Sara Freeman

LONDON – The reasons why fewer black than white patients undergo knee replacement as a treatment option for end-stage osteoarthritis remain elusive.

According to the findings of a 725-patient study, women and blacks with knee osteoarthritis (OA) were less willing than men or their white counterparts to consider having total knee replacement (TKR) surgery.

Black patients were also found to be less aware of the benefits of joint replacement and had worse expectations of the outcome than did white patients.

Despite a number of sociocultural differences, however, it is not clear why the uptake of TKR differs among ethnic groups.

"We know that joint replacement is an effective – actually the only effective – intervention for end-stage osteoarthritis," said study author Dr. C. Kent Kwoh, who is professor of medicine, epidemiology and clinical and translational science at the University of Pittsburgh and chief of the rheumatology section at VA Pittsburgh Healthcare System.

"The problem is that there have been many studies that have shown there are disparities in joint replacement; [blacks] get hip and knee replacement much less often than do whites," Dr. Kwoh added in an interview during a poster session at the annual European Congress of Rheumatology. "The question is, Why?"

Previous research has shown that even when faced with very severe and painful OA and a physician recommendation for TKR, black patients are less willing than whites to consider this an option.

The present study was in a much larger community-based sample than has been the case in past investigations, said Dr. Kwoh, and it aimed to identify more specific factors and patient attitudes that might influence the decision to undergo TKR.

Using a cross-sectional survey design, the investigators recruited patients aged 50 years or older who had chronic, frequent knee pain and radiographic evidence of OA.

The study population consisted of 234 black and 491 white patients, with mean respective ages of 58 years and 68 years (P less than .0004).

In addition to being younger, black patients tended to have worse knee pain, with higher total WOMAC (Western Ontario and McMaster Universities) osteoarthritis index scores (54 vs. 43), and OA Pain Assessment scores for constant (7 vs. 11) and intermittent (14 vs. 11) pain than white patients (P less than .0004 for all comparisons).

"There were differences in a number of [other] variables [between whites and blacks], such as income, employment status, education, access to insurance, expectations of outcome, trust in the health system, and religiosity, that may impact the choice for joint replacement" Dr. Kwoh observed.

However, putting all of these variables into a multivariate model didn’t seem to fully explain the disparity in TKR acceptance between the two groups.

The adjusted odds ratio for willingness to undergo TKR was 0.38 comparing black vs. white patients (95% confidence interval, 0.19-0.74; P = .005) and 2.52 for male vs. female sex (95% CI, 1.37-4.66; P = .003).

"We’re left a little bit puzzled at this point," Dr. Kwoh admitted. "Our other studies have shown differences in expectations; that is, if you have worse expectations, you were less likely to consider joint replacement."

In that previous work, however, an adjustment of the findings according to patient expectations seemed to take care of the difference in willingness. "In this study, we weren’t able to show that," Dr. Kwoh said. "So maybe there are other, unmeasured confounders that we have to address."

As to where these findings leave the practicing physician who advises patients, Dr. Kwoh noted that patient education is important and that patients really need to have a good understanding of the risks and benefits.

"Joint replacement is effective, we know that it works very well, it has low morbidity and low mortality, and so patients who really need it should avail themselves to it," Dr. Kwoh advised.

Dr. Kwoh stated that he had no conflicts of interest. The study was funded by the University of Pittsburgh Multidisciplinary Clinical Research Center for Rheumatic and Musculoskeletal Diseases.

LONDON – The reasons why fewer black than white patients undergo knee replacement as a treatment option for end-stage osteoarthritis remain elusive.

According to the findings of a 725-patient study, women and blacks with knee osteoarthritis (OA) were less willing than men or their white counterparts to consider having total knee replacement (TKR) surgery.

Black patients were also found to be less aware of the benefits of joint replacement and had worse expectations of the outcome than did white patients.

Despite a number of sociocultural differences, however, it is not clear why the uptake of TKR differs among ethnic groups.

"We know that joint replacement is an effective – actually the only effective – intervention for end-stage osteoarthritis," said study author Dr. C. Kent Kwoh, who is professor of medicine, epidemiology and clinical and translational science at the University of Pittsburgh and chief of the rheumatology section at VA Pittsburgh Healthcare System.

"The problem is that there have been many studies that have shown there are disparities in joint replacement; [blacks] get hip and knee replacement much less often than do whites," Dr. Kwoh added in an interview during a poster session at the annual European Congress of Rheumatology. "The question is, Why?"

Previous research has shown that even when faced with very severe and painful OA and a physician recommendation for TKR, black patients are less willing than whites to consider this an option.

The present study was in a much larger community-based sample than has been the case in past investigations, said Dr. Kwoh, and it aimed to identify more specific factors and patient attitudes that might influence the decision to undergo TKR.

Using a cross-sectional survey design, the investigators recruited patients aged 50 years or older who had chronic, frequent knee pain and radiographic evidence of OA.

The study population consisted of 234 black and 491 white patients, with mean respective ages of 58 years and 68 years (P less than .0004).

In addition to being younger, black patients tended to have worse knee pain, with higher total WOMAC (Western Ontario and McMaster Universities) osteoarthritis index scores (54 vs. 43), and OA Pain Assessment scores for constant (7 vs. 11) and intermittent (14 vs. 11) pain than white patients (P less than .0004 for all comparisons).

"There were differences in a number of [other] variables [between whites and blacks], such as income, employment status, education, access to insurance, expectations of outcome, trust in the health system, and religiosity, that may impact the choice for joint replacement" Dr. Kwoh observed.

However, putting all of these variables into a multivariate model didn’t seem to fully explain the disparity in TKR acceptance between the two groups.

The adjusted odds ratio for willingness to undergo TKR was 0.38 comparing black vs. white patients (95% confidence interval, 0.19-0.74; P = .005) and 2.52 for male vs. female sex (95% CI, 1.37-4.66; P = .003).

"We’re left a little bit puzzled at this point," Dr. Kwoh admitted. "Our other studies have shown differences in expectations; that is, if you have worse expectations, you were less likely to consider joint replacement."

In that previous work, however, an adjustment of the findings according to patient expectations seemed to take care of the difference in willingness. "In this study, we weren’t able to show that," Dr. Kwoh said. "So maybe there are other, unmeasured confounders that we have to address."

As to where these findings leave the practicing physician who advises patients, Dr. Kwoh noted that patient education is important and that patients really need to have a good understanding of the risks and benefits.

"Joint replacement is effective, we know that it works very well, it has low morbidity and low mortality, and so patients who really need it should avail themselves to it," Dr. Kwoh advised.

Dr. Kwoh stated that he had no conflicts of interest. The study was funded by the University of Pittsburgh Multidisciplinary Clinical Research Center for Rheumatic and Musculoskeletal Diseases.

LONDON – The reasons why fewer black than white patients undergo knee replacement as a treatment option for end-stage osteoarthritis remain elusive.

According to the findings of a 725-patient study, women and blacks with knee osteoarthritis (OA) were less willing than men or their white counterparts to consider having total knee replacement (TKR) surgery.

Black patients were also found to be less aware of the benefits of joint replacement and had worse expectations of the outcome than did white patients.

Despite a number of sociocultural differences, however, it is not clear why the uptake of TKR differs among ethnic groups.

"We know that joint replacement is an effective – actually the only effective – intervention for end-stage osteoarthritis," said study author Dr. C. Kent Kwoh, who is professor of medicine, epidemiology and clinical and translational science at the University of Pittsburgh and chief of the rheumatology section at VA Pittsburgh Healthcare System.

"The problem is that there have been many studies that have shown there are disparities in joint replacement; [blacks] get hip and knee replacement much less often than do whites," Dr. Kwoh added in an interview during a poster session at the annual European Congress of Rheumatology. "The question is, Why?"

Previous research has shown that even when faced with very severe and painful OA and a physician recommendation for TKR, black patients are less willing than whites to consider this an option.

