While it’s easy to understand why many people who live with a chronic physical ailment become depressed, research has shown that the relationship often goes both ways. People who are depressed are also more likely to later develop a physical disease. Research has shown this to be true for lupus, inflammatory bowel disease, and psoriasis. Now a new study finds that it also applies to rheumatoid arthritis (RA).

According to the study, which was presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting in Atlanta, women who had been diagnosed with depression were significantly more likely to be diagnosed with RA at least four years later.

This finding was based on an analysis of data taken from the Nurses’ Health Study and the Nurses’ Health Study II, which provided researchers with information on nearly 195,000 women. More research is needed, but widespread inflammation may be the connecting factor between depression and autoimmune conditions including RA.

Interestingly, this particular study found a connection between depression and the risk of only seronegative RA.

Most people with RA are seropositive, which means that they have high levels of specific autoimmune antibodies (rheumatoid factor and/or anti-cyclic citrullinated peptide) in their blood. Seronegative patients do not have these antibodies, although some people eventually develop them. Both seropositive and seronegative rheumatoid arthritis patients experience symptoms like joint pain, fatigue, and fevers, though experts are still investigating how the presence or lack of antibodies might influence the course of the disease.

“Depression was strongly associated with risk for incident seronegative RA, independent of potential confounders including smoking, dietary intake, body mass index, physical activity, and menopause,” the authors wrote.

More research will be needed to determine why depression was tied to seronegative but not seropositive RA.

“This is interesting and contributes to knowledge of differences between these two dominant subtypes of rheumatoid disease,” Mayo Clinic rheumatologist John Davis, III, MD, told CreakyJoints. This knowledge can help doctors and researchers better understand the differences in what causes seronegative versus seropositive RA, “which could improve treatment options,” Dr. Davis says.

Track Your Arthritis Symptoms

Join CreakyJoints’ patient-centered research registry to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Keep Reading

• 5 Ways to Manage Depression When You Have Arthritis
• There’s a Link Between Rheumatoid Arthritis and Depression — and Lowering Inflammation May Help Both
• More Than Half of People with Depression Over Age 50 Also Have Arthritis

The post Women with Depression More Likely to Develop Seronegative Rheumatoid Arthritis (But Not Seropositive) appeared first on CreakyJoints.

Every year, top researchers, doctors, and other experts gather together at the world’s largest medical meeting for rheumatology professionals: the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting, held in 2019 in Atlanta.

The point of the meeting is for doctors to learn the latest thinking in how to prevent, diagnose, treat, and care for patients with all kinds of arthritis and rheumatologic conditions, and for researchers to share their latest discoveries, including updates on new medications to more effectively treat these diseases.

Of course, the patient perspective at such meetings matters and is growing in importance, as more and more research factors in patient-reported outcomes, or PROs. We at CreakyJoints do our best to learn as much as possible at conferences like ACR so we report back key updates for our patient community back home. The CreakyJoints team was on site at ACR, reviewing studies, attending sessions from top experts, and chatting with patients and physicians for their take on the most important findings and trends.

A Need for More Focus on Hispanic Patients

One area we paid especially close attention to this year at ACR was research among Hispanic patient populations.

Although the Hispanic population is the largest minority in the United States, comprising nearly 60 million Americans, there are very limited disease-specific resources — and a large need for it.

According to Pew Hispanic research, 71 percent of Hispanics obtain health information through their social networks and 79 percent of them act on this information. But the general health information available for the Hispanic community online heavily leans towards dangerous misinformation, which has led to low levels of diagnosis and a growing knowledge gap, as well as a community that spends the least on health care, according to the U.S. Bureau of Labor Statistics, and has decreased participation in open enrollment, according to data from the Centers for Medicare & Medicaid Services.

We are proud of our efforts to help reduce this disparity through CreakyJoints Español, our Hispanic-focused website, social media, and external outreach initiative.

Although there is much more work to do, we are happy to see that some rheumatology professionals are focused on changing this. We need more research (clinical trials, observational studies, and those involving patient-reported outcomes) conducted among the Hispanic patient community.  If we increase participation of Hispanic patients in rheumatology research, we will better understand how to effectively treat different patient communities and, in turn, improve our ability to provide personalized and precision medicine for all individuals.

Below you can read about some of the key studies shared at this ACR meeting that focused on Hispanic patient communities.

For more research breakthrough from ACR 2019, check out our main guide: 50+ Arthritis Updates That Should Be on Your Radar.

For more specific research on the following conditions, check out our ACR coverage on:

• Rheumatoid Arthritis (RA) Updates
• Axial Spondyloarthritis (axSpA) Updates
• Psoriatic Arthritis (PsA) Updates
• Osteoarthritis (OA) Updates
• Gout Updates

1. Hispanic RA patients may report feeling worse than their doctors observe — and fibromyalgia may be a factor

When RA patients get regular check-ups at the rheumatologist, doctors assess how they’re doing in a number of different ways, such as blood tests, counting tender/swollen joints, and looking at imaging such as X-rays. Doctors also do what’s called a “physician global assessment,” which is a score of how they think patients are doing based on a number of different factors and patients do a self-report of how they’re doing, based on various surveys you complete about how you feel in various aspects of your life and disease management. Researchers from Rush University Medical Center in Chicago presented data at the ACR 2019 meeting that showed that Hispanic patients with rheumatoid arthritis often report they are doing worse than their doctors perceive them to be — a worse discrepancy than with non-Hispanic White patients or Black patients with RA. The researchers noted that these kinds of discrepancies were more common in patients who also met criteria for having fibromyalgia.

If you feel like your pain, fatigue, ability to do everyday tasks is poor and not improving, despite being on medication for RA, make sure to bring this up with your doctor and discuss what you can do as a team to help you feel better. If you suspect you might have symptoms of fibromyalgia but have not discussed this with your doctor, ask about this too. You might need separate medication or lifestyle changes to manage symptoms that are unique to fibromyalgia.

2. It’s important to ask your rheumatologist about your cardiovascular risk

When it comes to cardiovascular risk in people inflammatory forms of arthritis, Hispanic patients may face a double disadvantage. For one thing, evidence suggests that the tools that doctors use to calculate heart disease risk might underestimate the risk of anyone living with chronic inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, or lupus, because they don’t factor in systemic inflammation that we now know can have a significant impact on heart disease risk. For another, the “Hispanic population has been underrepresented in [cardiovascular] risk assessment research,” according to researchers from Westchester Medical Center in Valhalla, New York.

They studied a group of patients over age 40 who did not have an established heart disease diagnosis and were not currently on cholesterol-lowering medication and calculated their heart disease risk using the Atherosclerotic Cardiovascular Disease (ASCVD) calculator. In group of 53 patients that was 85 percent Hispanic, they found that 13 percent of patients met the criteria for starting cholesterol-lowering statin drugs based on their calculated scores.

“Although we have a small sample size,” the researchers noted, “this study demonstrates the ease and feasibility of performing [cardiovascular risk assessment in clinical practice.”

3. A formula that predicts the risk of high blood pressure can help Hispanic rheumatology patients

The PROOF-BP calculator is a special formula, or algorithm, which helps predict risk of developing hypertension, or chronic high blood pressure. Researchers from a Mexican hospital shared data that demonstrated this calculator can be used to help lower the number of Hispanic patients who are living with untreated hypertension. When they used the calculator in a group of 217 rheumatology patients (the most frequent diagnosis was rheumatoid arthritis, with 36 percent of patients), they found that 39 percent of people were initially classified as having either a medium to high risk of hypertension, but only 43 percent of patients that required additional evaluation followed the recommendation. More research may be needed to make sure patients understand what hypertension is and how it can affect heart disease risk in people with rheumatic conditions, and how to encourage people at risk of hypertension to get regular follow-up and treatment if necessary.

4. How early does ‘early treatment’ of rheumatoid arthritis need to be? A Puerto Rico study sheds some new light.

Doctors now know that early and aggressive treatment of rheumatoid arthritis with disease-modifying drugs (DMARDs) is associated with better outcomes, but questions remain over the ideal early window. This is especially important when you consider how in many parts of America, it can take weeks or months to get an appointment at a rheumatologist once you’re referred from your primary care doctor. Previous research has established that people who are diagnosed and start treatment within six months fare better than those who are treated after six months, but is a shorter window — less than three months — even better?

A new analysis of a group of Puerto Rican patients found that the answer was no. Researchers could not detect an improvement in patients’ outcomes based on whether they started DMARD medication with three months of being diagnosed versus between three and six months. It’s not the final word, of course, and other factors need to be considered, such as how long patients have symptoms present before getting diagnosed, how aggressive the course of disease is, etc. But it does seem to indicate that “the therapeutic window of less than six months seems reasonable for this group of patients,” the authors note.

5. Hispanic patients with rheumatoid arthritis take three to four times as long to see a rheumatologist as other patient groups*

Rush University researchers analyzed data on 152 patients who were first diagnosed with rheumatoid arthritis at their clinic between 2011 and 2016: 35 percent were White, 37 percent were Black, 20 percent were Hispanic, and 8 percent fell into an “other” category. They found that there was a median delay to a first rheumatology visit of six to eight months for all patient groups, except for Hispanic patients — who experienced a delay of 22.7 months. Interestingly, native language did not appear to play a role in the delay, as there was no difference between those who selected Spanish as their preferred language and those who selected English. What may make a difference is whether or not patients regularly see a primary care doctor: A higher percentage of White and Black patients were referred to the rheumatology clinic by primary care physicians relative to Hispanic patients, who mainly referred themselves.

The researchers concluded that all RA patients, but especially Hispanic patients with the longest delays, “are at risk of poorer outcomes as a consequence of delayed presentation to a rheumatologist leading to delay in treatment initiation.” We need more research to understand what factors lead to this delay and how to shorten the time to diagnosis, especially for Hispanic patients.

*Note: This study was presented at the 2018 ACR meeting, but we felt the findings were so important that we needed to include them here.

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

The post ACR 2019: New Findings that Hispanic Arthritis Patients Should Know appeared first on CreakyJoints.

Earlier this year, the FDA approved upadacitinib (Rinvoq) for the treatment of rheumatoid arthritis. The manufacturer (AbbVie) has been studying whether this oral medication, a JAK inhibitor, might be effective for other inflammatory conditions as well. Now they’ve completed a study that suggests the drug may be useful for ankylosing spondylitis (AS) patients.

The research was presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting in Atlanta and findings were simultaneously published in the journal The Lancet.

In this double-blind, placebo-controlled phase 2/3 study, 187 patients with ankylosing spondylitis were randomly assigned to one of two groups. Half of the study participants were given 15 mg of upadacitinib; the other half were given a placebo. After 14 weeks, 52 percent of those taking upadactinib had an improvement in disease activity of at least 40 percent (ASAS 40 response criteria) compared to 26 percent of those who had been taking a placebo.

The authors reported that the rate of adverse events in the upadactinib and placebo groups was similar. Side effects of this drug may include an increased risk of infections, nausea, and fever. The drug label also warns that it may increase the risk of developing serious infections (such as shingles and tuberculosis) as well as lymphoma. There are also concerns in JAK inhibitors generally about an increased risk of blood clots called deep vein thrombosis (DVT).

