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Uncomplicated pregnancies in women with lupus may not boost risk for CV events
Pregnancy may not increase the risk of a cardiovascular event (CVE) in women with systemic lupus erythematosus as much as disease-related morbidities, according to findings from a large, retrospective study presented at the European Congress of Rheumatology.
In fact, uncomplicated pregnancy may be a positive marker for later cardiovascular health in lupus patients, Dr. May Ching Soh reported at the meeting.
“Physicians and patients may derive some reassurance that perhaps a pregnancy uncomplicated by maternal-placental pathology may be associated with lower risk for future cardiovascular events,” Dr. Soh said in an interview. “However, we cannot at this time recommend relaxing on our laurels and not screening and actively managing cardiovascular risk factors in all patients with systemic lupus erythematosus.”
Dr. Soh, an obstetrician in the Women’s Centre at Oxford Radcliffe Hospital, part of the Oxford (England) University Hospitals NHS Trust, extracted data from linked Swedish population registries on systemic lupus erythematosus (SLE) patients’ parity status, the occurrence of features of maternal-placental syndrome (MPS, defined as hypertensive disorders of pregnancy, small-for-gestational-age, stillbirth, and placental abruption), SLE-related morbidities (in-patient admissions, renal disease, malignancies, and infections), and CVE outcomes (coronary artery disease, stroke, peripheral vascular disease, and death from these causes).
The final cohort comprised 3,232 women with SLE who had been born in 1951-1971. A total of 72% had children.
The mean age at follow-up was 49 years. Nulliparous women had more SLE-related morbidities, more cardiovascular risk factors, and more cardiovascular events than did parous women.
CVEs were most common among those women who had never given birth (3.4 per 1,000 person-years), followed by women with pregnancies complicated by MPS (2.8 per 1,000 person-years). Compared with women who had an uncomplicated pregnancy, the risk of a CVE was doubled in the nulliparous group (hazard ratio, 2.2) and close to double in the MPS-pregnancy group (HR, 1.8).
The time to first CVE also was significantly delayed in women who had uncomplicated pregnancies. By age 30, almost none had occurred in these women, but 5% of those with MPS-complicated pregnancies and 10% of the nulliparous women had experienced an event by that age. The separation continued as women aged. By age 40, an event had occurred in about 4% of the MPS-free women, 8% of the MPS group, and 10% of the nulliparous group. The rates at age 45 were 5%, 8%, and 15%, respectively.
“Our nonparous cohort did develop cardiovascular events earlier, but the MPS cohort also had accelerated development compared to the women who had uncomplicated pregnancies,” Dr. Soh said. “In fact, an adverse pregnancy outcome should serve as a red flag for physicians to start screening early for cardiovascular disease and actively managing risk factors.”
She had no financial disclosures.
On Twitter @Alz_Gal
Pregnancy may not increase the risk of a cardiovascular event (CVE) in women with systemic lupus erythematosus as much as disease-related morbidities, according to findings from a large, retrospective study presented at the European Congress of Rheumatology.
In fact, uncomplicated pregnancy may be a positive marker for later cardiovascular health in lupus patients, Dr. May Ching Soh reported at the meeting.
“Physicians and patients may derive some reassurance that perhaps a pregnancy uncomplicated by maternal-placental pathology may be associated with lower risk for future cardiovascular events,” Dr. Soh said in an interview. “However, we cannot at this time recommend relaxing on our laurels and not screening and actively managing cardiovascular risk factors in all patients with systemic lupus erythematosus.”
Dr. Soh, an obstetrician in the Women’s Centre at Oxford Radcliffe Hospital, part of the Oxford (England) University Hospitals NHS Trust, extracted data from linked Swedish population registries on systemic lupus erythematosus (SLE) patients’ parity status, the occurrence of features of maternal-placental syndrome (MPS, defined as hypertensive disorders of pregnancy, small-for-gestational-age, stillbirth, and placental abruption), SLE-related morbidities (in-patient admissions, renal disease, malignancies, and infections), and CVE outcomes (coronary artery disease, stroke, peripheral vascular disease, and death from these causes).
The final cohort comprised 3,232 women with SLE who had been born in 1951-1971. A total of 72% had children.
The mean age at follow-up was 49 years. Nulliparous women had more SLE-related morbidities, more cardiovascular risk factors, and more cardiovascular events than did parous women.
CVEs were most common among those women who had never given birth (3.4 per 1,000 person-years), followed by women with pregnancies complicated by MPS (2.8 per 1,000 person-years). Compared with women who had an uncomplicated pregnancy, the risk of a CVE was doubled in the nulliparous group (hazard ratio, 2.2) and close to double in the MPS-pregnancy group (HR, 1.8).
The time to first CVE also was significantly delayed in women who had uncomplicated pregnancies. By age 30, almost none had occurred in these women, but 5% of those with MPS-complicated pregnancies and 10% of the nulliparous women had experienced an event by that age. The separation continued as women aged. By age 40, an event had occurred in about 4% of the MPS-free women, 8% of the MPS group, and 10% of the nulliparous group. The rates at age 45 were 5%, 8%, and 15%, respectively.
“Our nonparous cohort did develop cardiovascular events earlier, but the MPS cohort also had accelerated development compared to the women who had uncomplicated pregnancies,” Dr. Soh said. “In fact, an adverse pregnancy outcome should serve as a red flag for physicians to start screening early for cardiovascular disease and actively managing risk factors.”
She had no financial disclosures.
On Twitter @Alz_Gal
Pregnancy may not increase the risk of a cardiovascular event (CVE) in women with systemic lupus erythematosus as much as disease-related morbidities, according to findings from a large, retrospective study presented at the European Congress of Rheumatology.
In fact, uncomplicated pregnancy may be a positive marker for later cardiovascular health in lupus patients, Dr. May Ching Soh reported at the meeting.
“Physicians and patients may derive some reassurance that perhaps a pregnancy uncomplicated by maternal-placental pathology may be associated with lower risk for future cardiovascular events,” Dr. Soh said in an interview. “However, we cannot at this time recommend relaxing on our laurels and not screening and actively managing cardiovascular risk factors in all patients with systemic lupus erythematosus.”