The present study was in a much larger community-based sample than has been the case in past investigations, said Dr. Kwoh, and it aimed to identify more specific factors and patient attitudes that might influence the decision to undergo TKR.

Using a cross-sectional survey design, the investigators recruited patients aged 50 years or older who had chronic, frequent knee pain and radiographic evidence of OA.

The study population consisted of 234 black and 491 white patients, with mean respective ages of 58 years and 68 years (P less than .0004).

In addition to being younger, black patients tended to have worse knee pain, with higher total WOMAC (Western Ontario and McMaster Universities) osteoarthritis index scores (54 vs. 43), and OA Pain Assessment scores for constant (7 vs. 11) and intermittent (14 vs. 11) pain than white patients (P less than .0004 for all comparisons).

"There were differences in a number of [other] variables [between whites and blacks], such as income, employment status, education, access to insurance, expectations of outcome, trust in the health system, and religiosity, that may impact the choice for joint replacement" Dr. Kwoh observed.

However, putting all of these variables into a multivariate model didn’t seem to fully explain the disparity in TKR acceptance between the two groups.

The adjusted odds ratio for willingness to undergo TKR was 0.38 comparing black vs. white patients (95% confidence interval, 0.19-0.74; P = .005) and 2.52 for male vs. female sex (95% CI, 1.37-4.66; P = .003).

"We’re left a little bit puzzled at this point," Dr. Kwoh admitted. "Our other studies have shown differences in expectations; that is, if you have worse expectations, you were less likely to consider joint replacement."

In that previous work, however, an adjustment of the findings according to patient expectations seemed to take care of the difference in willingness. "In this study, we weren’t able to show that," Dr. Kwoh said. "So maybe there are other, unmeasured confounders that we have to address."

As to where these findings leave the practicing physician who advises patients, Dr. Kwoh noted that patient education is important and that patients really need to have a good understanding of the risks and benefits.

"Joint replacement is effective, we know that it works very well, it has low morbidity and low mortality, and so patients who really need it should avail themselves to it," Dr. Kwoh advised.

Dr. Kwoh stated that he had no conflicts of interest. The study was funded by the University of Pittsburgh Multidisciplinary Clinical Research Center for Rheumatic and Musculoskeletal Diseases.

LONDON – The reasons why fewer black than white patients undergo knee replacement as a treatment option for end-stage osteoarthritis remain elusive.

According to the findings of a 725-patient study, women and blacks with knee osteoarthritis (OA) were less willing than men or their white counterparts to consider having total knee replacement (TKR) surgery.

Black patients were also found to be less aware of the benefits of joint replacement and had worse expectations of the outcome than did white patients.

Despite a number of sociocultural differences, however, it is not clear why the uptake of TKR differs among ethnic groups.

"We know that joint replacement is an effective – actually the only effective – intervention for end-stage osteoarthritis," said study author Dr. C. Kent Kwoh, who is professor of medicine, epidemiology and clinical and translational science at the University of Pittsburgh and chief of the rheumatology section at VA Pittsburgh Healthcare System.

"The problem is that there have been many studies that have shown there are disparities in joint replacement; [blacks] get hip and knee replacement much less often than do whites," Dr. Kwoh added in an interview during a poster session at the annual European Congress of Rheumatology. "The question is, Why?"

Previous research has shown that even when faced with very severe and painful OA and a physician recommendation for TKR, black patients are less willing than whites to consider this an option.

The present study was in a much larger community-based sample than has been the case in past investigations, said Dr. Kwoh, and it aimed to identify more specific factors and patient attitudes that might influence the decision to undergo TKR.

Using a cross-sectional survey design, the investigators recruited patients aged 50 years or older who had chronic, frequent knee pain and radiographic evidence of OA.

The study population consisted of 234 black and 491 white patients, with mean respective ages of 58 years and 68 years (P less than .0004).

In addition to being younger, black patients tended to have worse knee pain, with higher total WOMAC (Western Ontario and McMaster Universities) osteoarthritis index scores (54 vs. 43), and OA Pain Assessment scores for constant (7 vs. 11) and intermittent (14 vs. 11) pain than white patients (P less than .0004 for all comparisons).

"There were differences in a number of [other] variables [between whites and blacks], such as income, employment status, education, access to insurance, expectations of outcome, trust in the health system, and religiosity, that may impact the choice for joint replacement" Dr. Kwoh observed.

However, putting all of these variables into a multivariate model didn’t seem to fully explain the disparity in TKR acceptance between the two groups.

The adjusted odds ratio for willingness to undergo TKR was 0.38 comparing black vs. white patients (95% confidence interval, 0.19-0.74; P = .005) and 2.52 for male vs. female sex (95% CI, 1.37-4.66; P = .003).

"We’re left a little bit puzzled at this point," Dr. Kwoh admitted. "Our other studies have shown differences in expectations; that is, if you have worse expectations, you were less likely to consider joint replacement."

In that previous work, however, an adjustment of the findings according to patient expectations seemed to take care of the difference in willingness. "In this study, we weren’t able to show that," Dr. Kwoh said. "So maybe there are other, unmeasured confounders that we have to address."

As to where these findings leave the practicing physician who advises patients, Dr. Kwoh noted that patient education is important and that patients really need to have a good understanding of the risks and benefits.

"Joint replacement is effective, we know that it works very well, it has low morbidity and low mortality, and so patients who really need it should avail themselves to it," Dr. Kwoh advised.

Dr. Kwoh stated that he had no conflicts of interest. The study was funded by the University of Pittsburgh Multidisciplinary Clinical Research Center for Rheumatic and Musculoskeletal Diseases.

LONDON – The reasons why fewer black than white patients undergo knee replacement as a treatment option for end-stage osteoarthritis remain elusive.

According to the findings of a 725-patient study, women and blacks with knee osteoarthritis (OA) were less willing than men or their white counterparts to consider having total knee replacement (TKR) surgery.

Black patients were also found to be less aware of the benefits of joint replacement and had worse expectations of the outcome than did white patients.

Despite a number of sociocultural differences, however, it is not clear why the uptake of TKR differs among ethnic groups.

"We know that joint replacement is an effective – actually the only effective – intervention for end-stage osteoarthritis," said study author Dr. C. Kent Kwoh, who is professor of medicine, epidemiology and clinical and translational science at the University of Pittsburgh and chief of the rheumatology section at VA Pittsburgh Healthcare System.

"The problem is that there have been many studies that have shown there are disparities in joint replacement; [blacks] get hip and knee replacement much less often than do whites," Dr. Kwoh added in an interview during a poster session at the annual European Congress of Rheumatology. "The question is, Why?"

Previous research has shown that even when faced with very severe and painful OA and a physician recommendation for TKR, black patients are less willing than whites to consider this an option.

The present study was in a much larger community-based sample than has been the case in past investigations, said Dr. Kwoh, and it aimed to identify more specific factors and patient attitudes that might influence the decision to undergo TKR.

Using a cross-sectional survey design, the investigators recruited patients aged 50 years or older who had chronic, frequent knee pain and radiographic evidence of OA.

The study population consisted of 234 black and 491 white patients, with mean respective ages of 58 years and 68 years (P less than .0004).

In addition to being younger, black patients tended to have worse knee pain, with higher total WOMAC (Western Ontario and McMaster Universities) osteoarthritis index scores (54 vs. 43), and OA Pain Assessment scores for constant (7 vs. 11) and intermittent (14 vs. 11) pain than white patients (P less than .0004 for all comparisons).

"There were differences in a number of [other] variables [between whites and blacks], such as income, employment status, education, access to insurance, expectations of outcome, trust in the health system, and religiosity, that may impact the choice for joint replacement" Dr. Kwoh observed.

However, putting all of these variables into a multivariate model didn’t seem to fully explain the disparity in TKR acceptance between the two groups.

