StemCell Therapy

Magnetic resonance imaging (MRI)-detected inflammation may predict treatment response in patients with early, poor prognosis rheumatoid arthritis (RA), according to study data published in Arthritis Care & Research.

Investigators conducted a post hoc analysis of the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) study (ClinicalTrials.gov Identifier: NCT01142726), a phase 3b randomized controlled trial of patients with early RA (persistent symptoms, 2 years). Patient eligibility criteria included Disease Activity State (DAS) 28 (C-reactive protein [CRP]) 3.2, active clinical synovitis of 2 joints for at least 8 weeks, and anticitrullinated peptide-2 positivity. Patients included in the study had never received methotrexate or had received 10 mg/week methotrexate for 4 weeks up to a month prior to enrollment.

During the 12-month treatment period, researchers randomly assigned patients 1:1:1 to abatacept plus methotrexate, abatacept monotherapy, or methotrexate monotherapy. They performed an MRI assessment of each patients most clinically active hand and wrist at baseline, 6 months, and 12 months. High baseline MRI-detected inflammation indicated poorer RA prognosis. Investigators compared disease activity at 12 months across treatment groups and stratified them according to baseline MRI inflammation levels. Disease activity measures included Simple Disease Activity Index remission, Clinical Disease Activity Index remission, Boolean remission, and DAS28 (CRP).

Of 351 patients enrolled in the AVERT study, 119 received abatacept plus methotrexate and 116 received methotrexate monotherapy. Among these 235 patients, 225 (95.7%) had baseline MRI data available. At baseline, 125 (55.6%) patients were classified as having low MRI inflammation and 100 (44.4%) as having high inflammation. Disease activity scores were significantly greater in the high inflammation group compared with the low inflammation group. Among patients with high baseline inflammation, the percentage of patients achieving remission at 12 months was significantly greater in the abatacept plus methotrexate group than in the methotrexate group. Specifically, compared with the methotrexate monotherapy group, more patients in the abatacept plus methotrexate group achieved remission on the Simple Disease Activity Index (45.1% vs 16.3%; P =.0022), Clinical Disease Activity Index (47.1% vs 20.4%; P =.0065), and Boolean (39.2% vs 16.3%; P =.0156) indices. In addition, a greater percentage of the abatacept plus methotrexate group achieved DAS28 (CRP) <2.6 compared with the methotrexate group (60.8% vs 40.8%; P =.0667), although the difference was not significant. Researchers observed similar trends in the low inflammation group, although abatacept plus methotrexate was not significantly higher than methotrexate monotherapy.

Study limitations included the fact that calculations were from a post hoc analyses and that the AVERT study was not specifically designed to investigate the prognostic ability of baseline MRI inflammation.

These post hoc analyses of the AVERT study showed that patients with early RA and a high level of MRI inflammation at baseline were more likely to achieve clinical remission with abatacept plus MTX compared with MTX. MRI as a measure of inflammation can provide added value as an objective assessment of disease to influence clinical decision making and guide the more precise use of therapies to treat RA, the researchers concluded.

Disclosure: This study was supported by Bristol-Myers Squibb Company. Please see the original reference for a full list of authors disclosures.

Reference

Ahmad HA, Baker JF, stergaard M, et al. Baseline objective inflammation by magnetic resonance imaging as a predictor of therapeutic benefit in early, poor prognosis rheumatoid arthritis [published online September 24, 2019]. Arthritis Care Res. doi:10.1002/acr.24072

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Baseline MRI Inflammation May Predict Treatment Response in Early Rheumatoid Arthritis - Rheumatology Advisor

Certolizumab pegol (CZP) may be safe and effective in the long-term treatment of psoriatic arthritis (PsA), according to results of a post hoc analysis presented at the 28th European Academy of Dermatology and Venereology Congress, held October 9 to 13, 2019, in Madrid, Spain.

Researchers presented 4-year data from the RAPID-PsA trial (ClinicalTrials.gov Identifier: NCT01087788) that evaluated the long-term safety and efficacy of CZP in PsA.

RAPID-PsA, a double-blind, placebo-controlled trial to 24 weeks, dose-blind to 48 weeks, and open-label to 216 weeks, included data from patients with active PsA and failed previous treatment with 1 disease-modifying antirheumatic drug. All patients received a loading dose of CZP 400 mg at weeks 0, 2, and 4, and were randomly assigned to receive either CZP 200 mg every 2 weeks or 400 mg every 4 weeks. These assigned doses were continued up to week 216.

In this analysis, data from patients receiving CZP 200 mg or 400 mg were collected, and PsA severity was assessed by 7 minimal disease activity criteria: tender and swollen joint counts 1, Psoriasis Area Severity Index 1 or body surface area affected 3%, patient pain visual analog score 15, patient global disease activity visual analog score 20, Health Assessment Questionnaire Disability Index 0.5, and tender entheseal points 1.

In total, 273 patients were randomly assigned to receive either dose of CZP at baseline. At 24 weeks, 95 patients achieved minimal disease activity, and 37 achieved very low disease activity. At baseline, 166 patients had an affected body surface area 3%; 39 of these patients achieved minimal disease activity plus affected body surface area 3% at 24 weeks.

For all 3 composite outcome measures, patient response rates remained high up to week 216 in patients who had a response at week 24.

In this analysis, a high [percentage] of patients [treated with CZP] demonstrated durability of their initial week 24 response to week 216, the researchers concluded. The greatest durability was observed for [minimal disease activity], although both [very low disease activity] and [minimal disease activity] plus [body surface area] 3% were achieved by over 80% of week 24 responders at week 216.

Disclosure: This clinical trial was supported by UCB Pharma. Please see the original reference for a full list of authors disclosures.

Reference

Gottlieb AB, Gisondi P, Eells J, Peterson L, Kavanaugh A. Durability of response in patients with psoriatic arthritis treated with certolizumab pegol over 216 weeks: post-hoc analyses from the RAPID-PsA study. Presented at: 28th European Academy of Dermatology and Venereology Congress; October 9-13, 2019; Madrid, Spain. Abstract #P0432.

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Durable Response to Long-Term Treatment With Certolizumab in Psoriatic Arthritis - Rheumatology Advisor

Dear Dr. Roach: What is known about arthritis later in life for someone who had early treatment for Lyme disease? I had it as a teenager in the late 1980s and was told by my doctor that arthritis could be an issue later. I was treated with an IV antibiotic, which I believe was the go-to treatment at the time. J.A.

Dear J.A.: Lyme disease, a bacterial infection transmitted by the deer tick, causes arthritis in about half of people with untreated Lyme disease. Among those who are recognized and treated early, joint and muscle pains are common, but inflammation of the joints, along with the possibility of joint damage, is unusual. So, if you were recognized and treated early, the likelihood of developing any joint problems should be no different from your risk if you had never had Lyme disease.

Lyme arthritis most commonly affects one knee, but it can affect other joints, such as the shoulder, ankle, elbow or jaw (TMJ). Eleven percent of untreated Lyme disease patients developed permanent joint damage, but only 2% developed permanent joint disability. This study comes from a time when Lyme disease frequently went unnoticed and untreated.