Unlike biologic drugs that are given by infusion or injection, JAK inhibitors like upadactinib are taken orally via a pill. These medications work by blocking janus kinases (JAKs), enzymes that are involved in the inflammation process.

Ankylosing spondylitis is a type of inflammatory arthritis that primarily impacts the lower spine and sacroiliac joints in the pelvis (though it can affect other joints too). Current guidelines suggest that most AS patients start treatment with an NSAID (non-steroidal anti-inflammatory drug) before progressing to an anti-TNF-blocker if necessary. If JAK inhibitors like upadactinib are ultimately approved for AS, it’s not yet clear where would fall in an growing group of available targeted therapies.

Use Our ArthritisPower App to Manage Your Arthritis

Join CreakyJoints’ patient-centered research registry to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Keep Reading

• ACR 2019: 12 New Things to Know About Axial Spondyloarthritis
• 14 Things You Should Do Any Time You Start a New Medication for Arthritis
• If You Use NSAIDs Regularly to Treat Ankylosing Spondylitis, You’re at Risk of High Blood Pressure

The post The JAK Inhibitor Upadacitinib (Rinvoq) May Help Ankylosing Spondylitis Patients appeared first on CreakyJoints.

Methotrexate has long been the gold standard first-line treatment for rheumatoid arthritis (RA). It’s often used to treat psoriasis and psoriatic arthritis, too. While this disease-modifying drug is popular for good reason — it tends to be effective, affordable, and has an “acceptable safety profile” — it’s hardly free of side effects. Now a new study clarifies some of the possible risks associated with taking low-dose methotrexate and, in doing so, provides clinicians with additional information that can help them decide who should or should not take it and what kind of monitoring they may need.

The new study, which was presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals Annual Meeting in Atlanta, involved re-analyzing data from a large trial called CIRT (Cardiovascular Inflammation Reduction Trial) that focused on patients with coronary artery disease, type 2 diabetes, and/or metabolic syndrome (but NOT rheumatoid arthritis or another rheumatic condition).

Because methotrexate appeared to lower the risk of cardiovascular events in rheumatic patients, researchers had theorized that it might help those who had a cardiovascular or metabolic disease stay healthy. That initial premise, unfortunately, did not hold up, as patients in the CIRT trial who were randomized to take low-dose methotrexate were not less likely than those given a placebo to experience a cardiovascular event.

But CIRT did provide researchers an opportunity to learn more about how the risk of adverse effects of methotrexate compared to placebo, especially in a very large trial of patients on the same low doses of the medication used to treat inflammatory arthritis.

Although methotrexate has been used to treat rheumatic patients for decades, the only studies aimed at assessing its risks have been observational (no placebo group) or too small to be considered definitive. Researchers led by Daniel Solomon, MD, of Brigham and Women’s Hospital, conducted a secondary analysis of CIRT data for the specific purpose of learning more about the risks taking of methotrexate versus placebo.

At the recent ACR meeting, they reported that 85 percent of the nearly 2,400 CIRT participants who took methotrexate for about two years experienced any type of side effect, or adverse event. While that sounds high, the nearly 2,000 people in the placebo group also had a high rate of adverse events (78 percent).

When the researchers focused in on specific adverse events that they considered to be “of interest,” however, some notable differences between the groups became more clear: They found 20 to 30 percent of those taking methotrexate had a high risk of anemia as well as a 15 to 20 percent risk of any infection, such as upper respiratory illness, compared to those in the placebo group. People taking methotrexate were also significantly more likely to develop pneumonia. One surprising finding, Dr. Solomon pointed out, was an increased risk of skin cancer among people on MTX. This could be especially relevant to patients with psoriasis and psoriatic arthritis, who have an increased risk of skin cancer to begin with.

The researchers noted that those taking methotrexate had a higher risk of gastrointestinal, liver, and lung problems, too.

“While the trial was conducted in non-rheumatic disease patients and only select adverse events were [reviewed], the elevated risks observed for infectious, pulmonary, gastrointestinal, hematologic, and skin cancer events represent a broad range of clinical issues, requiring further examination,” the authors wrote. “These results quantify risk of [methotrexate] for the many clinicians and patients considering treatment across the spectrum of systemic rheumatic diseases.”

“I think these [results] will inform future guidelines about the safe prescribing of methotrexate,” Dr. Solomon told MedPage Today. “I don’t want to leave people with the impression that methotrexate is a more dangerous drug than you would realize. I think most rheumatologists recognize it has its toxicities, we know how to monitor it, we do that carefully, but we just have to recognize, just like our other DMARDs, it also has toxicities.”

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Keep Reading

• These Are the Methotrexate Side Effects That Make Arthritis Patients Stop Taking It
• 10 Methotrexate Myths Rheumatologists Want to Clear Up, Once and for All
• Monitoring Methotrexate Use: What Inflammatory Arthritis Patients Must Know

The post The Largest Randomized Trial on Methotrexate Revealed a Lot of Info About Its Side Effects appeared first on CreakyJoints.

The American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting brought a lot of good news and interesting updates for people living with rheumatoid arthritis. The CreakyJoints team was on site at ACR, reviewing studies, attending sessions from top osteoarthritis experts, and chatting with patients and physicians for their take on the most important findings and trends for patients back home.

After sorting through it all, reading updates from other groups covering the meeting, including RheumNow, Medpage Today, Healio, and MD Magazine, and asking our team of advisors to share the insights they really want patients to know about, we curated this guide to osteoarthritis research and trends from ACR you should make sure to be aware of.

For more research breakthroughs from ACR 2019, check out our main guide: 50+ Arthritis Updates That Should Be on Your Radar.

For more specific research on the following conditions, check out our ACR coverage on:

• Rheumatoid Arthritis Updates
• Axial Spondyloarthritis Updates
• Psoriatic Arthritis Updates
• Gout Updates

1. New osteoarthritis emphasize exercise and many types of lifestyle changes. Last updated in 2012, new treatment guidelines for osteoarthritis were presented at ACR, though they are still undergoing peer review and will be published sometime in 2020. The guidelines include a comprehensive approach of treatment options with “strong” and “conditional” recommendations that can be mixed and matched for different patients, rather than following a specific hierarchy of “first try this, then try that.”

Exercise, in particular, had a strong recommendation for all types of OA. There was a “large and impressive body of evidence in support of exercise in the treatment of arthritis,” rheumatologist Sharon Kolasinski, MD, principal investigator for the guideline told the ACR Daily News.

Other changes included conditionally recommending tai chi, yoga, topical and oral NSAIDs, intra-articular steroids, cognitive behavioral therapy, the antidepressant duloxetine, radiofrequency ablation, topical capsaicin, and kinesio taping. The guidelines recommend against using transcutaneous electrical nerve stimulation and supplements glucosamine and chondroitin.

CreakyJoints will provide more coverage of the new OA guidelines after they have gone through peer review and are published.

2. There were mixed results for methotrexate in erosive hand osteoarthritis. Erosive osteoarthritis (OA) of the hands is known for its severe pain and rapid loss of function, characteristic erosions in the joints that create distinctive deformities, along with local signs of inflammation such as swelling, redness, and warmth in the finger joints. Treatment for erosive OA has been limited so many people were eager to see the results of this trial using the disease-modifying drug methotrexate to treat erosive hand OA. The findings were mixed: overall there was no difference in pain reduction between people on MTX and those on a placebo, but the study provided encouraging evidence that MTX could slow erosion in affected joints.

“Although this data shouldn’t change clinical practice yet, it does offer some hope of disease modifying therapy for hand osteoarthritis,” rheumatologist Paul Sufka, MD, social media editor for the medical journals of the American College of Rheumatology, told CreakyJoints. “We may just need to find ways to identify patients who should be started on this therapy earlier.” Read more.

3. Prednisone may help hand OA. Although hand osteoarthritis (OA) is extremely common, treating it can be tricky because the science supporting remedies beyond topical and/or oral pain relievers like ibuprofen or acetaminophen has been limited or conflicting. Dutch researchers presented interesting data that showed six-week treatment with low-dose oral prednisolone led to a substantial improvement of symptoms in patients with painful hand OA and signs of inflammation. “There were significant improvements in hand pain, which therefore improves function,” Dr. Sufka reported for RheumNow.

4. More data suggests opioids should not be used to treat OA pain. With lots of people with many different kinds of chronic pain, including various forms of arthritis, taking the powerful drugs, researchers at Tufts Medical Center in Boston stepped back to ask whether opioids actually work to relieve pain and improve life for people with OA. They found that opioids offered only small improvements in pain and the drugs did not help with depression or quality of life. Surprisingly, stronger opioids demonstrated consistently worse pain relief, the researchers reported. Read more.

5. Osteoarthritis comorbidities are serious. Because of the systemic inflammation it causes, rheumatoid arthritis (RA) directly affects more organs than osteoarthritis (OA), but a new study using a national databank suggests that the total-body health impact might be more extensive for those with OA. The prevalence of many health problems in patients with OA was significantly higher than in those with RA, including everything allergies, asthma, cancer, depression, diabetes, and more. “Our data suggest that the burden of having OA in terms of overlapping symptoms and other problems is not negligible in comparison [with RA],” the researchers wrote. Read more.

6. New disease-modifying drug lorecivivint for OA reported preliminary phase 2 results. “There really hasn’t been a drug that changes the course of the disease and disease modification in osteoarthritis,” Yusuf Yazici, MD, assistant professor at NYU Langone and chief medical officer at Samumed, the developer of lorecivivint, told MD Magazine. “You also should show structural benefit, because that’s what the damage is happening in the knee.” Initial results showed that patients who got injections in their more painful knee had improved pain and function out to six months and for as long as 12 months in some patients. They’ve also seen improvement in joint space narrowing as measured by X-rays. More phase 2 and phase 3 trials will be underway throughout next year.

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Keep Reading

• Osteoarthritis Risk Factors and Causes You Need to Know About
• Knee Braces for Arthritis: When They Help and What to Look For
• Could Steroid Injections Actually Make Osteoarthritis Worse? What a New Study Found

The post ACR 2019: New Things to Know About Osteoarthritis appeared first on CreakyJoints.

The American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting brought a lot of good news and interesting updates for people living with rheumatoid arthritis. The CreakyJoints team was on site at ACR, reviewing studies, attending sessions from top psoriatic arthritis (PsA) experts, and chatting with patients and physicians for their take on the most important findings and trends for patients back home.

After sorting through it all, reading updates from other groups covering the meeting, including RheumNow, Medpage Today, Healio, and MD Magazine, and asking our team of advisors to share the insights they really want patients to know about, we curated this guide to psoriatic arthritis research and trends from ACR you should make sure to be aware of.

For more research breakthroughs from ACR 2019, check out our main guide: 50+ Arthritis Updates That Should Be on Your Radar.

For more specific research on the following conditions, check out our ACR coverage on:

• Rheumatoid Arthritis Updates
• Axial Spondyloarthritis Updates
• Osteoarthritis (OA) Updates
• Gout Updates

1. PsA treatment should be personalized for patients’ most troubling symptoms. The main trend in PsA these days is more treatment options, which means more ability to personalize treatment for the complicated symptoms and “domains” of psoriatic arthritis.