The adjusted odds ratio for willingness to undergo TKR was 0.38 comparing black vs. white patients (95% confidence interval, 0.19-0.74; P = .005) and 2.52 for male vs. female sex (95% CI, 1.37-4.66; P = .003).

"We’re left a little bit puzzled at this point," Dr. Kwoh admitted. "Our other studies have shown differences in expectations; that is, if you have worse expectations, you were less likely to consider joint replacement."

In that previous work, however, an adjustment of the findings according to patient expectations seemed to take care of the difference in willingness. "In this study, we weren’t able to show that," Dr. Kwoh said. "So maybe there are other, unmeasured confounders that we have to address."

As to where these findings leave the practicing physician who advises patients, Dr. Kwoh noted that patient education is important and that patients really need to have a good understanding of the risks and benefits.

"Joint replacement is effective, we know that it works very well, it has low morbidity and low mortality, and so patients who really need it should avail themselves to it," Dr. Kwoh advised.

Dr. Kwoh stated that he had no conflicts of interest. The study was funded by the University of Pittsburgh Multidisciplinary Clinical Research Center for Rheumatic and Musculoskeletal Diseases.

LONDON – The reasons why fewer black than white patients undergo knee replacement as a treatment option for end-stage osteoarthritis remain elusive.

According to the findings of a 725-patient study, women and blacks with knee osteoarthritis (OA) were less willing than men or their white counterparts to consider having total knee replacement (TKR) surgery.

Black patients were also found to be less aware of the benefits of joint replacement and had worse expectations of the outcome than did white patients.

Despite a number of sociocultural differences, however, it is not clear why the uptake of TKR differs among ethnic groups.

"We know that joint replacement is an effective – actually the only effective – intervention for end-stage osteoarthritis," said study author Dr. C. Kent Kwoh, who is professor of medicine, epidemiology and clinical and translational science at the University of Pittsburgh and chief of the rheumatology section at VA Pittsburgh Healthcare System.

"The problem is that there have been many studies that have shown there are disparities in joint replacement; [blacks] get hip and knee replacement much less often than do whites," Dr. Kwoh added in an interview during a poster session at the annual European Congress of Rheumatology. "The question is, Why?"

Previous research has shown that even when faced with very severe and painful OA and a physician recommendation for TKR, black patients are less willing than whites to consider this an option.

The present study was in a much larger community-based sample than has been the case in past investigations, said Dr. Kwoh, and it aimed to identify more specific factors and patient attitudes that might influence the decision to undergo TKR.

Using a cross-sectional survey design, the investigators recruited patients aged 50 years or older who had chronic, frequent knee pain and radiographic evidence of OA.

The study population consisted of 234 black and 491 white patients, with mean respective ages of 58 years and 68 years (P less than .0004).

In addition to being younger, black patients tended to have worse knee pain, with higher total WOMAC (Western Ontario and McMaster Universities) osteoarthritis index scores (54 vs. 43), and OA Pain Assessment scores for constant (7 vs. 11) and intermittent (14 vs. 11) pain than white patients (P less than .0004 for all comparisons).

"There were differences in a number of [other] variables [between whites and blacks], such as income, employment status, education, access to insurance, expectations of outcome, trust in the health system, and religiosity, that may impact the choice for joint replacement" Dr. Kwoh observed.

However, putting all of these variables into a multivariate model didn’t seem to fully explain the disparity in TKR acceptance between the two groups.

The adjusted odds ratio for willingness to undergo TKR was 0.38 comparing black vs. white patients (95% confidence interval, 0.19-0.74; P = .005) and 2.52 for male vs. female sex (95% CI, 1.37-4.66; P = .003).

"We’re left a little bit puzzled at this point," Dr. Kwoh admitted. "Our other studies have shown differences in expectations; that is, if you have worse expectations, you were less likely to consider joint replacement."

In that previous work, however, an adjustment of the findings according to patient expectations seemed to take care of the difference in willingness. "In this study, we weren’t able to show that," Dr. Kwoh said. "So maybe there are other, unmeasured confounders that we have to address."

As to where these findings leave the practicing physician who advises patients, Dr. Kwoh noted that patient education is important and that patients really need to have a good understanding of the risks and benefits.

"Joint replacement is effective, we know that it works very well, it has low morbidity and low mortality, and so patients who really need it should avail themselves to it," Dr. Kwoh advised.

Dr. Kwoh stated that he had no conflicts of interest. The study was funded by the University of Pittsburgh Multidisciplinary Clinical Research Center for Rheumatic and Musculoskeletal Diseases.

LONDON – Biologic treatment may open a "therapeutic window" for the improved nonmedical management of rheumatoid arthritis, according to a leading Swedish physiotherapist at the annual European Congress of Rheumatology.

The advent of biologics just over a decade ago has undoubtedly tightened disease control and improved outcomes, compared with more conventional therapies for many patients with RA.

But biologics have also made it much more possible for patients to undertake prescribed exercise regimens that are recommended for older adults with chronic diseases such as arthritis, said Christina Opava of the Karolinska Institutetand Karolinska University Hospital in Stockholm.

"Biologics do not necessarily take away the need for exercise, but they may open up a therapeutic window for people to regain and maintain their physical activity while on treatment," she noted.

In an interview, Ms. Opava added that "everything is not about disease control. We also need to pay attention to a healthy lifestyle."

Over the past few decades, the treatment of RA has changed dramatically, with improved medications and nonmedical options. In addition, many more patients today are empowered to self-manage their condition, and have greater expectations of and worries about how treatments and their disease will affect their overall quality and duration of life.

In a recent review article, four nonpharmacologic options topped the list of strategies that have a sound evidence base: self-management interventions, exercise or a suitable physical activity program, comprehensive occupational therapy with patients who are able to work but are at risk of losing their jobs, and use of wrist and finger splints (Curr. Opin. Rheumatol. 2011;23:259-64).

More research is needed on the use of assistive devices, foot orthoses, and dietary interventions in order to determine the true effectiveness of the strategies, the review authors suggested.

Having worked as a rheumatology health care professional for more than 30 years, Ms. Opava emphasized that nonmedical options should not be forgotten. Strategies to help patients self-manage their condition, for example, may include tailored patient education, behavioral and cognitive approaches, and individualized weekly action plans (Ann. Rheum. Dis. 2010;69:955-63).

Ms. Opava’s research has focused on the benefits of regular exercise in arthritis, and determining what the minimum amount of exercise could be and how this could be most effectively prescribed (Arthritis Rheum. 2003;49:428-34). Planned and structured exercise has been shown to be effective in RA, and "by now, there are enough studies to support its safety as well as its benefit," she said.

The challenge, of course, is that not all patients may be able to partake in the same level or type of exercise, which – according to the American College of Sports Medicine guidelines – can be the same for adults aged 50-64 years with a chronic condition such as arthritis and those aged 65 years or older.

"Everyone has to choose their own mode of exercise," Ms. Opava explained, noting that health care professionals need to assess the patient’s physical capacity before prescribing any form of exercise or physical activity program. Exercise and physical activity also need to be enjoyable for patients, so that there is greater likelihood that patients will stick with their exercise regimen.

Patient education and empowerment are vital to achieving and maintaining a healthy lifestyle that includes appropriate exercise and physical activity. All health care professionals who treat patients with arthritis should reinforce the benefits of healthy living as a central component of managing the condition, Ms. Opava suggested.

"Most of us know what a healthy lifestyle is, but it’s more difficult to lead a healthy lifestyle consistently," she added, noting that it basically involved avoiding physical inactivity, eating a healthful diet, moderating alcohol intake, and not smoking.

Ms. Opava had no conflicts of interest to declare.

LONDON – Biologic treatment may open a "therapeutic window" for the improved nonmedical management of rheumatoid arthritis, according to a leading Swedish physiotherapist at the annual European Congress of Rheumatology.

The advent of biologics just over a decade ago has undoubtedly tightened disease control and improved outcomes, compared with more conventional therapies for many patients with RA.

