Sara Freeman

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain, and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study's authors.

“The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease,” added Dr. Derek Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England.

The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL); and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded to the questionnaire, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers.

Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

“High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history,” Dr. Mattey said.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain, and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study's authors.

“The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease,” added Dr. Derek Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England.

The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL); and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded to the questionnaire, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers.

Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

“High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history,” Dr. Mattey said.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain, and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study's authors.

“The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease,” added Dr. Derek Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England.

The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL); and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded to the questionnaire, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers.

Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

“High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history,” Dr. Mattey said.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – The pretreatment measurement of a serum protein could help determine if young children with juvenile idiopathic arthritis are likely to respond to methotrexate.

Data from the ongoing SPARKS–Childhood Arthritis Response to Medication Study (CHARMS) show that the pretreatment serum levels of myeloid-related protein (MRP) 8/14 are higher in children who will respond well to treatment with the disease-modifying antirheumatic drug, but levels are lower in those who are less likely to benefit.

The finding holds promise for the development of a simple predictive test that could be used to avoid giving unnecessary and prolonged methotrexate treatment to the estimated 30% of children who are unlikely to respond to the DMARD.

“Essentially what we are trying to do is give effective treatment at clinical presentation,” said Halima Moncrieffe, Ph.D., a research fellow at University College of London (UCL) Institute of Child Health. Dr. Moncrieffe noted that giving methotrexate to all children at diagnosis possibly represents a missed opportunity, as children who wre unlikely to respond face worsening arthritisanefore it is recognized that the disease-modifying antirheumatic drug has no great effect.

SPARKS-CHARMS thus is looking for biologic, genetic, or psychological factors that could help predict and explain the response to treatments for JIA. The overall study involves more than 800 children who are being treated at the Great Ormond Street Hospital in London. At enrollment, and before any treatment, standard assessments are made and a blood sample is taken for analysis. Assessments are then repeated 6 months after treatment.

Dr. Moncrieffe presented findings on 109 study participants who had been treated with methotrexate from a mean age of 5.2 years and had a mean disease duration of 0.9 years before treatment initiation; 70% were female.

After the researchers excluded children with systemic disease because they had higher inflammatory protein levels than did other JIA subtypes, the results showed higher pretreatment concentrations of MRP8/14, also known as calprotectin or S100A8/A9, in the blood samples of children who achieved an ACR70 response to methotrexate at 6 months than in those who did not respond.

The difference was not initially significant, but a comparison of samples from children who achieved an ACR50 or an ACR70 response with those who had an ACR30 or no response did show a statistical benefit (P = .008).

“MRP8/14 is a very stable protein,” Dr. Moncrieffe said. It can be measured in a simple serum sample, left on a bench, and even sent through the post before being analyzed at a later date. It could therefore lend itself to the development of a routine predictive test and, together with the genetic findings from SPARKS-CHARMS, help physicians make clinical decisions based on a child's likelihood of responding to treatment.

Dr. Lucy Wedderburn, professor of pediatric rheumatology at UCL Institute of Child Health and an honorary consultant in rheumatology at Great Ormond Street Hospital, said, “MRP8/14 is a protein we already knew to be important.”

Dr. Wedderburn, lead investigator of the study, added: “Levels of this protein are very high in the serum of children with JIA and in those who respond well to treatment. Higher levels have also been found in children who are in remission when compared to children without JIA.”

The study was funded by SPARKS UK, The Big Lottery Fund, Arthritis Research UK, and Great Ormond Street Hospital Children's Charity. Dr. Moncrieffe and Dr. Wedderburn declared that they had no conflicts of interest.

Giving methotrexate to all children at diagnosis possibly represents a missed opportunity.

Source DR. MONCRIEFFE

BRIGHTON, ENGLAND – The pretreatment measurement of a serum protein could help determine if young children with juvenile idiopathic arthritis are likely to respond to methotrexate.

Data from the ongoing SPARKS–Childhood Arthritis Response to Medication Study (CHARMS) show that the pretreatment serum levels of myeloid-related protein (MRP) 8/14 are higher in children who will respond well to treatment with the disease-modifying antirheumatic drug, but levels are lower in those who are less likely to benefit.

The finding holds promise for the development of a simple predictive test that could be used to avoid giving unnecessary and prolonged methotrexate treatment to the estimated 30% of children who are unlikely to respond to the DMARD.

“Essentially what we are trying to do is give effective treatment at clinical presentation,” said Halima Moncrieffe, Ph.D., a research fellow at University College of London (UCL) Institute of Child Health. Dr. Moncrieffe noted that giving methotrexate to all children at diagnosis possibly represents a missed opportunity, as children who wre unlikely to respond face worsening arthritisanefore it is recognized that the disease-modifying antirheumatic drug has no great effect.

