individual of the medicinal and recreational legalization of marijuana. Rosalie Pacula, a senior economist at the RAND Corporation, told the audience that almost nothing is known about marijuana’s health impact because the landscape is changing so rapidly and laws vary from state to state (even county to county in some places) and often evolve within states. Daniele Piomelli, MD, professor of anatomy and neurobiology, pharmacology and biological chemistry at University of California, Irvine, explained exactly how cannabis works in the brain and what the scientific literature shows cannabis helps with. Good news: there is substantial evidence of its effectiveness for chronic pain.

Author: Andrea Kane for the Arthritis Foundation

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