Diagnosing Lyme disease can be a challenge, especially when a rash has gone unnoticed or was never present at all. A doctor needs vigilance and appropriate laboratory testing to find undiagnosed Lyme disease. Conjunctivitis, damage to the nerves of the face or eyes, Lyme meningitis and abnormal electrocardiograms (including heart block) all are occasional manifestations of Lyme disease and should prompt a clinician to consider the diagnosis.

Early treatment of Lyme disease was, and is still, most commonly oral doxycycline.

Dear Dr. Roach: I just completed a bone density scan that showed that I have osteopenia. My doctor has suggested that I take both vitamin D and calcium. I read your recent column that said this can increase stroke risk, which my doctor did not tell me. I am confused that she would suggest I take vitamin D and calcium if it would increase risk of stroke. L.B.

Dear L.B.: Taken together, calcium and vitamin D reduce the risk of fracture in women with osteoporosis. Naturally, your doctor is concerned about your bones and wants to prevent a fracture, which can be devastating.

However, there is a substantial and growing body of literature suggesting that calcium supplements, but not dietary calcium, increase the risk of heart disease, and a new study showed an increased risk of stroke among those taking calcium supplements and vitamin D. However, there are other studies that have NOT shown an association between calcium supplements and heart attack or stroke. Experts are divided.

There is then a question of competing risks: The benefit of a decreased fracture risk you get in taking the calcium and vitamin D versus the possible harm in stroke and heart disease. Your doctor may have balanced the risk and felt the calcium was more benefit than harm. She may also be in the school that feels calcium supplements have little or no risk.

I am risk-averse for my patients and feel that, when possible, taking calcium through food, not supplements, gives the best of both worlds: reduced fracture risk without increasing the risk of heart disease and stroke. This may require a broader change in diet, which may be inconvenient to some. Calcium-fortified foods are another option.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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The link between Lyme disease and arthritis - News - Sarasota Herald-Tribune

The Eastland Companion Animal Hospital in Bloomington is asking dog owners if they want to participate in research on using stem cells to treat dogs with arthritis.

Local dogs wouldjoin a double-blind, placebo-controlled studyto show the effectiveness of stem cells in treating large dogs(70 pounds or more) with arthritis in up to two joints of the knee, hip, elbow, or shoulder. The veterinary clinic has partnered with Animal Cell Therapies, who it's worked with before, to bring this study to Bloomington.

Dr. Kathy Petrucci, founder and CEO of Animal Cell Therapies, explained how dogs will receive the treatment.

The dogs that will receive the stem cells will be sedated, Petrucci said. Depending on what joints are affected, they will receive up to two injections in the joint and they will also receive an IV dose of stem cells.

The FDA oversees the cells that are received from donors for the study. Mothers donating these cells are screened for diseases, and cells are tested for any infections to ensure safety.

Stem cell therapy has been controversial, especially related to humans.

I think a lot of the controversy comes from the misunderstanding of the cell types, Petrucci said. The research in stem cells first started centered around embryonic or fetal tissue use. Its controversial to use embryos and fetal tissues for treatment for anything. The fact that we are using a disposable tissue as our cell sources makes it not controversial at all.

Why Umbilical-Derived Cells

Petrucci explained why umbilical-derived cells are more effective in treating arthritis versus other sources.

We looked at fat, bone marrow, embryonic cells, Petrucci said. The embryonic cells are a lot more unpredictable, and the bone marrow cells are more difficult to work with and less predictable. We didnt think the fat cells are as potent as umbilical-derived cells. Umbilical-derived cells are a lot younger and theyre a little bit more predictable. They are more easy to collect. We obtain cells from donors when the tissue would be normally thrown away. Theres no surgery required, no extra biopsies to obtain fat, no bone marrow from research animals. Its a good, ethical source of stem cells.

Umbilical-derived stem cells have proven successful in past studies on treatment for arthritis, according to Petrucci.

We did a study at the University of Florida on elbows only and we had success with that study, Petrucci said. We had good success with dogs under 70 pounds and (less) success with dogs over 70 pounds, so we changed our dose, which is why were testing dogs 70 pounds and over in this study.

Criteria for eligibility includes dogs weighing 70 pounds or more, being one year of age or older, in general good health, no neurologic issues, arthritis in up to two joints of the knee, hip, elbow, or shoulder, and have all four functioning limbs.

Owners must bring their dogs back to the clinic after 30 days to check for progress and complete a questionnaire. About 50 to 100 dogs are expected to participate in the study.

People like you value experienced, knowledgeable and award-winning journalism that covers meaningful stories in Bloomington-Normal. To support more stories and interviews like this one,please consider making a contribution.

Stem Cell Treatment - Excerpt

Stem Cell Research - Full Story

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Bloomington Vet Joins Study For Stem Cell Therapy To Treat Dogs With Arthritis - WGLT News

Rezhna Taha,1 Maria Papadopoulou,1,2 Madeleine Zetterberg,1,2 Solveig Oskarsdottir,3 Marita Andersson Grnlund1,2

1Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 2Department of Ophthalmology, Sahlgrenska University Hospital, Mlndal, Sweden; 3Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

Correspondence: Rezhna TahaDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, SwedenTel +46 31 704 093555Fax +46 31 848952Email rezhna.taha.najim@vgregion.se

Purpose: To evaluate quality of life (QoL) in children with juvenile idiopathic arthritis (JIA).Methods: Forty children with a mean age of 7.9 years were included. The children underwent an ophthalmological examination and completed questionnaires on physical function (CHAQ) and vision-related (VR) QoL (EYE-Q).Results: No differences regarding visual acuity (VA), refraction, intraocular pressure or physical or VRQoL were found between those with JIA without (n=33) and those with JIA-associated uveitis (n=7). When comparing physical function measured by CHAQ disability index and JIA subtype, a difference was found; children with polyarthritis scored the worst (p=0.0098). Children with subnormal VA scored worse on EYE-Q compared with those with normal VA (p=0.013). We found correlations between duration of JIA and CHAQ disability index (r=0.42, p=0.0007) and CHAQ well-being (r=0.34, p=0.022).Conclusion: This study indicates the importance of measuring not only physical function but also VRQoL in children with JIA and JIA-associated uveitis.

Keywords: child arthritis, juvenile idiopathic arthritis, PROM, uveitis, quality of life

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Visual Function And Quality Of Life In A Cohort Of Swedish Children Wi | OPTH - Dove Medical Press

The PatientReported Outcomes Measurement Information System (PROMIS) is a universally applicable set of itembanks for the evaluation of patientreported health. Both the PROMIS Pain Interference (PROMISPI) and the PROMIS Pain Behavior (PROMISPB) itembanks were found to have good psychometric properties for patients with rheumatoid arthritis and to be useful as computerized adaptive tests (CATs) in clinical practice and research, according to a study published in Arthritis Care & Research.

The objective of the current study was to evaluate the psychometric properties of the PROMIS-PI and the PROMIS-PB item banks (40 and 39 items, respectively) in Dutch and Flemish patients with rheumatoid arthritis. Properties examined in those assessments are unidimensionality, crosscultural validity (Differential Item Functioning [DIF] for language [Dutch vs Flemish]), other forms of measurement invariance, floor and ceiling effects, monotonicity, Graded Response Model (GRM) fit, local dependence, construct validity, and reliability.

