A Common Treatment for Your Knee Osteoarthritis May be Making it Worse, Studies Say

CNN | By Madeline Holcombe

A common treatment for some arthritis pain might actually be making the condition worse, according to two new studies.

“Knee osteoarthritis is one of the most chronic, degenerative and progressive conditions, with an estimated incidence of 800,000 patients each year in the US alone,” said lead author of one of the studies, Dr. Upasana Bharadwaj.

Osteoarthritis is a common form of arthritis where the cartilage within a joint breaks down over time and the bones around it change, getting worse over time, according to the US Centers for Disease Control and Prevention.

At least 10% of the patients in the study used injections to manage the pain, added Bharadwaj, who is a postdoctoral research fellow in the department of radiology at the University of California San Francisco’s School of Medicine. Two of those pain management injectables are corticosteroids, the more common of the two, and hyaluronic acid.

The studies, which were presented at the annual meeting of the Radiological Society of North America, used either radiograph or MRI images to track the progression of osteoarthritis in the knees of patients. Some of those patients didn’t receive any treatment and others got corticosteroid or hyaluronic acid injections, according to the studies.

Both papers showed a statistically significant increase in progression of degenerative changes in knee cartilage over two years in people that had corticosteroid injections compared with those who had hyaluronic acid or no injections, according to the study authors.

However, just because the images might look worse doesn’t always mean that the people are feeling more pain, said Azad Darbandi, lead author of the other study.

“You might see that the knee looks bad on a radiograph, but the patient might not be having worse symptoms,” added Darbandi, a researcher and medical student at the Chicago Medical School of Rosalind Franklin University of Medicine and Science.

The studies highlight a debate in the osteoarthritis scientific community about the role of changes in the structure of the joint. Currently, pain is the primarily recognized symptom, said Jason Kim, the Arthritis Foundation’s vice president of osteoarthritis research. Kim was not involved in either study.

The takeaway from the studies is that corticosteroids should be administered with caution for osteoarthritis pain.

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Team USA Players Share Emotional Embrace with Iran’s Saeid Ezatolahi

Fox Sports | By Martin Rogers

[We all need a feel good story. Here’s one to get your week started on the right “foot”!]

He’d given everything, and this time, it hadn’t been enough. As the final whistle at Al Thumama Stadium signaled a 1-0 United States victory, there was nothing left for the Iran defensive midfielder to do. So, he sat on the turf, deep into the Qatari night, buried his head in his hands and let the tears tumble.

Seconds later, he felt a big arm around his shoulder. It was Josh Sargent, the USA forward, who had dueled with him during a first half in which the Americans desperately chased a goal until one came after 38 minutes via Christian Pulisic.

Sargent kneeled next to Ezatolahi, hugged him and offered some words of kindness and sympathy. Soon after, USA substitute Brenden Aaronson noticed the scene, saw the anguish on the Iranian player’s face, and came over, too. As did DeAndre Yedlin.

Tim Weah joined them. As he approached, Weah’s face changed from one of beaming delight to something more solemn. As Ezatolahi tried to collect himself, Weah took him by the hands and pulled him to his feet, before hugging and whispering in his ear.

"I think it’s more than just football," Weah told me, as he left the stadium to return to the team’s Doha headquarters. "I think the United States and Iran have had so many issues politically and I just wanted to show that we are all human beings and we all love each other. 

"I just wanted to spread peace and love and show him we come from different backgrounds, we grew up differently. He is still my family, he is still my brother and I love him the same way as the guys I grew up with." 

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Colorado and Oregon Trigger Protections for Leaves Relating to Non-COVID Respiratory Illnesses

Littler Publications

At the outset of the COVID-19 pandemic, a number of jurisdictions enacted sick leave laws specifically designed for absences due to COVID-19. Some states, however, enacted permanent changes to their leave laws that apply during a “public health emergency,” which can apply both to COVID-19 as well as other public health emergencies. With reports of higher-than-average respiratory syncytial virus (RSV) and flu transmission, some of these public health emergency provisions are being triggered, including in both Colorado and Oregon. In such jurisdictions, employees have additional rights, potentially including paid sick leave and job protection for covered absences. 