But biologics have also made it much more possible for patients to undertake prescribed exercise regimens that are recommended for older adults with chronic diseases such as arthritis, said Christina Opava of the Karolinska Institutetand Karolinska University Hospital in Stockholm.

"Biologics do not necessarily take away the need for exercise, but they may open up a therapeutic window for people to regain and maintain their physical activity while on treatment," she noted.

In an interview, Ms. Opava added that "everything is not about disease control. We also need to pay attention to a healthy lifestyle."

Over the past few decades, the treatment of RA has changed dramatically, with improved medications and nonmedical options. In addition, many more patients today are empowered to self-manage their condition, and have greater expectations of and worries about how treatments and their disease will affect their overall quality and duration of life.

In a recent review article, four nonpharmacologic options topped the list of strategies that have a sound evidence base: self-management interventions, exercise or a suitable physical activity program, comprehensive occupational therapy with patients who are able to work but are at risk of losing their jobs, and use of wrist and finger splints (Curr. Opin. Rheumatol. 2011;23:259-64).

More research is needed on the use of assistive devices, foot orthoses, and dietary interventions in order to determine the true effectiveness of the strategies, the review authors suggested.

Having worked as a rheumatology health care professional for more than 30 years, Ms. Opava emphasized that nonmedical options should not be forgotten. Strategies to help patients self-manage their condition, for example, may include tailored patient education, behavioral and cognitive approaches, and individualized weekly action plans (Ann. Rheum. Dis. 2010;69:955-63).

Ms. Opava’s research has focused on the benefits of regular exercise in arthritis, and determining what the minimum amount of exercise could be and how this could be most effectively prescribed (Arthritis Rheum. 2003;49:428-34). Planned and structured exercise has been shown to be effective in RA, and "by now, there are enough studies to support its safety as well as its benefit," she said.

The challenge, of course, is that not all patients may be able to partake in the same level or type of exercise, which – according to the American College of Sports Medicine guidelines – can be the same for adults aged 50-64 years with a chronic condition such as arthritis and those aged 65 years or older.

"Everyone has to choose their own mode of exercise," Ms. Opava explained, noting that health care professionals need to assess the patient’s physical capacity before prescribing any form of exercise or physical activity program. Exercise and physical activity also need to be enjoyable for patients, so that there is greater likelihood that patients will stick with their exercise regimen.

Patient education and empowerment are vital to achieving and maintaining a healthy lifestyle that includes appropriate exercise and physical activity. All health care professionals who treat patients with arthritis should reinforce the benefits of healthy living as a central component of managing the condition, Ms. Opava suggested.

"Most of us know what a healthy lifestyle is, but it’s more difficult to lead a healthy lifestyle consistently," she added, noting that it basically involved avoiding physical inactivity, eating a healthful diet, moderating alcohol intake, and not smoking.

Ms. Opava had no conflicts of interest to declare.

LONDON – Biologic treatment may open a "therapeutic window" for the improved nonmedical management of rheumatoid arthritis, according to a leading Swedish physiotherapist at the annual European Congress of Rheumatology.

The advent of biologics just over a decade ago has undoubtedly tightened disease control and improved outcomes, compared with more conventional therapies for many patients with RA.

But biologics have also made it much more possible for patients to undertake prescribed exercise regimens that are recommended for older adults with chronic diseases such as arthritis, said Christina Opava of the Karolinska Institutetand Karolinska University Hospital in Stockholm.

"Biologics do not necessarily take away the need for exercise, but they may open up a therapeutic window for people to regain and maintain their physical activity while on treatment," she noted.

In an interview, Ms. Opava added that "everything is not about disease control. We also need to pay attention to a healthy lifestyle."

Over the past few decades, the treatment of RA has changed dramatically, with improved medications and nonmedical options. In addition, many more patients today are empowered to self-manage their condition, and have greater expectations of and worries about how treatments and their disease will affect their overall quality and duration of life.

In a recent review article, four nonpharmacologic options topped the list of strategies that have a sound evidence base: self-management interventions, exercise or a suitable physical activity program, comprehensive occupational therapy with patients who are able to work but are at risk of losing their jobs, and use of wrist and finger splints (Curr. Opin. Rheumatol. 2011;23:259-64).

More research is needed on the use of assistive devices, foot orthoses, and dietary interventions in order to determine the true effectiveness of the strategies, the review authors suggested.

Having worked as a rheumatology health care professional for more than 30 years, Ms. Opava emphasized that nonmedical options should not be forgotten. Strategies to help patients self-manage their condition, for example, may include tailored patient education, behavioral and cognitive approaches, and individualized weekly action plans (Ann. Rheum. Dis. 2010;69:955-63).

Ms. Opava’s research has focused on the benefits of regular exercise in arthritis, and determining what the minimum amount of exercise could be and how this could be most effectively prescribed (Arthritis Rheum. 2003;49:428-34). Planned and structured exercise has been shown to be effective in RA, and "by now, there are enough studies to support its safety as well as its benefit," she said.

The challenge, of course, is that not all patients may be able to partake in the same level or type of exercise, which – according to the American College of Sports Medicine guidelines – can be the same for adults aged 50-64 years with a chronic condition such as arthritis and those aged 65 years or older.

"Everyone has to choose their own mode of exercise," Ms. Opava explained, noting that health care professionals need to assess the patient’s physical capacity before prescribing any form of exercise or physical activity program. Exercise and physical activity also need to be enjoyable for patients, so that there is greater likelihood that patients will stick with their exercise regimen.

Patient education and empowerment are vital to achieving and maintaining a healthy lifestyle that includes appropriate exercise and physical activity. All health care professionals who treat patients with arthritis should reinforce the benefits of healthy living as a central component of managing the condition, Ms. Opava suggested.

"Most of us know what a healthy lifestyle is, but it’s more difficult to lead a healthy lifestyle consistently," she added, noting that it basically involved avoiding physical inactivity, eating a healthful diet, moderating alcohol intake, and not smoking.

Ms. Opava had no conflicts of interest to declare.

LONDON – Biologic treatment may open a "therapeutic window" for the improved nonmedical management of rheumatoid arthritis, according to a leading Swedish physiotherapist at the annual European Congress of Rheumatology.

The advent of biologics just over a decade ago has undoubtedly tightened disease control and improved outcomes, compared with more conventional therapies for many patients with RA.

But biologics have also made it much more possible for patients to undertake prescribed exercise regimens that are recommended for older adults with chronic diseases such as arthritis, said Christina Opava of the Karolinska Institutetand Karolinska University Hospital in Stockholm.

"Biologics do not necessarily take away the need for exercise, but they may open up a therapeutic window for people to regain and maintain their physical activity while on treatment," she noted.

In an interview, Ms. Opava added that "everything is not about disease control. We also need to pay attention to a healthy lifestyle."

Over the past few decades, the treatment of RA has changed dramatically, with improved medications and nonmedical options. In addition, many more patients today are empowered to self-manage their condition, and have greater expectations of and worries about how treatments and their disease will affect their overall quality and duration of life.

In a recent review article, four nonpharmacologic options topped the list of strategies that have a sound evidence base: self-management interventions, exercise or a suitable physical activity program, comprehensive occupational therapy with patients who are able to work but are at risk of losing their jobs, and use of wrist and finger splints (Curr. Opin. Rheumatol. 2011;23:259-64).

More research is needed on the use of assistive devices, foot orthoses, and dietary interventions in order to determine the true effectiveness of the strategies, the review authors suggested.

Having worked as a rheumatology health care professional for more than 30 years, Ms. Opava emphasized that nonmedical options should not be forgotten. Strategies to help patients self-manage their condition, for example, may include tailored patient education, behavioral and cognitive approaches, and individualized weekly action plans (Ann. Rheum. Dis. 2010;69:955-63).

