Childhood Arthritis Raises Risk Of Broken Bones

Childhood arthritis increases the risk of fractures, particularly during adolescence, according to a large study of British patient records. The researchers say that more targeted treatments promoting bone health would benefit patients with childhood-onset arthritis throughout their lifespan.

In addition to raising the risk of fracture during childhood, the researchers also found that childhood-onset arthritis potentially heightens fracture risk after age 45.

A research team led by pediatric rheumatologist Jon M. Burnham, M.D., of The Children's Hospital of Philadelphia and the University of Pennsylvania, analyzed the medical records of 1,959 patients in the United Kingdom who first experienced arthritis between ages one and 19. The researchers compared those patients to a larger control group of 207,000 patients in a primary care database.

The study appeared online in the Annals of the Rheumatic Diseases on April 21. It was the first research to examine, in a population-based study, the risk of fractures in childhood arthritis patients.

Juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid arthritis, is the most common pediatric rheumatic disease, affecting approximately one in 1,000 U.S. children. It was already known that low bone mass occurs in patients with JIA, because of risk factors such as chronic inflammation, delayed puberty, malnutrition, weakness, inactivity and treatment with steroid medications.

"The goal of this study was to determine if the bone abnormalities seen in JIA are clinically significant, resulting in higher fracture rates, and that is exactly what we found," said Dr. Burnham. "The low bone mass in JIA is associated with skeletal fragility, and causes both short-term and long-term health problems. Someone who fails to attain peak bone mass during adolescence and young adulthood is more vulnerable to fractures in later life, when bone mass inexorably declines."

Fractures are not unusual in healthy, active children, and the researchers compared the records of patients who had juvenile-onset arthritis with those of control subjects. Their data source was the United Kingdom General Practice Research Database, representing primary care records from 1987 to 2002.

The researchers found that 6.7 percent of patients with JIA sustained first fractures, compared to 3.3 percent of control subjects with first fractures, during an average follow-up period of four years. The comparative risk for patients with arthritis was highest at ages 10 to 15 and peaked again after age 45. Patients with arthritis were significantly more likely than controls to suffer fractures in their arm and leg bones.

Dr. Burnham added that the study findings should encourage physicians caring for children with arthritis to more closely monitor their patients for signs of osteoporosis, and to focus on nutritional steps that promote bone health, such as increasing regular intake of calcium and vitamin D.

Because bone health is affected by a combination of factors, including inflammation, inactivity, delayed puberty, impaired nutrition and the use of steroid medications, he added, further studies should concentrate on determining how JIA interacts with these risk factors, and how specific therapies might benefit JIA patients. Dr. Burnham is currently leading multidisciplinary research on bone and muscle strength in JIA and other inflammatory diseases.

Source: http://www.medicalnewstoday.com/articles/43062.php

CT scan's merits weighed against its risks

BLUFFTON -- Recent reports say that CT scans are overused nationwide and could cause cancer in as many as 3 million people over the next three decades.

Computed Tomography (CT) scans superimpose hundreds of X-ray images to make 3-D pictures of the body. In a matter of minutes, they can show doctors what is occurring inside the body without having to cut someone open. They are especially useful in high-trauma situations that require quick decision-making or to find out what is happening to a stroke patient.

The scans, however, expose patients to radiation, which has the potential to cause cancer.

Dr. Robert Hewes of Hilton Head Regional Medical Center said a CT scan is equivalent to one year's exposure of sunlight. The information doctors can obtain from the scans sometimes far outweighs the risks, he said.

The New England Journal of Medicine study, released last month, reports that one-third of CT scans are medically unnecessary.

Hewes said that number is much higher than what he sees locally. Doctors determine what tests are appropriate based on the type of injury or ailment, a person's medical history and physical exam.

"We want to make sure the patients are getting appropriate exams with the least amount of radiation possible," he said. "I have to say, though, that we also need to be careful of the population, especially those people who are young and females."

Women are more vulnerable to radiation, which can lead to an increased risk of still births.

Dr. Joseph Borelli, president of Bluffton's MRI at Belfair and chairman of the national committee on MRI Accreditation, said excessive levels of radiation lead to breaks in a person's DNA, allowing cancer to spread.

