The rheumatology month in review highlights top data from the 2023 Congress of Clinical Rheumatology West, cognitive behavioral therapy (CBT) for reducing pain catastrophizing in patients with fibromyalgia, and the link between gout and a decreased likelihood of developing Alzheimer Disease.

Highlights From CCR West 2023

HCPLive traveled to San Diego to cover the 2023 Congress of Clinical Rheumatology West, which ran from September 7 – 10. Coverage included how to discern when to consider switching or intensifying treatment rheumatoid arthritis (RA), results of guselkumab treatment on patients with active psoriatic arthritis (PsA), and the efficacy of cannabis treatment in patients with rheumatic disease.

Jeffrey Sparks, MD, MMSc: Treatment Strategies for Rheumatoid Arthritis

In an interview with HCPLive Rheumatology, Sparks elaborated on his presentation, “Biologic & tsDMARDs Choices for Rheumatoid Arthritis: Does it Matter?” and how to tailor RA treatment for an individual patient’s needs.

Ultimately, Sparks explained, there are numerous effective options for treating RA. The choice often depends on factors like patient preference, the prescriber's familiarity with a particular drug, and clinical characteristics, such as infection risk, contraindications, and preferences regarding the mode of administration. Regarding tailoring treatment to the individual, he emphasized the concept of shared decision-making.

Guselkumab Produces Long-Lasting Pharmacodynamic Effects, Disease Improvement in PsA

In a cohort of biologic-naïve patients with active PsA, sustainable pharmacodynamic effects, improvements in disease activity, and significant reductions in serum cytokines and collagen degradation proteins were observed in patients receiving long-term guselkumab treatment, which were maintained through week 100.

“These results provide molecular evidence that sustained reductions in serum acute phase proteins and collagen degradation proteins seen with guselkumab treatment may contribute to continuous and durable improvements in joint symptoms, consistent with clinical observations in guselkumab-treatment patients through week 100 in DISCOVER-2,” concluded investigators.

Stephen Ziegler, PhD, JD: The Risks and Benefits of Cannabis Treatment in Rheumatic Disease

According to Ziegler, practitioners are often risk-averse and prioritize managing the risks and benefits of treatments. With limited clear information and policy inconsistencies, implementing these treatments is challenging. He argued removing psilocybin and cannabis from Schedule I of the Controlled Substances Act (CSA) is essential to enable more research and establish clear guidelines for their use.

When it comes to these treatments, there are inherent risks and potential benefits, as with any medical intervention. One significant risk is that Schedule I substances violate federal law, which can have legal consequences. Additionally, due to the lack of research caused by their Schedule I status, providers face challenges in making informed recommendations. Issues including proper dosing and treatment protocols become ambiguous, and inconsistent state policies further complicate matters.

Top Stories of the Month

Among the top coverage of September included a study evaluating the effects of CBT in patients with fibromyalgia. Although fibromyalgia is often a difficult condition to treat, previous research has shown non-pharmacologic interventions, such as CBT, can reduce emotional distress, pain, and disability among this patient population.

Additionally, results of a pooled analysis indicated those with gout or hyperuricemia had a reduced risk of developing Alzheimer disease relative to their counterparts without gout or hyperuricemia, with 93% heterogeneity.

CBT Reduces Pain Catastrophizing Post-Treatment in Fibromyalgia

In this randomized, controlled trial, investigators initially enrolled 114 adult women with fibromyalgia, of which 98 were given a baseline neuroimaging evaluation and participated in 8 weeks of either individual CBT or a fibromyalgia education control condition (EDU).

Those receiving CBT experienced significant improvements in pain interference, as measured by Brief Pain Inventory scores. Additionally, patients in the CBT cohort reported larger decreases in pain catastrophizing post-treatment when compared with the EDU cohort.

Gout, Hyperuricemia Linked to Decreased Likelihood of Alzheimer Disease

A systematic review and meta-analysis of prospective and retrospective cohort studies on the topic, results of the study suggest a diagnosis of gout or hyperuricemia was associated with a 31% reduction in risk of Alzheimer disease, with investigators noting a high level of heterogeneity driven by regional distribution of the studies. Further analysis suggested these results were consistent across subgroups defined by sample size, study design, location, and after adjustment for confounding factors.

“The findings suggested that gout or hyperuricemia might have a protective effect against [Alzheimer disease]. This negative correlation should be verified by more cohort studies due to the existence of substantial heterogeneity,” noted investigators.