“We used to have a much smaller array of drugs available to us, so treatment decisions were fairly straightforward,” M. Elaine Husni, MD, MPH, vice chair of the department of rheumatic & immunologic diseases at the Cleveland Clinic in Ohio told the ACR Daily News. “The availability of so many new agents is exciting, but now it’s not always clear what to use, which can be confusing.”

Patients with psoriatic arthritis may have different degrees of involvement of skin, joint pain, finger and toe swelling (dactylitis), and pain where tendons and ligaments attach to bone (enthesitis). It’s important for doctors and patients to identify which areas are most problematic for patients and choose treatment options that are best suited for them, Dr. Husni says.

2. Having multiple PsA symptoms is linked with worse quality of life for patients. There’s a misperception that psoriatic arthritis is just joint pain with skin involvement. Nope. An interesting study sought to assess the impact of such PsA symptoms as enthesitis, dactylitis, and axial disease on quality of life and work productivity. They found that having these psoriatic arthritis symptoms were significantly associated with worse patient quality of life and/or work productivity regardless of how many joints were affected by PsA.

Considering these manifestations of PsA in treatment is important to improve how patients feel. We need to treat the whole PsA patient.

3. Treating psoriasis aggressively could reduce the risk of psoriatic arthritis. Since up to 30 percent of people with psoriasis go on to develop psoriatic arthritis, you could argue that psoriasis is really early-stage psoriatic arthritis, rheumatologist Jack Cush, MD, of RheumNow, said during the conference’s Rheumatology Round-Up session. He pointed out an interesting study out of Argentina that found that treating psoriasis patients with biologics seemed to reduce the risk of going on to develop psoriatic arthritis.

4. Guselkumab (Tremfya) had good phase 3 trial results for psoriatic arthritis. A biologic that blocks interleukin-23 (IL-23), guselkumab is already FDA-approved for psoriasis. In two new studies (this one and this one), the drug performed significantly better than a placebo in people with active psoriatic arthritis, including those who had never taken biologics before and those who had not had good responses to biologics.

“IL-23 is really revolutionary,” Michael Putman, MD, a rheumatologist at Northwestern University School of Medicine and founder and host of the EBRheum podcast, told CreakyJoints. “We’re seeing very impressive gains in PsA and psoriasis.” Read more.

Dosing-wise, IL-23 inhibitors may be better for patients because they’re given less frequently than other TNF biologics, noted University of Utah rheumatologist Jessie Walsh, MD, in a RheumNow video panel discussion. There may be hints of safety advantages as well, especially compared to IL-17s and TNFs, she noted.

5. Ixekizumab (Taltz) outperformed adalimumab for psoriatic arthritis in a year-long trial. CreakyJoints previously reported on initial findings from the same study; final results were presented at ACR 2019. As MD magazine reported, “at week 52, analyses revealed 39 percent of patients in the ixekizumab group and 26 percent of the adalimumab group achieved the primary endpoint of simultaneous ACR50 and PASI100.” Sixty-four of patients who got ixekizumab and 41 percent of those who got adalimumab achieved PASI 100 when examined separately.

ACR50 criteria means an improvement in disease activity of at least 50 percent; PASI 100 means a 100% improvement in psoriasis symptoms.

This extended data shows that interleukin-17 inhibitors like Taltz not only improve psoriasis, according to lead investigator Philip Mease, MD, director of rheumatology research at Swedish Rheumatology Research Group, in an interview with MD magazine, “but also beneficially affect the various musculoskeletal domains of PSA including arthritis, enthesitis, dactylitis, and so forth.”

6. Drug withdrawal is tricky for PsA. In one trial of ixekizumab (Taltz), patients who had achieved low disease activity after 36 weeks on the medication (about 40 percent) were randomized to continue taking it or start on a placebo (patients were blinded, so they didn’t know whether they were on placebo or not). Over time, almost all the patients who were on the placebo eventually flared and were re-started on the drug. Patients who went back on the drug did well and were able to get back to minimal disease activity.

What this study showed us, according to Northwestern University rheumatologist Eric Ruderman, MD, in a RheumNow video, is that taking patients entirely off a drug is not likely to be an effective strategy. We need more research to see what happens to patients when their medication dose is reduced instead, he said.

7. PsA treatment may be affected by which kind of health care provider you see. Psoriatic arthritis is a complicated disease — some patients may be primarily treated by a rheumatologist; others by a dermatologist; others by primary care providers. A study from researchers at the University of Pennsylvania, with the help of IBM Watson technology, analyzed patient records from insurance databases to see what kind of providers PsA patients saw and, in turn, what kind of medications they were prescribed. They found that 65 percent of rheumatologists’ patients were prescribed early pharmacologic treatment compared to only 46 percent of dermatologists’ patients.

8. Do probiotics work for PsA? A study from researchers at the University of Nebraska College of Medicine and the University of Pennsylvania looked at patient data from FORWARD, The National Databank for Rheumatic Diseases, and found that many more patients with psoriatic arthritis report taking probiotic supplements over the last decade, but there were no differences in patient self-reports of better function before and after patients started taking them. More research is needed to “examine whether probiotics affect disease activity and function in patients with PsA,” say study authors.

9. Patients’ sex may affect how well PsA treatment works. Spanish research looked at how males versus females with psoriatic arthritis responded to biologic therapy. In a group of 108 patients, 93 percent were taking anti-TNF biologics and the rest were on IL-17 inhibitors. The researchers categorized patients by whether their PsA symptoms were primarily axial (affecting the lower back) or peripheral (affecting joints such as the knees). They found that regardless of type of PsA, male patients had a higher response to both kinds of biologic therapies and males were more likely to achieve low disease activity than females. The researchers call for more study into what could be causing this disparity in order to improve PsA management and develop new therapies.

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Keep Reading

• Psoriatic Arthritis Risk Factors and Causes You Need to Know About
• Psoriatic Arthritis Complications You Might Not Be Aware Of
• How Psoriatic Arthritis Affects Your Feet

The post ACR 2019: 9 New Things to Know About Psoriatic Arthritis appeared first on CreakyJoints.

The American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting brought a lot of good news and interesting updates for people living with rheumatoid arthritis. The CreakyJoints team was on site at ACR, reviewing studies, attending sessions from top gout experts, and chatting with patients and physicians for their take on the most important findings and trends for patients back home.

After sorting through it all, reading updates from other groups covering the meeting, including RheumNow, Medpage Today, Healio, and MD Magazine, and asking our team of advisors to share the insights they really want patients to know about, we curated this guide to gout research and trends from ACR you should make sure to be aware of.

For more research breakthroughs from ACR 2019, check out our main guide: 50+ Arthritis Updates That Should Be on Your Radar.

For more specific research on the following conditions, check out our ACR coverage on:

• Rheumatoid Arthritis Updates
• Axial Spondyloarthritis Updates
• Psoriatic Arthritis Updates
• Osteoarthritis (OA) Updates

1. Gout is curable. “Gout is associated with multiple comorbidities and other disease states as well as it’s a very disabling condition for a lot of patients, but most importantly it’s curable and I think we need to get that word out,” Duke rheumatologist Robert Keenan, MD said in a RheumNow panel on gout updates. “We can actually cure gout.”

2. New guidelines call for a ‘treat-to-target’ approach to gout. New clinical guidelines for managing gout were presented at ACR, though they are still under review and won’t be officially published until sometime next year. In a notable update from the last gout guidelines published in 2012, this version calls for a “treat-to-target” strategy around helping patients achieve and maintain optimal uric acid levels of 6 mg/dL or lower. These guidelines contrast with those from the American College of Physicians, the major organization for internal medicine doctors, who instead recommend a “treat to symptom avoidance” strategy.

“We believe that since the last guidelines, enough studies have been published to support the idea that lowering [uric acid] to below 6 mg/dL has shown meaningful improvements in flares and reducing tophi,” Tuhina Neogi, MD, PhD, professor of epidemiology at the Boston University School of Public Health and chief of rheumatology at the Boston Medical Center, told Healio Rheumatology.

The gout guidelines call for starting allopurinol at a low dose and increasing the dosage until the uric acid target is reached, even in patients with chronic kidney disease.

Other highlights include a strong recommendation to use allopurinol as a first-line uric acid-lowering therapy and to use an anti-inflammatory medication regimen of colchicine, NSAIDs, or prednisone for three to six months when beginning uric acid-lowering therapy. In gout patients who aren’t responding to or who cannot take allopurinol the guidelines suggest switching to febuxostat (Uloric) rather than adding uricosuric. Patients who have ongoing flares and tophi may need to switch to pegloticase (Krystexxa).

The guidelines also suggest testing for the genetic marker HLA-B*5801 before starting allopurinol in patients of Southeast Asian descent and African American descent. People with this gene variation may have serious side effects to allopurinol.

CreakyJoints will provide more coverage of the new gout guidelines after they have gone through peer review and are published.

3. Common type 2 diabetes drugs could raise gout risk. People with type 2 diabetes are more likely than average to develop gout, though it’s not clear if it’s the diabetes itself or other common risk factors like obesity and hypertension that explain the connection. But new research suggests that that the drugs used to treat diabetes might also tip the balance one way or the other. People with diabetes who took a drug in the GLP1 agonists class were more apt to develop gout compared to those who used an SGLT2 inhibitor instead. The research does not prove that drugs in this class cause gout, but the connection may be worth exploring further. Read more.

4. The biologic medication anakinra (Kineret) can help stop gout flares. Anakinra, an IL-1 inhibitor, is currently FDA-approved to treat rheumatoid arthritis, though it’s sometimes used off-label to treat other inflammatory forms of arthritis including gout. In a new study, participants experiencing a gout flare were randomly assigned to get either the biologic anakinra or the steroid triamcinolone. Patients using anakinra tended to have the quickest response in terms of less pain and lower levels of inflammatory biomarkers in their blood. However, both groups reported similar improvements in pain intensity within 72 hours. Read more.

5. Giving pegloticase (Krystexxa) patients methotrexate at the same time may help. Pegloticase is an infused drug used to treat uncontrolled gout. But in some cases, patients on pegloticase develop anti-drug antibodies that cause the medication to not work as well. A small study showed that using an immunomodulating drug like methotrexate along with pegloticase can prevent these antibodies from occurring and allow patients to stay on therapy longer.

6. A new type of medication called an ‘inflammasome inhibitor’ is being studied for gout flares. Most gout flares happen as a result of inflammation of specific immune system components called inflammasomes from urate crystals, triggering a cascade of activity that leads to the release of other inflammation-causing proteins and resulting in a flare of gout, NYU Langone rheumatologist Olga Petryna, MD, explained in a report for RheumNow.

In this preliminary study from Dutch researchers, a type of medication called an inflammasome inhibitor was studied to learn more about how it can work to stop joint inflammation in people with gout. The researchers noted that the medication helps to lower levels of different kinds of inflammation-causing proteins, “making it a potential therapeutic target for the treatment of acute flares of gout,” Dr. Petryna noted.

7. Seronegative rheumatoid arthritis may actually be misdiagnosed gout. In a RheumNow video on gout updates, Florida rheumatologist Guillermo Valenzuela, MD, highlighted an important area of potential gout misdiagnosis that patients should be aware of: seronegative rheumatoid arthritis could actually be gout. “If we look back in the literature, we find a high degree of association between those [seronegative] patients and gout that is subclinically diagnosed. Synovial biopsies have demonstrated the presence of micro-tophi,” Dr. Valenzuela explained. “Don’t forget about gout,” he cautioned doctors, “in a differential diagnosis.”

