Rheumatology Month in Review: January 2025

This rheumatology month in review highlights new research across rheumatological diseases, including psoriatic arthritis (PsA), gout, and fibromyalgia.

New Psoriatic Arthritis Research

Non-Urgent ED Utilization High For People With PsA, AS in Rural Areas

People with PsA and ankylosing spondylitis (AS), particularly in rural settings, frequently utilized emergency departments (Eds) for less and non-urgent health concerns, highlighting the need for more accessible health services in these areas.
“ED use for less and non-urgent health concerns was frequent for persons with PsA and AS, particularly in rural settings. These data can inform tailored health service delivery including access solutions for persons residing in rural areas,” lead investigator Victor Mocanu, MD, Post-Graduate Medical Education, Cumming School of Medicine, University of Calgary, and colleagues concluded.

Psoriatic Arthritis Care Priorities Differ Between Patient and Clinicians

Philip Mease, MD, Clinical Professor, University of Washington School of Medicine and Director, Rheumatology Research, Swedish Medical Center, and colleagues conducted 4 focus groups of patients with PsA across 3 US rheumatology practices using mixed methods to identify attributes of PsA important to patients.

Altogether, 51 items were generated describing PsA. The last Delphi rating exercise was completed by 38 patients and 13 clinicians. The investigators found that patients distributed points across a wider range of items than physicians. When comparing prioritization between groups using group mean score per item, they found that items with the top 10 mean scores for both groups included arthritis, disease activity, pain, fatigue, physical function, and spine symptoms. Disparity was seen across other prioritized domains including access to care, daily activities, stiffness, future health uncertainty, and sleep quality for patients compared with specific disease skin and joint manifestations, comorbidities, structural damage, and disease management goals for clinicians.

Gout Management Updates

Adherence Low for ULT Dosing ACR Gout Guidelines

While rheumatologists self-report high adherence to the 2020 American College of Rheumatology (ACR) Guideline for Gout Management, there are gaps in knowledge and adherence, particularly around dosing of treatment regimens.

While guidelines were highly adhered to, ULT initiation and especially dosing were not highly adhered to. These findings are notable as proper ULT administration has been shown to improve outcomes in people with gout in multiple ways. For instance, other recent research presented during November’s ACR Convergence found that using the novel ULT to Acute Treatment Ratio (ULTrA) index was linked to reduction in gout-related hospital admissions.

Gout Flare State Definitions Help Describe Disease Burden
Most people with gout were able to achieve patient acceptable symptom state (PASS) or low disease activity (LDA) in the second 6 months after initiating allopurinol, and these disease state definitions aligned with gout flare burden on patients.

Stamp and colleagues found no association between gout flare states and the EQ-5D-3L or Health Assessment Questionnaire. There was a statistically significant association between consequences, identity, and concern scores, 3 of 8 items on Brief Illness Perception Questionnaire, with a gradient of increasing scores across the 3 states of PASS, LDA, and non-LDA/PASS at both months 1-6 and 7-12. These findings were further supported by combining PASS/LDA status and comparing to non-LDA/PASS.

NLR and MLR May Predict Gout Flare and CVD Mortality Risk
Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) may predict gout flare risk and increased risk of cardiovascular (CVD) mortality.

The investigators found that levels of the neutrophil activation marker calprotectin correlated with NLR (r = 0.56, P = .0004) and MLR correlated with total number of gout attacks (r = 0.39, P = .02). NLR and MLR, but not absolute monocyte or neutrophil counts, were significantly correlated with body mass index and significantly increased in gout patients with high CVD risk (P <.05). Logistic regression analysis revealed that patients in the upper quartile of NLR or MLR had increased odds of developing high CVD risk (odds ratio 7.5 [95% CI, 1.7–33.0]).

New Fibromyalgia Research

People With Fibromyalgia May Have Impaired Mitochondrial Function
New research found that people with fibromyalgia syndrome (FMS) had impaired bioenergetic health index (BHI), a proxy of mitochondrial function, which also had a slight correlation with pain.

Macchi and colleagues studied mitochondrial dysfunction in peripheral blood mononuclear cells isolated from 50 patients with primary FMS and 20 apparently healthy controls. They did not find any differences in mitochondrial basal respiration between patients with primary FMS and healthy controls, but they did find that people with FMA had a lower median BHI (−22.1%, P =.03) than healthy controls.

Gabapentin Does Not Increase Risk of Falls in Older Adults with Fibromyalgia
Incident use of gabapentin was not associated with increased fall-related visits in older adults with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia.

The investigators found that the weighted cumulative incidence of a fall-related visit per 1000 person-years was 103.60 at 30 days, 90.44 at 90 days, and 84.44 at 180 days for gabapentin users. For duloxetine users, incidence was 203.43 at 30 days, 177.73 at 90- days, and 158.21 at 180 days. Accordingly, incident gabapentin users had a lower risk of falls at 6-month follow-up (hazard ratio, 0.52 [95% CI, 0.43-0.64]) but no difference in the hazards of experiencing severe falls. These findings were supported by sensitivity and subgroup analyses.