Both the PROMISPI and PROMISPB item-banks were found to have sufficient unidimensionality (OmegaH 0.99 and 0.95; ECV 0.95 and 0.78; respectively), to have negligible local dependence (0.3% and 1.4% of itempairs), good monotonicity (scalability coefficient of the scale, 0.75 and 0.46), and a good graded response model fit. Both item-banks also showed good cross-cultural validity (absence of differential item functioning for language), measurement invariance (absence of differential item functioning for age, sex, disease activity, and administration mode), good construct validity, high reliability (>0.90 in the range of patients with rheumatoid arthritis), and absence of floor and ceiling effects (0% maximum or minimum score for both). The PROMIS-PI correlated strongly with the Dutch-Flemish PROMIS Global Health Pain intensity (r=0.80), the Short-Form Health Survey Physical Functioning scale (r=-0.71) and the Health Assessment Questionnaire Disability Index (r=0.71). The PROMIS-PB also correlated strongly with the Dutch-Flemish PROMIS Global Health Pain intensity 266 (r=0.61). These findings add to the evidence that the PROMIS item-banks provide an adequate assessment of pain interference and behavior, respectively.

Both the PROMIS-PI and PROMIS-PB banks showed good psychometric properties in patients with [rheumatoid arthritis]. Using the highly efficient PROMIS-PI and PROMIS-PB CATs in research and clinical practice is considered to be user-friendly and feasible with little administration time, and has the potential for valid and precise standardized and routine patient monitoring of pain interference and pain behavior, concluded the study authors.

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Reference

Crins MHP, Terwee CB, Westhovens R, et al. First validation of the full PROMIS pain interference and pain behavior item banks in patients with rheumatoid arthritis [published online September 28, 2019]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.24077

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Validation of PROMIS Pain Interference and Pain Behavior for Rheumatoid Arthritis - Clinical Pain Advisor

Elevated anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF) titers have been independently associated with increased mortality in patients with rheumatoid arthritis (RA), according to research published in Arthritis Care & Research.

Researchers conducted a retrospective real-world study examining the role of ACPA and RF seropositivity in risk prediction for mortality in RA. Investigators also studied the association between ACPA and RF titers and all-cause mortality, examining whether the use of disease-modifying antirheumatic drugs (DMARDs) affected these associations.

Study data were obtained from 2 US administrative claims databases linked to laboratory data. Patients were followed from the date of the analysis-specific index until death, end of health plan enrollment, or the end of the study period (June 2016).

In total, 133,775 patients with RA were included from both databases (ACPA n=53,849; RF n=79,926). Baseline characteristics were generally balanced between groups, with DMARD use, RA diagnoses, previous or current positive smoking status, and the presence of chronic obstructive pulmonary disease significantly elevated in seropositive patients (P <.001).

The ACPA group had 184,170 patient-years of follow-up. In this group, 5.7% of patients died, and the mortality incidence rate was 16.7 per 1000 patient-years (95% CI, 16.1-17.3). The RF group had 297,830 patient-years of follow-up; 6.5% of patients died, and the mortality incidence rate was 17.5 per 1000 patient-years (95% CI, 17-18). Both ACPA and RF positivity were associated with a significant increase in mortality risk (P <.0001 for both).

In the ACPA group with baseline RF data, ACPA positivity was associated with increased mortality compared with RF positivity; double ACPA and RF positivity were associated with the highest mortality risk (hazard ratio [HR] 1.61; 95% CI, 1.45-1.79). Single ACPA positivity was associated with a higher risk compared with single RF positivity.

In the RF group with baseline ACPA data, the highest mortality risk was also noted in the ACPA and RF double-positive group (HR 1.22; 95% CI, 1.09-1.36). According to the investigators, all other combinations of the presence of ACPA and RF were associated with a significantly increased mortality risk compared with ACPA and/or RF seronegativity.

Also, mortality risk positively correlated with ACPA and RF titers and was the highest in groups of patients with the highest titers for both ACPA and RF (HR 1.60 and 1.78, respectively; 95% CI, 1.45-1.76 and 1.66-1.91). The findings were consistent when the groups were combined.

Survival curves comparing patients with ACPA and RF serostatus showed similar patterns of divergence. Compared with single ACPA and RF positivity, single ACPA and RF negativity was associated with a higher survival rate.

Both ACPA and RF single-positive patients who received conventional synthetic DMARD (csDMARD) therapies had a statistically significant increase in mortality risk (ACPA HR 1.52; RF HR 1.47). Patients who had single ACPA or RF positivity who received csDMARDs had a 46% and 62% increased mortality risk vs patients with double ACPA and RF negativity. No increase in mortality risk was noted in patients receiving biologic DMARDs.

Study limitations included those inherent to the nature of observational studies, including the absence of randomization.

Elevated ACPA and RF titers were independently associated with increased mortality among patients diagnosed with RA, the researchers concluded. Additional analyses are warranted, including evaluation of the association of disease activity and mortality.

Disclosure: This clinical trial was supported by Bristol-Myers Squibb. Multiple authors report affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Reference

Alemao E, Bao Y, Weinblatt ME, Shadick N. Association of seropositivity and mortality in rheumatoid arthritis and the impact of treatment with disease-modifying antirheumatic drugs [published online September 17, 2019]. Arthritis Care Res. doi: 10.1002/acr.24071

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Increased Mortality and Seropositivity in Rheumatoid Arthritis - Rheumatology Advisor

Adults with rheumatoid arthritis (RA) are more likely to demonstrate cognitive impairment compared with healthy adults, according to research published in the Journal of Clinical Neuroscience. Researchers highlight the potential burden of cognitive impairment in RA management.

Researchers conducted a cross-sectional, case-control study of consecutive patients to examine the prevalence of cognitive impairment and the specific factors associated with this impairment in RA.

Patients were recruited from the rheumatology unit of a university-affiliated, tertiary referral hospital between January 2016 and December 2018. Eligible patients were aged 18 years or older with an RA diagnosis based on American College of Rheumatology criteria. Patients with diagnosed dementia prior to RA diagnosis were excluded.

The final study cohort included 210 patients with RA and 70 healthy controls (83.8% and 78.6% women, respectively): Both groups were homogenous in terms of age, sex, and education level, although patients in the RA group were more likely to have hypertension, diabetes, and mood disorders.

Investigators found a statistically significant difference between the rates of cognitive impairment between the RA and control groups; 72.4% and 97.65% of patients in the RA group classified as cognitively impaired based on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), respectively. Comparatively, only 20% and 68.6% of patients in the control group were classified as cognitively impaired (MMSE and MoCA, respectively). More patients in the RA group experienced neuropsychiatric impairment (59.5%) or subjective memory complaints (67.1%).