SPARKS-CHARMS thus is looking for biologic, genetic, or psychological factors that could help predict and explain the response to treatments for JIA. The overall study involves more than 800 children who are being treated at the Great Ormond Street Hospital in London. At enrollment, and before any treatment, standard assessments are made and a blood sample is taken for analysis. Assessments are then repeated 6 months after treatment.

Dr. Moncrieffe presented findings on 109 study participants who had been treated with methotrexate from a mean age of 5.2 years and had a mean disease duration of 0.9 years before treatment initiation; 70% were female.

After the researchers excluded children with systemic disease because they had higher inflammatory protein levels than did other JIA subtypes, the results showed higher pretreatment concentrations of MRP8/14, also known as calprotectin or S100A8/A9, in the blood samples of children who achieved an ACR70 response to methotrexate at 6 months than in those who did not respond.

The difference was not initially significant, but a comparison of samples from children who achieved an ACR50 or an ACR70 response with those who had an ACR30 or no response did show a statistical benefit (P = .008).

“MRP8/14 is a very stable protein,” Dr. Moncrieffe said. It can be measured in a simple serum sample, left on a bench, and even sent through the post before being analyzed at a later date. It could therefore lend itself to the development of a routine predictive test and, together with the genetic findings from SPARKS-CHARMS, help physicians make clinical decisions based on a child's likelihood of responding to treatment.

Dr. Lucy Wedderburn, professor of pediatric rheumatology at UCL Institute of Child Health and an honorary consultant in rheumatology at Great Ormond Street Hospital, said, “MRP8/14 is a protein we already knew to be important.”

Dr. Wedderburn, lead investigator of the study, added: “Levels of this protein are very high in the serum of children with JIA and in those who respond well to treatment. Higher levels have also been found in children who are in remission when compared to children without JIA.”

The study was funded by SPARKS UK, The Big Lottery Fund, Arthritis Research UK, and Great Ormond Street Hospital Children's Charity. Dr. Moncrieffe and Dr. Wedderburn declared that they had no conflicts of interest.

Giving methotrexate to all children at diagnosis possibly represents a missed opportunity.

Source DR. MONCRIEFFE

BRIGHTON, ENGLAND – The pretreatment measurement of a serum protein could help determine if young children with juvenile idiopathic arthritis are likely to respond to methotrexate.

Data from the ongoing SPARKS–Childhood Arthritis Response to Medication Study (CHARMS) show that the pretreatment serum levels of myeloid-related protein (MRP) 8/14 are higher in children who will respond well to treatment with the disease-modifying antirheumatic drug, but levels are lower in those who are less likely to benefit.

The finding holds promise for the development of a simple predictive test that could be used to avoid giving unnecessary and prolonged methotrexate treatment to the estimated 30% of children who are unlikely to respond to the DMARD.

“Essentially what we are trying to do is give effective treatment at clinical presentation,” said Halima Moncrieffe, Ph.D., a research fellow at University College of London (UCL) Institute of Child Health. Dr. Moncrieffe noted that giving methotrexate to all children at diagnosis possibly represents a missed opportunity, as children who wre unlikely to respond face worsening arthritisanefore it is recognized that the disease-modifying antirheumatic drug has no great effect.

SPARKS-CHARMS thus is looking for biologic, genetic, or psychological factors that could help predict and explain the response to treatments for JIA. The overall study involves more than 800 children who are being treated at the Great Ormond Street Hospital in London. At enrollment, and before any treatment, standard assessments are made and a blood sample is taken for analysis. Assessments are then repeated 6 months after treatment.

Dr. Moncrieffe presented findings on 109 study participants who had been treated with methotrexate from a mean age of 5.2 years and had a mean disease duration of 0.9 years before treatment initiation; 70% were female.

After the researchers excluded children with systemic disease because they had higher inflammatory protein levels than did other JIA subtypes, the results showed higher pretreatment concentrations of MRP8/14, also known as calprotectin or S100A8/A9, in the blood samples of children who achieved an ACR70 response to methotrexate at 6 months than in those who did not respond.

The difference was not initially significant, but a comparison of samples from children who achieved an ACR50 or an ACR70 response with those who had an ACR30 or no response did show a statistical benefit (P = .008).

“MRP8/14 is a very stable protein,” Dr. Moncrieffe said. It can be measured in a simple serum sample, left on a bench, and even sent through the post before being analyzed at a later date. It could therefore lend itself to the development of a routine predictive test and, together with the genetic findings from SPARKS-CHARMS, help physicians make clinical decisions based on a child's likelihood of responding to treatment.

