Key Osteoarthritis, Rheumatoid Arthritis, and Lupus Findings From ACR Meeting

Persons as young as 45 to 64 years will account for more than half of new diagnoses of knee osteoarthritis (OA) over the next decade as the rate of disease in younger persons increases. A vaccine designed to reeducate the immune system has been shown to be safe and feasible in the treatment of patients with rheumatoid arthritis (RA). Vitamin D supplementation has been found to play a beneficial role in patients with systemic lupus erythematosus (SLE).

These are some of the key rheumatologic research findings presented at the American College of Rheumatology (ACR) Annual Scientific Meeting held this week in Chicago. The ACR conference offers a comprehensive, evidence-based educational program designed to help clinicians improve their care of patients with rheumatologic conditions.

Close to 6.5 million Americans aged 35 to 84 years are expected to receive a diagnosis of knee OA in the next 10 years, according to the Brigham and Women’s Hospital researchers who conducted the study. The increase in younger persons with knee OA will increase the need for total knee replacements and place an additional burden on the US health care system, they noted.

Other OA research findings reported at the meeting include the following:

•  The risk of bone fracture is 20% higher in postmenopausal women who have OA than in those who do not, and postmenopausal women with OA experience almost 30% more falls.
•  Since rofecoxib was removed from the market in 2004, resulting in the increased use of narcotic analgesics, there has been an increase in falls and fractures among older persons. Falls occur 4 times more frequently in patients who take narcotic pain killers than in those who take other types of pain relief for OA, regardless of health status or age. Researchers concluded that prescribing narcotic pain relievers before or instead of other types of pain relievers-as recommended in several practice guidelines-has the unintended consequence of increasing the risk of falls and fractures in older persons. (Hear a podcast featuring the presenter of this study.)
•  Weight loss combined with exercise reduces pain and improves mobility in persons who have knee OA.
•  The risk of knee OA may increase with participation in sports such as soccer; elite long-distance running, weight lifting, and wrestling. (But there's also some good news in a podcast by the lead researcher.)

In the study of the immune system vaccine for patients with RA, those who had lower levels of disease activity before receiving the vaccine continued to have low disease activity and those who started with higher levels of disease activity showed improvements after the vaccine. The researchers noted that with the use of this concept, similar strategies may be developed and tested for RA prevention and treatment.

Other RA research findings reported at the meeting include the following:

•  Women with RA-who are at increased risk for fractures-also are at increased risk for experiencing a fracture before age 50 years.
•  Patients with RA who have low levels of inflammatory disease activity are at lower risk for heart complications and stroke.
•  Patients who receive anti–tumor necrosis factor α (anti–TNF-α) therapy for RA are at higher risk for malignant melanoma. However, such therapy does not increase the overall risk of solid cancer in persons with RA.
•  Physicians appear to be stopping anti–TNF-α for patients with RAbefore they undergo surgery but may be doing so far sooner than is necessary, according to researchers at the Hospital for Special Surgery (HSS) in New York.
•  Patients with RA who undergo total knee replacement surgery have lower expectations about their postsurgical outcomes than patients with OA.
•  Treatment with a biologic agent reduces fatigue in persons with RA.
•  Early and appropriate treatment provided by a rheumatologist may decrease costly interventions, such as orthopedic surgery, in persons with RA.

The vitamin D supplementation for SLE researchers showed that there is a connection between SLE and the disturbance of regulatory T cells, T-helper lymphocytes, and B cells. They noted that large, randomized, controlled trials are needed to confirm their encouraging findings about the benefits of vitamin D for patients with SLE.

Other SLE findings reported at the meeting include the following:

•  To help physicians better counsel women who have SLE and are considering pregnancy, HSS researchers in the PROMISSE (Predictors of pRegnancy Outcome: bioMarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) study set out to determine the frequency, predictors, and potential causes of pregnancy complications. They concluded that their findings support advising patients with SLE who wish to become pregnant that the best time is when the SLE is stable and they are not experiencing a disease flare.
•  The incidence of SLE in African American women is significantly higher than previously thought, according to the Georgia Lupus Registry study, providing additional evidence to indicate that SLE is a significant and complex disease for which the diagnosis is challenging.
•  Targeted therapy directed against type 1 interferon (IFN), including IFN-α, might reduce the signs and symptoms of lupus.
•  Most neuropsychiatric events seen in patients with lupus-eg, anxiety, depression, and headache-are not attributable to lupus.
•  Life challenges, such as unreliable transportation and insufficient childcare, often prevent patients with low socioeconomic status who have lupus from keeping appointments with their physician.
•  The new ACR management guidelines for lupus nephritis, with recommendations for screening, treatment, and patient management, were described in a clinical symposium. The guidelines will be released in 2012.

Findings on other conditions reported at the meeting include the following:
•  The use of CT scans appears to help in the diagnosis of gout by detecting the urate crystals that often are a symptom of the disease.
•  The presence of syndesmophytes and acute phase reactants and the patient’s smoking status all may serve as predictors of the progression of structural damage in the spine in patients who have spondyloarthritis.
•  In patients with the Wegener granulomatosis form of vasculitis who are in remission, stress may be associated with a greater likelihood of the disease flaring. The study was the first to suggest that mental health is a risk factor in patients with vasculitis.
•  Outcomes are better for children with juvenile idiopathic arthritis who are treated early and aggressively.

For more information, visit the ACR Web site at http://www.rheumatology.org. Or, contact the organization at American College of Rheumatology, 2200 Lake Boulevard NE, Atlanta, GA 30319; telephone: (404) 633-3777; fax: (404) 633-1870.

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