Ms. Opava’s research has focused on the benefits of regular exercise in arthritis, and determining what the minimum amount of exercise could be and how this could be most effectively prescribed (Arthritis Rheum. 2003;49:428-34). Planned and structured exercise has been shown to be effective in RA, and "by now, there are enough studies to support its safety as well as its benefit," she said.

The challenge, of course, is that not all patients may be able to partake in the same level or type of exercise, which – according to the American College of Sports Medicine guidelines – can be the same for adults aged 50-64 years with a chronic condition such as arthritis and those aged 65 years or older.

"Everyone has to choose their own mode of exercise," Ms. Opava explained, noting that health care professionals need to assess the patient’s physical capacity before prescribing any form of exercise or physical activity program. Exercise and physical activity also need to be enjoyable for patients, so that there is greater likelihood that patients will stick with their exercise regimen.

Patient education and empowerment are vital to achieving and maintaining a healthy lifestyle that includes appropriate exercise and physical activity. All health care professionals who treat patients with arthritis should reinforce the benefits of healthy living as a central component of managing the condition, Ms. Opava suggested.

"Most of us know what a healthy lifestyle is, but it’s more difficult to lead a healthy lifestyle consistently," she added, noting that it basically involved avoiding physical inactivity, eating a healthful diet, moderating alcohol intake, and not smoking.

Ms. Opava had no conflicts of interest to declare.

LONDON – Biologic treatment may open a "therapeutic window" for the improved nonmedical management of rheumatoid arthritis, according to a leading Swedish physiotherapist at the annual European Congress of Rheumatology.

The advent of biologics just over a decade ago has undoubtedly tightened disease control and improved outcomes, compared with more conventional therapies for many patients with RA.

But biologics have also made it much more possible for patients to undertake prescribed exercise regimens that are recommended for older adults with chronic diseases such as arthritis, said Christina Opava of the Karolinska Institutetand Karolinska University Hospital in Stockholm.

"Biologics do not necessarily take away the need for exercise, but they may open up a therapeutic window for people to regain and maintain their physical activity while on treatment," she noted.

In an interview, Ms. Opava added that "everything is not about disease control. We also need to pay attention to a healthy lifestyle."

Over the past few decades, the treatment of RA has changed dramatically, with improved medications and nonmedical options. In addition, many more patients today are empowered to self-manage their condition, and have greater expectations of and worries about how treatments and their disease will affect their overall quality and duration of life.

In a recent review article, four nonpharmacologic options topped the list of strategies that have a sound evidence base: self-management interventions, exercise or a suitable physical activity program, comprehensive occupational therapy with patients who are able to work but are at risk of losing their jobs, and use of wrist and finger splints (Curr. Opin. Rheumatol. 2011;23:259-64).

More research is needed on the use of assistive devices, foot orthoses, and dietary interventions in order to determine the true effectiveness of the strategies, the review authors suggested.

Having worked as a rheumatology health care professional for more than 30 years, Ms. Opava emphasized that nonmedical options should not be forgotten. Strategies to help patients self-manage their condition, for example, may include tailored patient education, behavioral and cognitive approaches, and individualized weekly action plans (Ann. Rheum. Dis. 2010;69:955-63).

Ms. Opava’s research has focused on the benefits of regular exercise in arthritis, and determining what the minimum amount of exercise could be and how this could be most effectively prescribed (Arthritis Rheum. 2003;49:428-34). Planned and structured exercise has been shown to be effective in RA, and "by now, there are enough studies to support its safety as well as its benefit," she said.

The challenge, of course, is that not all patients may be able to partake in the same level or type of exercise, which – according to the American College of Sports Medicine guidelines – can be the same for adults aged 50-64 years with a chronic condition such as arthritis and those aged 65 years or older.

"Everyone has to choose their own mode of exercise," Ms. Opava explained, noting that health care professionals need to assess the patient’s physical capacity before prescribing any form of exercise or physical activity program. Exercise and physical activity also need to be enjoyable for patients, so that there is greater likelihood that patients will stick with their exercise regimen.

Patient education and empowerment are vital to achieving and maintaining a healthy lifestyle that includes appropriate exercise and physical activity. All health care professionals who treat patients with arthritis should reinforce the benefits of healthy living as a central component of managing the condition, Ms. Opava suggested.

"Most of us know what a healthy lifestyle is, but it’s more difficult to lead a healthy lifestyle consistently," she added, noting that it basically involved avoiding physical inactivity, eating a healthful diet, moderating alcohol intake, and not smoking.

Ms. Opava had no conflicts of interest to declare.

LONDON – Biologic treatment may open a "therapeutic window" for the improved nonmedical management of rheumatoid arthritis, according to a leading Swedish physiotherapist at the annual European Congress of Rheumatology.

The advent of biologics just over a decade ago has undoubtedly tightened disease control and improved outcomes, compared with more conventional therapies for many patients with RA.

But biologics have also made it much more possible for patients to undertake prescribed exercise regimens that are recommended for older adults with chronic diseases such as arthritis, said Christina Opava of the Karolinska Institutetand Karolinska University Hospital in Stockholm.

"Biologics do not necessarily take away the need for exercise, but they may open up a therapeutic window for people to regain and maintain their physical activity while on treatment," she noted.

In an interview, Ms. Opava added that "everything is not about disease control. We also need to pay attention to a healthy lifestyle."

Over the past few decades, the treatment of RA has changed dramatically, with improved medications and nonmedical options. In addition, many more patients today are empowered to self-manage their condition, and have greater expectations of and worries about how treatments and their disease will affect their overall quality and duration of life.

In a recent review article, four nonpharmacologic options topped the list of strategies that have a sound evidence base: self-management interventions, exercise or a suitable physical activity program, comprehensive occupational therapy with patients who are able to work but are at risk of losing their jobs, and use of wrist and finger splints (Curr. Opin. Rheumatol. 2011;23:259-64).

More research is needed on the use of assistive devices, foot orthoses, and dietary interventions in order to determine the true effectiveness of the strategies, the review authors suggested.

Having worked as a rheumatology health care professional for more than 30 years, Ms. Opava emphasized that nonmedical options should not be forgotten. Strategies to help patients self-manage their condition, for example, may include tailored patient education, behavioral and cognitive approaches, and individualized weekly action plans (Ann. Rheum. Dis. 2010;69:955-63).

Ms. Opava’s research has focused on the benefits of regular exercise in arthritis, and determining what the minimum amount of exercise could be and how this could be most effectively prescribed (Arthritis Rheum. 2003;49:428-34). Planned and structured exercise has been shown to be effective in RA, and "by now, there are enough studies to support its safety as well as its benefit," she said.

The challenge, of course, is that not all patients may be able to partake in the same level or type of exercise, which – according to the American College of Sports Medicine guidelines – can be the same for adults aged 50-64 years with a chronic condition such as arthritis and those aged 65 years or older.

"Everyone has to choose their own mode of exercise," Ms. Opava explained, noting that health care professionals need to assess the patient’s physical capacity before prescribing any form of exercise or physical activity program. Exercise and physical activity also need to be enjoyable for patients, so that there is greater likelihood that patients will stick with their exercise regimen.

Patient education and empowerment are vital to achieving and maintaining a healthy lifestyle that includes appropriate exercise and physical activity. All health care professionals who treat patients with arthritis should reinforce the benefits of healthy living as a central component of managing the condition, Ms. Opava suggested.

"Most of us know what a healthy lifestyle is, but it’s more difficult to lead a healthy lifestyle consistently," she added, noting that it basically involved avoiding physical inactivity, eating a healthful diet, moderating alcohol intake, and not smoking.

Ms. Opava had no conflicts of interest to declare.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18)), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics (Rheumatology News, May 2011, p. 1).

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a rheumatologist you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics.

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a [physician] you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics.

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a [physician] you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Biologic therapies do not increase the overall risk of cancer in patients with inflammatory arthritis, according to observational data from the Danish Biologics Register, DANBIO, presented by Dr. Lene Dreyer at the annual European Congress of Rheumatology.