Dr. Soh, an obstetrician in the Women’s Centre at Oxford Radcliffe Hospital, part of the Oxford (England) University Hospitals NHS Trust, extracted data from linked Swedish population registries on systemic lupus erythematosus (SLE) patients’ parity status, the occurrence of features of maternal-placental syndrome (MPS, defined as hypertensive disorders of pregnancy, small-for-gestational-age, stillbirth, and placental abruption), SLE-related morbidities (in-patient admissions, renal disease, malignancies, and infections), and CVE outcomes (coronary artery disease, stroke, peripheral vascular disease, and death from these causes).
The final cohort comprised 3,232 women with SLE who had been born in 1951-1971. A total of 72% had children.
The mean age at follow-up was 49 years. Nulliparous women had more SLE-related morbidities, more cardiovascular risk factors, and more cardiovascular events than did parous women.
CVEs were most common among those women who had never given birth (3.4 per 1,000 person-years), followed by women with pregnancies complicated by MPS (2.8 per 1,000 person-years). Compared with women who had an uncomplicated pregnancy, the risk of a CVE was doubled in the nulliparous group (hazard ratio, 2.2) and close to double in the MPS-pregnancy group (HR, 1.8).
The time to first CVE also was significantly delayed in women who had uncomplicated pregnancies. By age 30, almost none had occurred in these women, but 5% of those with MPS-complicated pregnancies and 10% of the nulliparous women had experienced an event by that age. The separation continued as women aged. By age 40, an event had occurred in about 4% of the MPS-free women, 8% of the MPS group, and 10% of the nulliparous group. The rates at age 45 were 5%, 8%, and 15%, respectively.
“Our nonparous cohort did develop cardiovascular events earlier, but the MPS cohort also had accelerated development compared to the women who had uncomplicated pregnancies,” Dr. Soh said. “In fact, an adverse pregnancy outcome should serve as a red flag for physicians to start screening early for cardiovascular disease and actively managing risk factors.”
She had no financial disclosures.
On Twitter @Alz_Gal
FROM THE EULAR 2015 CONGRESS
Key clinical point: An uncomplicated pregnancy doesn’t appear to accelerate the risk of cardiovascular events in women with systemic lupus erythematosus.
Major finding: Nulliparous women or women who had a pregnancy complicated by lupus had twice the risk for a cardiovascular event, compared with women who had an uncomplicated pregnancy.
Data source: The retrospective cohort study involved 3,232 women.
Disclosures: Dr. Soh had no financial disclosures.
NSAID dosing frequency matters little in ankylosing spondylitis
ROME – Radiographic progression occurs at similar rates in the spines of ankylosing spondylitis patients treated over 2 years with either continuous or on-demand diclofenac, according to results from a randomized, prospective multicenter trial presented at the European Congress of Rheumatology.
In the ENRADAS (Effects of NSAIDs on Radiographic Damage in Ankylosing Spondylitis) trial, Dr. Joachim Sieper of Charite-Universitätsmedizin Berlin and his colleagues compared continuous treatment with at least 50% of the maximum 150-mg daily dose of the NSAID diclofenac and on-demand treatment with diclofenac. During the entire 2 years of the study, no patient received treatment with a tumor necrosis factor blocker or any other drug other than diclofenac.
The investigators measured radiographic spine progression using the modified Stoke Ankylosing Spondylitis Spinal Score(mSASSS). At baseline, patients randomized to continuous treatment who had complete radiographic follow-up had a mean mSASSS of 10.9, while those randomized to the on-demand arm had a mean mSASSS of 16.4. After 2 years on treatment, the average change in mSASSS from baseline was 1.28 for the 62 patients in the continuous-treatment group and 0.79 for the 60 patients in the on-demand group, a difference that was not statistically significant, Dr. Sieper said.
There also was no statistically significant between-group difference when the analysis focused on the subgroup of patients who were C-reactive protein positive at baseline, 55% and 58% of patients in the groups, respectively, who had their average mSASSS increase by 1.68, compared with 0.96. Similarly, when the analysis focused only on patients who had syndesmophytes at baseline, 53% and 62% of patients, respectively, the average increases in mSASSS were 2.11 and 0.95, a difference that was not statistically significant. Presence of C-reactive protein and syndesmophytes are both known risk factors for radiographic progression.
Patient characteristics were similar in the two groups. NSAID intake over the 2-year study period, measured using a 0-100 composite score based on treatment duration and NSAID doses and intervals, was a mean of 76 vs. 44 for the continuous and on-demand groups, respectively. At the study’s end, 77% of patients remained on diclofenac and had not switched to another NSAID.
Side effects were similar in both groups, with 19 serious adverse events in the continuous-treatment patients and 21 serious adverse events in the on-demand patients.
Previous studies have suggested that NSAIDs given continuously over 2 years reduce radiographic progression, compared with on-demand therapy, in ankylosing spondylitis patients. Similar effects were seen in a prospective cohort.
“In our study, continuous vs. on-demand treatment … did not prevent radiographic progression in [ankylosing spondylitis]. It is highly unlikely that the results would have been different with a higher number of patients, because we found a trend for less progression in the on-demand group,” Dr. Sieper said.
Additional study is needed to determine whether an NSAID other than diclofenac, specifically a COX-2 selective drug, would have a different effect on radiographic progression, he said.
Dr. Sieper reported receiving honorarium for consultancies, speaker’s bureaus, or grants from AbbVie, Janssen, Merck, Lily, Novartis, Pfizer, and UCB.
ROME – Radiographic progression occurs at similar rates in the spines of ankylosing spondylitis patients treated over 2 years with either continuous or on-demand diclofenac, according to results from a randomized, prospective multicenter trial presented at the European Congress of Rheumatology.