Colorado Expands Public Health Emergency Leave to Include Absences Relating to RSV, Flu, and Other Respiratory Illnesses

Under Colorado’s Healthy Families and Workplaces Act (HFWA), employers are required to provide employees access to up to 80 hours of paid sick leave when a public health emergency (PHE)¹ has been declared. Employees can access this PHE leave (PHEL) if they are:

1. self-isolating or excluded from the workplace due to exposure, symptoms, or diagnosis of the communicable illness in the PHE;
2. seeking a diagnosis, treatment, or care (including preventive care, such as vaccination) of such an illness;
3. unable to work due to a health condition that may increase susceptibility to or risk of such an illness; or
4. caring for a child or other family member who is in category (1)-(3), or whose school or childcare is unavailable due to the PHE.

Colorado’s governor first declared COVID-19 a public health emergency on March 11, 2020, and this emergency declaration—which has since been amended dozens of times—remains in effect. That means that since January 1, 2021 (when the public health emergency leave portion of the HFWA took effect), Colorado employees have had access to PHEL in connection with COVID-19.

The most recent amendment to the governor’s emergency declaration issued on November 11, 2022 expands this public health emergency to cover not only COVID-19, but also RSV, influenza, and “other respiratory illnesses” in Colorado—an undefined term that could, in theory, encompass anything from whooping cough to the common cold.

This means that all Colorado employers must provide up to 80 hours of paid PHEL for absences relating to all of these illnesses. Notably, the state labor department confirmed in a statement on its website that this amendment does not create a fresh bucket of 80 hours of PHEL: “The expansion beyond COVID doesn’t give employees an extra 80 hours for those conditions, it just means they can use their 80 hours for a broader range of conditions.”

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PODIUM | Help Home Health Providers with Inflation

Colorado Politics | By Don Knox

Home care agencies serving Medicaid patients are in a catch-22 with the current inflation rate and the higher cost of everything these days. On one hand, the critical services these agencies provide in Colorado communities have never been more needed. The most vulnerable among us are often hit the hardest when times get tough, and the invaluable services provided by home care workers help to keep Colorado’s Medicaid patients safe and healthy in their homes. On the other hand, the cost of providing these services has also never been higher, while the reimbursement for these services has not yet been adjusted by the Colorado Legislature to keep pace.

If home care agencies can’t cover the multitude of costs that go into delivering safe and effective Medicaid care under current reimbursement rates, how will they be able to continue serving patients? The reality is, they may not be able to. Agencies are quite literally being squeezed out of Medicaid — with the fate of patients and caregivers alike hanging in the balance.

The solution? The state needs to ensure reimbursement rates for Medicaid providers keep up with inflation and the rising costs of expenses that are inherent in delivering Medicaid services in the home — including the need for these agencies to provide competitive compensation for hard-working caregivers. These workers are also struggling with the high cost of living.

It isn't only the state’s Medicaid population that stands to lose. Taxpayers also have a lot at stake. Extensive research demonstrates the lower costs for at-home services provided through Colorado Medicaid programs such as Home and Community-Based Services waivers. According to the U.S. Department of Health and Human Services, average monthly spending for Medicaid clients under these waivers was $485 per month, compared with an average monthly spending per Medicaid-covered nursing home resident of $2.4K. That's a staggering difference. According to HHS, by investing in home and community-based services, Colorado is among the states that likely has avoided building nursing home beds that otherwise would have been built. If provider agencies are squeezed out of providing these cost-saving services, Colorado taxpayers will be the ones forced to foot the bill.

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[The Colorado Legislature reconvenes on Monday, Jan. 9, 2023. However, the Joint Budget Committee (JBC) has already begun meeting and deciding on budget priorities. That’s why HHAC is already hard at work for you at the capitol, educating policymakers about the need for increased reimbursement rates. You can view the material we provided to the JBC and other legislators here.]