FRIDAY, Nov. 9 (HealthDay News) -- People diagnosed with rheumatoid arthritis run a greater risk of developing heart disease.

But that risk can be spotted and hopefully modified by using the same criteria used to identify heart-disease risk in the general population, a new study suggests.

Those screening checks include high blood pressure, high cholesterol, older age, and family history of cardiovascular illness. And people diagnosed with rheumatoid arthritis (RA) should be screened using those risk factors as soon as possible following their diagnosis of RA, the study authors said.

"The bottom-line is that RA patients are at increased risk of heart disease," said lead researcher Dr. Hilal Maradit Kremers, a research associate with the Mayo Clinic Department of Health Sciences Research in Rochester, Minn.

"But we need to know how can we predict which RA patients are at a higher risk than others, so that we can then put more effort in the prevention of heart disease in these people," she added. "And so, here we attempted to do just that, by using a typical cardiovascular risk profile to predict heart disease among these patients."

Kremers and her colleagues presented their findings this week at the American College of Rheumatology annual meeting, in Boston.

The study findings follow a 2005 Mayo Clinic report that suggested that the increase in heart disease risk among RA patients may be due to the systemic inflammation brought on by the disease, which, in turn, prompts arterial plaque to form blood clots. The new findings also come on the heels of a Mayo Clinic study released last month that said RA patients are more than twice as likely to develop heart failure over a 15-year period than people who don't have the disease.

According to the Arthritis Foundation, rheumatoid arthritis is a chronic and often disabling disease with no known cause or cure that affects just over 2 million Americans. It's characterized by inflammation of the lining of the joints and, over time, can lead to joint damage, severe pain, and immobility.

Treatments -- such as nonsteroidal anti-inflammatories, analgesics and physical therapy -- focus primarily on controlling pain and limiting inflammation and joint destruction.

For the new study, Kremers and her colleagues set out to predict the onset of heart disease over the course of a 10-year period among more than 1,100 people, approximately half of whom had just been diagnosed with RA. The patients were 57 years old, on average, and nearly three-quarters were women.

The patients were evaluated on standard indicators for heart disease risk, as detailed by the American Heart Association. The indicators included: gender; having a family history of heart disease; having diabetes; and/or being black. Patients were also examined for other risk factors, such as high cholesterol and high blood pressure. Risky lifestyle habits -- including smoking, lack of exercise, and being overweight -- were also considered, the researchers said.

Based on the risk-assessment scores, the researchers assigned the patients to one of five different risk categories for heart disease -- ranging from very low to very high risk. Then the patients were tracked for an average of 12 to 14 years, during which time all incidences of heart attack, heart failure, heart surgeries, and cardiovascular-related deaths were noted.

The researchers found that while 85 percent of the RA patients between the ages of 50 and 59 had an intermediate or high risk for developing heart disease within 10 years of diagnosis, just 27 percent of comparable non-RA patients did. Among patients between the ages of 60 and 69 at the start of the study, 100 percent of the RA patients had an intermediate or high risk for heart disease, compared with 79 percent of non-RA patients.

When looking at just "high risk" among the 60 to 69 age group, the difference was even more dramatic: 85 percent for RA patients, compared to just 40 percent for non-RA patients.

The researchers concluded that more than half of RA patients 50 to 59, and all RA patients over the age of 60, had a 10 percent or greater risk of developing heart disease within 10 years of an RA diagnosis.

In light of the findings, the Mayo researchers are encouraging doctors to conduct heart-disease assessment screenings similar to the ones used in the study for each of their RA patients. These screenings should be done as soon as possible following an RA diagnosis and prevention strategies put into place, the researchers said.

"By simply doing the things that we already know, such as measuring blood pressure, blood sugars, and cholesterol -- all the standard things that we look at for the general population -- we can help identify the risk for a major cardiovascular event among the RA population," Kremers said.

Dr. Hayes Wilson, chief of rheumatology at Piedmont Hospital in Atlanta, said he endorsed the Mayo researchers' work.

"Anything that helps us characterize and categorize risk factors helps us in the treatment of the disease," he said. "And, until we can figure out what the smoking gun is, hopefully this advice will help us prevent cardiovascular disease or related diseases by helping RA patients better appreciate the risks they face."

More information

To learn more about rheumatoid arthritis, visit the Arthritis Foundation  .

FRIDAY, Nov. 9 (HealthDay News) -- Sore, arthritic knees may do better with flip-flops and flexible walking shoes than with other types of footwear, new research suggests.

In fact, the closer to barefoot, the better for the knees, the study finds.

"The main finding of the study is that footwear not only affects your feet but can affect other joints at your lower extremity, in particular the amount of load your knees experience when you walk," said lead researcher Dr. Najia Shakoor, an assistant professor of internal medicine at Rush University Medical College in Chicago.