In the ENRADAS (Effects of NSAIDs on Radiographic Damage in Ankylosing Spondylitis) trial, Dr. Joachim Sieper of Charite-Universitätsmedizin Berlin and his colleagues compared continuous treatment with at least 50% of the maximum 150-mg daily dose of the NSAID diclofenac and on-demand treatment with diclofenac. During the entire 2 years of the study, no patient received treatment with a tumor necrosis factor blocker or any other drug other than diclofenac.
The investigators measured radiographic spine progression using the modified Stoke Ankylosing Spondylitis Spinal Score(mSASSS). At baseline, patients randomized to continuous treatment who had complete radiographic follow-up had a mean mSASSS of 10.9, while those randomized to the on-demand arm had a mean mSASSS of 16.4. After 2 years on treatment, the average change in mSASSS from baseline was 1.28 for the 62 patients in the continuous-treatment group and 0.79 for the 60 patients in the on-demand group, a difference that was not statistically significant, Dr. Sieper said.
There also was no statistically significant between-group difference when the analysis focused on the subgroup of patients who were C-reactive protein positive at baseline, 55% and 58% of patients in the groups, respectively, who had their average mSASSS increase by 1.68, compared with 0.96. Similarly, when the analysis focused only on patients who had syndesmophytes at baseline, 53% and 62% of patients, respectively, the average increases in mSASSS were 2.11 and 0.95, a difference that was not statistically significant. Presence of C-reactive protein and syndesmophytes are both known risk factors for radiographic progression.
Patient characteristics were similar in the two groups. NSAID intake over the 2-year study period, measured using a 0-100 composite score based on treatment duration and NSAID doses and intervals, was a mean of 76 vs. 44 for the continuous and on-demand groups, respectively. At the study’s end, 77% of patients remained on diclofenac and had not switched to another NSAID.
Side effects were similar in both groups, with 19 serious adverse events in the continuous-treatment patients and 21 serious adverse events in the on-demand patients.
Previous studies have suggested that NSAIDs given continuously over 2 years reduce radiographic progression, compared with on-demand therapy, in ankylosing spondylitis patients. Similar effects were seen in a prospective cohort.
“In our study, continuous vs. on-demand treatment … did not prevent radiographic progression in [ankylosing spondylitis]. It is highly unlikely that the results would have been different with a higher number of patients, because we found a trend for less progression in the on-demand group,” Dr. Sieper said.
Additional study is needed to determine whether an NSAID other than diclofenac, specifically a COX-2 selective drug, would have a different effect on radiographic progression, he said.
Dr. Sieper reported receiving honorarium for consultancies, speaker’s bureaus, or grants from AbbVie, Janssen, Merck, Lily, Novartis, Pfizer, and UCB.
ROME – Radiographic progression occurs at similar rates in the spines of ankylosing spondylitis patients treated over 2 years with either continuous or on-demand diclofenac, according to results from a randomized, prospective multicenter trial presented at the European Congress of Rheumatology.
In the ENRADAS (Effects of NSAIDs on Radiographic Damage in Ankylosing Spondylitis) trial, Dr. Joachim Sieper of Charite-Universitätsmedizin Berlin and his colleagues compared continuous treatment with at least 50% of the maximum 150-mg daily dose of the NSAID diclofenac and on-demand treatment with diclofenac. During the entire 2 years of the study, no patient received treatment with a tumor necrosis factor blocker or any other drug other than diclofenac.
The investigators measured radiographic spine progression using the modified Stoke Ankylosing Spondylitis Spinal Score(mSASSS). At baseline, patients randomized to continuous treatment who had complete radiographic follow-up had a mean mSASSS of 10.9, while those randomized to the on-demand arm had a mean mSASSS of 16.4. After 2 years on treatment, the average change in mSASSS from baseline was 1.28 for the 62 patients in the continuous-treatment group and 0.79 for the 60 patients in the on-demand group, a difference that was not statistically significant, Dr. Sieper said.
There also was no statistically significant between-group difference when the analysis focused on the subgroup of patients who were C-reactive protein positive at baseline, 55% and 58% of patients in the groups, respectively, who had their average mSASSS increase by 1.68, compared with 0.96. Similarly, when the analysis focused only on patients who had syndesmophytes at baseline, 53% and 62% of patients, respectively, the average increases in mSASSS were 2.11 and 0.95, a difference that was not statistically significant. Presence of C-reactive protein and syndesmophytes are both known risk factors for radiographic progression.
Patient characteristics were similar in the two groups. NSAID intake over the 2-year study period, measured using a 0-100 composite score based on treatment duration and NSAID doses and intervals, was a mean of 76 vs. 44 for the continuous and on-demand groups, respectively. At the study’s end, 77% of patients remained on diclofenac and had not switched to another NSAID.
Side effects were similar in both groups, with 19 serious adverse events in the continuous-treatment patients and 21 serious adverse events in the on-demand patients.
Previous studies have suggested that NSAIDs given continuously over 2 years reduce radiographic progression, compared with on-demand therapy, in ankylosing spondylitis patients. Similar effects were seen in a prospective cohort.
“In our study, continuous vs. on-demand treatment … did not prevent radiographic progression in [ankylosing spondylitis]. It is highly unlikely that the results would have been different with a higher number of patients, because we found a trend for less progression in the on-demand group,” Dr. Sieper said.
Additional study is needed to determine whether an NSAID other than diclofenac, specifically a COX-2 selective drug, would have a different effect on radiographic progression, he said.
Dr. Sieper reported receiving honorarium for consultancies, speaker’s bureaus, or grants from AbbVie, Janssen, Merck, Lily, Novartis, Pfizer, and UCB.
AT THE EULAR 2015 CONGRESS
Key clinical point: There are no differences with respect to radiographic progression in the spines of ankylosing spondylitis patients treated over 2 years with either continuous or on-demand diclofenac.
Major finding: The average 2-year change in mSASSS from baseline was 1.28 for the 62 patients in the continuous-treatment group and 0.79 for the 60 patients in the on-demand group, a difference that was not statistically significant.
Data source: A randomized, prospective multicenter trial of 122 patients with ankylosing spondylitis.
