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Pain and Arthritis Newsletter
October 8, 2012
In this Issue
• Rheumatoid Arthritis May Be Linked to More Blood Clots
• Child Abuse Injuries Have Risen, Study Finds

Rheumatoid Arthritis May Be Linked to More Blood Clots

But overall risk remains small, study finds

TUESDAY, Oct. 2 (HealthDay News) -- New research confirms suspicions that people with rheumatoid arthritis are at somewhat higher risk of developing blood clots in their veins in the decade after diagnosis.

The risk appears to be greater during hospitalization, as it is within the general population, the Swedish researchers added.

The study, published in the Oct. 3 issue of the Journal of the American Medical Association, doesn't prove that rheumatoid arthritis directly increases the likelihood of blood clots.

Still, it provides "strong evidence that there is a connection between rheumatoid arthritis and blood clots, and that something related to rheumatoid arthritis -- inflammation, treatment, other factors -- is increasing the risk of blood clots," said study author Dr. Marie Holmqvist, a postdoctoral researcher at the Karolinska Institute in Stockholm.

Rheumatoid arthritis is different from osteoarthritis, the arthritis associated with wear-and-tear and aging. Rheumatoid arthritis frequently starts between the ages of 25 and 55, and causes inflammation in the joints, resulting in swelling, stiffness, pain and reduced joint function.

Previous research has suggested a link between rheumatoid arthritis and blood clots known as deep vein thrombosis, a clot usually located in the leg or thigh. If the clot travels to the lung, it is called a pulmonary embolism. The clots can lead to heart attack and stroke.

In the new study, researchers sought to better understand the extra risk and determine whether it goes up when patients are hospitalized. They tracked more than 45,000 people in Sweden with rheumatoid arthritis and similar people without the disease from 1997 to 2010.

Of the nearly 38,000 patients who had the most doctor visits for the condition, 2.2 percent suffered from diagnosed blood clots. The number was half that -- 1.1 percent -- among the people without the condition.

"Few individuals experienced a blood clot, so rheumatoid arthritis patients in general shouldn't fear blood clots in their everyday life," Holmqvist said.

Blood clots in both groups were more common in the first year after hospitalization, and the rates were similar in those with rheumatoid arthritis and those without during that year.

If it's true that rheumatoid arthritis causes blood clots, Holmqvist said, it may have something to do with the inflammation that afflicts those with the condition or their treatment.

Dr. Daniel Solomon, chief of clinical sciences in rheumatology at Brigham and Women's Hospital in Boston, said other factors increasing the risk could include genes, exposure to tobacco and the inactivity that's more common in patients with moderate or severe rheumatoid arthritis. For now, however, it's not clear what's going on.

Solomon praised the study and said it adds to existing knowledge about the risk of blood clots in rheumatoid arthritis patients. Along with other studies, it provides more knowledge about vascular problems -- medical conditions that clog blood vessels -- in these patients, he said.

"While most of these patients will not experience a blood clot, a significant minority will over their lifetime," he said. "Since we do not have a clear strategy for managing this risk, it is too early to determine whether worrying about it is useful. But providers and patients should receive education about it."

More information

For more about rheumatoid arthritis, see the U.S. National Library of Medicine.

Child Abuse Injuries Have Risen, Study Finds

Child protective agencies reported decline, but hospital data tell a different story

MONDAY, Oct. 1 (HealthDay News) -- Despite government agency reports suggesting a decrease in child abuse cases, new data show that the number of children hospitalized due to serious abuse-related injuries actually increased slightly from 1997 to 2009.

In the new study, researchers analyzed U.S. hospital statistics from the Kids Inpatient Database. During this 12-year period, the incidence of serious injuries due to child abuse -- including fractures and abusive head trauma -- increased by 4.9 percent. By contrast, child protective service records showed a 55 percent decrease in child abuse injuries in that time period.

The new findings appear online Oct. 1 and in the November print issue of Pediatrics.

Many reasons could account for the apparent disconnect, said study co-author Dr. John Mishel Leventhal, a professor of pediatrics at the Yale School of Medicine.

For starters, "we were looking at the most serious injuries that require hospital stays, while others have looked at child abuse rates overall," he said. There may also have been changes in reporting and injury coding as well as the criteria for who is admitted to the hospital.

The new data show that serious abuse-related hospitalizations are more common in infants under 1 year old and tend to disproportionately affect families on Medicaid, the U.S. health program for low-income individuals and families. "Rates of stress may be high in poorer families, and stress is linked to risk of abuse," Leventhal said.

"Prevention messages must be clearer, louder and heard in various settings including health care, daycare, parent support groups," he said. To really make a dent in the rates of serious abusive injuries in children, a national awareness and prevention campaign is needed, the researchers suggested.

Many children are injured by people who are not related to them, Leventhal warned. "Be careful about whom you leave your kids with, and even if it is embarrassing, say 'Don't hurt my kid when you take care of them.'" He said he often advises parents to "take five" when they feel frustrated: "Step back, take a deep breath and walk out of the room."

The findings point to the challenges of using any one source of data to track child abuse, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York, in New Hyde Park.

"These are all preventable injuries, and the canary in the coal mine," Adesman said. "Abuse is a signal that there are problems in the household or parenting that can't be ignored. We need to do better in terms of prevention and earlier intervention in these homes."

More information

The U.S. Department of Health and Human Services offers advice on preventing child abuse and neglect.

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