Her team was to present the findings Thursday at the American College of Rheumatology annual meeting in Boston.

Previous research by Shakoor and her team suggested that walking barefoot was associated with lower load on the knees compared to walking with normal walking shoes.

A team of researchers at Rush performed gait analysis on 13 men and three women with osteoarthritis of the knee as they walked barefoot and then with two stability shoes (Dansko clogs and Brooks Addiction shoes), flip-flops and flexible walking shoes (Puma H-Street).

Right now, experts typically recommend stability shoes as supportive, stable and comfortable walking shoes.

A standard measure of load on the knee, using percent body weight times height, was assessed at normal walking speed.

The researchers found that the stability shoes were associated with significantly increased load on the knees compared to barefoot walking. Flip-flops, flexible walking shoes and barefoot walking all put a similar load on the knees.

Shakoor cautioned, "We are not advocating flip-flops. Flip-flops can be associated with other foot problems such as plantar faciitis and are probably not appropriate footwear for older individuals because of their increased association with falls. Therefore, based on this preliminary data we would probably recommend walking shoes over flip-flops for clinical use."

Physical therapist Teresa Schuemann agreed that flip-flops should not top the prescription pad for people with osteoarthritis. Schuemann, a spokeswoman for the American Physical Therapy Association, stressed caution when interpreting these results.

"Depending on what the sole of the shoe is made of, it may or may not absorb shock," said Shuemann, who pointed out that these results may be due in part to stability shoes having a more firm sole and less shock absorption as a result. Yet, she said, a more flexible sole may not be the long-term answer to knee pain. "The question is what is the alignment of the shoe. If your foot falls to the inside of the arch, you're going to be hurting your knee because you are not bearing weight on it."

Schuemann advised people who have been told to wear stability shoes to talk to their doctor about these results before slipping into flip-flops. Stability shoes are usually prescribed to help align the leg from foot to hip and also may be necessary for other reasons, such as arches that are too high or too low.

"If you have osteoarthritis and perfectly aligned feet, the more flexible shoes are probably helpful," she said. But only a minority of people can claim perfect alignment and as people get older and arches fall, that adds more stress to the feet, said Schuemann. The average age of people in the study was 56 -- prime fallen arch years.

The research, according to Shakoor, "gives a better understanding of the biomechanics of the lower extremity."

This is only the first step for the researchers, who plan to evaluate the long-term effects of specific shoes on joint loads in a controlled clinical trial.

"I think [this research] is actually quite novel from the standpoint of understanding that stresses and strains on feet and knees and hips aren't all to be regarded the same way," said rheumatologist Eric Matteson, of the Mayo Clinic. "What's interesting is that we have this emphasis on proper shoe wear, but we need to consider that what we wear has an impact on other joints."

Matteson said there are still some questions that need to be answered.

"We need to do a little bit more work on this. The study was very small and there are a lot of ways that gait analysis can be performed, although they did a pretty sophisticated gait analysis," he explained. "They don't have a lot of different kinds of patients with different kinds of knee problems and they don't have a great diversity of shoewear relating it to different kinds of problems, but it does make me reflect on some of the advice that I have been giving."

According to Matteson, osteoarthritis of the knee is not the same for all people. Some people feel pain inside their knees, others feel it on the outside. He expressed interest in determining how footwear might relate with the different manifestations of knee pain. Osteoarthritis is a massive problem, said Matteson, affecting 20 million to 30 million Americans every year.

"Literally hundreds of thousands of knee replacement surgeries are due to osteoarthritis," he noted.

Knee osteoarthritis is caused by cartilage breakdown in the knee joint. Factors that increase the risk of knee osteoarthritis include being overweight, age, injury or stress to the joints, and family history.

In knee osteoarthritis, there is abundant evidence that patients with abnormally high loading knees (high amounts of stress on part or all of the knee joint) are at increased risk of both injury and disease progression, according to the American College of Rheumatology.

More information

For more on osteoarthritis, head to the Arthritis Foundation  .

FRIDAY, Nov. 9 (HealthDay News) -- With Friday's announcement of almost $5 billion to be paid out to those people claiming they were hurt by the now-withdrawn painkiller Vioxx, the drug's maker, Merck & Co., may have hoped to end the glare of publicity on these types of drugs.

But, according to experts, the move has merely swung the focus back on the medications once again.

Cox-2 inhibitor drugs such as Vioxx, Bextra and Celebrex were initially hailed as a means of treating pain without causing gastrointestinal problems like bleeding, as can happen with related analgesics known as nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs include cox-2 inhibitors and common over-the-counter drugs, such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin.