Mean MMSE and MoCA scores were significantly lower in patients with RA, whereas mean Hospital Anxiety and Depression Scale (HADS) Total, HADS Anxiety, and HADS Depression scores were significantly higher. Patients with RA performed significantly worse on MMSE in terms of individual analysis of cognitive domains, particularly in terms of attention, remote memory, repetition, stage command, writing, read and obey, and copy. MoCA results demonstrated statistically significant differences between RA patients and controls in almost all cognitive domains, excluding orientation.

Patients being treated with biologic therapy were less likely to be classified as cognitively impaired according to the MMSE, whereas patients treated with oral glucocorticoid therapies and those who had positive rheumatoid factor were more likely to be classified as cognitively impaired based on the MoCA.

A linear regression analysis found that Health Assessment Questionnaire results were correlated with MMSE scores, MoCA scores, and HADS scores (r=-0.21, -0.27, and 0.46, respectively). Logistic regression analyses found that patients who were older, or who exhibited their first disease symptoms at an older age, had increased odds of being classified as cognitively impaired according to the MoCA.

Limitations to the study included the cross-sectional nature of the design, meaning that despite statistical significance, the causal pathway to cognitive impairment could not be determined. Additionally, this sample is not representative of all patients with RA, and therefore results may not be generalizable.

Patients with RA may present more neurological deficits than is commonly thought, the researchers concluded. For persons with chronic diseases such as RA, intact cognitive function is critical for the successful performance of daily activities based on ones current health condition Further studies are needed to better investigate the epidemiology and the physiopathology of dementia in RA patients.

Reference

Vitturi BK, Nascimento BAC, Alves BR, de Campos FSC, Torigoe DY. Cognitive impairment in patients with rheumatoid arthritis [published online August 22, 2019]. J Clin Neurosci. doi: 10.1016/j.jocn.2019.08.027

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Rheumatoid Arthritis and Cognitive Impairment - Rheumatology Advisor

The European Medicines Agencys (EMA) Committee for Medicinal Products for Human Use (CHMP) agreed on a positive opinion for AbbVies upadacitinib (RINVOQ), according to the company. The JAK inhibitor is a once-daily selective treatment used for adult patients with moderate to severe active rheumatoid arthritis who are intolerant to 1 or more disease-modifying antirheumatic drugs.

CHMP's positive opinion is a scientific recommendation for marketing authorization to the European Commission, which authorizes marketing approval in the European Union. This opinion is supported by data from a global phase 3 SELECT rheumatoid arthritis program. 4400 patients with moderate to severe active rheumatoid arthritis were evaluated in 5 different trials, including SELECT-NEXT, SELECT-BEYOND, SELECT-MONOTHERAPY, SELECT-COMPARE, and SELECT-EARLY.

All primary and secondary endpoints were met, including low disease activity based on Disease Activity Score 28 C-Reactive Protein. Improved response was seen with upadacitinib, both as a monotherapy and in combination with conventional synthetic DMARDs compared to placebo.

The SELECT program showed a consistent safety profile across all five studies, with the most frequent adverse reactions being infections.

REFERENCE

AbbVie receives chmp positive opinion for upadacitinib (rinvoq) for the treatment of adults with moderate to severe active rheumatoid arthritis [news release]. North Chicago, Ill.; PR Newswire: October 18, 2019. https://www.prnewswire.com/news-releases/abbvie-receives-chmp-positive-opinion-for-upadacitinib-rinvoq-for-the-treatment-of-adults-with-moderate-to-severe-active-rheumatoid-arthritis-300940994.html. Accessed October 18, 2019.

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Positive Opinion of Upadacitinib for Active Rheumatoid Arthritis - Pharmacy Times

Nine widely-used medications have experienced substantial price surges over the past 2 years, adding $5.1 billion to overall drug spending during this time period, according to a new report.

Furthermore, 7 of these 9 drugs were found by the Institute of Clinical and Economic Review (ICER) to be lacking sufficient clinical evidence to support such price increases. Not only did adalimumab top the list of best-selling drugs last year, but the anti-inflammatory medication ranked first in terms of the most substantial price hikes from 2016 to 2018.

Of the drugs listed, the ICER indicated that lenalidomide and dimethyl fumarate were the only 2 with new clinical evidence. However, the report noted that this is not a determination that the new evidence necessarily justified these prices increases.

Below are the top 9 drug price hikes based on wholesale acquisition cost (WAC) increase, net price increase, and overall estimated increase in drug spend.

1.Adalimumab (Humira)

WAC increase: 19.1%Net Price increase: 15.9%Drug spending increase: $1.86 billion

Indicated for: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, adult and pediatric Crohn disease, ulcerative colitis, plaque psoriasis, adult and adolescent hidradenitis suppurativa, and adult and pediatric non-infectious uveitis.

2.Rituxan (rituximab)

WAC increase: 17%Net Price increase: 23.6%Drug spending increase: $806 million

Indicated for: non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, pemphigus vulgaris, granulomatosis with polyangiitis, and microscopic polyangiitis.

3. Pregabalin (Lyrica)

WAC increase: 28.3%Net Price increase: 22.2%Drug spending increase: $688 million

Indicated for: Neuropathic pain associated with diabetic peripheral neuropathy, neuropathic pain associated with spinal cord injury postherpetic neuralgia, adjunctive therapy for partial-onset seizures in patients 1 month of age and older, and fibromyalgia.

4. Elvitegravir, Cobicistat, Emtricitabine, Tenofovir (EVG/COBI/FTC/TAF) (Genvoya)

WAC increase: 14.3%Net Price increase: 21.7%Drug spending increase: $651 million

Indicated for: HIV in antiretroviral (ART)-nave adults and pediatric patients aged 12 years and older and to replace the current ART regimen in virologically suppressed patients.

5. Emtricitabine/Tenofovir Disoproxil Fumarate (Truvada)

WAC increase: 14.3%Net Price increase: 23.1%Drug spending increase: $550 million

Indicated for: to be used in combination with other antiretroviral agents for the treatment of HIV-infected adults and childred aged 12 yeas and older and for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV in adulst and adolescents at high risk.

5. Pegfilgrastim (Neulasta)

WAC increase: 14.6%Net Price increase: 13.4%Drug spending increase: $489 million

Indicated for: decrease the incidence of infection as manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia and to increase survival in patients acutely exposed to myelosuppressive doses of radiation.

6. Tadalafil (Cialis)

WAC increase: 26.2%Net Price increase: 32.5%Drug spending increase: $403 million

Indicated for: erectile dysfunction and benign prostatic hyperplasia

7.Dimethyl Fumarate (Tecfidera)

WAC increase: 16.7%Net Price increase: 9.8%Drug spending increase: $313 million

Indicated for: relapsing forms of multiple sclerosis

8.Lenalidomide (Revlimid)

WAC increase: 25.8%

According to the report, ICER received public comment that lenalidomide experienced important price increases, but due to uncertainties in the volume of unit sales, they were unable to accurately determine the change in drug spending.

Indicated for: myelodysplastic syndromes, mantle cell lymphoma that has relapsed or progressed after 2 prior therapies, and multiple myeloma.

Reference

Institute for Clinical and Economic Review. Unsupported Price Increase Report. October 8, 2019.https://icer-review.org/wp-content/uploads/2019/01/ICER_UPI_Final_Report_and_Assessment_100819_Final.pdf. Accessed October 9, 2019.

