Sara Freeman

Major Finding: At week 52 in the IMPACT study, when all psoriatic arthritis patients were being treated with infliximab, 42% of patients achieved MDA; 96% of those who had achieved MDA had no signs of radiologic progression, vs. 67% of those who did not achieve MDA. In the IMPACT II study, comparing the 40% of patients who were in MDA at week 52 with those who were not showed that 78% and 57% showed no signs of radiologic progression.

Data Source: IMPACT study data for 63 patients with psoriatic arthritis and IMPACT II data for 157 similar patients. Both studies compared infliximab and placebo.

Disclosures: Arthritis Research UK funded the study. Dr. Coates said she has received speaker fees from Centocor/Schering-Plough.

BIRMINGHAM, ENGLAND — Radiologic damage is reduced in patients with psoriatic arthritis that is treated with anti–tumor necrosis factor if they meet new minimal disease activity criteria, according to Dr. Laura C. Coates.

This first, and only, composite measure developed for psoriatic arthritis could potentially be used as an objective target or outcome measure in clinical trials, Dr. Coates said at the meeting.

“Minimal disease activity is a concept that has been defined by the Outcome Measures in Rheumatoid Arthritis Clinical Trials group as a state of disease activity deemed a useful target of treatment by both the patient and physician, given current treatment possibilities and limitations,” explained Dr. Coates of the University of Leeds (England).

Dr. Coates and her associates have recently developed minimal disease activity (MDA) criteria for psoriatic arthritis using data on 40 patients with the disease and the expert opinions of 60 rheumatologists and dermatologists (Ann. Rheum. Dis. 2010;69:48-53).

For a patient to achieve MDA, five of the following seven criteria must be met:

▸ A tender joint count less than or equal to one.

▸ A swollen joint count less than or equal to one.

▸ A Psoriasis Area and Severity Index score less than or equal to 1 or a body surface area less than or equal to 3.

▸ A patient pain visual analog score (VAS) less than or equal to 15.

▸ A patient global activity VAS less than or equal to 20.

▸ A Heath Assessment Questionnaire score less than or equal to 0.5.

▸ A tender entheseal points count less than one.

Prior studies have shown that one-third of Canadian patients with psoriatic arthritis can consistently meet the new MDA criteria for more than 1 year, and that when they do, there is a lower rate of joint damage assessed using a clinical scoring system.

Dr. Coates presented the findings of a study that is now looking at the effects of achieving MDA on radiologic outcomes. Data on 220 patients in the IMPACT [Infliximab Multinational Psoriatic Arthritis Clinical Trial] and IMPACT II trials of infliximab therapy vs. placebo were used. Patients in these trials had active psoriatic arthritis and had failed treatment with at least one disease-modifying antirheumatic drug or NSAID. Radiologic progression in the hands and feet was found to be significantly less in patients who achieved MDA with infliximab therapy.

Looking at the data from the original IMPACT trial (n = 63), investigators found that 48% of patients treated with infliximab achieved MDA, compared with 3% of placebo patients (P less than .0001). At week 52, by which time all patients were being treated with the anti-TNF agent, 42% of patients achieved MDA, the majority (96%) of whom had no signs of radiologic progression, compared with two-thirds (67%) of those who did not achieve MDA (P = .012). After 104 weeks of follow-up, 30% were in MDA. None of those who achieved MDA had signs of radiologic progression, compared with 58% of those who did not achieve MDA.

In IMPACT II (n =157), 52% of infliximab patients and 21% of placebo patients achieved MDA after 24 weeks of study (P = .001). At 1 year, when all patients were receiving infliximab, 40% of patients were in MDA. Again, comparing the patients who were in MDA at week 52 with those who were not showed that 78% and 57% showed no signs of radiologic progression (P = .009).

“Around 40%-50% of patients with psoriatic arthritis can achieve MDA” with anti-TNF therapy, Dr. Coates said. She noted that the placebo response was low and that patients who achieve MDA “are more likely to halt their radiographic progression.”

A limitation of the study was that little radiographic progression occurred in the cohort of patients studied.

“This is the only composite disease activity measure that has been developed for psoriatic arthritis to date,” Dr. Coates said. “It encompasses measures of joint disease, skin disease, entheses, and patient-related outcomes, so it really does cover a wide variety of psoriatic disease.”

One of the advantages of using the measure, Dr. Coates noted, is that it can be used “cross-sectionally” and on any day to determine whether MDA is achieved. Furthermore, it confirms a satisfactory level of disease activity, not just a response to treatment, as the current American College of Rheumatology or Psoriatic Arthritis Response Criteria do.

The x-ray shows distal phalangeal joint damage from psoriatic arthritis.

Source © 2010 National Medical Slide Bank/Custom Medical Stock Photo, All Rights Reserved

Major Finding: At week 52 in the IMPACT study, when all psoriatic arthritis patients were being treated with infliximab, 42% of patients achieved MDA; 96% of those who had achieved MDA had no signs of radiologic progression, vs. 67% of those who did not achieve MDA. In the IMPACT II study, comparing the 40% of patients who were in MDA at week 52 with those who were not showed that 78% and 57% showed no signs of radiologic progression.

Data Source: IMPACT study data for 63 patients with psoriatic arthritis and IMPACT II data for 157 similar patients. Both studies compared infliximab and placebo.