After an average of 9 years of follow-up, and representing almost 24,000 patient-years of treatment, the relative risk (RR) for developing any type of cancer for the first time was 1.03 (95% confidence interval [CI] 0.82-1.30) when comparing anti–tumor necrosis factor (anti-TNF) therapy with no biologic treatment.

The cancer risk was also not increased in patients with rheumatoid arthritis (RR = 1.05; 95% CI 0.82-1.34), psoriatic arthritis (RR = 1.98; 95% CI 0.24-16.18), or other arthritic diseases including ankylosing spondylitis (RR = 0.79; 95% CI 0.08-8.33).

Preliminary results suggest that the risk of nonmelanoma skin cancer (RR = 1.11; 95% CI 0.70-1.76) and non-Hodgkin’s lymphoma are also not increased (RR = 0.55; 95% CI 0.16-1.90).

While the findings add to increasing evidence that biologics may not increase cancer risk overall, more analysis is needed to determine if certain types of cancer are more likely to occur in the study population, or if certain patients are at greater risk of malignancy than others. Longer follow-up is also needed to rule out cancers that may take longer than a decade to manifest.

"There has always been concern for an increased risk of lymphoma with TNF-blockers," said Dr. Georg Schett, chair of the department of internal medicine, rheumatology, and clinical immunology at Friedrich-Alexander University Erlangen in Nuremberg, Germany.

Dr. Schett, who was not involved in the study, added that patients with more active arthritis may be more likely than those with less active disease to receive anti-TNF treatment, and so these patients may already be at increased risk for lymphoma.

Indeed, recent data from the British Society for Rheumatology Biologics Register (BSRBR) have shown that the risk of cancer is almost doubled in patients with RA compared with the general population before they are even given biologics.

"There is an increased risk of cancer in patients with rheumatoid arthritis because of the disease itself," agreed study investigator Dr. Dreyer in an interview. In particular, there was an increased risk of lung cancer in Danish patients because of smoking, said Dr. Dreyer, who is a rheumatologist at Gentofte Hospital in Copenhagen.

Dr. Merete Lund Hetland, a consultant rheumatologist from Glostrup University Hospital in Copenhagen and chair of the Danish register, added in an interview: "I think as a [physician] you would always tell your patient, ‘Well, we don’t think there is an increased risk, but there’s always a risk, so you should tell us if you experience any signs or symptoms [that might indicate cancer].’ "

Putting the cancer risk in further context, Dr. Dreyer noted that the risk of infection was higher than that of malignancy, and that of course the benefits of biologic treatment would probably outweigh the risk of malignancy in the majority of patients.

DANBIO (Dansk Reumatologisk Database) was set up in 2000 to prospectively follow all patients starting treatment with anti-TNFs for their arthritis in Denmark. Enrollment in the register is mandatory and included more than 13,500 patients with all types of inflammatory arthritis up until the data cut for the analysis of 2008. Of the enrolled patients, 5,598 had received treatment with anti-TNF agents and 8,101 had not. Two-thirds of patients had rheumatoid arthritis.

To assess cancer risk, data from DANBIO were linked to the Danish Cancer Registry, with a total of 181 first cancers occurring in patients treated with biologics and 132 in those who were not given biologics.

The risk of cancer was the same for men and women, did not increase with the cumulative duration of active treatment, and was independent of the anti-TNF agent used (primarily infliximab, etanercept, and adalimumab).

Similar to other European biologics registers, DANBIO is funded by research grants from all the major players in the biologics market in Denmark. These grants run through the Danish Rheumatism Association and the Danish Cancer Society, and the sponsors have no direct access or influence on how the registry data are collected, analyzed, or published.

"All companies are involved. They all pay the same amount, and we would monitor all drugs regardless of whether there was a sponsor or not," Dr. Hetland said.

The DANBIO team plans to examine the association between biologic treatment and malignancy further, looking at the subtypes of cancer that develop. The team also plans to investigate in more detail the different types of cancer that develop by the type of arthritis.

DANBIO is financially supported by grants from the Danish Rheumatism Association and the Danish Cancer Society. Dr. Hetland has acted as a consultant to Roche, and has received grants and research support on behalf of DANBIO from Abbott, BMS, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. Dreyer had no disclosures. Dr. Schett was not involved in the study.

LONDON – Hypothyroidism is prevalent in patients with inflammatory arthritis and is associated with increased cardiovascular risk, according to the findings of a large, primary care practice study.

The prevalence of hypothyroidism in Dutch women with inflammatory arthritis (IA) was 6.5% vs. 3.9% (P less than .0005) for those without. Corresponding figures in Dutch men were 2.4% and 0.8%, respectively (P less than .0005), according to results presented at the annual European Congress of Rheumatology.

Hypothyroidism and IA were each found to independently increase the risk of cardiovascular disease (CVD) in women, compared with women who had neither disease. Women with both conditions had more than three times the risk for CVD, compared with controls.

The findings highlight the need for primary care providers to be aware of the link between hypothyroidism and IA, suggested Dr. Hennie Raterman of the Free University Medical Center in Amsterdam.

"In inflammatory arthritis patients, you see a high coexistence of cardiovascular risk factors and cardiovascular diseases such as acute myocardial infarction and stroke," Dr. Raterman said in an interview. "On top of that, and if you have the coexistence of the two autoimmune diseases [IA and hypothyroidism], the risk is further amplified."

General practitioners act as the gatekeepers to specialist health care services in the Netherlands, and are therefore well placed to provide information about the prevalence of comorbid disease, Dr. Raterman observed.

The cross-sectional study involved the examination of electronic medical records from approximately 175,000 patients who were seen at 96 general practice clinics in the Netherlands up until 2006. IA was identified in 1,518 patients; this included patients with a diagnosis of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondyloarthritis.

The overall prevalence of hypothyroidism was 5% (n = 76/1,518) in patients with IA vs. 2.3% (n = 4,153/173,543) in those without IA in the general practice population (P less than .0005).

As hypothyroidism was found to be most prevalent in women with IA, and the number of men (n = 13) included in the sample with IA was too low to achieve statistical power, the second part of the study focused on CVD risk in female patients only.

After adjustment for age and the presence of diabetes, hypertension and hypercholesterolemia, the odds ratios for the development of CVD relative to controls was 1.19 for women with hypothyroidism, 1.48 for those with IA, and 3.72 for those with both autoimmune diseases.

In the treatment of patients with comorbid IA and hypothyroidism, Dr. Raterman said that it was important to keep both conditions well controlled.

Diabetes is another autoimmune condition that may cluster in patients with IA and hypothyroidism, so paying attention to that disease may also prove important. Perhaps treating one autoimmune disease will improve the outcome of other comorbid conditions, he suggested.

Dr. Raterman and colleagues recently demonstrated that the use of anti–tumor necrosis factor-alpha therapy in patients with rheumatoid arthritis and hypothyroidism can improve thyroid function (J. Rheumatol. 2011;38:247-51).

Keeping the arthritis and the thyroid disease well controlled may be enough to address the already high risk for CVD in patients with one or the other, or both autoimmune diseases, but "when that’s not enough I think you have to target all the cardiovascular risk factors."

Dr. Raterman reported that he had no relevant conflicts of interest.

LONDON – Hypothyroidism is prevalent in patients with inflammatory arthritis and is associated with increased cardiovascular risk, according to the findings of a large, primary care practice study.

The prevalence of hypothyroidism in Dutch women with inflammatory arthritis (IA) was 6.5% vs. 3.9% (P less than .0005) for those without. Corresponding figures in Dutch men were 2.4% and 0.8%, respectively (P less than .0005), according to results presented at the annual European Congress of Rheumatology.

Hypothyroidism and IA were each found to independently increase the risk of cardiovascular disease (CVD) in women, compared with women who had neither disease. Women with both conditions had more than three times the risk for CVD, compared with controls.