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Top 9 Drugs With the Biggest Price Increases Over 2 Years - Pharmacy Times

Nearly 60% of respondents in a national survey of people with juvenile arthritis and other rheumatic diseases reported struggling to afford their medications in the past year.

The online survey, conducted by the American College of Rheumatology (ACR) in June, with the results recently released, included 1,517 adults living in the U.S. Participants were asked about their lifestyle, access to healthcare, and its affordability.

Results showed that although most of the respondents (90%) had health insurance coverage, nearly 60% had difficulties affording their treatments.

Nearly half reported that insurance companies impose a step therapy, in which patients must take and fail to respond to an insurer-preferred treatment before they are covered for therapy options prescribed by their doctors. This occurred even when a patients doctor doubted the efficacy of the insurer-preferred option.

Out-of-pocket costs greater than $1,000 a year were reported by one in four of the respondents. In 6% of the cases, yearly out-of-pocket costs skyrocketed to over $5,000.

While more than 50% of the respondents are currently followed by or have been referred to a rheumatologist, the waiting period before a first consultation was more than 30 days in approximately 60% of the cases.

Nearly two-thirds of patients (63.81%) reported impairments to their daily lives, with the disease affecting their ability to perform simple tasks such as eating, getting dressed, cooking meals, or running errands.

These findings make clear that Americans living with rheumatic disease regardless of age, gender, or income level struggle to find affordable care, Paula Marchetta, MD, president of the American College of Rheumatology, said in a press release.

To address these challenges, it is crucial for patients, clinicians, and policymakers to work together to improve access to rheumatology care so that patients can live longer, healthier, and more fulfilling lives, Marchetta added.

Together with people with rheumatology, ACR staffers recently attended the annual Advocates for Arthritis event at Capitol Hill, to push for changes to legislation. Specifically, the advocates urged for a stop in the excessive use of step therapy by insurance companies and for legislation that would increase the number of rheumatologists.

The 2019 survey followed last years 2018 ACR survey, which asked patients from all 50 states and the District of Columbia, How easy is it to live with rheumatic disease in my state? This years assessment adds further information on the challenges faced by people diagnosed with a rheumatic disease.

According to the Centers for Disease Control and Prevention, nearly one in four Americans have a rheumatic disease, which includes juvenile arthritis, rheumatoid arthritis, systemic lupus erythematosus, and Sjgrens syndrome. As as many as 300,000 children in the country are estimated to have juvenile arthritis.

Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.

Total Posts: 11

Ana holds a PhD in Immunology from the University of Lisbon and worked as a postdoctoral researcher at Instituto de Medicina Molecular (iMM) in Lisbon, Portugal. She graduated with a BSc in Genetics from the University of Newcastle and received a Masters in Biomolecular Archaeology from the University of Manchester, England. After leaving the lab to pursue a career in Science Communication, she served as the Director of Science Communication at iMM.

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US Survey Finds 60% of Americans Struggle to Afford Medications for JA, Other Rheumatic Diseases - Juvenile Arthritis News

Although liver fibrosis and liver stiffness are more common in patients with rheumatoid arthritis (RA) compared with the general population, methotrexate (MTX) treatment does not appear to be a contributing factor, according to research published in the European Journal of Internal Medicine.

Using data from consecutive patients with RA, researchers sought to determine the role of MTX therapy in the development of liver stiffness and liver fibrosis. Categorically, patients who were MTX-nave and MTX-treated were assessed via real-time 2-dimensional shear wave elastography technology (2D.SWE.SSI).

The total cohort included 140 MTX-treated, 33 MTX-nave, and 100 healthy controls with a similar mean age and gender distribution across all groups. However, MTX-nave patients had a significantly shorter disease duration and higher Health Assessment Questionnaire compared with patients who were treated with MTX. In the MTX-treated group, the mean cumulative dose of MTX was 37153560 mg, with a mean time of treatment exposure of 71.366.4 months.

Liver stiffness (kPa) values were significantly lower in healthy controls compared with both patients who were MTX-nave and MTX-treated (4.320.7 vs 4.920.8 and 4.850.9, respectively). The difference in kPA values between the 2 MTX groups was not statistically significant.

Researchers, through the results of a multiple linear regression analysis, found that RA diagnosis, older age, and being a man were independently associated with higher liver stiffness values. An additional multiple linear regression analysis found that increasing age and being a man, but not treatment with and cumulative dose of MTX, were independently associated with increasing liver stiffness in patients with RA.

Based on a proposed cutoff of 7.1 kPa, only 4 out of 173 patients with RA were classified as having significant liver fibrosis (kPa values range 7.1-7.6). All 4 of these patients were in the MTX-treated RA group. However, these patients did not have liver function abnormalities or clinical signs of hepatic failure.

One study limitation is the lack of histological confirmation of hepatic fibrosis, which researchers note would have been difficult to justify from an ethical point of view. Additional limitations include the possibility of selection bias and the cross-sectional nature of the study design.

Significant liver fibrosis and liver stiffness in RA patients appear to be independent of MTX use, the researchers concluded. [The] 2D.SWE.SSI technique could be a promising tool to assess the severity of and to follow-up liver stiffness in RA patients and other chronic inflammatory conditions under MTX treatment.

Reference

Erre GL, Cadoni ML, Meloni P, et al. Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: a cross-sectional controlled study with real-time two-dimensional shear wave elastography [published online August 29, 2019]. Eur J Intern Med. doi: 10.1016/j.ejim.2019.08.022

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Liver Fibrosis, Stiffness Rates in Rheumatoid Arthritis and Methotrexate Therapy - Rheumatology Advisor

As a specialist in joint pain, Guermazi has done thousands of steroid injections over decades of work. He has trained other doctors as he was trained: to believe that the injections are safe as long as they arent overused. But now he has come to believe that the procedure is more dangerous than he knew. And he and a group of his Boston University colleagues are raising a warning flag for doctors and patients alike.

Millions of times every year, people with joint pain allow doctors to run a needle through their skin, then their muscle, then their tendons, and into the fluid-filled space of a painful joint to calm inflammation. Such inflammation can be the result of many types of injury or disease, but most commonly it is the result of gradual wear and tear known as osteoarthritis, in which the cartilage diminishes, the space between the bones narrows, and eventually bones start to rub on one another. At that stage, a person may need a surgical joint replacement. The progression of the disease itself cant be reversed with drugs, so medical treatment is aimed at easing pain and maximizing mobility. Steroid injections are one of the chief ways this is attempted.

In the journal Radiology this week, Guermazi and his colleagues at Boston University published a study of 459 patients at their hospital who got injections, in the hips or knees, in 2018. Of those patients, 8 percent had complications that worsened the state of their joints. In some cases, the arthritis actually sped up. Others developed small fractures under the cartilage or had complications that compromised the blood supply to bone. In the worst cases, patients had what Guermazi and his colleagues described as rapid joint destruction.