Dr. Lucy Wedderburn, professor of pediatric rheumatology at UCL Institute of Child Health and an honorary consultant in rheumatology at Great Ormond Street Hospital, said, “MRP8/14 is a protein we already knew to be important.”

Dr. Wedderburn, lead investigator of the study, added: “Levels of this protein are very high in the serum of children with JIA and in those who respond well to treatment. Higher levels have also been found in children who are in remission when compared to children without JIA.”

The study was funded by SPARKS UK, The Big Lottery Fund, Arthritis Research UK, and Great Ormond Street Hospital Children's Charity. Dr. Moncrieffe and Dr. Wedderburn declared that they had no conflicts of interest.

Giving methotrexate to all children at diagnosis possibly represents a missed opportunity.

Source DR. MONCRIEFFE

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study’s authors.

"We know that smoking is a risk factor for rheumatoid arthritis ... and is associated with more severe disease and worse response to therapy," said Dr. Derek Mattey on April 13 at the annual meeting of the British Society for Rheumatology.

"The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease," added Dr. Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England. The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL) and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers. Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

"We’ve shown that smoking has a dose-dependent relationship with measures of disease severity in AS," Dr. Mattey said. "High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history."

All these associations appeared to be independent of age, sex, duration, and social deprivation level.

Commenting on the findings after their presentation, Dr. Deborah Symmons of the University of Manchester, England, said: "As this is a cross-sectional study, it is possible that correlation works in the opposite direction, in that people with more active disease and more pain find it more difficult to give up smoking."

Looking at the data longitudinally might be more appropriate, she suggested.

Dr. Mattey agreed that a reverse correlation was possible, but said that most of these patients started smoking before their disease started.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study’s authors.

"We know that smoking is a risk factor for rheumatoid arthritis ... and is associated with more severe disease and worse response to therapy," said Dr. Derek Mattey on April 13 at the annual meeting of the British Society for Rheumatology.

"The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease," added Dr. Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England. The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL) and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers. Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

"We’ve shown that smoking has a dose-dependent relationship with measures of disease severity in AS," Dr. Mattey said. "High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history."

All these associations appeared to be independent of age, sex, duration, and social deprivation level.

Commenting on the findings after their presentation, Dr. Deborah Symmons of the University of Manchester, England, said: "As this is a cross-sectional study, it is possible that correlation works in the opposite direction, in that people with more active disease and more pain find it more difficult to give up smoking."

Looking at the data longitudinally might be more appropriate, she suggested.

Dr. Mattey agreed that a reverse correlation was possible, but said that most of these patients started smoking before their disease started.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study’s authors.

"We know that smoking is a risk factor for rheumatoid arthritis ... and is associated with more severe disease and worse response to therapy," said Dr. Derek Mattey on April 13 at the annual meeting of the British Society for Rheumatology.

"The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease," added Dr. Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England. The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL) and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers. Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

"We’ve shown that smoking has a dose-dependent relationship with measures of disease severity in AS," Dr. Mattey said. "High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history."

All these associations appeared to be independent of age, sex, duration, and social deprivation level.

Commenting on the findings after their presentation, Dr. Deborah Symmons of the University of Manchester, England, said: "As this is a cross-sectional study, it is possible that correlation works in the opposite direction, in that people with more active disease and more pain find it more difficult to give up smoking."

Looking at the data longitudinally might be more appropriate, she suggested.

Dr. Mattey agreed that a reverse correlation was possible, but said that most of these patients started smoking before their disease started.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study’s authors.

"We know that smoking is a risk factor for rheumatoid arthritis ... and is associated with more severe disease and worse response to therapy," said Dr. Derek Mattey on April 13 at the annual meeting of the British Society for Rheumatology.

"The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease," added Dr. Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England. The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL) and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers. Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

"We’ve shown that smoking has a dose-dependent relationship with measures of disease severity in AS," Dr. Mattey said. "High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history."

All these associations appeared to be independent of age, sex, duration, and social deprivation level.

Commenting on the findings after their presentation, Dr. Deborah Symmons of the University of Manchester, England, said: "As this is a cross-sectional study, it is possible that correlation works in the opposite direction, in that people with more active disease and more pain find it more difficult to give up smoking."

Looking at the data longitudinally might be more appropriate, she suggested.

Dr. Mattey agreed that a reverse correlation was possible, but said that most of these patients started smoking before their disease started.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study’s authors.