The findings highlight the need for primary care providers to be aware of the link between hypothyroidism and IA, suggested Dr. Hennie Raterman of the Free University Medical Center in Amsterdam.

"In inflammatory arthritis patients, you see a high coexistence of cardiovascular risk factors and cardiovascular diseases such as acute myocardial infarction and stroke," Dr. Raterman said in an interview. "On top of that, and if you have the coexistence of the two autoimmune diseases [IA and hypothyroidism], the risk is further amplified."

General practitioners act as the gatekeepers to specialist health care services in the Netherlands, and are therefore well placed to provide information about the prevalence of comorbid disease, Dr. Raterman observed.

The cross-sectional study involved the examination of electronic medical records from approximately 175,000 patients who were seen at 96 general practice clinics in the Netherlands up until 2006. IA was identified in 1,518 patients; this included patients with a diagnosis of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondyloarthritis.

The overall prevalence of hypothyroidism was 5% (n = 76/1,518) in patients with IA vs. 2.3% (n = 4,153/173,543) in those without IA in the general practice population (P less than .0005).

As hypothyroidism was found to be most prevalent in women with IA, and the number of men (n = 13) included in the sample with IA was too low to achieve statistical power, the second part of the study focused on CVD risk in female patients only.

After adjustment for age and the presence of diabetes, hypertension and hypercholesterolemia, the odds ratios for the development of CVD relative to controls was 1.19 for women with hypothyroidism, 1.48 for those with IA, and 3.72 for those with both autoimmune diseases.

In the treatment of patients with comorbid IA and hypothyroidism, Dr. Raterman said that it was important to keep both conditions well controlled.

Diabetes is another autoimmune condition that may cluster in patients with IA and hypothyroidism, so paying attention to that disease may also prove important. Perhaps treating one autoimmune disease will improve the outcome of other comorbid conditions, he suggested.

Dr. Raterman and colleagues recently demonstrated that the use of anti–tumor necrosis factor-alpha therapy in patients with rheumatoid arthritis and hypothyroidism can improve thyroid function (J. Rheumatol. 2011;38:247-51).

Keeping the arthritis and the thyroid disease well controlled may be enough to address the already high risk for CVD in patients with one or the other, or both autoimmune diseases, but "when that’s not enough I think you have to target all the cardiovascular risk factors."

Dr. Raterman reported that he had no relevant conflicts of interest.

LONDON – Hypothyroidism is prevalent in patients with inflammatory arthritis and is associated with increased cardiovascular risk, according to the findings of a large, primary care practice study.

The prevalence of hypothyroidism in Dutch women with inflammatory arthritis (IA) was 6.5% vs. 3.9% (P less than .0005) for those without. Corresponding figures in Dutch men were 2.4% and 0.8%, respectively (P less than .0005), according to results presented at the annual European Congress of Rheumatology.

Hypothyroidism and IA were each found to independently increase the risk of cardiovascular disease (CVD) in women, compared with women who had neither disease. Women with both conditions had more than three times the risk for CVD, compared with controls.

The findings highlight the need for primary care providers to be aware of the link between hypothyroidism and IA, suggested Dr. Hennie Raterman of the Free University Medical Center in Amsterdam.

"In inflammatory arthritis patients, you see a high coexistence of cardiovascular risk factors and cardiovascular diseases such as acute myocardial infarction and stroke," Dr. Raterman said in an interview. "On top of that, and if you have the coexistence of the two autoimmune diseases [IA and hypothyroidism], the risk is further amplified."

General practitioners act as the gatekeepers to specialist health care services in the Netherlands, and are therefore well placed to provide information about the prevalence of comorbid disease, Dr. Raterman observed.

The cross-sectional study involved the examination of electronic medical records from approximately 175,000 patients who were seen at 96 general practice clinics in the Netherlands up until 2006. IA was identified in 1,518 patients; this included patients with a diagnosis of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondyloarthritis.

The overall prevalence of hypothyroidism was 5% (n = 76/1,518) in patients with IA vs. 2.3% (n = 4,153/173,543) in those without IA in the general practice population (P less than .0005).

As hypothyroidism was found to be most prevalent in women with IA, and the number of men (n = 13) included in the sample with IA was too low to achieve statistical power, the second part of the study focused on CVD risk in female patients only.

After adjustment for age and the presence of diabetes, hypertension and hypercholesterolemia, the odds ratios for the development of CVD relative to controls was 1.19 for women with hypothyroidism, 1.48 for those with IA, and 3.72 for those with both autoimmune diseases.

In the treatment of patients with comorbid IA and hypothyroidism, Dr. Raterman said that it was important to keep both conditions well controlled.

Diabetes is another autoimmune condition that may cluster in patients with IA and hypothyroidism, so paying attention to that disease may also prove important. Perhaps treating one autoimmune disease will improve the outcome of other comorbid conditions, he suggested.

Dr. Raterman and colleagues recently demonstrated that the use of anti–tumor necrosis factor-alpha therapy in patients with rheumatoid arthritis and hypothyroidism can improve thyroid function (J. Rheumatol. 2011;38:247-51).

Keeping the arthritis and the thyroid disease well controlled may be enough to address the already high risk for CVD in patients with one or the other, or both autoimmune diseases, but "when that’s not enough I think you have to target all the cardiovascular risk factors."

Dr. Raterman reported that he had no relevant conflicts of interest.

Major Finding: The incidence of GI perforation was highest in patients who used glucocorticoids in combination with DMARDs other than methotrexate (3.03 per 1,000 patient-years).

Data Source: Retrospective study of 143,433 patients with rheumatoid arthritis with at least two nondiagnostic claims in a U.S. administrative database filed between 2001 and 2009.

Disclosures: Dr. Curtis disclosed research and consulting relationships with Abbot, Amgen, BMS, Centocor, CORRONA, Crescendo, Pfizer, Roche, and UCB.

LONDON – Although a potentially serious complication, perforation of the gastrointestinal tract is rare, judging from the findings of an analysis of more than 140,000 patients with rheumatoid arthritis.

Upper or lower GI tract perforation occurred in 696 (0.5%) of patients, with an overall, unadjusted incidence rate of 1.7 cases per 1,000 person-years, according to Dr. Jeffrey Curtis. “For [most of] the rheumatoid arthritis patients someone has in their practice, [GI perforation] is going to be very uncommon, I think that should be reassuring,” he said during an interview.

“We also observed that there were cases [of GI perforation] for every biologic group,” added Dr. Curtis, a rheumatologist, epidemiologist, and associate professor of medicine at the University of Alabama at Birmingham. This should help dispel any concerns that the adverse event might occur with certain biologic agents used to treat RA, he suggested.

In a retrospective study, Dr. Curtis and his associates analyzed records of 143,433 RA patients from a large U.S.-based administrative claims database for the years 2001–2009. The investigators used a validated algorithm to identify cases of upper and lower GI perforation and to determine predictive factors. The median follow-up was 2.5 years.

Older age was found to be a predictor of GI perforation, with adjusted relative risks of 1.6 and 2.1 for people aged 40–64 years and 65 years, respectively, compared with RA patients younger than 40 years. The mean age of the 142,737 patients who did not have a GI perforation was 57.6 years, and the mean age of the 696 patients who did was 62 years (P less than .01).

Diverticulitis and diverticulosis without diverticulitis were also significantly more common in patients who experienced a GI perforation than in those who did not, although the incidence was still low, with rates of 2.9% vs. 0.3% and 1.4% vs. 0.4%, respectively (both P less than .01). Diverticulitis but not diverticulosis was a significant risk factor for perforation. The main risk factors among the RA medication groups of most relevance were the use of oral glucocorticosteroids and nonsteroidal anti-inflammatory drugs, not biologics and not the disease-modifying antirheumatic drugs, he said. Indeed, the incidence of GI perforation was highest in patients who used glucocorticoids in combination with DMARDs other than methotrexate (3.03 per 1,000 patient years).