Disclosures: Dr. Sieper reported receiving honorarium for consultancies, speaker’s bureaus, or grants from AbbVie, Janssen, Merck, Lily, Novartis, Pfizer, and UCB.
Ultrasound-detected tenosynovitis signals early RA
ROME – A quick ultrasound scan of the hand may be all that is needed to help determine if a patient with early inflammatory arthritis will go on to develop rheumatoid arthritis (RA).
Adjusted odds ratios (OR) for making a diagnosis of RA were 7.1 for having cyclic citrullinated peptide or rheumatoid factor antibodies (P < .0001), 7.9 for having 10 or more joints involved (P < .0001), and 6.6 for having tenosynovitis in the hand or wrist (P < .0001). The association held in patients with seronegative disease, with an OR of 7.6 for having 10 or more involved joints (P < .0001) and 4.8 for hand/wrist tenosynovitis (P = .003).
Rheumatologists are challenged to diagnose rheumatoid arthritis early, particularly in patients who may have had symptoms for only a few weeks, said Dr. Andrew Filer, senior lecturer at the University of Birmingham (England).
“One of the problems is that, in the first 3 months of the disease, it really is undifferentiated in a lot of patients, even using the 2010 [American College of Rheumatology/European League Against Rheumatism response] criteria for rheumatoid arthritis,” he said. While about a third of patients with inflammatory arthritis will go on to develop RA, the net has been cast so wide that there are patients whose inflammatory arthritis will resolve without treatment, he added.
Dr. Filer and his associates have been working for the past 15 years to find ways to help clinicians identify RA as early as possible. Some of their most recent research has focused on using musculoskeletal ultrasound to examine the small joints (Ann. Rheum. Dis. 2011;70:500-7) and has already shown that it is more accurate than traditional clinical assessment at predicting patient outcomes in very early arthritis.
Results from the Birmingham Early Arthritis Cohort (BEACON) presented at the European Congress of Rheumatology show that ultrasound-detected tenosynovitis can independently identify patients who will go on to develop RA.
The study involved 107 patients with at least one swollen joint and whose symptoms had started in the last 3 months. Of these, 43 developed very early RA, 20 had non-RA persistent disease, and the remaining 44 had resolving disease at 18-month follow-up.
Although a wide variety of tendons throughout the body was examined, including those in the shoulders, ankles, hands, and wrists, it was the extensor carpi ulnaris (ECU) tendon in the wrists and flexor tendons in the fingers that were found to be the most important to examine. The ECU tendon is responsible for straightening and rotating the wrist, as well as integral for gripping and pulling.
“Looking at the tendons was a new area for us, and it’s taken a while for organizations like OMERACT [Outcome Measures in Rheumatology] to come up with some usable criteria and grading,” Dr. Filer observed. Now that these exist and show that ultrasound is a reproducible tool for evaluating tenosynovitis in RA (Ann. Rheum. Dis. 2013;72:1328-34), it was possible to conduct the current prospective study.
Dr. Filer discussed the findings in a press briefing ahead of their scientific presentation by clinical research fellow Dr. Ilfita Sahbudin and noted that tenosynovitis was more difficult to assess clinically than joint inflammation as it was more “hidden.”“Even if it’s really established rheumatoid disease it’s quite difficult for even experienced rheumatologists to detect swelling of tendons; [we] really have to use imaging like ultrasound or MRI to detect this reliably,” he said at the briefing. “Scanning of wrist ECU and finger flexor tendons adds robust diagnostic data for RA in that first window of very early disease.”
Dr. Filer suggested that early arthritis clinics should start to integrate these scans into their protocols to validate the findings.
He reported having no financial disclosures.
ROME – A quick ultrasound scan of the hand may be all that is needed to help determine if a patient with early inflammatory arthritis will go on to develop rheumatoid arthritis (RA).
Adjusted odds ratios (OR) for making a diagnosis of RA were 7.1 for having cyclic citrullinated peptide or rheumatoid factor antibodies (P < .0001), 7.9 for having 10 or more joints involved (P < .0001), and 6.6 for having tenosynovitis in the hand or wrist (P < .0001). The association held in patients with seronegative disease, with an OR of 7.6 for having 10 or more involved joints (P < .0001) and 4.8 for hand/wrist tenosynovitis (P = .003).
Rheumatologists are challenged to diagnose rheumatoid arthritis early, particularly in patients who may have had symptoms for only a few weeks, said Dr. Andrew Filer, senior lecturer at the University of Birmingham (England).
“One of the problems is that, in the first 3 months of the disease, it really is undifferentiated in a lot of patients, even using the 2010 [American College of Rheumatology/European League Against Rheumatism response] criteria for rheumatoid arthritis,” he said. While about a third of patients with inflammatory arthritis will go on to develop RA, the net has been cast so wide that there are patients whose inflammatory arthritis will resolve without treatment, he added.
Dr. Filer and his associates have been working for the past 15 years to find ways to help clinicians identify RA as early as possible. Some of their most recent research has focused on using musculoskeletal ultrasound to examine the small joints (Ann. Rheum. Dis. 2011;70:500-7) and has already shown that it is more accurate than traditional clinical assessment at predicting patient outcomes in very early arthritis.
Results from the Birmingham Early Arthritis Cohort (BEACON) presented at the European Congress of Rheumatology show that ultrasound-detected tenosynovitis can independently identify patients who will go on to develop RA.
The study involved 107 patients with at least one swollen joint and whose symptoms had started in the last 3 months. Of these, 43 developed very early RA, 20 had non-RA persistent disease, and the remaining 44 had resolving disease at 18-month follow-up.
Although a wide variety of tendons throughout the body was examined, including those in the shoulders, ankles, hands, and wrists, it was the extensor carpi ulnaris (ECU) tendon in the wrists and flexor tendons in the fingers that were found to be the most important to examine. The ECU tendon is responsible for straightening and rotating the wrist, as well as integral for gripping and pulling.