8. There’s no one best diet for gout. While diets low in purine are often recommended for gout, research from Harvard showed that three different diet types each helped lower uric acid levels and improved heart disease risk factors: low-fat restricted calorie, Mediterranean restricted calorie, and low-carb non-restricted calorie.

However, it’s important to note that each of their effects on uric acid were lower than that of taking a uric acid-lowering drug; in other words, diet can be complementary to medication for gout but it should not replace it.

Rather than focusing on specific foods thought to be high or low in purine, it may be best to focus on simply losing weight, which could help lower uric acid and in turn reduce heart disease risk factors that are also elevated in many patients with gout.

9. Tart cherry doesn’t affect uric acid levels. Tart cherry juice or supplements are a popular gout home remedy, but there’s not great research on whether or not it actually works — or if so, why. A New Zealand study found that tart cherry juice did not lower uric acid levels in patients with gout. “If it works, it’s due to different mechanism; possibly through reducing flares,” rheumatologist Nicola Dalbeth, of the University of Auckland, said in a RheumNow panel.

10. The type of provider you see for gout can affect the quality of your care. Gout patients who were seen by a rheumatologist were more likely to get appropriate blood tests for uric acid levels and subsequent prescriptions for uric acid-lowering medications compared with gout patients who saw other health care providers, a study showed. Unfortunately, less than half of those with advanced gout see a rheumatologist. The authors concluded, “more frequent referral to rheumatologists and closer adherence to guidelines may improve outcomes for gout patients.”

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Keep Reading

• The 4 Stages of Gout Progression
• Gout Complications You Should Know About
• The Difference Between Gout and Pseudogout

The post ACR 2019: 10 New Things to Know About Gout appeared first on CreakyJoints.

The American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting brought a lot of good news and interesting updates for people living with rheumatoid arthritis. The CreakyJoints team was on site at ACR, reviewing studies, attending sessions from top axial spondyloarthritis (axSpA) experts, and chatting with patients and physicians for their take on the most important findings and trends for patients back home.

After sorting through it all, reading updates from other groups covering the meeting, including RheumNow, Medpage Today, Healio, and MD Magazine, and asking our team of advisors to share the insights they really want patients to know about, we curated this guide to axial spondyloarthritis research and trends from ACR you should make sure to be aware of.

For more research breakthroughs from ACR 2019, check out our main guide: 50+ Arthritis Updates That Should Be on Your Radar.

For more specific research on the following conditions, check out our ACR coverage on:

• Rheumatoid Arthritis Updates
• Psoriatic Arthritis (PsA) Updates
• Osteoarthritis (OA) Updates
• Gout Updates

1. Doctors want to get rid of the distinction between ‘ankylosing spondylitis’ and ‘non-radiographic axial spondyloarthritis.’ The conventional thinking is that both of these types of inflammatory back pain fall under an umbrella called axial spondyloarthritis (axSpA); with AS, you can see damage on X-rays and with non-rad axSpA, there’s not yet visible damage on X-rays. But research increasingly shows that the disease burden is the same, and patients will require similar treatment. “Axial SpA describes one disease spectrum with an artificial distinction between patients with radiographic and nonradiographic disease,” Désirée van der Heijde, MD, PhD, of Leiden University Medical Center, Netherlands, told the ACR Daily News. “Given all the similarities and the difficulties in the correct assessment of radiographic sacroiliitis, it is preferred to use the term axial SpA to diagnose a patient — and it is not necessary to make a distinction between non-radiographic and radiographic axial SpA.”

2. Non-radiographic axSpA patients may be getting subpar treatment. In a large survey of about 1,000 patients — half of which had ankylosing spondylitis and half of which had non-radiographic axial spondyloarthritis — the nr-axSpA patients were less likely to be prescribed biologic medications than the AS patients, even though they shared similar equal disease and symptom burden. “For the same amount of burden patients are not being treated, not being taken seriously because they don’t have definitive ankylosing spondylitis,” study co-author Atul Deodhar, MD, of Oregon Health and Science University, told MD magazine.

3. More approvals for non-radiographic axial spondyloarthritis are coming. Part of the reason nr-axSpA patients may be undertreated, of course, is that until 2019 there were no FDA-approved biologic medicines specifically for this indication. That changed with the approval of anti-TNF biologic certolizumab pegol (Cimzia) earlier this year; now research on other types of biologics is underway and looks promising.

Data on ixekizumab (Taltz), which is an IL-17 inhibitor, showed that it did significantly better than placebo improving disease activity in nr-axSpA patients after 16 and 52 weeks. A different trial on secukinumab (Cosentyx), which is also an IL-17 inhibitor, reported significant improvement in signs and symptoms of nr-axSpA through 16 weeks. Both of these IL-17 inhibitors are already approved for ankylosing spondylitis.

“Hopefully this leads to further approvals so that we have the same treatment options for nr-axSpA as we do for AS,” rheumatologist Jean Liew, MD, a senior fellow at the University of Washington, told CreakyJoints.

4. Treating non-radiographic axSpA earlier can improve outcomes. Extreme diagnosis delays in axial spondyloarthritis — some patients can take more than a decade to get the right diagnosis — may contribute not only to a delay in treatment, but a poorer response to treatment once started. A study of nr-axSpA patients on certolizumab pegol Cimzia) found that patients who had shorter symptom duration (less than three years) had more improvement in disease activity scores and on quality of life measures than those who started treatment later. Doctors may use this and other data to help nr-axSpA patients get on more aggressive therapy sooner.

5. JAK inhibitors are moving into axSpA. JAK inhibitors — which are oral medications that target specific immune system pathways — have been making big headlines at ACR for the last few years, as they’ve become more widely used in rheumatoid arthritis and as more types of JAKs come on to the market. Tofacitinib (Xeljanz) has been approved for rheumatoid arthritis since 2012 and psoriatic arthritis since 2017; baricitinib (Olumiant) was approved for RA in 2018, and upadacitinib (Rinvoq) was just approved for rheumatoid arthritis earlier this year.

Now researchers have promising initial results for using upadacitinib to treat active ankylosing spondylitis. “Upadacitinb was shown to be very effective in controlling symptoms and achieving ASAS 40 response when compared to placebo,” says rheumatologist and CreakyJoints medical advisor Vinicius Domingues, MD. ASAS40 is an improvement in disease activity and function of at least 40 percent.

“Having an oral agent as an option for AS will be exciting, as oral DMARD therapies such as methotrexate are not effective in AS,” Dr. Liew told CreakyJoints. Read more.

6. Comorbidities are common in axSpA and deserve more attention. A large German study of 1,776 patients aimed to assess which comorbidities — or co-occurring diseases — were most prevalent in people with axSpA, and in turn, how they influenced patients’ disease activity or daily function. They found that that the three most common comorbidities were hypertension (52 percent of patients), depression (25 percent of patients), and lung disease (23 percent of patients). The hypertension is particularly concerning, as NSAID medications are a first-line therapy for axSpA and hypertension is a well-known side effect.

7. The reasons for diagnostic delays in axSpA are complicated. A study of U.S. health care providers sought to examine how doctors engage with patients who are suspected to have inflammatory back pain. Among the insights, it seems diagnostic delays occur because of many different reasons. For one, patients may be bouncing around from doctor to doctor: 46 percent of providers reported that patients had seen other providers prior to seeing them. However, almost two-thirds of primary care providers (internists and family medicine doctors) said they were the first doctor patients had seen. From there, wait time to see a rheumatologist was an issue: 90 percent of providers estimated that their referred patient would have to wait up to two months to see a rheumatologist. The authors concluded that long wait times as well as insurance restrictions were the primary factors preventing patients from seeing a specialist sooner. Here’s more on what to expect at a rheumatologist during a visit to discuss AS.

8. There’s a lot of overlap between axSpA and fibro. Small studies have suggested an overlap between spondyloarthritis (SpA) and fibromyalgia, but now a larger meta-analysis confirms it: About 17 percent of SpA patients also have fibromyalgia, compared to 2 to 8 percent of the general population that has fibromyalgia. Females with SpA were significantly more likely than men to have the dual diagnosis of fibromyalgia. They also found that people who live with both conditions are more apt to have higher levels of SpA disease activity. Whether that’s a coincidence or related to the underlying pathology of these conditions is unclear. Read more.

9. Females with axSpA fare worse. Research out of Ireland looked at 734 patients with axSpA: 171 were female and 563 were male. They found that females with axSpA have report higher disease activity, greater negative impact on quality of life, higher NSAID use, and proportionately lower use of biologic medication than male patients. The authors concluded, “dedicated research into female patient with axSpA is needed to appropriately address and treat their disease” — and we couldn’t agree more.

“[Understanding gender differences] is an important area that we need to study more as we try to personalize treatments for our patients,” University of California San Francisco rheumatologist Lianne Gensler, MD, told RheumNow.

10. We need better ways to evaluate radiographic progression in ankylosing spondylitis. Doctors have struggled with being able to measure radiographic progression in AS, according to Dr. Gensler, because X-rays are not a very sensitive tool. (Measuring radiographic progression is important because it allows doctors to know how well treatment is working not just to treat symptoms, but prevent long-term damage.) At ACR, research explored using low-radiation CT scans of the thoracic (middle) spine specifically because that’s where people with AS tend to progress and have the most burden of damage, according to Dr. Gensler.

11. Dactylitis may be more common in SpA than we thought. A French study found that almost 30 percent of patients suspected of early spondyloarthritis have dactylitis (which is when the entire digit is swollen, like a sausage). Dactylitis was more common in females and those with psoriasis. This symptom is commonly discussed in regards to psoriatic arthritis, but SpA patients should pay close attention to it as well, particularly because it could be a clue for people with early-stage disease that their back pain is, in fact, inflammatory and not due to an injury or mechanical problem.

12. Axial spondyloarthritis takes a large toll on patients’ ability to work. High disease activity and functional impairment in SpA are linked with a decreased ability to work, according to Belgian research on 262 patients. Interestingly, the researchers didn’t find any particular links with patients’ sex, age, symptom duration, type of work, or type of SpA in terms of their decreased ability to work; in other words, patients seemed to be affected across the board. This “underscores the need for tight disease control in patients with SpA,” the authors concluded.

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Keep Reading

• Is Your Back Pain Inflammatory or Mechanical? Take This Quiz to Find Out
• Diseases That Could Mimic Ankylosing Spondylitis — and Delay Your Diagnosis
• What Is Enthesitis? The Painful Arthritis Symptom You Should Know About

The post ACR 2019: 12 New Things to Know About Axial Spondyloarthritis appeared first on CreakyJoints.

The American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting brought a lot of good news and interesting updates for people living with rheumatoid arthritis. The CreakyJoints team was on site at ACR, reviewing studies, attending sessions from top RA experts, and chatting with patients and physicians for their take on the most important findings and trends for patients back home.

After sorting through it all, reading updates from other groups covering the meeting, including RheumNow, Medpage Today, Healio, and MD Magazine, and asking our team of advisors to share the insights they really want patients to know about, we curated this guide to rheumatoid arthritis research and trends from ACR you should make sure to be aware of.