Steroid monotherapy carried an incidence of 2.86 per 1,000 patient-years. Steroids used in combination with methotrexate and biologics also increased the risk of the GI complications (2.24 and 1.87 per 1,000 patient-years, respectively).

The rates of GI perforations in patients treated with biologics, methotrexate, or other DMARDs without steroids were 1.02, 1.08, and 1.71 per 1,000 patient-years, respectively. NSAID use was associated with an incidence rate of 1.68 per 1,000 patient-years.

In the study, 80% of the perforations seen were in the lower GI tract, so the use of gastroprotective medications may not be that useful.

Although still important, upper GI bleeding and peptic ulcer disease are perhaps less critical than antecedent diverticulitis and its associated complications.

Minimization of NSAID and steroid use is probably warranted in higher-risk patients, Dr. Curtis advised. “In somebody with a history of diverticulitis, I would be very cautious.”

Major Finding: The incidence of GI perforation was highest in patients who used glucocorticoids in combination with DMARDs other than methotrexate (3.03 per 1,000 patient-years).

Data Source: Retrospective study of 143,433 patients with rheumatoid arthritis with at least two nondiagnostic claims in a U.S. administrative database filed between 2001 and 2009.

Disclosures: Dr. Curtis disclosed research and consulting relationships with Abbot, Amgen, BMS, Centocor, CORRONA, Crescendo, Pfizer, Roche, and UCB.

LONDON – Although a potentially serious complication, perforation of the gastrointestinal tract is rare, judging from the findings of an analysis of more than 140,000 patients with rheumatoid arthritis.

Upper or lower GI tract perforation occurred in 696 (0.5%) of patients, with an overall, unadjusted incidence rate of 1.7 cases per 1,000 person-years, according to Dr. Jeffrey Curtis. “For [most of] the rheumatoid arthritis patients someone has in their practice, [GI perforation] is going to be very uncommon, I think that should be reassuring,” he said during an interview.

“We also observed that there were cases [of GI perforation] for every biologic group,” added Dr. Curtis, a rheumatologist, epidemiologist, and associate professor of medicine at the University of Alabama at Birmingham. This should help dispel any concerns that the adverse event might occur with certain biologic agents used to treat RA, he suggested.

In a retrospective study, Dr. Curtis and his associates analyzed records of 143,433 RA patients from a large U.S.-based administrative claims database for the years 2001–2009. The investigators used a validated algorithm to identify cases of upper and lower GI perforation and to determine predictive factors. The median follow-up was 2.5 years.

Older age was found to be a predictor of GI perforation, with adjusted relative risks of 1.6 and 2.1 for people aged 40–64 years and 65 years, respectively, compared with RA patients younger than 40 years. The mean age of the 142,737 patients who did not have a GI perforation was 57.6 years, and the mean age of the 696 patients who did was 62 years (P less than .01).

Diverticulitis and diverticulosis without diverticulitis were also significantly more common in patients who experienced a GI perforation than in those who did not, although the incidence was still low, with rates of 2.9% vs. 0.3% and 1.4% vs. 0.4%, respectively (both P less than .01). Diverticulitis but not diverticulosis was a significant risk factor for perforation. The main risk factors among the RA medication groups of most relevance were the use of oral glucocorticosteroids and nonsteroidal anti-inflammatory drugs, not biologics and not the disease-modifying antirheumatic drugs, he said. Indeed, the incidence of GI perforation was highest in patients who used glucocorticoids in combination with DMARDs other than methotrexate (3.03 per 1,000 patient years).

Steroid monotherapy carried an incidence of 2.86 per 1,000 patient-years. Steroids used in combination with methotrexate and biologics also increased the risk of the GI complications (2.24 and 1.87 per 1,000 patient-years, respectively).

The rates of GI perforations in patients treated with biologics, methotrexate, or other DMARDs without steroids were 1.02, 1.08, and 1.71 per 1,000 patient-years, respectively. NSAID use was associated with an incidence rate of 1.68 per 1,000 patient-years.

In the study, 80% of the perforations seen were in the lower GI tract, so the use of gastroprotective medications may not be that useful.

Although still important, upper GI bleeding and peptic ulcer disease are perhaps less critical than antecedent diverticulitis and its associated complications.

Minimization of NSAID and steroid use is probably warranted in higher-risk patients, Dr. Curtis advised. “In somebody with a history of diverticulitis, I would be very cautious.”

Major Finding: The incidence of GI perforation was highest in patients who used glucocorticoids in combination with DMARDs other than methotrexate (3.03 per 1,000 patient-years).

Data Source: Retrospective study of 143,433 patients with rheumatoid arthritis with at least two nondiagnostic claims in a U.S. administrative database filed between 2001 and 2009.

Disclosures: Dr. Curtis disclosed research and consulting relationships with Abbot, Amgen, BMS, Centocor, CORRONA, Crescendo, Pfizer, Roche, and UCB.

LONDON – Although a potentially serious complication, perforation of the gastrointestinal tract is rare, judging from the findings of an analysis of more than 140,000 patients with rheumatoid arthritis.

Upper or lower GI tract perforation occurred in 696 (0.5%) of patients, with an overall, unadjusted incidence rate of 1.7 cases per 1,000 person-years, according to Dr. Jeffrey Curtis. “For [most of] the rheumatoid arthritis patients someone has in their practice, [GI perforation] is going to be very uncommon, I think that should be reassuring,” he said during an interview.

“We also observed that there were cases [of GI perforation] for every biologic group,” added Dr. Curtis, a rheumatologist, epidemiologist, and associate professor of medicine at the University of Alabama at Birmingham. This should help dispel any concerns that the adverse event might occur with certain biologic agents used to treat RA, he suggested.

In a retrospective study, Dr. Curtis and his associates analyzed records of 143,433 RA patients from a large U.S.-based administrative claims database for the years 2001–2009. The investigators used a validated algorithm to identify cases of upper and lower GI perforation and to determine predictive factors. The median follow-up was 2.5 years.

Older age was found to be a predictor of GI perforation, with adjusted relative risks of 1.6 and 2.1 for people aged 40–64 years and 65 years, respectively, compared with RA patients younger than 40 years. The mean age of the 142,737 patients who did not have a GI perforation was 57.6 years, and the mean age of the 696 patients who did was 62 years (P less than .01).

Diverticulitis and diverticulosis without diverticulitis were also significantly more common in patients who experienced a GI perforation than in those who did not, although the incidence was still low, with rates of 2.9% vs. 0.3% and 1.4% vs. 0.4%, respectively (both P less than .01). Diverticulitis but not diverticulosis was a significant risk factor for perforation. The main risk factors among the RA medication groups of most relevance were the use of oral glucocorticosteroids and nonsteroidal anti-inflammatory drugs, not biologics and not the disease-modifying antirheumatic drugs, he said. Indeed, the incidence of GI perforation was highest in patients who used glucocorticoids in combination with DMARDs other than methotrexate (3.03 per 1,000 patient years).

Steroid monotherapy carried an incidence of 2.86 per 1,000 patient-years. Steroids used in combination with methotrexate and biologics also increased the risk of the GI complications (2.24 and 1.87 per 1,000 patient-years, respectively).

The rates of GI perforations in patients treated with biologics, methotrexate, or other DMARDs without steroids were 1.02, 1.08, and 1.71 per 1,000 patient-years, respectively. NSAID use was associated with an incidence rate of 1.68 per 1,000 patient-years.

In the study, 80% of the perforations seen were in the lower GI tract, so the use of gastroprotective medications may not be that useful.

Although still important, upper GI bleeding and peptic ulcer disease are perhaps less critical than antecedent diverticulitis and its associated complications.

Minimization of NSAID and steroid use is probably warranted in higher-risk patients, Dr. Curtis advised. “In somebody with a history of diverticulitis, I would be very cautious.”