“Looking at the tendons was a new area for us, and it’s taken a while for organizations like OMERACT [Outcome Measures in Rheumatology] to come up with some usable criteria and grading,” Dr. Filer observed. Now that these exist and show that ultrasound is a reproducible tool for evaluating tenosynovitis in RA (Ann. Rheum. Dis. 2013;72:1328-34), it was possible to conduct the current prospective study.
Dr. Filer discussed the findings in a press briefing ahead of their scientific presentation by clinical research fellow Dr. Ilfita Sahbudin and noted that tenosynovitis was more difficult to assess clinically than joint inflammation as it was more “hidden.”“Even if it’s really established rheumatoid disease it’s quite difficult for even experienced rheumatologists to detect swelling of tendons; [we] really have to use imaging like ultrasound or MRI to detect this reliably,” he said at the briefing. “Scanning of wrist ECU and finger flexor tendons adds robust diagnostic data for RA in that first window of very early disease.”
Dr. Filer suggested that early arthritis clinics should start to integrate these scans into their protocols to validate the findings.
He reported having no financial disclosures.
ROME – A quick ultrasound scan of the hand may be all that is needed to help determine if a patient with early inflammatory arthritis will go on to develop rheumatoid arthritis (RA).
Adjusted odds ratios (OR) for making a diagnosis of RA were 7.1 for having cyclic citrullinated peptide or rheumatoid factor antibodies (P < .0001), 7.9 for having 10 or more joints involved (P < .0001), and 6.6 for having tenosynovitis in the hand or wrist (P < .0001). The association held in patients with seronegative disease, with an OR of 7.6 for having 10 or more involved joints (P < .0001) and 4.8 for hand/wrist tenosynovitis (P = .003).
Rheumatologists are challenged to diagnose rheumatoid arthritis early, particularly in patients who may have had symptoms for only a few weeks, said Dr. Andrew Filer, senior lecturer at the University of Birmingham (England).
“One of the problems is that, in the first 3 months of the disease, it really is undifferentiated in a lot of patients, even using the 2010 [American College of Rheumatology/European League Against Rheumatism response] criteria for rheumatoid arthritis,” he said. While about a third of patients with inflammatory arthritis will go on to develop RA, the net has been cast so wide that there are patients whose inflammatory arthritis will resolve without treatment, he added.
Dr. Filer and his associates have been working for the past 15 years to find ways to help clinicians identify RA as early as possible. Some of their most recent research has focused on using musculoskeletal ultrasound to examine the small joints (Ann. Rheum. Dis. 2011;70:500-7) and has already shown that it is more accurate than traditional clinical assessment at predicting patient outcomes in very early arthritis.
Results from the Birmingham Early Arthritis Cohort (BEACON) presented at the European Congress of Rheumatology show that ultrasound-detected tenosynovitis can independently identify patients who will go on to develop RA.
The study involved 107 patients with at least one swollen joint and whose symptoms had started in the last 3 months. Of these, 43 developed very early RA, 20 had non-RA persistent disease, and the remaining 44 had resolving disease at 18-month follow-up.
Although a wide variety of tendons throughout the body was examined, including those in the shoulders, ankles, hands, and wrists, it was the extensor carpi ulnaris (ECU) tendon in the wrists and flexor tendons in the fingers that were found to be the most important to examine. The ECU tendon is responsible for straightening and rotating the wrist, as well as integral for gripping and pulling.
“Looking at the tendons was a new area for us, and it’s taken a while for organizations like OMERACT [Outcome Measures in Rheumatology] to come up with some usable criteria and grading,” Dr. Filer observed. Now that these exist and show that ultrasound is a reproducible tool for evaluating tenosynovitis in RA (Ann. Rheum. Dis. 2013;72:1328-34), it was possible to conduct the current prospective study.
Dr. Filer discussed the findings in a press briefing ahead of their scientific presentation by clinical research fellow Dr. Ilfita Sahbudin and noted that tenosynovitis was more difficult to assess clinically than joint inflammation as it was more “hidden.”“Even if it’s really established rheumatoid disease it’s quite difficult for even experienced rheumatologists to detect swelling of tendons; [we] really have to use imaging like ultrasound or MRI to detect this reliably,” he said at the briefing. “Scanning of wrist ECU and finger flexor tendons adds robust diagnostic data for RA in that first window of very early disease.”
Dr. Filer suggested that early arthritis clinics should start to integrate these scans into their protocols to validate the findings.
He reported having no financial disclosures.
AT THE EULAR 2015 CONGRESS
Key clinical point: Ultrasound scanning of the hand and wrist can detect tenosynovitis, which is a strong predictor of early rheumatoid arthritis.
Major finding: The adjusted odds ratio for making a diagnosis of RA was 6.6 for having tenosynovitis in the hand or wrist (P < .0001), which compared favorably to having seropositive disease (OR, 7.1) and more than 10 hand joints involved (OR, 7.9).
Data source: 107 patients from the Birmingham Early Arthritis Cohort who had one or more swollen joints and symptom onset within the preceding 3 months.
Disclosures: Dr. Filer reported having no financial disclosures.
VIDEO: EULAR updates cardiovascular-disease risk recommendations
ROME – The European League Against Rheumatism introduced an update to its 2009 recommendations on assessing and managing cardiovascular-disease risk in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
The update features an expanded evidence base for the recommendations, especially for psoriatic arthritis and ankylosing spondylitis, Dr. Michael T. Nurmohamed said in an interview at the European Congress of Rheumatology. One new element in the revision included a scaling down of the previously suggested annual assessment to a more flexible approach to the timing of serial assessments based on the risk level of individual patients. Another addition is the possible use of carotid ultrasound to measure atherosclerotic burden as a complement to more routinely-measured risk factors such as blood pressure and serum lipids, said Dr. Nurmohamed, convener of the current task force as well as the panel that formulated the first version (Ann. Rheum. Dis. 2010;69:325-31).