Patterns of harm can be slow to emerge in medicine, and causal relationships are difficult to prove. But these findings build on a gradual accretion of evidence challenging the widespread use of steroid injections. In 2015, Cochrane Musculoskeletal did a meta-analysis to see if the intervention was even helpful. After collating data from 27 knee-arthritis trials carried out around the world, the authors concluded that the quality of evidence was low and overall inconclusive. Some of the studies they analyzed found small to moderate improvements in pain and physical function, but the results were not statistically reliable. Whether there is truly any positive effect, the authors concluded, is unclear.

Since then, the role of the placebo effect in steroid injections has gotten attention. In 2017, rheumatologists at Tufts University and Boston University did a randomized controlled trial in people with knee pain. A control group got a sham injection that contained no steroids. In what became a bombshell paper in the journal JAMA, people with knee arthritis reported that their pain was no different if they received injections of steroids or saline. Whats more, the people who got the steroid injections saw more erosion in the cartilage in their knees.

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A Warning From a Doctor Who Has Done Thousands of Steroid Injections for Arthritis - The Atlantic

Claire King, 57, has played the role of Kim Tate in ITVs Emmerdale since 1989. The actress has been open about her almost 30-year battle with rheumatoid arthritis. Rheumatoid arthritis is a long-term condition that causes painful joints, as well as stiffness and swelling. The condition is something her mother Angela also has. Speaking to Mail Online in 2017, Claire revealed: I was shocked and devastated when I was diagnosed with arthritis at 30. You presume it's an older person's disease. Nowadays, I have had to give up bombing round on a race horse at 40 miles an hour but I still go for a hack. It doesnt hold me back, its manageable. Youve just got to get on with it.

The former Coronation Street star has feared the painful, chronic disease would leave her wheelchair-bound when she was first diagnosed.

The actress was told about her condition after going to the doctors with throbbing and painful fingers.

A blood test later revealed and confirmed her condition of rheumatoid arthritis

But thankfully with exercise, supplements and eating healthy, Claire has managed to keep the symptoms minimal and manageable.

Claire revealed that she is taking natural treatments and supplements thanks to her brothers recommendation.

She revealed she takes omega 3 which is a supplement that has demonstrated its ability to improve symptoms in a number of studies.

Claire who said she finds the winter months harder in terms of pain was put on hydroxychloroquine sulphate to suppress her immune system at 38 as well as meloxicam, an anti-inflammatory.

She also takes B vitamins, including vitamin B12, as it reduces homocysteine, an amino acid found in high levels in people with rheumatoid arthritis which increases pain and inflammation.

When it comes to eating for her condition, Claire said: Its must common sense, I eat healthy stuff, as unprocessed as possible.

"Keeping your weight in check is important when you have arthritis. I make sure I get enough iron, so plenty of spinach and green veg.

"There is a link between anaemia, low red blood cell levels, and rheumatoid arthritis.

"Iron helps prevent this by helping produce haemoglobin, the protein in red blood cells that carries oxygen throughout the body.

Exercising is also crucial for arthritis as it helps ease pain and stiffness.

It also increases the strength and flexibility, reducing joint pain and helping to combat fatigue.

I love walking, I live in the Dales so I'm out hiking every weekend.

"I'm lucky enough to have a second home in Spain with a pool so when I'm there I'm swimming every day.

"I do some stretching without fail every morning too which sets me up to feel better for the rest of the day.

"Exercise helps keep the joints mobile and just doing a little of what you can manage and what you enjoy can make a difference long-term, added Claire.

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Claire King health: Emmerdale star's diagnosis I was shocked and devastated' - Express

Everyone, from family members to strangers on the subway, knows that I love to crochet. Its rare to find me without my lightweight, ergonomic hooks and a ball of yarn. This year, I completed seven shawls, four scarves, two purses, and one big blanket. I hope to finish more projects in time for Christmas.

For me, crocheting and other forms of art are much more than merely a way to pass the time. Theyve improved my quality of life since I grew up with juvenile arthritis (JA). Throughout my childhood and teenage years, I spent hours drawing or crafting while lying on the couch. My art served as both distraction therapy and a way to keep busy when I wasnt well enough to go out to play with friends.

Reflecting on my dedication to my crafts over the years, I realize its been more than a physical coping method. My hobbies also help me to deal with the emotional burden of JA. Engaging in activities that I enjoy offers me hope, benefits my mental health, and gives me an identity apart from my disease.

Hope is a powerful thing that can inspire us to work hard to achieve a goal and to maintain a positive outlook during dark times.

Ive had flares that knocked me down for days or weeks at a time. I may not have been up to crafting then, but my next project was never far from my thoughts. I would scroll through Pinterest, longing to follow the tutorials that appeared in my feed. Looking at boards full of new projects made me eager to recover. I found it easier to stick to medication and physical therapy routines when I had something to look forward to.

As I recovered from flares, I often pushed myself to work on my projects. I would start slowly, with 15-minute stretches, before building up to longer sessions. Spending time crafting and drawing helped to keep my spirits up and was probably good physical therapy, too.

Id be lying if I told you that Ive never struggled with depression. I had some dark times, particularly in my teens. Living with chronic pain made me feel isolated from others, and my usual activities, including art, became unappealing to me.

I didnt start feeling better until things changed in my life, including the introduction of a new medication regimen and counseling. I also credit my improved mental health to taking art classes. Learning how to draw improved my self-esteem, gave me confidence, and brought joy into my life. The first drawings in my sketchbook were somber, black-and-white portraits. But by the time I graduated from the course, my portfolio was filled with colorful paintings of fluffy animals, babies, and musicians. I also made a lifelong friend through the class.

Of course, hobbies are nota cure for depression or anxiety. No amount of wreath-making or crocheting can take away negative feelings. But yarn crafts, painting, and other forms of self-expression are used by therapists to help those suffering from mental health problems.

Juvenile-onset arthritis has affected me every day since childhood. While Ive learned to cope with chronic pain, the disease still affects many aspects of my daily life. Some days, its hard for me to remember that having arthritis is not who I am its just something I have.

My blog and social media accounts may be titled, The Girl with Arthritis, but Im glad that the people in my life dont call me that. My family and friends call me the artist. More recently, Ive been the girl who crochets pretty shawls and the baker. Taking pride in my favorite activities and sharing them with others have helped me to create an identity separate from JA.

Parents: Encourage your child to pursue an activity they show interest in. I genuinely believe that anyone with a chronic disease can benefit from participating in a hobby they love. While crafting happens to be my favorite thing to do, the possibilities are endless.

My friends write stories and poetry, learn computer coding, make music, scrapbook, create comics, and even play the board game Dungeons & Dragons. Find something that brings joy to your life and adapt it to suit your needs. Your child might find a supportive community through classes or clubs. Youll never know until you encourage them to follow their passions.

***

Note: Juvenile Arthritis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Juvenile Arthritis News, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to juvenile arthritis.

Elizabeth Medeiros is a young adult who has dealt with juvenile arthritis since she was a small child. However, her pain hasnt stopped her from working on a product design degree in Boston. Her passion is to create products that make life easier for the chronically ill, such as shoes and walking canes. When shes not in class, Elizabeth enjoys writing about how shes coped with arthritis at such a young age. You can find more of her writings at ArthritisGirl.Blogspot.com and on Instagram @GirlWithArthritis.