"We know that smoking is a risk factor for rheumatoid arthritis ... and is associated with more severe disease and worse response to therapy," said Dr. Derek Mattey on April 13 at the annual meeting of the British Society for Rheumatology.

"The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease," added Dr. Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England. The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL) and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers. Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

"We’ve shown that smoking has a dose-dependent relationship with measures of disease severity in AS," Dr. Mattey said. "High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history."

All these associations appeared to be independent of age, sex, duration, and social deprivation level.

Commenting on the findings after their presentation, Dr. Deborah Symmons of the University of Manchester, England, said: "As this is a cross-sectional study, it is possible that correlation works in the opposite direction, in that people with more active disease and more pain find it more difficult to give up smoking."

Looking at the data longitudinally might be more appropriate, she suggested.

Dr. Mattey agreed that a reverse correlation was possible, but said that most of these patients started smoking before their disease started.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Patients with ankylosing spondylitis who currently smoke are likely to be headed for increased disease activity and worse quality of life outcomes.

The results of a cross-sectional, postal survey found that, compared with never smoking, current smoking is associated with higher levels of disease activity, worse functional status, greater pain and overall poorer quality of life.

This is the largest study to date to look at the effects of smoking on disease activity and severity and associated quality of life in ankylosing spondylitis (AS), according to the study’s authors.

"We know that smoking is a risk factor for rheumatoid arthritis ... and is associated with more severe disease and worse response to therapy," said Dr. Derek Mattey on April 13 at the annual meeting of the British Society for Rheumatology.

"The influence of smoking in AS is a lot less clear, however, and [until now] there have been no studies beyond susceptibility and very few studies on smoking as a risk for more severe disease," added Dr. Mattey of Keele University and the University Hospital of North Staffordshire, England.

Questionnaires were sent to 1,000 patients with AS registered at 10 secondary-care rheumatology practices in England. The questionnaire asked about smoking history and used several patient-reported outcome measures. These included the Bath AS disease activity and functional indices (BASDAI/BASFI); pain numeric rating scale (NRS); the AS quality of life questionnaire (ASQoL) and the evaluation of AS quality of life (EASi-QoL).

Data were looked at in terms of smoking status and in relation to the pack-year history. A pack-year is a means to quantify how much a person has smoked over a long time period. It is calculated by multiplying the number of packs smoked per day by the number of years smoked. The higher the pack-year, the longer the person has smoked.

Of 612 patients who responded, 606 provided information about their smoking history. The mean age of respondents was 50.8 years, 72% were male, and the mean disease duration was 17.2 years (standard deviation = 11.7 years). Around half of the cohort had never smoked, with approximately 28% reporting that they were past smokers and 21% saying that they were current smokers.

Mean BASDAI, BASFI, pain NRS, ASQoL, and EASi-QoL scores were all higher, indicating a worse outcome, in patients that had ever smoked, compared with never smokers. Significant, dose-dependent, correlations were also found between the number of pack-years and these disease outcome measures, with worse outcomes the higher the number of pack-years.

"We’ve shown that smoking has a dose-dependent relationship with measures of disease severity in AS," Dr. Mattey said. "High disease activity and more severe pain are most strongly associated with current smoking, while decreased function and poor quality of life are associated more closely with pack-year history."

All these associations appeared to be independent of age, sex, duration, and social deprivation level.

Commenting on the findings after their presentation, Dr. Deborah Symmons of the University of Manchester, England, said: "As this is a cross-sectional study, it is possible that correlation works in the opposite direction, in that people with more active disease and more pain find it more difficult to give up smoking."

Looking at the data longitudinally might be more appropriate, she suggested.

Dr. Mattey agreed that a reverse correlation was possible, but said that most of these patients started smoking before their disease started.

Dr. Mattey said that he had no conflicts of interest but noted that a coinvestigator, Dr. Jonathan Packham, had received an educational grant from Wyeth UK.

BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.

Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.

"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.

"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.

However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.

The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).

A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.

Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.

Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.

Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.

Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.

Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.

However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.

Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.

Ms. Law declared she had no conflicts of interest.

BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.

Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.

"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.

"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.

However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.

The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).

A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.

Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.

Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.

Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.

Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.

Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.

However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.

Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.

Ms. Law declared she had no conflicts of interest.

BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.

Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.

"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.

"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.

However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.

The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).

A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.

Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.

Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.

Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.

Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.

Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.

However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.

Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.

Ms. Law declared she had no conflicts of interest.

BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.

Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.

"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.

"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.

However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.

The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).

A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.

Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.

Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.

Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.

Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.

Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.

However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.

Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.

Ms. Law declared she had no conflicts of interest.

BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.

Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.

"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.

"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.

However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.