A second EULAR task force recently developed new recommendations on assessing and managing other comorbidities in patients with rheumatologic diseases, such as osteoporosis, cancer, peptic ulcers, and renal dysfunction. Chronic kidney disease is an important modifier of cardiovascular-disease risk, and hence the new comorbidity recommendations complement the new cardiovascular-disease statement, said Dr. Nurmohamed, professor and head of the rheumatology research department at VU University Medical Center in Amsterdam.
Dr. Nurmohamed had no disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @mitchelzoler
ROME – The European League Against Rheumatism introduced an update to its 2009 recommendations on assessing and managing cardiovascular-disease risk in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
The update features an expanded evidence base for the recommendations, especially for psoriatic arthritis and ankylosing spondylitis, Dr. Michael T. Nurmohamed said in an interview at the European Congress of Rheumatology. One new element in the revision included a scaling down of the previously suggested annual assessment to a more flexible approach to the timing of serial assessments based on the risk level of individual patients. Another addition is the possible use of carotid ultrasound to measure atherosclerotic burden as a complement to more routinely-measured risk factors such as blood pressure and serum lipids, said Dr. Nurmohamed, convener of the current task force as well as the panel that formulated the first version (Ann. Rheum. Dis. 2010;69:325-31).
A second EULAR task force recently developed new recommendations on assessing and managing other comorbidities in patients with rheumatologic diseases, such as osteoporosis, cancer, peptic ulcers, and renal dysfunction. Chronic kidney disease is an important modifier of cardiovascular-disease risk, and hence the new comorbidity recommendations complement the new cardiovascular-disease statement, said Dr. Nurmohamed, professor and head of the rheumatology research department at VU University Medical Center in Amsterdam.
Dr. Nurmohamed had no disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @mitchelzoler
ROME – The European League Against Rheumatism introduced an update to its 2009 recommendations on assessing and managing cardiovascular-disease risk in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
The update features an expanded evidence base for the recommendations, especially for psoriatic arthritis and ankylosing spondylitis, Dr. Michael T. Nurmohamed said in an interview at the European Congress of Rheumatology. One new element in the revision included a scaling down of the previously suggested annual assessment to a more flexible approach to the timing of serial assessments based on the risk level of individual patients. Another addition is the possible use of carotid ultrasound to measure atherosclerotic burden as a complement to more routinely-measured risk factors such as blood pressure and serum lipids, said Dr. Nurmohamed, convener of the current task force as well as the panel that formulated the first version (Ann. Rheum. Dis. 2010;69:325-31).
A second EULAR task force recently developed new recommendations on assessing and managing other comorbidities in patients with rheumatologic diseases, such as osteoporosis, cancer, peptic ulcers, and renal dysfunction. Chronic kidney disease is an important modifier of cardiovascular-disease risk, and hence the new comorbidity recommendations complement the new cardiovascular-disease statement, said Dr. Nurmohamed, professor and head of the rheumatology research department at VU University Medical Center in Amsterdam.
Dr. Nurmohamed had no disclosures.
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AT THE EULAR 2015 CONGRESS
Anti-TNFs help psoriatic arthritis patients get back to work
ROME – Anti–tumor necrosis factor agents have a slight edge over conventional disease-modifying antirheumatic drugs when it comes to helping psoriatic arthritis patients who are having work issues, according to a large British observational study presented at the European Congress of Rheumatology.
Among 236 of 400 subjects working at baseline, presenteeism improved from 30% to 10% and productivity loss improved from 45% to 10% among patients who started taking anti-TNF (anti-tumor necrosis factor) agents. Gains were more modest when patients were started on DMARDs, with presenteeism improving from 30% to 20% and productivity loss from 40% to 25%. The difference in change of presenteeism between the two treatment groups became statistically significant at 2 weeks and remained so at 24 weeks.
“Work disability is a continuum,” said the presenting author, Dr. William Tillett of the Royal National Hospital for Rheumatic Diseases in Bath (England). It starts with the normal situation then graduates from presenteeism, where the individual is sick but still attends the workplace, to absenteeism, where the individual is sick and no longer attends the place of work, and eventual unemployment, he explained. “This study suggests that work disability is reversible in the real-world setting,” he added.
The study is from the Long-term Outcomes in Psoriatic ArthritiS (LOPAS II) working group, a 2-year, multicenter, prospective, observational cohort study of work disability in psoriatic arthritis. The group has previously reported that unemployment in psoriatic arthritis is associated with older age, disease duration of 2-5 years, and worse physical function, but that employer awareness and helpfulness enabled patients to stay on the job. Higher levels of global and joint-specific disease activity and worse physical function were associated with greater levels of reporting to work sick (presenteeism) and productivity loss (Rheumatology 2015;54:157-62).
The latest study by Dr. Tillett and his team is a follow-up to see how treatment affects work performance. At baseline, before treatment with anti-TNF or DMARDs, the LOPAS II team of investigators found that 164 (41%) of their 400 subjects were unemployed. Unemployed patients tended to be older (median of 59 years vs. 49 years) and to have worse physical function (a median score of 1.4 on the Health Assessment Questionnaire vs. 1.0). Subsequent treatment with anti-TNFs or DMARDs didn’t change overall employment levels.
Patients who started on anti-TNFs tended to have longer disease duration (median of 11 vs. 5 years) and a greater median number of tender (16 vs. 11) and swollen (7 vs. 5) joints, but otherwise there were no significant differences in demographic or clinical measures between the two treatment groups.
Median scores on the Disease Activity Index for Psoriatic Arthritis (DAPSA) improved over 24 weeks from 53 to 14 among anti-TNF patients, which is considered a good response, but only improved from 39 to 30 in the DMARD group, which is considered a poor response. All of the findings were statistically significant.
The results revealed a “surprisingly poor clinical response to synthetic DMARDs on clinical outcomes … as opposed to good response amongst patients commenced on TNF inhibitors,” Dr. Tillett said in an interview. The improvement in work disability and disease activity seen also was greater and more rapid among those who started on anti-TNF rather than synthetic DMARD.
Dr. Tillett reported receiving grant/research support from AbbVie and speaker or advisory board fees from UCB, Pfizer, and AbbVie. The other authors said they have no disclosures.