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Hobbies Help Me Cope with the Mental Challenges of Juvenile Arthritis - Juvenile Arthritis News

Justin Furman can no longer go for long walks along the beach.

The 30-year-old Toronto man says that during his honeymoon in Zanzibar this past summer, even something as simple as walking would hurt his knees.

Ive been dealing with [the pain] for a decade now. My wife is used to [and] sympathetic to the issue at this point, he told Global News. Its frustrating.

READ MORE: A quiet epidemic Why so many Canadians experience knee pain

Furman, like many Canadians, deals with joint pain, a problem he said started after a series of football injuries years prior.

I played until I tore my hamstring about three-quarters of the way, he continued. Now the pain is predominantly in my right knee It just feels unstable.

David Wilson, professor of orthopedics and co-director of the Centre for Hip Health and Mobility at the University of British Columbia and Vancouver Coastal Health Research Institute, tells Global News the two common causes of joint pain are injury and arthritis.

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The most common type of arthritis is osteoarthritis, which involves degeneration of the joint tissues like cartilage and bone, he explained. People are at higher risk of osteoarthritis if they have injured their joints, are overweight, or have an occupation that puts a lot of repetitive load on the joint.

About six million Canadians have arthritis thats one in every five people and nearly 60 per cent of people with arthritis are women, according to the Arthritis Society.

The prevalence of arthritis is on the rise by 2040, 50 per cent more people will have arthritis, the organization says. People with arthritis are more likely to experience anxiety, mood disorders, poor mental health, and difficulty sleeping, compared to those without arthritis.

Arthritis can be tricky because it can be hard for some to recognize when normal aches and pains of older joints turn into osteoarthritis.

Osteoarthritis is a slow-moving disease, Wilson explained. In the hip, in particular, the symptoms can come and go as well.

Many people are surprised to be diagnosed with osteoarthritis, especially if they are in their 30s or 40s, he noted.

However, there are more and more cases of osteoarthritis in these younger age groups, he said. A diagnosis of osteoarthritis can make a young person feel old, but it is the first step to coming up with a plan for managing or treating joint pain caused by this disease.

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Anna Weigt-Bienzle of Toronto was diagnosed with rheumatoid arthritis at the age of 22.

She tells Global News almost all of her joints were impacted.

Its also a symmetrical disease, so if my right wrist joint is hurting, the left is likely to be affected as well.

Some days its debilitating and others I hardly notice it. Mornings can be challenging since thats when I tend to experience the most stiffness in my joints, so I try to wake up a littler earlier to give my body extra time.

And when you have a condition like rheumatoid arthritis, so much of your everyday life begins to change.

Having to go to work for the first time with my cane at 26 was a definite hit to my pride, she continued.

Ive had a flare-up on a date where my TMJ [the joint that connects the jaw to the skull] was inflamed and I could hardly open my mouth, which made eating nearly impossible, not to mention an end-of-night kiss.

Another time, Weigt-Bienzle had a flare-up in her knee during a party in an apartment without an elevator. A friend had to carry her down the stairs.

She says coming to a proper diagnosis took two years.

I was bounced around between several doctors and given various diagnoses, including lupus, Parkinsons and MS before they were able to figure out it was rheumatoid arthritis.

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Besides taking medication, she also practises yoga three times a week to manage the pain.

I make sure to walk frequently and utilize my standing desk intermittently at work, she explained. With joint pain it can be challenging to move at times, but the longer you stay still, the worse it is.

Wilson says as soon as you feel any type of pain, talk to your family doctor.

They are best equipped to assess the cause of pain, understand your specific health situation and where joint pain fits in, and recommend how to manage it, he said. If the pain is from osteoarthritis, there are effective treatment options, including physical therapy, weight loss, medication and joint replacement.

Furman says he went to see a doctor as soon the pain started. He had several MRIs and was told he had a torn meniscus.

I was instructed to deal with the pain as long as I could.

In the meantime, he manages his pain with off-the-counter drugs like Advil and Robaxacet.

Generally, just have to give the knees a rest every so often, he said.

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READ MORE: It was like getting my life back New knee replacement protocol helps patients go home sooner

Before you take any type of medication, Wilson says talk to your doctor first.

If you have osteoarthritis, you will likely have to manage it for years, and a doctor should be part of all decisions on long-term use of any medication, he said.

Some prescription medications are designed to reduce the side-effects that become a concern with long-term use of pain medication.

He adds that people can also discuss natural remedies and supplements with their doctors. Many of the claims made for them are optimistic and unsubstantiated by solid research.

Exercise can also be helpful.

READ MORE: How arthritis sufferers can reduce inflammation through food

There is a structured osteoarthritis education and exercise program that has been rolled out in five provinces called GLA:D, Wilson said.

GLA:D has been shown, he adds, to reduce pain and increase physical activity.

Best of all, exercise doesnt have the risks of medication and surgery.

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2019 Global News, a division of Corus Entertainment Inc.

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Some days its debilitating: When joint pain takes over your life - Global News

OBJECTIVE:

To define the risk of coronary artery disease (CAD) in adults with a history ofjuvenile arthritis(JA) METHODS: We used the National Health and Nutrition Examination 2007-2014 Surveys. Two comparison groups were identified: 1) random sample withoutarthritis, and 2) respondents with reported rheumatoidarthritis(RA). Coronary artery disease was defined as yes to survey questions: Have you ever been told you had congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, or stroke? Potential confounders for CAD included age, gender, race, smoking status, and any component of metabolic syndrome.

There were 232 respondents who reported JA; 1,028 randomly selected withoutarthritis; and 1,105 who reported RA. In simple logistic regression, the JA group had a three -fold increased odds of CAD compared to those withoutarthritis(odds ratio (OR): 3.2, 95% confidence interval (CI): 2.1-4.8, p<0.0001). Controlling for confounders, the odds of CAD in JA continued to be increased (OR: 4.2, 95% CI: 4.7-10.5, p=0.002). When comparing the JA and RA groups, in simple logistic regression, the JA group had a lower odds of CAD (OR 0.7, 95% CI: 0.5-0.9, p=0.03). Controlling for confounders, there was no significant difference in odds of CAD between groups (OR 0.8, 95% CI: 0.5-1.3, p=0.4).

Adults with a history of JA have a higher risk of CAD compared to adults withoutarthritis. Providers should be aware of the increased risk of CAD in adults withjuvenile arthritisand aggressively screen these patients for modifiable risk factors.

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Coronary Artery Disease in Adults with History of Juvenile Arthritis - DocWire News

Published: November, 2019

To manage the painful joint disease known as osteoarthritis, people often take ibuprofen (Advil, Motrin) and naproxen (Aleve, Anaprox). But these and related drugs known as NSAIDs may account for the higher rates of heart disease seen in people with osteoarthritis, a new study suggests.

Researchers matched 7,743 people with osteoarthritis with 23,229 healthy people who rarely or never took NSAIDs. People with osteoarthritis had a 42% higher risk of heart failure and a 17% higher risk of coronary artery disease compared with healthy people. After controlling for a range of factors that contribute to heart disease (including high body mass index, high blood pressure, and diabetes), they concluded that 41% of the increased risk of heart disease related to osteoarthritis was due to the use of NSAIDs.