The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).

A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.

Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.

Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.

Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.

Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.

Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.

However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.

Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.

Ms. Law declared she had no conflicts of interest.

BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.

Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.

"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.

"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.

However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.

The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).

A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.

Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.

Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.

Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.

Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.

Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.

However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.

Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.

Ms. Law declared she had no conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – The risk of cancer is almost 50% higher in people with rheumatoid arthritis who are treated with nonbiologic agents when compared to the general population, according to data just released from the British Society for Rheumatology Biologics Register.

Although the link between rheumatoid arthritis (RA) and malignancy has been previously identified – particularly with respect to a higher risk of non-Hodgkin’s lymphoma (NHL) – these new data from the British Society for Rheumatology Biologics Register (BSRBR) are from a more-contemporary population of patients who have been treated in the era of widespread use of methotrexate (MTX) and other nonbiologic disease-modifying antirheumatic drugs (DMARDs).

Dr. Eric L. Matteson, who is a professor of medicine at the division of rheumatology at the Mayo Clinic, Rochester, Minn., noted in an interview that the registry findings seem to indicate that overall cancer risk is increased in patients with RA and that this risk is similar in patients exposed to biologics and nonbiologics, with the exception that nonmelanoma skin cancer appears to be somewhat more frequent in the biologics treated patients.

"I think the conclusions arrived at are consistent with previous studies and so not surprising regarding nonbiologics, in particular, methotrexate. A study from Australia by Dr. Rachelle Buchbinder, for example, already reported in 2008 an almost identical finding of 50% increased risk of cancer in patients with RA treated with methotrexate."

There was an estimated 50% excess risk of malignancy among RA patients exposed to MTX relative to the general population (standardized incidence ratio, 1.5; 95% confidence interval, 1.2-1.9). In that study, the risk of non-Hodgkin’s lymphoma was more than five times higher in RA patients than in the general population (SIR, 5.1; 95% CI 2.2-10.0). Other cancers for which there was evidence of increased risk were lung cancer (SIR, 2.9; 95% CI 1.6-4.8) and melanoma (SIR, 3.0; 95% CI 1.2-6.2). (Arthritis Care Res. 2008;59:794-9).

Dr. Matteson qualified his remarks by noting that he did not hear the presentation and assumes methotrexate was the comparator drug.

In reporting the findings, Dr. Louise Mercer, a clinical research fellow at the Arthritis Research UK Epidemiology Unit, University of Manchester, England, where the BRSBR is coordinated, on April 13 at the British Society for Rheumatology Annual Conference (Rheumatology 2011;50:iii37-8, abstract OP18) noted that they set a baseline for analyzing the cancer risk of biologic therapy, compared with conventional RA therapy within the BSRBR patient population – the primary reason the register was set up 10 years ago.

The analysis included 3,727 RA patients treated with nonbiologic DMARDS who were enrolled in the register between 2002 and 2008. Data from the national cancer registry for England and Wales provided information about whether or not they developed cancer. SIRs were used to compare the observed vs. the expected number of cancers and were adjusted for age and gender.

Of 148 malignancies occurring in 10,447 patient-years, 128 were solid cancers – including melanoma, and lung, breast, and colorectal cancers – and 20 were hematologic – including NHL and Hodgkin’s lymphoma. The median time from enrollment in the register to cancer diagnosis was 1.3 years, with 52% of patients dying as a result of incident cancer.

The standardized incidence ratio for all cancers was 1.48. Looking at specific types of malignancy, the highest SIR was recorded for NHL, at 3.73, although the risk of lung cancer was also substantial, with a SIR of 2.71. The SIR for colorectal cancer was 0.96.

Considering these findings, "vigilance for cancer, especially lung cancer and lymphoma should be maintained," Dr. Mercer advised.

"Our experience is that all cancers were increased by about 48%, with quite a marked increase in NHL and lung cancer, said Dr. Deborah Symmons, during a separate presentation at the meeting. An interesting finding, she noted, was that any benefit of NSAID drugs used to treat RA in lowering the risk of colorectal cancer appeared to be "wearing off."

Dr. Symmons, also of the Arthritis Research UK Epidemiology Unit in Manchester and a principle investigator for the BSRBR, explained that this adds to the evidence that, "the cancer risk in our general rheumatoid population is increased for some cancers."

These data are of interest, as they will eventually be used to compare the cancer risk of biologic vs. nonbiologic DMARDs. Such analysis is unlikely to be undertaken any time soon, however, as it is planned to occur when 20,000 years of patient follow-up have been accumulated. To date, there has been no signal that an earlier analysis is warranted.