ROME – Anti–tumor necrosis factor agents have a slight edge over conventional disease-modifying antirheumatic drugs when it comes to helping psoriatic arthritis patients who are having work issues, according to a large British observational study presented at the European Congress of Rheumatology.
Among 236 of 400 subjects working at baseline, presenteeism improved from 30% to 10% and productivity loss improved from 45% to 10% among patients who started taking anti-TNF (anti-tumor necrosis factor) agents. Gains were more modest when patients were started on DMARDs, with presenteeism improving from 30% to 20% and productivity loss from 40% to 25%. The difference in change of presenteeism between the two treatment groups became statistically significant at 2 weeks and remained so at 24 weeks.
“Work disability is a continuum,” said the presenting author, Dr. William Tillett of the Royal National Hospital for Rheumatic Diseases in Bath (England). It starts with the normal situation then graduates from presenteeism, where the individual is sick but still attends the workplace, to absenteeism, where the individual is sick and no longer attends the place of work, and eventual unemployment, he explained. “This study suggests that work disability is reversible in the real-world setting,” he added.
The study is from the Long-term Outcomes in Psoriatic ArthritiS (LOPAS II) working group, a 2-year, multicenter, prospective, observational cohort study of work disability in psoriatic arthritis. The group has previously reported that unemployment in psoriatic arthritis is associated with older age, disease duration of 2-5 years, and worse physical function, but that employer awareness and helpfulness enabled patients to stay on the job. Higher levels of global and joint-specific disease activity and worse physical function were associated with greater levels of reporting to work sick (presenteeism) and productivity loss (Rheumatology 2015;54:157-62).
The latest study by Dr. Tillett and his team is a follow-up to see how treatment affects work performance. At baseline, before treatment with anti-TNF or DMARDs, the LOPAS II team of investigators found that 164 (41%) of their 400 subjects were unemployed. Unemployed patients tended to be older (median of 59 years vs. 49 years) and to have worse physical function (a median score of 1.4 on the Health Assessment Questionnaire vs. 1.0). Subsequent treatment with anti-TNFs or DMARDs didn’t change overall employment levels.
Patients who started on anti-TNFs tended to have longer disease duration (median of 11 vs. 5 years) and a greater median number of tender (16 vs. 11) and swollen (7 vs. 5) joints, but otherwise there were no significant differences in demographic or clinical measures between the two treatment groups.
Median scores on the Disease Activity Index for Psoriatic Arthritis (DAPSA) improved over 24 weeks from 53 to 14 among anti-TNF patients, which is considered a good response, but only improved from 39 to 30 in the DMARD group, which is considered a poor response. All of the findings were statistically significant.
The results revealed a “surprisingly poor clinical response to synthetic DMARDs on clinical outcomes … as opposed to good response amongst patients commenced on TNF inhibitors,” Dr. Tillett said in an interview. The improvement in work disability and disease activity seen also was greater and more rapid among those who started on anti-TNF rather than synthetic DMARD.
Dr. Tillett reported receiving grant/research support from AbbVie and speaker or advisory board fees from UCB, Pfizer, and AbbVie. The other authors said they have no disclosures.
ROME – Anti–tumor necrosis factor agents have a slight edge over conventional disease-modifying antirheumatic drugs when it comes to helping psoriatic arthritis patients who are having work issues, according to a large British observational study presented at the European Congress of Rheumatology.
Among 236 of 400 subjects working at baseline, presenteeism improved from 30% to 10% and productivity loss improved from 45% to 10% among patients who started taking anti-TNF (anti-tumor necrosis factor) agents. Gains were more modest when patients were started on DMARDs, with presenteeism improving from 30% to 20% and productivity loss from 40% to 25%. The difference in change of presenteeism between the two treatment groups became statistically significant at 2 weeks and remained so at 24 weeks.
“Work disability is a continuum,” said the presenting author, Dr. William Tillett of the Royal National Hospital for Rheumatic Diseases in Bath (England). It starts with the normal situation then graduates from presenteeism, where the individual is sick but still attends the workplace, to absenteeism, where the individual is sick and no longer attends the place of work, and eventual unemployment, he explained. “This study suggests that work disability is reversible in the real-world setting,” he added.
The study is from the Long-term Outcomes in Psoriatic ArthritiS (LOPAS II) working group, a 2-year, multicenter, prospective, observational cohort study of work disability in psoriatic arthritis. The group has previously reported that unemployment in psoriatic arthritis is associated with older age, disease duration of 2-5 years, and worse physical function, but that employer awareness and helpfulness enabled patients to stay on the job. Higher levels of global and joint-specific disease activity and worse physical function were associated with greater levels of reporting to work sick (presenteeism) and productivity loss (Rheumatology 2015;54:157-62).
The latest study by Dr. Tillett and his team is a follow-up to see how treatment affects work performance. At baseline, before treatment with anti-TNF or DMARDs, the LOPAS II team of investigators found that 164 (41%) of their 400 subjects were unemployed. Unemployed patients tended to be older (median of 59 years vs. 49 years) and to have worse physical function (a median score of 1.4 on the Health Assessment Questionnaire vs. 1.0). Subsequent treatment with anti-TNFs or DMARDs didn’t change overall employment levels.
Patients who started on anti-TNFs tended to have longer disease duration (median of 11 vs. 5 years) and a greater median number of tender (16 vs. 11) and swollen (7 vs. 5) joints, but otherwise there were no significant differences in demographic or clinical measures between the two treatment groups.
Median scores on the Disease Activity Index for Psoriatic Arthritis (DAPSA) improved over 24 weeks from 53 to 14 among anti-TNF patients, which is considered a good response, but only improved from 39 to 30 in the DMARD group, which is considered a poor response. All of the findings were statistically significant.
The results revealed a “surprisingly poor clinical response to synthetic DMARDs on clinical outcomes … as opposed to good response amongst patients commenced on TNF inhibitors,” Dr. Tillett said in an interview. The improvement in work disability and disease activity seen also was greater and more rapid among those who started on anti-TNF rather than synthetic DMARD.