For more research breakthrough from ACR 2019, check out our main guide: 50+ Arthritis Updates That Should Be on Your Radar.

For more specific research on the following conditions, check out our ACR coverage on:

• Axial Spondyloarthritis (axSpA) Updates
• Psoriatic Arthritis (PsA) Updates
• Osteoarthritis (OA) Updates
• Gout Updates

1. We need more information on which drugs will work best for which patients. In a RheumNow panel, rheumatologists Jack Cush, MD; Arthur Kavanaugh, MD; and Jonathan Kay, MD, discussed research in which Scottish rheumatologist Iain McInnes and colleagues studied blood samples of RA patients taking the new JAK inhibitor upadacitinib (Rinvoq) to better understand which pathways the medication is affecting. In the future, Dr. Kay noted, doctors will be able to “individualize treatment by profiling the gene expression of an individual patient” which may help identify which patients are likely to respond to a certain type of medication, how quickly, and when to change to a medication that works in a different way.

“Any new drug that comes along is now the 20th or 21st new drug in rheumatoid arthritis and you have to figure out how to use it when you already have a whole bunch that are working very well,” says Dr. Cush. “We need reasons to know how to use a new drug.”

2. RA medication clinical trials lack diversity for age, sex, and race/ethnicity. Researchers from the University of California, San Francisco and Stanford University examined the diversity of RA clinical trial participants over the last 10 years in order to characterize the representation of racial/ethnic minorities, women, and the elderly. After examining 240 clinical trials, they found — perhaps not surprisingly — that while non-Caucasian groups comprise about 40 percent of the U.S. population, they only represented 16 percent of randomized clinical trial population for RA. Males were underrepresented and older adults were often excluded from trials.

3. Research continues on the efficacy and side effect profile of JAK inhibitor upadacitinib (Rinvoq). This JAK — the third to be approved for rheumatoid arthritis, after tofacitinib (Xeljanz) and baricitinib (Olumiant) — got FDA approved for rheumatoid arthritis earlier this year. Upacitinib works slightly differently from the other available JAKs — it’s considered “more selective.” Researchers are very interested in seeing, over time, whether there are differences in safety or outcomes compared with other JAKs in the same class.

The ACR meeting included multiple studies that were mostly reassuring, rheumatologist Jean Liew, MD, a senior fellow at the University of Washington, told CreakyJoints. Upa — as doctors call it — was associated with a higher incidence of shingles compared to methotrexate or adalimumab (Humira). “This appears to be a class effect,” says Dr. Liew, which means this increased risk also applies other JAKs.

The data also showed that venous thrombosis events, major cardiac events like heart attack or stroke, and malignancy were not increased in patients taking upa compared to the other treatment groups. However, because the medication is still very new to the market, we “need to keep following the study patients for longer because it may take longer to see these types of events,” says Dr. Liew.

4. Data on another JAK inhibitor, filgotinib, looks promising for RA. The ACR meeting included multiple phase 3 studies on another JAK inhibitor, filgotinib, which will be seeking FDA approval next year. Studies showed that the drug had a favorable safety and tolerability profile, regardless if it was used alone (“monotherapy”) or in conjunction with methotrexate and conventional synthetic DMARDs (csDMARDs), reported MD magazine.

5. Should patients in remission taper RA medication? It wouldn’t be an ACR meeting without ample research on tapering, and many of the studies come to similar conclusions: Tapering works for some patients, but many go on to experience flares. In one study, researchers had a group of patients who had been diagnosed with rheumatoid arthritis less than five years earlier and had no swollen joints for at least 12 months while taking a DMARD (about 80 percent on methotrexate). They randomized 78 people to stay on their current DMARD dose and moved 77 to a half-dose of the same medication. Over the next 12 months, 6.4 percent of patients on the stable dose experienced a flare, compared to 24.7 percent of patients moved to a half dose.

The researchers concluded that concluded that continued DMARD therapy with stable doses led to significantly fewer disease activity flares and less frequent joint damage progression on imaging than tapered DMARD treatment — but whether or not to taper needs to be a shared decision between patients and rheumatologists. Read more.

6. Patients doing well on a JAK inhibitor may be able to stop taking methotrexate. Reporting for RheumNow, McMaster University rheumatologist Arthur Lau, MD highlighted research at ACR in which patients who were on the JAK inhibitor tofacitinib (Xeljanz) and methotrexate and had achieved low disease activity were then randomized for 24 weeks to keep taking both medications or to take only tofacitinib. They found that patients reported very little differences in health-related quality of life for mental and physical function between the two groups. If you’re able to achieve low disease activity after starting on a JAK inhibitor, you may be able to discontinue methotrexate and maintain good quality of life, Dr. Lau said. “This reassures me that once patients initially do well, they can likely discontinue methotrexate and be likely to well in the future,” he says.

7. Scientists are learning more about how to predict who will get RA. A Swedish study from the Karolinska Institute found that people who had anti-cyclic citrullinated protein (anti-CCP) antibodies and inflammation of the tendons (tenosynovitis) at the start of the study were more likely to go on to develop RA over the course of two years. Read more.

8. Asthma or COPD could affect RA risk. You may have already heard that people with rheumatoid arthritis (RA) are more likely to develop the serious lung disease chronic obstructive pulmonary disease (COPD). In 2017, Harvard researchers examined data from the large group of Nurses’ Health Study participants and found that women with RA were about 68 percent more likely to develop COPD.

Now, some of the same research team has combined data on 205,153 participants in two waves of the Nurses’ Health Study and found that the connection also works the other way: After adjusting for age, women with COPD were almost 2.4 times as likely to develop RA and 2.7 times as likely to develop seropositive RA as women without lung disease. The research suggests that the possibility of RA should be on the minds of physicians when people with lung disease develop joint pain. Read more.

9. ‘Bioelectronic medicine’ for RA is getting more attention. Stimulating the vagus nerve — which connects the brain to the gut — via an implantable device was safe and well-tolerated in a small pilot study of RA patients who have not responded to biologic therapies, researchers reported at ACR. They also noted reduced signs and symptoms of RA in a meaningful number of patients and plan on conducting larger trials in the future. Read more here about vagus nerve stimulation technology in the management of hard-to-treat rheumatoid arthritis.

10. A new type of RA medication — a BTK inhibitor — did well in a phase 2 trial for RA. Bruton’s tyrosine kinase (BTK) plays a role in certain parts of the immune system, such as B cells, that affect inflammation. An oral drug that inhibits BTK — fenebrutinib — was modestly effective for treating rheumatoid arthritis (RA) and apparently safe, MedPage Today reported from ACR. BTK inhibition may be a growing area of research in treating rheumatic diseases.

11. RA may occur in different ‘disease patterns’ that could affect patient care. An interesting study from researchers at the Rosalind Franklin University of Medicine and Science and Mayo Clinic sought to better understand the range of the course of RA disease. They surveyed more than 900 patients and identified several distinct disease patterns: 30 percent of patients reported constant symptoms that get worse over time, 29 percent have symptoms that come and go and get worse over time, 24 percent have symptoms that come and go and don’t get worse over time, 15 percent had constant symptoms that did not change, and 2 percent reported being in remission with minimal symptoms.

12. RA patients can accurately do their own joint counts. Monitoring the number of joints that are tender and swollen is an important way that rheumatologists track patients’ progress. Researchers in New Zealand found that when patients were given the ability to do their own joint counts via a mobile app, their ratings were very close to those of their rheumatologist, which could help doctors keep better track of patients between appointments, especially among people who live far away from their health care provider.

13. Seropositive patients have benefited more from RA treatment breakthroughs than seronegative patients. A study from Leiden University Medical Center looked at differences in disease activity and RA patients achieving remission among those who were anti-CCP positive versus negative. They found that ACPA-negative rheumatoid arthritis patients have not benefitted as much as ACPA-positive patients from treatment advances over the last 25 years. “This contributes to the sense that greater attention is warranted on the seronegative form of the disease to improve outcomes for these patients,” Mayo Clinic rheumatologist John Davis, III, MD, told CreakyJoints.

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Keep Reading

• Understanding RA Drug Side Effects: What Patients Should Know
• A Patient’s Guide to Monitoring RA Disease Activity
• 13 Things Only People with Rheumatoid Arthritis Can Truly Understand

The post ACR 2019: 13 New Things to Know About Rheumatoid Arthritis appeared first on CreakyJoints.

You expect to hear major news and important updates for people living with arthritis and related diseases at the world’s largest medical meeting for rheumatology professionals: that of the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting, held in 2019 in Atlanta. This year’s meeting did not disappoint.

The CreakyJoints team was on the scene: sharing our own ArthritisPower research findings, including a patient poster from our own Jennifer Walker; poring over the research studies in the poster hall, where the thousands of studies from rheumatology researchers are shared throughout the conference; attending educational sessions with the top experts in their fields; and chatting with patients and physicians in attendance for their take on the most important findings and trends for patients back home.

After sorting through it all, reading updates from other groups covering the meeting, including RheumNow, Medpage Today, Healio, and MD Magazine, and asking our team of advisors to share the insights they really want patients to know about, we curated this guide to research and trends from ACR you should make sure to be aware of.

For more specific research on the following conditions, check out our ACR coverage on:

• Rheumatoid Arthritis (RA) Updates
• Axial Spondyloarthritis (axSpA) Updates
• Psoriatic Arthritis (PsA) Updates
• Osteoarthritis (OA) Updates
• Gout Updates

And FYI: You can participate in research studies about arthritis by using our ArthritisPower app to join our patient-centered research registry.

Here is a table of contents to the sections in this resource:

• Managing Symptoms & Disease Progression
• Doctor-Patient Communication
• Mental Health
• Methotrexate
• Medication Safety & Side Effects
• Medical Marijuana
• Exercise & Nutrition
• Managing Heart Disease
• Vaccines & Preventing Infection
• Inflammatory Bowel Disease
• Pregnancy & Family Planning
• Fibromyalgia
• Lupus
• Other Updates

Managing Symptoms & Disease Progression

1. Arthritis is a leading cause of chronic pain in America. A new study using CDC data aimed to compare the prevalence of chronic pain among arthritis patients to the U.S. population at large. The researchers determined that 48 percent of those with arthritis (all kinds, including RA, gout, lupus, and fibromyalgia) lived with chronic pain, which was substantially higher than how many people without arthritis reported having chronic pain; 22 percent of adults with arthritis had “high impact chronic pain,” defined as pain that has lasted at least three months and is severe enough to interfere with a major life activities. Read more.

2. The arthritis symptoms that matter most to patients may not be the ones they discuss with their doctor. Patient-reported outcomes (PROs) are a patient’s own assessments of how arthritis affects daily tasks and they are increasingly important in monitoring disease activity as well as measuring the success of clinical trials. Which symptoms matter the most to patients to track? When researchers, including those from our non-profit organization, the Global Healthy Living Foundation (GHLF), set out to study this, they learned that the three PROs patients cared the most about were fatigue (83 percent), pain (83 percent), and mental health (82 percent). Read more.

3. Fatigue can take a long time to improve. Fatigue is one of the most important issues for patients with all kinds of rheumatologic conditions. While treating disease often helps improve fatigue, research shows it the improvement does not happen overnight — and for some patients, fatigue can persist indefinitely. A study at ACR found that, among rheumatoid arthritis patients, 70 percent of newly diagnosed patients who initially presented with high levels of fatigue “reported significant improvements” within a year. People who did not report improvements in fatigue were more likely to also have fibromyalgia or be obese. Read more.