"In the [anti-TNF] clinical trials, most of which were less than a year [in duration] there was not an increase in cancer except for [nonmelanoma skin cancer]," Dr. Symmons observed. "The cancer risk in observational studies is not increased in the short term," she added, "but we still don’t know what the long-term risk might be."

Echoing her comments were the separate findings of a Wyeth-sponsored study presented as a poster at the meeting. Dr. Peter Taylor of the Kennedy Institute of Rheumatology in London and his associates looked at the risk of malignancy associated with TNF inhibitors in registries and prospective observational studies. They reported a pooled-risk estimate of 1.11 for lymphoma, 1.45 for nonmelanoma skin cancer, and 1.79 for melanoma comparing TNF-treated patients with nonexposed RA patients.

Dr. Taylor and his team said of their findings: "This systematic review and meta-analysis provide reassurance to physicians and patients that treatment of RA patients with TNF inhibitors does not increase the risk of malignancy in general, or of lymphoma in particular, but does appear to increase the risk of skin cancer, including melanoma."

The systemic review and meta-analysis was sponsored by Wyeth. Dr. Taylor has received research grants and honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and UCB. The BSRBR is funded by a grant from the British Society for Rheumatology. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme Ltd., Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and run the BSRBR. All decisions concerning data analysis, interpretation and publications are made autonomously of any industrial contribution.

Dr. Mercer, Dr. Symmons, and Dr. Matteson declared that they had no personal conflicts of interest.

BRIGHTON, ENGLAND – Multiple factors predict whether patients with inflammatory polyarthritis will require treatment with a biologic agent, according to new data from the Norfolk Arthritis Register.

Indeed, younger age, ACPA (anti–citrullinated protein/peptide antibody) positivity, and inefficacy of the first nonbiologic disease-modifying antirheumatic drug, (DMARD) within the first 6 months were associated with a higher chance of requiring biologic treatment with an anti–tumor necrosis factor (TNF) drug or rituximab (Rheumatology [Oxford] 2011;50 [suppl. 3];iii37-9, abstract OP16).

However, none of these baseline predictors is included in the National Institute for Health and Clinical Excellence (NICE) guidelines for prescribing biologic therapy," said Dr. Suzanne Verstappen, who presented the findings at the annual meeting of the British Society for Rheumatology.

More than 800 patients who were enrolled in the Norfolk Arthritis Register (NOAR), a primary care–based inception cohort, were studied, reported Dr. Verstappen, a research fellow at the Arthritis Research UK Epidemiology Unit at the University of Manchester (England). Two groups of patients were identified: those who were recruited in the prebiologic era of 1990-1994 (n = 407), and those who were recruited in 2000-2004 (n = 416), after biologic agents had become widely available in the United Kingdom.

For inclusion in the analysis, all patients had to have at least two swollen joints for 4 or more consecutive weeks. They also had to have symptom duration of less than 24 months, failure to respond to at least one nonbiologic DMARD, and 1 year or more of available follow-up data.

At baseline, the mean age of patients was 53 years in the prebiologic cohort and 57 years in the postbiologic cohort, with women accounting for about 63% of the overall study population. The average symptom duration was 5.4 and 6.7 months, respectively, and the prebiologic-era group had more swollen (seven vs. three) and tender (seven vs. three) joints than did the postbiologic-era group. DAS28 (disease activity score based on a 28-joint count) assessments were also higher at baseline in the prebiologic-era group, compared with postbiologic-era patients (4.5 vs. 3.7), although their use of nonbiologic DMARDs was lower at baseline (34% vs. 65%).

At follow-up, a higher percentage of patients in the 2000-2004 cohort had started to use a biologic agent (10.8% vs. 7.9% for the 1990-1994 cohort). As would be expected, the time before starting a biologic agent for the first time was longer (almost 12 years) for those who were recruited before these agents became available; the later cohort of patients received biologic treatment 3.9 years after recruitment into NOAR.

The most common first biologic agent used in the earlier cohort of patients was infliximab (44%) with etanercept, adalimumab, and rituximab being used in 34%, 19%, and 3% of patients, which reflected the timing of their introduction into U.K. clinical practice. Patients who were recruited later were more likely to receive adalimumab (51%), followed by etanercept (27%) and infliximab (22%).

Patients in both groups had used at least three nonbiologic DMARDs before starting biologic treatment, and around half to two-thirds of patients had also used steroids.

"In both cohorts, ACPA positivity at baseline was the strongest baseline predictor" for receiving biologic therapy, Dr. Verstappen reported. Hazard ratios were 7.58 and 4.66 for the pre- and postbiologic-era groups, respectively.