However, cox-2-mediated stomach protection came at a price. In September 2004, Vioxx was pulled from the market after studies linked its long-term use to increased risk for heart attacks. In April 2005, Bextra was pulled because of similar fears, as well as evidence of increased risks for a rare but potentially fatal skin reaction. Celebrex remains the only cox-2 inhibitor sold in the United States, and its label carries a black-box warning detailing potential heart risks.

Dr. Eric J. Topol, director of the Scripps Translational Science Institute in La Jolla, Calif., and Scripps' chief academic officer, was one of the experts who first exposed the problems with Vioxx. He said he doesn't have a problem with cox-2 inhibitors, but he does take issue with Merck's response to emerging data about heart risks.

Topol claims Merck hid evidence about the risk for heart attack associated with Vioxx. "This whole field wouldn't be in the state it's in had it not been for the problems that occurred early on with Vioxx," he said. "They wouldn't have had to make a settlement if they hadn't concealed things."

In December 2005, the editors of the New England Journal of Medicine accused researchers and Merck of withholding key heart risk data that showed up in one of the first large trials of Vioxx; the findings from that trial were published in the journal. Specifically, the editors charged that the study published in November 2000 was submitted to the journal after information about three heart attacks among Vioxx trial participants was deleted by Merck, which funded the study.

In a statement quoted by the Associated Press, Merck said the additional heart attacks "did not materially change any of the conclusions of the article." Merck also said the additional heart attack data was not included in the study, because the heart attacks were reported after Merck's cut-off date for including study data.

Cox-2 inhibitors do work to ease pain, Topol said. "They work at least as well as NSAIDs and, in some patients, better," he said. "Unfortunately, this whole class of drugs has been hit by an outlier."

With the FDA slapping a strong "black box" warning on Celebrex's label, Topol believes the public and doctors are now well-informed about that drug, so they can make appropriate decisions about which patients should or should not receive the medicine.

"Celebrex is safe for most patients, so is Vioxx," Topol asserted. Celebrex, at higher doses, can increase the risk for blood clots, "but the risk never appeared to be as at the same level as Vioxx," he said.

Topol believes people who have heart disease might be at increased risk of heart attack from Celebrex, but there is no real proof of that, he said.

Going without cox-2s may have its downside for patients, too, experts added.

Since Vioxx and Bextra were taken off the market, rates of gastrointestinal events serious enough to require hospitalization have risen significantly, according to a presentation Thursday at the American College of Rheumatology annual meeting, in Boston.

In fact, these complications have risen 21 percent, said a group led by Dr. Gurkirpal Singh, a rheumatologist and a clinical professor of medicine at Stanford University School of Medicine.

Again, when it comes to stomach risks, the decision as to whether to prescribe Celebrex should be made on a case-by-case basis, one expert said.

"There is a lot of confusion over the cox-2 inhibitor Celebrex and the traditional NSAIDs as well," said Dr. Mark Fendrick, a professor of internal medicine at the University of Michigan School of Medicine and professor of health management and policy at the University of Michigan School of Public Health.

For arthritis patients, Fendrick starts treatment with exercise and physical therapy. "I try hard to avoid all drugs and then use topical medications and acetaminophen as first-line medications," he said.

But for patients who need other medication, Fendrick bases his advice on a combination of the individual patient's risk factors for heart disease versus their risk for gastrointestinal problems. "I recommend cox-2 inhibitors like Celebrex for patients who are at risk of gastrointestinal side effects but at low risk for heart disease," he said.

Celebrex has never been shown to be a superior pain reliever and anti-inflammatory drug over any of the other NSAIDs, Fendrick said. "So, alternatives for pain relief and anti-inflammatory effect are just about as good as traditional NSAIDs," he said.

For people who have a high risk of gastrointestinal side effects, such as those with a history of gastrointestinal problems and those taking anticoagulant drugs, Fendrick recommends coupling NSAIDs with stomach-soothing drugs called proton pump inhibitors. These drugs include widely used medications such as Nexium, Prevacid and Prilosec.

More information

There's more on pain relievers at the U.S. National Library of Medicine.

(HealthDay News) - Osteoarthritis, a disease of the joints, can be triggered by injury and overuse, by obesity, and by musculoskeletal problems.

Here are ways to help protect your joints, courtesy of the Arthritis Foundation:

• As excess weight can cause stress and excess wear and tear on joints, keep your body at a healthy weight.
• Get regular exercise to strengthen muscles that surround and protect the joints.
• Practice good posture.
• Be careful when lifting or carrying heavy objects.
• Don't ignore pain. When something starts to hurt, stop activity or exercise to prevent strain or injury.
• Don't stay in one position for too long. Try to move the body's joints and muscles regularly.
• Always wear protective equipment, including helmets and wrist pads, when appropriate.