4. There can be a lag time between what clinical tests show and what patients feel. In one study, researchers led by Janet Pope, MD, MPH, at Western University in Ontario, saw there may be some lag time between when objective clinical tests show that patients are getting better and when patients actually start to feel better. The time it took for patients to reach remission or low disease activity varied widely depending on whether or not patient-reported factors were used as the goalpost. Knowing that this lag time of several months exists is important, because it suggests that health care providers shouldn’t necessarily rush to change up a patient’s treatment regimen if clinical scores are good; waiting it out a few months to see if pain and inflammation improve might be a better option. Read more.

5. Pain and inflammation often go together, but not always. In other research on RA patients being treated with the JAK inhibitor baricitinib (Olumiant), many people achieved inflammation control within 24 weeks, yet not everyone who had less inflammation reported corresponding improvements in pain. “Despite apparently well-controlled inflammation [swollen joint count ≤1 and CRP ≤1 mg/dL], residual pain may persist,” the authors concluded. “This may have implications for management decisions beyond treating to disease activity targets alone.” Read more.

Doctor-Patient Communication

6. Talk about treatment goals with your doctor. Do you talk to your rheumatologist about your arthritis treatment goals? Mayo Clinic researchers reported that patients with rheumatoid arthritis who did so were more likely to have less severe disease activity and achieve remission. Unfortunately, in this survey of 907 RA patients, more than 60 percent were not asked by their doctor about their goals for treatment. If this hasn’t come up in conversations with your doctor, check out this information about shared decision-making and how you can work more closely with your doctor as a team.

7. If you have questions about sexual health, bring them up to your doctor. Arthritis and related conditions can have a huge impact on sexual function, libido, intimacy, and more. But doctors may not get the necessary training or have the comfort level to bring this up with patients. A study from Northwell Health surveyed 50 health care providers and found that only 48 percent report discussing the impact of a patient’s disease on their sexuality. Some 36 percent of providers said they never discuss it, though two-thirds of those surveyed agreed that sexual health issues are relevant to rheumatology. While this research certainly implies that doctors need more training in this area, what it means for patients is that you should not wait for your physician to bring up this topic if you are experiencing sexual health issues — you may need to broach it instead. Read more about how arthritis can affect your sex life.

Mental Health

8. Physical activity plays a role in depression risk. It’s important to recognize that depression is very common among people with rheumatic disease — all kinds of disease, in all kinds of patients, in all kinds of communities. What was interesting about this research from Mexico was that patients with an inactive lifestyle as well as those who reported more sedentary behavior were more likely to experience depression than those who were more active. There is some chicken-egg logic here, as depression can also affect motivation and make people less active, but it is interesting to look as physical activity as a possible intervention for preventing or treating depression.

9. Depression may affect seropositive and seronegative rheumatoid arthritis differently. Researchers at Brigham and Women’s Hospital, led by rheumatologist Jeffrey Sparks, MD, reported that depression is a risk factor for seronegative but not seropositive RA. “This is interesting and contributes to knowledge of differences between these two dominant subtypes of rheumatoid disease,” Mayo Clinic rheumatologist John Davis, III, MD, told CreakyJoints. This knowledge can help doctors and researchers better understand the differences in what causes seronegative versus seropositive RA, “which could improve treatment options,” Dr. Davis says.

10. Depression is prevalent in psoriatic arthritis, but treating the underlying disease helps. Previous research has indicated that people with psoriatic arthritis may have higher rates of depression than even people with other rheumatic diseases, so understanding how to treat this is of utmost importance. Now, new data shows that patients who took biologic medications for PsA — in one study they were on the TNF blocker golimumab (Simponi); in two others, they were on the IL-12/23 blocker ustekinumab (Stelara) — experienced a significant improvement in depression symptoms. “There is a lot we can do for our patients with depression, and the first step is to treat the underlying condition,” said NYU Langone rheumatologist Olga Petryna, MD, reporting for RheumNow.

11. Having PTSD, depression, and anxiety could affect how well patients stick to their medication regimen. In a study on U.S. Veterans with rheumatoid arthritis, researchers sought to examine whether having post-traumatic stress disorder, depression, or anxiety could affect patients’ medication adherence. There was, indeed, a connection. Veterans with RA and a diagnosis of PTSD, depression, or anxiety discontinued disease-modifying medications (including methotrexate and TNF biologics) sooner than those without these diagnoses. More research is needed to understand how these mental health conditions affect patients’ medication adherence.

Methotrexate

12. A large trial shed more light on potential side effects of methotrexate. As a first-line drug for RA and also used for other types of inflammatory disease, methotrexate is very commonly prescribed. It also raises a lot of concerns for patients about potential side effects, perhaps because of its historical use as a chemotherapy drug (albeit in much higher doses). Harvard researchers, led by rheumatologist Daniel Solomon, MD, did an analysis on a large group of patients who did NOT have inflammatory arthritis taking methotrexate as part of a separate study to see if the drug could prevent heart disease in people without RA. (It didn’t.)

But this new analysis of the randomized controlled trial — in which 2,350 people were taking MTX and compared with an equal-sized group on a placebo — was an interesting way to study the types of side effects of methotrexate at the dosages that are used to treat RA. The trial was “one of the largest experiences with low-dose methotrexate in adult patients,” Dr. Solomon told MedPage Today, since previous research on this topic has been limited to observational studies and much smaller randomized trials.

What they found: There was about a 20 percent increased risk of adverse events in the MTX group; most were mild and included GI problems and nausea, mouth sores, and issues with blood count, such as anemia and a reduction in white blood cells. There was also a 15 to 20 percent increased risk of infections, such as upper respiratory illness, compared to placebo. One surprising finding, Dr. Solomon pointed out, was an increased risk of skin cancer among people on MTX. This could be especially relevant to patients with psoriasis and psoriatic arthritis, who have an increased risk of skin cancer to begin with.

“I think these [results] will inform future guidelines about the safe prescribing of methotrexate,” Dr. Solomon told MedPage. “I don’t want to leave people with the impression that methotrexate is a more dangerous drug than you would realize. I think most rheumatologists recognize it has its toxicities, we know how to monitor it, we do that carefully, but we just have to recognize, just like our other DMARDs, it also has toxicities.” Read more.

13. Patients have mixed feelings on methotrexate — and doctors could do a better job of educating on what side effects to expect. Do patients’ concerns about potential bothersome effects of methotrexate impact whether they take it? When researchers, including those from our nonprofit organization, the Global Healthy Living Foundation, set out to study this, they learned that patients commonly reported fatigue and GI upset as bothersome side effects. Patients who stopped taking methotrexate reported having substantially more gastrointestinal issues — including nausea, abdominal pain, and loss of appetite — from methotrexate than current users did. However, despite many patients reporting side effects, those who currently take methotrexate consider the drug important in managing their disease and health. Read more.

14. Patients may need the injectable form of methotrexate to achieve the optimal dose. As a first-line disease-modifying therapy for RA, methotrexate has changed the course of disease for countless patients, Harvard Medical School rheumatologist Michael Weinblatt, MD, told the ACR Daily News. But questions related to delivery and dosing remain. He noted that as methotrexate dosage increases from 15 mg to 25 mg, the “bioavailability” — or how much your body is able to absorb — of the oral form of the drug becomes significantly less. “Subcutaneous [injectable] methotrexate offers the advantage of providing 100 percent of the drug to the patient.”

“Generally speaking, if you’re going to do doses greater than 20 mg per week and you want to ensure absorption for the patient, the subcutaneous option is very attractive,” Dr. Weinblatt said. “If you’re not getting the results you’d like, before you assume that patients are methotrexate non-responders and decide to add a biologic or a JAK inhibitor, which can carry significant costs, you really should consider first-dose escalating methotrexate to 20 to 25 mg per week either given subcutaneously or split-dose oral, giving them at least four to six weeks to respond.”

15. Methotrexate may have an independent impact on lowering heart disease risk in RA. It’s well-known that RA patients have an increased heart disease risk and that taking methotrexate appears to reduce that risk. But is the connection simply because methotrexate reduces disease activity, or does it have another mechanism of heart-protective action? Researchers studied a group of U.S. Veterans with RA over the course of 10 years. They found that MTX use was associated with a 30 percent reduced risk of various cardiovascular disease events (such as heart attack and stroke) and a 60 percent reduced risk of congestive heart failure hospitalizations. They concluded that “the protective effect of MTX was independent of other factors, including treatment-related changes in disease activity,” which suggests that there are additional reasons methotrexate helps to lower heart disease risk in RA patients.

Medication Safety & Side Effects

16. Doctors are seeking more information about JAK inhibitors and VTE risk. Venous thromboembolism — when blood clots form in the veins, often in the legs, and then travel throughout the body — is a known potential side effect from JAK inhibitor medications, but more research and understanding is needed to help protect patients and optimize treatment. In particular, doctors need to better understand what about JAK inhibitors may be causing an increased risk of VTE in order to identify which patients are at risk and to intervene, University of Massachusetts rheumatologist Jonathan Kay, MD, said during a RheumNow panel discussion.

If you have risk factors for VTE, you should talk to your doctor before starting a JAK inhibitor.

17. Long-term glucocorticoid use is linked to serious infections — even in low doses. It’s well-known that taking steroids to manage RA or other inflammatory diseases can increase the risk of infection, but there’s not as much research on the extent of this risk in people taking low doses of steroids (less than 5 mg a day). Using data from Medicare patients, researchers, led by University of Pennsylvania rheumatologist Michael George, MD, found that long-term use of glucocorticoids is associated with a significant increase in the risk of serious infections, even at doses of 5 mg/day or lower.

18. A large study reported reassuring news about cancer risk and biologic drugs. French researchers looked at a national claim database that included 83,706 rheumatoid arthritis patients who took either conventional disease-modifying drugs (DMARDs) or biologics and found that the risk of developing organ-specific cancers and blood cancers did not differ between patients who were taking conventional vs. biologic DMARDs. “This confirms what we know: that biologics really don’t increase the risk of cancer or lymphoma,” UT Southwestern Medical Center rheumatologist Kathryn Dao, MD, reported for RheumNow.

19. Serious infections in anti-TNF biologics are not common. A Spanish study that looked at medical records of inflammatory arthritis patients being treated with anti-TNF biologics over the course of three year found that only about 10 percent of patients had a serious infection (one that required hospitalization). Comorbidities like diabetes and concurrent steroid use increased that risk.

Medical Marijuana

20. The popularity of medical marijuana lags way behind clinical evidence. This was eye-opening: Less than 200 patients have been studied in randomized controlled trials for patients with rheumatological conditions, according to Mary-Ann Fitzcharles, MD, a rheumatologist and pain medicine specialist at McGill University in Montreal, Canada, during an ACR session called Cannabinoids: The Science for Pain Therapy, reported the ACR Daily News. She noted that “preclinical” evidence is compelling, with cannabinoids showing an excellent effect on acute and chronic pain and inflammation. Doctors need to do more to educate patients on therapeutic dosing, she added.