Patients with two alleles of the shared epitope were also more likely to start biologic therapy early (HR, 3.42 and 3.25 for the pre- and postbiologic-era groups, respectively).

In the postbiologic-era group, younger age was also associated with earlier biologic agent use, compared with older patients (HR, 0.97). Patients in this group were also more likely to receive biologic treatment if they had failed treatment with their first nonbiologic DMARD. (Failure was defined as either stopping the nonbiologic DMARD because of inefficacy or needing a second agent within the first 6 months of treatment.)

Baseline disease activity measures were not associated with the need to receive biologic therapy, although the study did not evaluate cumulative disease activity over time.

"If we identify patients who are ACPA positive and those who have failed their first nonbiologic DMARD very early on in the disease, we could perhaps fast-track them to biologic therapy and reduce long-term disability," Dr. Verstappen concluded.

NOAR is funded by Arthritis Research UK. Dr. Verstappen stated that she had no conflicts of interest.

BRIGHTON, ENGLAND – Multiple factors predict whether patients with inflammatory polyarthritis will require treatment with a biologic agent, according to new data from the Norfolk Arthritis Register.

Indeed, younger age, ACPA (anti–citrullinated protein/peptide antibody) positivity, and inefficacy of the first nonbiologic disease-modifying antirheumatic drug, (DMARD) within the first 6 months were associated with a higher chance of requiring biologic treatment with an anti–tumor necrosis factor (TNF) drug or rituximab (Rheumatology [Oxford] 2011;50 [suppl. 3];iii37-9, abstract OP16).

However, none of these baseline predictors is included in the National Institute for Health and Clinical Excellence (NICE) guidelines for prescribing biologic therapy," said Dr. Suzanne Verstappen, who presented the findings at the annual meeting of the British Society for Rheumatology.

More than 800 patients who were enrolled in the Norfolk Arthritis Register (NOAR), a primary care–based inception cohort, were studied, reported Dr. Verstappen, a research fellow at the Arthritis Research UK Epidemiology Unit at the University of Manchester (England). Two groups of patients were identified: those who were recruited in the prebiologic era of 1990-1994 (n = 407), and those who were recruited in 2000-2004 (n = 416), after biologic agents had become widely available in the United Kingdom.

For inclusion in the analysis, all patients had to have at least two swollen joints for 4 or more consecutive weeks. They also had to have symptom duration of less than 24 months, failure to respond to at least one nonbiologic DMARD, and 1 year or more of available follow-up data.

At baseline, the mean age of patients was 53 years in the prebiologic cohort and 57 years in the postbiologic cohort, with women accounting for about 63% of the overall study population. The average symptom duration was 5.4 and 6.7 months, respectively, and the prebiologic-era group had more swollen (seven vs. three) and tender (seven vs. three) joints than did the postbiologic-era group. DAS28 (disease activity score based on a 28-joint count) assessments were also higher at baseline in the prebiologic-era group, compared with postbiologic-era patients (4.5 vs. 3.7), although their use of nonbiologic DMARDs was lower at baseline (34% vs. 65%).

At follow-up, a higher percentage of patients in the 2000-2004 cohort had started to use a biologic agent (10.8% vs. 7.9% for the 1990-1994 cohort). As would be expected, the time before starting a biologic agent for the first time was longer (almost 12 years) for those who were recruited before these agents became available; the later cohort of patients received biologic treatment 3.9 years after recruitment into NOAR.

The most common first biologic agent used in the earlier cohort of patients was infliximab (44%) with etanercept, adalimumab, and rituximab being used in 34%, 19%, and 3% of patients, which reflected the timing of their introduction into U.K. clinical practice. Patients who were recruited later were more likely to receive adalimumab (51%), followed by etanercept (27%) and infliximab (22%).

Patients in both groups had used at least three nonbiologic DMARDs before starting biologic treatment, and around half to two-thirds of patients had also used steroids.

"In both cohorts, ACPA positivity at baseline was the strongest baseline predictor" for receiving biologic therapy, Dr. Verstappen reported. Hazard ratios were 7.58 and 4.66 for the pre- and postbiologic-era groups, respectively.

Patients with two alleles of the shared epitope were also more likely to start biologic therapy early (HR, 3.42 and 3.25 for the pre- and postbiologic-era groups, respectively).

In the postbiologic-era group, younger age was also associated with earlier biologic agent use, compared with older patients (HR, 0.97). Patients in this group were also more likely to receive biologic treatment if they had failed treatment with their first nonbiologic DMARD. (Failure was defined as either stopping the nonbiologic DMARD because of inefficacy or needing a second agent within the first 6 months of treatment.)

