Adapted from BMJ 29 June 2024

Localised shock wave treatment has been used to treat patients with tendinitis, non-healing bone fractures, chronic leg ulcers, soft tissue wounds, post-stroke spasticity and spinal cord injury.

Now, Austrian researchers have found a small, but definite effect, in heart muscle regeneration in patients who have coronary artery bypass surgery.

An electric current is applied to electrodes in water, not the patient, so they get a sonic shock rather than an electrical shock. The sonic wave cannot be heard by humans. They say that this, “activates the innate immune system of treated cells, leading to increased DNA accessibility and cellular plasticity, together with the secretion of angiogenic cytokines and growth factors. This induces angiogenesis in the hibernating myocardium. Newly formed vessels then support the recruitment of chronically under-supplied myocardium.”

In a trial of 63 patients undergoing CABG surgery, some had the sonic treatment and others had sham treatment. After a year, left ventricular ejection fraction in the shockwave group increased by 11.3% compared to 6.3% in the control group. The treated group could walk further in six minutes compared to the untreated group and also reported a better quality of life.

Lead researcher Johannes Holfield said, ” for the first time, we are seeing the heart muscle regenerate in a clinical setting, which could help millions of people.” Larger trials are now planned for chronic ischaemia patients.

Adapted from The State of Musculoskeletal Health Report 2023 by Versus Arthritis

Over ten million people in the UK have arthritis.

Health inequalities are defined as “unfair and avoidable differences in health across the population, and between different groups in society”.

One health inequality is deprivation. For example hip and knee osteoarthritis is commoner in the most deprived compared to the least deprived. Some ethnic groups are also affected considerably more than others. As a reference point, White British people have a 16.8% prevalence of a long term musculoskeletal problem (MSK). UK Chinese people have a 7.4% prevalence and UK Pakistani people have a 20.8% prevalence.

People with a MSK problem are 20% less likely to be in work compared with those who don’t have such a condition. In 2021 23.3 million working days were lost due to these conditions making it the third most common reason for working days lost.

I in 3 current UK employees have a long term health condition. 1 in 10 have a MSK condition. I in 3 of these employees with a long term MSK condition have not discussed it with their employer.

Of people who have no long term health condition 82.1% are in employment but this drops to 62.4% of those with a MSK condition. Of those with no long term health condition 15.2% are economically inactive. This rises to 34.9% of those with MSK conditions.

MSK conditions account for the third largest area of NHS spending at £4.7 billion in 2013-14 and are estimated to have cost £6.3 billion in 2022-23. The cost due to just Osteoarthritis and Rheumatoid arthritis will be £3.43 billion by 2030.

For many people, joint replacement surgery is the most effective treatment for their MSK condition. But many operations were not carried out over the Covid period. The conditions have not got better, the waiting lists have just got a lot longer. Approximately half of the operations done in 2019 were carried out in 2020 and the figures were still lagging in 2021.

Rheumatoid Arthritis affects 27,000 new patients each year. 30% of those with the Rh A develop osteoporosis. One in ten will develop interstitial lung disease over their lifetime. 60% of people with Rh A are physically inactive. One third of them have a mental health problem such as anxiety or depression. About a third of diagnosed people will stop work within five years of diagnosis.

Risk factors for getting the condition include age. It comes on most commonly between the ages of 40 and 70. It is 2 to 3 times more common in women compared to men. Being overweight increases the risk. There are hereditary factors involved. The gut microbiome is thought to play a part. Smoking increases the risk, worsens the disease and weakens treatment response.

My comment: As a GP I had hoped that new therapies and operations would revolutionise the outlook for musculoskeletal conditions and indeed there has been a lot of positive change. There is still some way to go. There isn’t much you can do about your heredity or gut microbiome but you can be a non smoker, keep slim and keep active. Meanwhile I wonder if anyone is researching how people of Chinese extraction have much fewer MSK conditions than any other group.

Adapted from Medscape 5 Dec 2022 by Vinod Rane BS Pharm

Glucosamine, popularly used for osteoarthritis, has previously been found to have anti-inflammatory properties and regular use has now been shown to reduce cancers overall and particularly kidney, lung and rectal cancer.

This was a large prospective study that included 453,645 participants aged 38 to 73 who did not have cancer at the start of the study.

19.4% were taking glucosamine regularly and 80.6% were not. The patients were followed up for a median of 12 years.

Cancer was reduced in cancer overall 0.95, kidney cancer 0.68, lung cancer 0.84 and rectal cancer 0.76.

The study did not include the dose, form and duration of supplement use and there could be a risk that the people who took glucosamine also followed other healthier behaviours than those who didn’t.

My comment: I have been taking glucosamine for 23 years now and it has been a great benefit to my joints. I can see that confounding could be a problem. Non smokers greatly reduce lung cancer, vitamin D users are less likely to get rectal cancer, and slim people are less likely to get kidney cancer.

Zhou J et al Associaton between glucosamine use and cancer mortality. A large prospective cohort study. Front Nutr. 2022;9:947818.