But that’s a problem, because, as noted below, many physicians are reluctant to talk about cannabis with their patients.

21. Rheumatologists are split on whether marijuana and CBD should be used to treat rheumatologic conditions. When researchers at the University of Vermont Medical Center surveyed rheumatology clinicians about their patients’ usage of medical marijuana and CBD, they found that 45 percent of more than 100 doctors disagreed that marijuana or CBD should be recommended as medical therapy for people with rheumatologic conditions.

Legality may play a role: More doctors who practiced in states where marijuana was legal for medical and recreational use said they were comfortable addressing questions about usage than in states where it was not legal. The authors concluded that “surrounding laws likely impact clinician perception and comfort with medical use.”

22. The legal status of medical marijuana affects patient habits. When researchers surveyed 1,059 patients through the CreakyJoints patient community and the ArthritisPower research registry, legality also played a big role in patient perceptions and habits. Of the approximately two-thirds of patients surveyed who said they had never used marijuana for medical purposes, 40 percent said illegality was a factor.

There was also a link between whether medical marijuana was legal where patients lived and whether patients spoke with their doctor about their usage. Among patients who live in states where marijuana is medically legal, 68 percent said they told their doctor about using it, while only 54 percent of patients in states where medical marijuana was not legal talked with their doctor about it.

“It’s alarming that not everyone is telling their doctor about their marijuana use, regardless of its legal status,” says study co-author W. Benjamin Nowell, PhD, director of Patient-Centered Research at the Global Healthy Living Foundation. “It is important that your rheumatologist and other providers are aware of what you might be using in addition to prescribed medication.” Read more.

Exercise & Nutrition

23. Omega-3 supplements were associated with lower disease activity in RA patients. Researchers at Brigham and Women’s Hospital looked at the association between omega-3 supplementation and disease activity in patients being followed for many years as part of the long-term Brigham and Women’s Rheumatoid Arthritis Sequential Study (BRASS). They found that after a year of taking supplements, omega-3 users were more likely to have significantly fewer painful or swollen joints and to have lower disease activity scores. Read more.

24. A plant-rich diet may reduce RA risk — but it may be more about weight management than specific foods. Brigham and Women’s researchers analyzed data on 79,465 women from the original Nurses’ Health Study (NHS) and on 95,741 women from a second group, the Nurses’ Health Study II (NHS II) who did not have RA at the time they started keeping records of their diet. While the researchers found that consuming a healthy plant-based diet — rich in whole grains, fruits, vegetables, and nuts — may be associated with a modest reduction in RA risk, it seemed to be affected by body mass index. In other words, eating this way allows people to maintain a healthy body weight, and that, in turn, may be responsible for RA risk reduction. It seems like more evidence that there are no “magic” foods for inflammatory arthritis; rather, overall healthy dietary patterns are what impact patients’ health.

25. Primary care doctors and patients aren’t talking enough about physical activity and arthritis. A CDC study found that nearly one-third of primary care providers aren’t asking patients about their physical activity or recommending physical activity as part of arthritis management. “While many adults with arthritis fear that physical activity will cause pain, routine physical activity can reduce pain levels comparable to NSAIDs,” Dana Guglielmo, MPH, of the CDC’s Arthritis Program, told Healio Rheumatology. “Adults with arthritis need and want their health care provider to counsel them on how to become physically active.”

26. Your ‘exercise identity’ could affect recovery and activity after joint replacement surgery. After undergoing knee replacement surgery, study participants filled out a survey at their physical therapist that assessed their “exercise identity” — the degree to which they viewed themselves as an exerciser. Researchers found that people with positive exercise identity take more daily steps and spend more time standing after knee replacement, so patients may benefit from messages and programs that are tailored to their exercise identity.

27. Yoga helps improve fatigue and mental health. Say ohm: Croatian researchers found that yoga led to a significant improvement in fatigue, depression, and anxiety in rheumatoid arthritis patients. The study was small (only 43 patients) but authors suggest that yoga could benefit people with RA as “supplementary non-pharmacological treatment.”

Managing Heart Disease

28. Taking hydroxychloroquine for RA or lupus can reduce heart risk by 17 percent. If you take the anti-malarial drug hydroxychloroquine (Plaquenil) as part of your treatment for lupus or rheumatoid arthritis (RA), you may be getting cardiovascular protection as an added bonus, a study showed. In another hydroxychloroquine study, Johns Hopkins researchers looked at blood levels of the medication in lupus patients who developed a blood clot (including heart attacks and clot-caused strokes). They found that patients with the highest levels of hydroxychloroquine in their bloodstream were the least likely to have developed a clot. Read more.

29. The Vectra multibiomarker disease activity blood test can help identify cardiovascular risk in RA. University of Alabama rheumatologist Jeff Curtis, MD, and colleagues evaluated data 30,751 Medicare patients over a 10-year period. They showed that the Vectra test, which is a blood test that measures inflammation as well as multiple biomarkers that can help predict a rheumatoid arthritis patient’s risk of radiographic progression, was better than other models at predicting which RA patients would go on to have a cardiovascular event such as heart attack or stroke. “This test is the first of its kind to be able to predict outcomes in our patients,” Dr. Curtis told Healio Rheumatology. “It will help us have a discussion about getting patients rheumatoid arthritis under control overall.”

30. African Americans with lupus face a very high risk of cardiovascular problems, which peak close to diagnosis. A study conducted by researchers from the University of Wisconsin School of Medicine and Public Health and Emory University found that African Americans with lupus were 18 times more likely than Caucasian patients to have a cardiovascular event during a 10-year period. The researchers also noted that cardiovascular incidents peaked within one to two years of diagnosis. “Future [cardiovascular disease] prevention efforts should target such populations to reduce racial disparities, particularly around the period of [lupus] diagnosis,” the authors wrote. Read more.

31. Research into cardiovascular disease in spondyloarthritis is an increasingly hot topic. According to rheumatologist Jean Liew, MD, a senior fellow at the University of Washington, who was the lead author of a study on this subject, new research included a look at biologic therapies and their effects on heart disease, such as measures of atherosclerosis; on the presence of cardiovascular risk factors such as metabolic syndrome and how that is associated with radiographic progression; and whether cardiovascular risk is well-understood in SpA patients, which is what Dr. Liew’s team studied. Stay tuned for more research into this area, especially as the recognition and diagnosis of SpA increases and more treatment options become available.

Vaccines & Preventing Infection

32. The live shingles vaccine didn’t cause problems for patients on biologics. People with inflammatory arthritis are about twice as likely to get shingles as otherwise-healthy adults, which is likely due to immune dysfunction from the disease itself and/or immune- suppressing drugs people take to treat their arthritis. Many patients worry about getting the live shingles vaccine (Zostavax) because of fears that it could actually cause a shingles infection in people taking immunosuppressive drugs. A new study, led by rheumatologist Jeffrey Curtis, MD, of the University of Alabama, randomized 617 patients taking a TNF inhibitor for rheumatoid arthritis, psoriatic arthritis, or another condition, to get the live shingles vaccine or a placebo injection, then followed them for six weeks (which is the amount of time the Food and Drug Administration considers people at risk for vaccine-related infections). The encouraging results: zero cases of shingles or a local zoster infection near the injection site. Eight patients developed a rash, but none were positive for the virus.

We still need more data, University of Calgary rheumatologist Steven Thomson, MD, told CreakyJoints, but this research “looks promising for those who can’t afford the inactivated vaccine.” Read more.

33. Preliminary research on the Shingrix shingles vaccine in inflammatory arthritis patients looks safe. The other type of shingles vaccine, Shingrix, is not a live vaccine, but presents potential issues for inflammatory arthritis patients for another reason. It’s a very strong vaccine and there are theoretical concerns that it could cause disease flares, especially since inflammatory arthritis patients were not included in the original trials of the Shingrix vaccine. University of Tennessee researchers looked at 47 patients who had received the Shingrix vaccine (most of them had rheumatoid arthritis) in 2018. They found that the vaccine was well-tolerated and there were no changes in levels of the inflammatory marker C-reactive protein or disease activity as measured by patient-reported outcomes.

34. Flu shots are very important and arthritis patients should get one every year. Reporting on a session about immunizations in immunosuppressed patients for RheumNow, Cleveland Clinic rheumatologist Cassandra Calabrese, DO, noted that “all of our patients should be getting a seasonal flu shot every year. There are very few contraindications to seasonal flu vaccine. If you have an egg allergy, you can have a flu vaccine. The only true contraindication is anaphylaxis to a previous flu vaccine or if you’ve had Guillain-Barré syndrome in the setting of a previous flu vaccine.”

35. The high-dose flu vaccine may be helpful in inflammatory arthritis patients. There is a relatively new version of the flu vaccine available, called the high-dose trivalent inactivated influenza vaccine. It is “stronger” than other types of flu vaccines and it is currently FDA-approved only for adults age 65 and older (because our immune response to the flu vaccine naturally decreases with age). Now, new data from McGill University shows that the same high-dose vaccine may improve the immune response in rheumatoid arthritis patients who are under the age of 65. “The high-dose vaccine does work really well in these patients, and this is the kind of protection we need to be giving our rheumatoid arthritis patients, especially as we get into influenza season,” Australian rheumatologist David Liew reported for RheumNow.

36. Many arthritis patients don’t get hepatitis screening before starting a biologic. Before you start taking a biologic drug or one of the new targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs), several screening tests are recommended, including for hepatitis. But a new study reveals that fewer than one in four patients in a national registry received hepatitis screening before starting these medications. Read more.

Inflammatory Bowel Disease

Gastrointestinal issues are common in arthritis patients, and inflammatory arthritis is common in people with inflammatory bowel disease. It’s important that the ACR meeting had a lot of research about the intersection of inflammatory arthritis and inflammatory bowel disease, such as this:

37. Rheumatologists and patients should talk more about digestive issues in order to identify IBD. “Please suspect IBD more often,” David T. Rubin, MD, professor of medicine, co-director of the Digestive Diseases Center, and chief of gastroenterology, hepatology, and nutrition at the University of Chicago, said to rheumatologists in an ACR session, Healio Rheumatology reported. He cautioned rheumatologists to be on the lookout for issues that could suggest IBD and then refer patients to a gastroenterologist. These include unusual dietary habits, such as eliminating foods from the diet because of GI issues, unexplained weight loss or blood in the stool, anemia, or low levels of vitamin D or B12.

38. About 25 percent of IBD patients have chronic back pain; many likely have spondyloarthritis. In an attempt to better quantify the incidence of chronic back pain among IBD patients, researchers led by Oleg Stens, MD, at Harbor-UCLA Medical Center analyzed two massive health surveys (NHANES 2009-10 and NHANES II) that contained data on a total of nearly 19,000 Americans. They found that nearly 25 percent of IBD patients had experienced chronic low back pain and also estimated that about 10 percent of IBD patients had spondyloarthritis (SpA). Read more.

39. Sacroiliitis is common in Crohn’s disease. But it may be underdiagnosed because Crohn’s patients don’t associate back pain with GI symptoms and may not be aware of the link between IBD and inflammatory arthritis. A study lead by NYU rheumatologist Fardina Malik, MD, found that gastrointestinal doctors can use an imaging technique called magnetic resonance enterography as a screening tool to check patients for sacroiliitis (inflammation of the sacroiliac joints) and then refer to a rheumatologist for further evaluation.