Baseline disease activity measures were not associated with the need to receive biologic therapy, although the study did not evaluate cumulative disease activity over time.

"If we identify patients who are ACPA positive and those who have failed their first nonbiologic DMARD very early on in the disease, we could perhaps fast-track them to biologic therapy and reduce long-term disability," Dr. Verstappen concluded.

NOAR is funded by Arthritis Research UK. Dr. Verstappen stated that she had no conflicts of interest.

BRIGHTON, ENGLAND – Multiple factors predict whether patients with inflammatory polyarthritis will require treatment with a biologic agent, according to new data from the Norfolk Arthritis Register.

Indeed, younger age, ACPA (anti–citrullinated protein/peptide antibody) positivity, and inefficacy of the first nonbiologic disease-modifying antirheumatic drug, (DMARD) within the first 6 months were associated with a higher chance of requiring biologic treatment with an anti–tumor necrosis factor (TNF) drug or rituximab (Rheumatology [Oxford] 2011;50 [suppl. 3];iii37-9, abstract OP16).

However, none of these baseline predictors is included in the National Institute for Health and Clinical Excellence (NICE) guidelines for prescribing biologic therapy," said Dr. Suzanne Verstappen, who presented the findings at the annual meeting of the British Society for Rheumatology.

More than 800 patients who were enrolled in the Norfolk Arthritis Register (NOAR), a primary care–based inception cohort, were studied, reported Dr. Verstappen, a research fellow at the Arthritis Research UK Epidemiology Unit at the University of Manchester (England). Two groups of patients were identified: those who were recruited in the prebiologic era of 1990-1994 (n = 407), and those who were recruited in 2000-2004 (n = 416), after biologic agents had become widely available in the United Kingdom.

For inclusion in the analysis, all patients had to have at least two swollen joints for 4 or more consecutive weeks. They also had to have symptom duration of less than 24 months, failure to respond to at least one nonbiologic DMARD, and 1 year or more of available follow-up data.

At baseline, the mean age of patients was 53 years in the prebiologic cohort and 57 years in the postbiologic cohort, with women accounting for about 63% of the overall study population. The average symptom duration was 5.4 and 6.7 months, respectively, and the prebiologic-era group had more swollen (seven vs. three) and tender (seven vs. three) joints than did the postbiologic-era group. DAS28 (disease activity score based on a 28-joint count) assessments were also higher at baseline in the prebiologic-era group, compared with postbiologic-era patients (4.5 vs. 3.7), although their use of nonbiologic DMARDs was lower at baseline (34% vs. 65%).

At follow-up, a higher percentage of patients in the 2000-2004 cohort had started to use a biologic agent (10.8% vs. 7.9% for the 1990-1994 cohort). As would be expected, the time before starting a biologic agent for the first time was longer (almost 12 years) for those who were recruited before these agents became available; the later cohort of patients received biologic treatment 3.9 years after recruitment into NOAR.

The most common first biologic agent used in the earlier cohort of patients was infliximab (44%) with etanercept, adalimumab, and rituximab being used in 34%, 19%, and 3% of patients, which reflected the timing of their introduction into U.K. clinical practice. Patients who were recruited later were more likely to receive adalimumab (51%), followed by etanercept (27%) and infliximab (22%).

Patients in both groups had used at least three nonbiologic DMARDs before starting biologic treatment, and around half to two-thirds of patients had also used steroids.

"In both cohorts, ACPA positivity at baseline was the strongest baseline predictor" for receiving biologic therapy, Dr. Verstappen reported. Hazard ratios were 7.58 and 4.66 for the pre- and postbiologic-era groups, respectively.

Patients with two alleles of the shared epitope were also more likely to start biologic therapy early (HR, 3.42 and 3.25 for the pre- and postbiologic-era groups, respectively).

In the postbiologic-era group, younger age was also associated with earlier biologic agent use, compared with older patients (HR, 0.97). Patients in this group were also more likely to receive biologic treatment if they had failed treatment with their first nonbiologic DMARD. (Failure was defined as either stopping the nonbiologic DMARD because of inefficacy or needing a second agent within the first 6 months of treatment.)

Baseline disease activity measures were not associated with the need to receive biologic therapy, although the study did not evaluate cumulative disease activity over time.

"If we identify patients who are ACPA positive and those who have failed their first nonbiologic DMARD very early on in the disease, we could perhaps fast-track them to biologic therapy and reduce long-term disability," Dr. Verstappen concluded.

NOAR is funded by Arthritis Research UK. Dr. Verstappen stated that she had no conflicts of interest.