Although this observational study doesn't prove cause and effect, it's already known that routine NSAID use can increase blood pressure, raise the risk of kidney problems, and cause stomach bleeding. For people with osteoarthritis, the findings underscore the importance of taking the lowest possible dose of an NSAID for the shortest possible time. The study appeared in the August 6 issue of Arthritis and Rheumatology.

Image: chapin31/Getty Images

Disclaimer:As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Pain relievers: A cause of higher heart risk among people with arthritis? - Harvard Health

There is an increase in global age-standardized prevalence and incidence rates of rheumatoid arthritis (RA), according to results of a systematic analysis published in the Annals of the Rheumatic Diseases. The analysis also indicated that rising rates of prevalence and incidence could contribute to the increased global burden of RA.

Using data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2017 study, researchers examined the trends in global, regional, and national prevalence, incidence, and associated disability-adjusted life years (DALYs) in patients with RA. No such global study has been published since 2010.

The GBD 2017 study included 195 countries, 7 super regions, and 21 regions across the globe, from 1990 to 2017; data on 354 diseases and injuries, 282 causes of death, and 84 risk factors were systematically analyzed.

Results of the analysis indicated that there were 19,965,115 globally prevalent cases of RA in 2017 (95% uncertainty interval [UI], 17,990,489-21,995,673 cases), with an age-standardized prevalence rate of 246.6 cases/100,000 population (95% UI, 222.4-270.8 cases), which increased by 7.4% between 1990 and 2017.

The trend for global age-standardized DALY rate decreased from 1990 to 2012, but increased and reached higher levels in the subsequent 5 years (2012-2017). At the global level, RA accounted for 3.4 million DALYs (95% UI, 2.6-4.4 million DALYs) with an age-standardized rate of 43.3 DALYs/100,000 population (95% UI, 33.0-54.5 DALYs). The age-standardized DALY rate decreased by 3.6% (95% UI, -9.7% to 0.3%) from 1990 to 2017.

At the regional level, age-standardized RA prevalence was highest in high-income North America, Western Europe, and the Caribbean (377.6, 346.8, and 338.9, respectively), whereas Southeast Asia, Oceania, and Western Sub-Saharan Africa had the lowest age-standardized rates (100.9, 135.3, and 135.7, respectively).

Age-standardized incidence rates were also highest in high-income North America (22.5), South Asia (20.7), and Western Europe (20.4); Southeast Asia (6.2), Oceania (7.9), and Western Sub-Saharan Africa (8.5) had the lowest rates.

Data from the analysis indicated that the percentage change in age-standardized prevalence rates between 1990 and 2017 was not similar across all GBD 2017 regions: East Asia, high-income North America, and Western Sub-Saharan Africa showed the most increasing significant trends (25%, 19%, and 14%, respectively) compared with Southern Sub-Saharan Africa, high-income Asia-Pacific, and Eastern Sub-Saharan Africa (-12%, -7%, and -5%), that showed decreasing significant trends.

Although the number of prevalent cases doubled from 1990 to 2017 (10,226,042 to 19,965,115), the contribution of the GBD 2017 regions was different.

At the national level, the age-standardized prevalence rate of RA ranged from 91 to 471 cases/100,000 population, with the highest age-standardized prevalence rates in the United Kingdom, Trinidad and Tobago, and Barbados (471.8, 404.4, and 402.6, respectively). Indonesia, Timor-Leste, and Sri Lanka had the lowest rates (91.1, 91.4, and 97.2, respectively). Age-standardized incidence rates ranged from 5.6 to 27.5 cases/100,000 population, with the highest incidence rates in the United Kingdom, Ireland, and Sweden.

Overall, the global age-standardized prevalence rate was higher in women, increasing with age and peaking between 70 to 74 years in men and 75 to 79 years in women in 2017.

Researchers noted a nonlinear association at the regional level between age-standardized DALY rate and sociodemographic index. Overall, they identified the lowest age-standardized DALY rate at a sociodemographic index level of 0.43, which they observed increased and decreased intermittently with [sociodemographic index] improvement.

Only high-income North America demonstrated an increase between 1990 and 2017. National-level analyses also identified a nonlinear association; study findings indicated that this association between age-standardized DALY rate, sociodemographic index, and high RA burden was not limited to the most- or less-developed countries.

Increasing population awareness regarding RA, its risk factors, and the importance of early diagnosis and treatment with disease modifying agents is warranted to reduce the future burden of this condition, the researchers concluded. Improving health data for better monitoring of disease burden and health outcomes are strongly suggested.

Reference

Safiri S, Kolahi AA, Hoy D, et al. Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis. 2019;78:1463-1471.

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Global Increase in Rheumatoid Arthritis Prevalence Rates and Disease Burden - Rheumatology Advisor

Used in conjunction with registry data, machine-learning may be a useful tool to predict the occurrence and intensity of persistent pain in patients with rheumatoid arthritis, according to a recent study published in Pain.

Researchers used data gathered from patient questionnaires (n=789) filled from the time of diagnosis for up to 5 years after diagnosis. A total of 21 parameters were assessed, including sociodemographic variables and factors deemed likely to influence persistent pain.

Unsupervised machine learning was used to identify subgroups within the distribution of patient pain levels. Gaussian mixture models were used to identify subgroups, and overfitting was assessed in all models. Supervised machine learning using Random Forest regression was used to identify the parameters that best predicted the subgroup of patients. The investigators also examined whether the evaluation of parameters at 3 months was optimal for predicting the occurrence and intensity of persistent pain.

After filtering the data to include only those patients with 4 assessments of pain level from 0 to 5 years after diagnosis, the data of 209 women and 79 men were analyzed (average age, 52.2 years). The use of unsupervised machine learning allowed to separate the patients into 3 subgroups according to their level of pain (ie, low, moderate, and high persistent pain). Patient global assessment and health assessment questionnaires administered at 3 months were found to allow to determine to which pain subgroups an individual would belong, using a supervised method. When the analysis was conducted again, excluding these parameters, tender joint count and swollen joint count assessed 3 months after diagnosis were found to be the most important nonpatient-related parameters for the prediction of pain level. For both patient- and nonpatient-related parameters, assessment at the time of diagnosis was not found to be an accurate predictor of persistent pain, as was the case when evaluations were conducted at 3 months.

Study limitations include the fact that this was a registry study, with no starting hypothesis.

The results indicate that early functional parameters of rheumatoid arthritis are informative for the development and degree of persistent pain, however, not earlier than 3 months after rheumatoid arthritis diagnosis, concluded the investigators.

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Reference

Ltsch, J, Alfredsson L, Lampa J. Machine-learning based knowledge discovery in rheumatoid arthritis related registry data to identify predictors of persistent pain [published online August 30, 2019]. Pain. doi: 10.1097/j-pain.0000000000001693

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Machine-Learning to Identify Predictors of Persistent Pain in Rheumatoid Arthritis - Clinical Pain Advisor