Pregnancy & Family Planning

This is an increasingly prominent topic at ACR meetings, with researchers exploring important questions for people concerned about how chronic inflammatory disease can affect their health during conception and pregnancy, as well as the health of their future children. It’s great to see so much research on reproductive health because a decade ago there was very little, noted UC San Diego rheumatologist Arthur Kavanaugh, MD, during the conference’s Rheumatology Round-Up session. “There’s a growing amount of data on pregnancy. You can’t just ignore fertility issues, outcomes of pregnancy, lactation issues,” he said. We’re learning more and more, he added, “that the best thing for a healthy baby is a healthy mom.”

40. Most babies exposed to biologics in utero do not experience serious infections. Last year, researchers at McGill University in Canada found that that there was no increased risk of infection in babies who were exposed to anti-TNF biologics compared to the offspring of women with RA who didn’t take these drugs as well as to women without RA at all. This year, the researchers presented a similar analysis of serious infections in babies exposed to non-TNFi biologics and found that they too, led to few infections in babies after they’re born. Read more.

41. Staying on biologic medication during pregnancy reduces the risk of arthritis flares. Two different studies — one Spanish and Italian, one German — addressed the question of what happens to pregnant women depending on whether or not they remain on their biologic during pregnancy. Both concluded that stopping biologics increased the risk of having flares; the German authors found that women who stopped their biologic also had an increased need for steroids. The other research team concluded, “patients with more aggressive RA may get benefit from continuing treatment beyond conception to ensure control of maternal disease and better pregnancy outcomes.”

42. Many new moms with rheumatic diseases are successfully breastfeeding. It’s natural to worry about whether you can breastfeed with a rheumatic disease (in part because of concerns over which medications are safe). Researchers from Duke University surveyed and followed 265 pregnant women with rheumatic diseases about their plans to breastfeed. They found that a large majority of women planned to breastfeed and were breastfeeding (sometimes along with formula) at follow-up. Women with more education and women who did not have pre-term births were more likely to breastfeed. The authors concluded, “the majority of women with rheumatic disease want to breastfeed and, given the safety of our medications for lactation, the large majority can do so successfully.”

Fibromyalgia

43. Monitoring tender points is becoming less relevant. In a session about fibromyalgia management, University of Michigan rheumatologist Daniel Clauw, MD, shared that evaluating tender points isn’t that relevant now and there are other ways doctors can evaluate the way fibromyalgia affects sensitization, such as asking questions like “Are you uncomfortable when people hug you?” or “Are you uncomfortable when people take your blood pressure?”

“[Fibro] is chronic widespread pain disorders, not just a focal pain disorder,” Philip Robinson, a rheumatologist in Brisbane, Australia, reported on the session for RheumNow.

44. Fibromyalgia patients rarely have just one type of pain. Doctors should think about the proportion of each type of pain a patient has — for example, nociceptive pain (pain due to damage to the body, such as from inflammation or injury); neuropathic pain (pain from nerve damage); or centralized pain (pain due to how your nervous system processes pain) — in order to improve treatment and outcomes.

“You’re never going to make any progress unless you target the cause of people’s pain,” Dr. Robinson says.

45. Opioids are not effective for fibromyalgia in the long term. They may help in the beginning, but the longer patients are on them and the higher the dose, the less effective they are, according to Dr. Robinson. The fibromyalgia session noted that there are more effective therapies, including SNRI antidepressants, anti-seizure drugs, and tricyclic antidepressant medications. There is also burgeoning evidence for non-pharmacological treatments, including cognitive behavioral therapy and regular physical activity. Doctors need to “put together a combination of treatments,” says Dr. Robinson. Read more about treatment options for the whole fibro patient.

46. Fibro patients may have a history of abuse. No one knows what causes fibromyalgia but some experts believe that stress may be a common trigger, especially in people who are susceptible for physiological reasons. Now a new study from the Cleveland Clinic adds support to the theory that psychological stress might increase the risk. Researchers enrolled 593 fibromyalgia patients and surveyed them about their symptoms and history of abuse. Nearly 38 percent of fibromyalgia patients said that they had been physically and/or sexually abused at some point. The authors recommend that physicians ask patients who are being evaluated for fibromyalgia about their history of abuse, as “this may give more clarity to the nature and severity of the [fibromyalgia] presentation and prompt the need for psychological interventions.” Read more.

47. Stigma for fibromyalgia is still a concern. Rheumatoid arthritis and fibromyalgia are common conditions in rheumatology, but while RA is perceived as a “valid” medical condition, those with fibromyalgia do not always get the same recognition for their painful condition. Israeli researchers set out to study physicians’ perceptions of RA and fibro and how that might affect patients’ access and care. They found that 98 percent of doctors would accept RA patients, but only 56 percent would accept fibro patients. Fibromyalgia patients were perceived as being more difficult than RA patients, with a large burden of symptoms and a lack of control on their disease, the authors concluded. “Improving illness understanding and providing coping skills to rheumatologists may improve doctors-patients relationships and outcomes,” they wrote.

48. Fibromyalgia patients may require professional support. Researchers from Rush University Medical Center in Chicago sought to better understand on whom fibro patients rely for emotional support, noting that the condition causes intense symptoms, especially pain and fatigue. They surveyed 115 fibromyalgia patients and found that they most often rely on their spouse/partner (63 percent) and friends (57 percent) while less commonly using professional support (21 percent). The authors noted that fibromyalgia likely puts a significant strain on relationships and patients who need it should be encouraged and helped to find and receive professional support.

Lupus

49. Clinical trials have been challenging, but the future is bright. Twenty phase 2/3 trials for lupus have failed over the years for various reasons (including poor design and implementation or a lack of safety or efficacy of the medication), noted Cedars-Sinai rheumatologist Daniel Wallace, MD, in the ACR Daily News. Studying lupus in clinical trials is complicated, he shared, because of the heterogeneity of the disease. However, “despite the ups and downs in lupus … we’re making progress, bit by bit,” Richard Furie, MD, chief of the division of rheumatology at Northwell Health, said in the paper. “I do think the future is bright for our patients.”

50. A new medication called anifrolumab is seeking FDA approval next year. It’s hardly a slam dunk: There were two phase 3 trials conducted on anifrolumab. One of them did not hit its primary endpoint, though secondary endpoints suggested that the drug had benefits. The second phase 3 study, which was presented for the first time at ACR, yielded more consistently positive results. Read more about how the drug works and who might be a good candidate for it.

51. Other lupus medications did well in phase 2 trials. One drug, obinituzumab (Gazyva), is for patients with lupus nephritis. Already FDA-approved to treat certain forms of leukemia, it targets CD20 antibodies, which are found on certain immune system cells called B lymphocytes that are involved in lupus. Investigators reported good results and will pursue phase III studies, according to CreakyJoints medical advisor Vinicius Domingues, MD.

A separate study on the medication telitacept found that it was effective and well-tolerated in systemic lupus erythematosus (SLE).

52. The biologic belimumab helps lupus patients reduce their use of steroid medications. Belimumab (Benlysta) was the first new treatment specifically for lupus in more than 50 years when it was approved nearly 10 years ago; researchers are continuing to study how it affects disease management in patients long-term. In examining “real-world evidence” (not from randomized controlled clinical trials) from hundreds of studies, researchers saw reduced disease activity after belimumab treatment in 51% and 77% of SLE patients at six months and one year, respectively. The medication also led to a decrease in steroid dosages and even complete discontinuation of steroids in up to 11 percent of patients.

53. The brand-name version of hydroxychloroquine (Plaquenil) may be better for lupus patients who can’t tolerate it for GI issues. In a RheumNow report, UT Southwestern Medical Center rheumatologist Kathryn Dao, MD, shared some insights from a talk from Johns Hopkins lupus expert Michelle Petri, MD. Dr. Petri shared that if patients have hydroxychloroquine intolerance because of gastrointestinal issues, the brand-name medication Plaquenil may help because it is coated and could cause less GI intolerance.

54. Weather may affect lupus symptoms. Shifts in weather patterns have long been associated with a variety of health ailments. Now a new study suggests that changes in the outdoor environment may make people who have lupus more susceptible to flare-ups of specific symptoms. Researchers, led by George Stojan, MD, of the Johns Hopkins Lupus Center, found that as the temperature increased, so did the risk of rash, joint inflammation, kidney problems, serositis (inflammation of smooth tissue membranes), and hematologic problems such as anemia and low white blood cell count. Read more.

Other Updates

55. New guidelines will help standardize and improve care for vasculitis patients. The ACR’s first-ever vasculitis clinical guidelines were presented at the ACR meeting, covering seven different diseases under the umbrella of vasculitis: giant cell arteritis (GCA), Takayasu’s syndrome (TAK), polyarteritis nodosa (PAN), Kawasaki disease, and three types of ANCA-associated vasculitis. One of the key themes of the guidelines was increased use of non-steroid medications, which until now have been a primary way of treating these diseases for decades. The guidelines are still undergoing peer review and should be published next year.

56. The biologic tocilizumab (Actemra) helps people with giant cell arteritis (GCA) remain in remission even after stopping it. The interleukin-6 inhibitor was FDA-approved for GCA — an inflammation of the lining of the arteries — in 2017 due to research showing that the drug was better than prednisone (a steroid) for helping many patients reach remission in GCA. Now new data shows that a sizeable group of people who reached remission with tocilizumab were still in remission two years after stopping the drug. “Patients should be started on tocilizumab as soon as they are diagnosed,” lead author John H. Stone, MD, MPH, told the ACR Daily News. “The goal should be to get them off steroids as quickly as possible and maintain their response with tocilizumab.” Read more.

57. MRI can make it easier to diagnose polymyalgia rheumatica (PMR). A Japanese study showed that using MRIs in the shoulders of people with suspected polymyalgia rheumatica — an inflammatory condition known for causing pain, especially in the shoulders — may contribute to more accurate diagnosis and prediction of recurrence. PMR is clinically diagnosed based on symptoms, but accurate diagnosis is difficult because the symptoms may occur in many other rheumatic diseases.

“Most of the time PMR is easy to identify, but sometimes it’s not,” rheumatologist Paul Sufka, MD, social media editor for the medical journals of the American College of Rheumatology, told CreakyJoints. “Our patients do best when we correctly identify what is going on, and evidence that MRI can be used to sort out if patients have active PMR might help them avoid unnecessary exposure to prednisone.”

Rheumatoid Arthritis: It’s Time for More Personalization

There was were so many important updates for RA patients that we included them in a separate article. Read it here.

Axial Spondyloarthritis: A Spotlight on Non-Radiographic

There was were so many important updates for axSpA patients that we included them in a separate article. Read it here.

Psoriatic Arthritis: An Expanding Toolkit

There was were so many important updates for PsA patients that we included them in a separate article. Read it here.

Gout: New ‘Treat-to-Target’ Guidelines

There was were so many important updates for gout patients that we included them in a separate article. Read it here.

Osteoarthritis: New Guidelines Call for an Integrated Approach

There was were so many important updates for osteoarthritis patients that we included them in a separate article. Read it here.

You Can Participate in Arthritis Research Too

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

The post ACR 2019: 50+ Arthritis Updates That Should Be on Your Radar appeared first on CreakyJoints.