Dr. Tillett reported receiving grant/research support from AbbVie and speaker or advisory board fees from UCB, Pfizer, and AbbVie. The other authors said they have no disclosures.
AT THE EULAR 2015 CONGRESS
Key clinical point: Work disability is a reversible outcome in psoriatic arthritis and improves significantly more with use of anti-TNF drugs than with synthetic DMARDs.
Major finding: Presenteeism improved from 30% to 10% and productivity loss improved from 45% to 10% among patients who started taking anti-TNF agents.
Data source: A 2-year, multicenter, prospective, observational cohort study of work disability in 400 patients with psoriatic arthritis.
Disclosures: Dr. Tillett reported receiving research support from AbbVie and speaker or advisory board fees from UCB, Pfizer, and Abbvie.
VIDEO: Do pathogenic intestinal bacteria drive scleroderma GI symptoms?
ROME – Patients with systemic sclerosis who have a range of gastointestinal symptoms and severity have higher amounts of pathogenic bacteria than do normal healthy control patients, according to Dr. Elizabeth Volkmann and her colleagues.
They examined the bacterial populations found in the cecal and sigmoid portion of the colon in 17 patients with systemic sclerosis (SSc) and found a large increase in bacteria known to perpetuate inflammation in other autoimmune diseases, particularly inflammatory bowel disease, as well as a decrease in healthy commensal bacteria that are thought to decrease inflammation. The levels of both commensal and pathogenic bacteria also correlated with the severity of symptoms that patients described, said Dr. Volkmann, a rheumatologist and clinical instructor at the University of California, Los Angeles.
Bifidobacterium and Lactobacillus, two species normally found at lower levels in chronic inflammatory conditions, were increased in SSc. “This was a rather unique feature of systemic sclerosis,” she said in an interview at the European Congress of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ROME – Patients with systemic sclerosis who have a range of gastointestinal symptoms and severity have higher amounts of pathogenic bacteria than do normal healthy control patients, according to Dr. Elizabeth Volkmann and her colleagues.
They examined the bacterial populations found in the cecal and sigmoid portion of the colon in 17 patients with systemic sclerosis (SSc) and found a large increase in bacteria known to perpetuate inflammation in other autoimmune diseases, particularly inflammatory bowel disease, as well as a decrease in healthy commensal bacteria that are thought to decrease inflammation. The levels of both commensal and pathogenic bacteria also correlated with the severity of symptoms that patients described, said Dr. Volkmann, a rheumatologist and clinical instructor at the University of California, Los Angeles.
Bifidobacterium and Lactobacillus, two species normally found at lower levels in chronic inflammatory conditions, were increased in SSc. “This was a rather unique feature of systemic sclerosis,” she said in an interview at the European Congress of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ROME – Patients with systemic sclerosis who have a range of gastointestinal symptoms and severity have higher amounts of pathogenic bacteria than do normal healthy control patients, according to Dr. Elizabeth Volkmann and her colleagues.
They examined the bacterial populations found in the cecal and sigmoid portion of the colon in 17 patients with systemic sclerosis (SSc) and found a large increase in bacteria known to perpetuate inflammation in other autoimmune diseases, particularly inflammatory bowel disease, as well as a decrease in healthy commensal bacteria that are thought to decrease inflammation. The levels of both commensal and pathogenic bacteria also correlated with the severity of symptoms that patients described, said Dr. Volkmann, a rheumatologist and clinical instructor at the University of California, Los Angeles.
Bifidobacterium and Lactobacillus, two species normally found at lower levels in chronic inflammatory conditions, were increased in SSc. “This was a rather unique feature of systemic sclerosis,” she said in an interview at the European Congress of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE EULAR 2015 CONGRESS
VIDEO: Ultrasound of tendons detects early rheumatoid arthritis
ROME – Tenosynovitis on ultrasound might be the next criterion added to the diagnostic criteria for rheumatoid arthritis if it is confirmed as a valid marker for early disease detection, according to Dr. Andrew Filer.
He and his colleagues performed ultrasound assessments of 16 tendon regions in 107 patients in the Birmingham Early Arthritis Cohort Study (BEACON) who had clinically apparent synovitis involving at least one joint with a symptom duration of 3 months or less. They examined patient outcomes at 18 months.
Tenosynovitis in either the extensor carpi ulnaris tendons or the hand flexor tendons independently predicted early RA, and both were still significant independent predictors of early RA in seronegative patients, Dr. Filer of the University of Birmingham (England) said in this video interview at the European Congress of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ROME – Tenosynovitis on ultrasound might be the next criterion added to the diagnostic criteria for rheumatoid arthritis if it is confirmed as a valid marker for early disease detection, according to Dr. Andrew Filer.
He and his colleagues performed ultrasound assessments of 16 tendon regions in 107 patients in the Birmingham Early Arthritis Cohort Study (BEACON) who had clinically apparent synovitis involving at least one joint with a symptom duration of 3 months or less. They examined patient outcomes at 18 months.
Tenosynovitis in either the extensor carpi ulnaris tendons or the hand flexor tendons independently predicted early RA, and both were still significant independent predictors of early RA in seronegative patients, Dr. Filer of the University of Birmingham (England) said in this video interview at the European Congress of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
ROME – Tenosynovitis on ultrasound might be the next criterion added to the diagnostic criteria for rheumatoid arthritis if it is confirmed as a valid marker for early disease detection, according to Dr. Andrew Filer.
He and his colleagues performed ultrasound assessments of 16 tendon regions in 107 patients in the Birmingham Early Arthritis Cohort Study (BEACON) who had clinically apparent synovitis involving at least one joint with a symptom duration of 3 months or less. They examined patient outcomes at 18 months.
Tenosynovitis in either the extensor carpi ulnaris tendons or the hand flexor tendons independently predicted early RA, and both were still significant independent predictors of early RA in seronegative patients, Dr. Filer of the University of Birmingham (England) said in this video interview at the European Congress of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE EULAR 2015 CONGRESS