He stands by the MRI, which stands for magnetic resonance imaging.

While an MRI takes about 20 minutes, compared to a five-minute CT, it can provide a better picture of the body.

"It picks up more tumors than a CT would," Borelli said. "And, it's better at looking at bone marrow."

Borelli doesn't expect MRI technology to catch up to CT speed. He also says CT scans are more portable and often used for military men and women in times of war.

Other alternatives include:

• X-rays provide one-dimensional views of fractures or broken bones.

• Ultrasound technology uses sound waves to show the structure and movement of the body's internal organs, along with its blood flow. It does not have any negative side effects and is the method of choice for tracking fetal growth and movement.

• A PET scan, or positron emission tomography scan, is a nuclear medicine exam. It carries higher amounts of radiation because a radioactive substance is injected into the body, which causes the person to be radioactive for a few days following the exam.

Source: http://www.beaufortgazette.com/local/story/121710.html

Crew injury Pretty Fly II, Cougar ll out of Hobart

A second crewman has been injured and a third yacht has this afternoon retired from the 63rd Rolex Sydney Hobart Yacht Race.

The NSW yacht Pretty Fly II, skippered by Colin Woods, is heading for Eden this afternoon after crew member Derek Brown suffered a broken nose and cheek bone when he was hit in the face by the spinnaker pole when the boat was about 27 nautical miles from the port town.

Pretty Fly II is making for a rendezvous with a Water Police boat in Eden Harbour so Brown can be transferred to Pambula Hospital.

Full article: http://www.sail-world.com/index.cfm?SEID=2&Nid=40267&SRCID=0&ntid=0&tickeruid=0&tickerCID=0

How to tell a broken bone from a hole in the snow

Winter is definitely here, with snow and ice in the morning, followed by sun and puddles in the afternoon. This can often cause a fall. Falling forward is a very common injury from many outside activities -- including skiing, snowboarding or running on icy trails -- and usually results in nothing more than a bruise or a bump.

Most commonly, falls mean a fracture of the wrist or hand, but sometimes the force of the blow can be transferred up the arm to the elbow. In this case, there could be a fracture or dislocation of the bones of the elbow, and the radial head is often where this occurs.

There are two bones in the forearm that connect to one in the upper arm. The humerus is the bone that goes from the shoulder to the elbow. At the elbow, it widens out so that it can connect to the bones of the forearm (the radius and the ulna). The construction of the forearm is complex in that it must allow rotation of the forearm so the wrist can go from facing down to facing up while still providing stability. This is achieved by having each bone swap functions at each end of the forearm. In the elbow, the radius is the bone that rotates. In the wrist, the ulna is the one that allows rotation. It is a pretty neat construct.

If there are excess loads to the forearm or wrist, these stresses can literally be sent up the arm to the elbow. This can result in so much force on the elbow and the forearm bones that something has to give. What gives depends upon many things, but one of the most important is that age of the person.

Young children tend to dislocate the elbow or fracture the end of the humerus or upper arm bone. Older people tend to fracture the wrist since they tend to have less calcium and weaker bones. Between the ages of 30 and 40, more commonly in women, the part of the radius bone that connects with the elbow is where the fracture occurs.

If you are unlucky enough to have an injury like this, here are some of the signs that you should look for:

Pain in and around the elbow, especially on the outside of the elbow.

Swelling around the elbow, especially on the outside.

Pain with bending or straightening the elbow.

Pain with trying to turn the forearm, such as with turning the palm up and down.

Pain in the elbow, especially on the outside, when gripping.

If any of these symptoms are present, you should get the arm in a sling or a splint to protect it and get it checked out. In most cases, the diagnosis is made from a routine X-ray, and we can classify the break as either a type I, II or III fracture depending on the severity.

If the initial X-rays are negative and the pain and especially loss of motion persist, you might need an MRI. This will allow proper treatment and hopefully a rapid return to full activity.

Paul Collins, M.D., is an orthopedic surgeon specializing in sports medicine at Orthopedic Health Care in Boise, Idaho. Collins is an avid participant in many outdoor activities.

Source: http://dailycamera.com/news/2007/dec/20/the-elbow-fractures-connected-to-the/