Disclosures: Arthritis Research UK funded the study. Dr. Coates said she has received speaker fees from Centocor/Schering-Plough.

BIRMINGHAM, ENGLAND — Radiologic damage is reduced in patients with psoriatic arthritis that is treated with anti–tumor necrosis factor if they meet new minimal disease activity criteria, according to Dr. Laura C. Coates.

This first, and only, composite measure developed for psoriatic arthritis could potentially be used as an objective target or outcome measure in clinical trials, Dr. Coates said at the meeting.

“Minimal disease activity is a concept that has been defined by the Outcome Measures in Rheumatoid Arthritis Clinical Trials group as a state of disease activity deemed a useful target of treatment by both the patient and physician, given current treatment possibilities and limitations,” explained Dr. Coates of the University of Leeds (England).

Dr. Coates and her associates have recently developed minimal disease activity (MDA) criteria for psoriatic arthritis using data on 40 patients with the disease and the expert opinions of 60 rheumatologists and dermatologists (Ann. Rheum. Dis. 2010;69:48-53).

For a patient to achieve MDA, five of the following seven criteria must be met:

▸ A tender joint count less than or equal to one.

▸ A swollen joint count less than or equal to one.

▸ A Psoriasis Area and Severity Index score less than or equal to 1 or a body surface area less than or equal to 3.

▸ A patient pain visual analog score (VAS) less than or equal to 15.

▸ A patient global activity VAS less than or equal to 20.

▸ A Heath Assessment Questionnaire score less than or equal to 0.5.

▸ A tender entheseal points count less than one.

Prior studies have shown that one-third of Canadian patients with psoriatic arthritis can consistently meet the new MDA criteria for more than 1 year, and that when they do, there is a lower rate of joint damage assessed using a clinical scoring system.

Dr. Coates presented the findings of a study that is now looking at the effects of achieving MDA on radiologic outcomes. Data on 220 patients in the IMPACT [Infliximab Multinational Psoriatic Arthritis Clinical Trial] and IMPACT II trials of infliximab therapy vs. placebo were used. Patients in these trials had active psoriatic arthritis and had failed treatment with at least one disease-modifying antirheumatic drug or NSAID. Radiologic progression in the hands and feet was found to be significantly less in patients who achieved MDA with infliximab therapy.

Looking at the data from the original IMPACT trial (n = 63), investigators found that 48% of patients treated with infliximab achieved MDA, compared with 3% of placebo patients (P less than .0001). At week 52, by which time all patients were being treated with the anti-TNF agent, 42% of patients achieved MDA, the majority (96%) of whom had no signs of radiologic progression, compared with two-thirds (67%) of those who did not achieve MDA (P = .012). After 104 weeks of follow-up, 30% were in MDA. None of those who achieved MDA had signs of radiologic progression, compared with 58% of those who did not achieve MDA.

In IMPACT II (n =157), 52% of infliximab patients and 21% of placebo patients achieved MDA after 24 weeks of study (P = .001). At 1 year, when all patients were receiving infliximab, 40% of patients were in MDA. Again, comparing the patients who were in MDA at week 52 with those who were not showed that 78% and 57% showed no signs of radiologic progression (P = .009).

“Around 40%-50% of patients with psoriatic arthritis can achieve MDA” with anti-TNF therapy, Dr. Coates said. She noted that the placebo response was low and that patients who achieve MDA “are more likely to halt their radiographic progression.”

A limitation of the study was that little radiographic progression occurred in the cohort of patients studied.

“This is the only composite disease activity measure that has been developed for psoriatic arthritis to date,” Dr. Coates said. “It encompasses measures of joint disease, skin disease, entheses, and patient-related outcomes, so it really does cover a wide variety of psoriatic disease.”

One of the advantages of using the measure, Dr. Coates noted, is that it can be used “cross-sectionally” and on any day to determine whether MDA is achieved. Furthermore, it confirms a satisfactory level of disease activity, not just a response to treatment, as the current American College of Rheumatology or Psoriatic Arthritis Response Criteria do.

The x-ray shows distal phalangeal joint damage from psoriatic arthritis.

Source © 2010 National Medical Slide Bank/Custom Medical Stock Photo, All Rights Reserved

Major Finding: At week 52 in the IMPACT study, when all psoriatic arthritis patients were being treated with infliximab, 42% of patients achieved MDA; 96% of those who had achieved MDA had no signs of radiologic progression, vs. 67% of those who did not achieve MDA. In the IMPACT II study, comparing the 40% of patients who were in MDA at week 52 with those who were not showed that 78% and 57% showed no signs of radiologic progression.

Data Source: IMPACT study data for 63 patients with psoriatic arthritis and IMPACT II data for 157 similar patients. Both studies compared infliximab and placebo.

Disclosures: Arthritis Research UK funded the study. Dr. Coates said she has received speaker fees from Centocor/Schering-Plough.

BIRMINGHAM, ENGLAND — Radiologic damage is reduced in patients with psoriatic arthritis that is treated with anti–tumor necrosis factor if they meet new minimal disease activity criteria, according to Dr. Laura C. Coates.

This first, and only, composite measure developed for psoriatic arthritis could potentially be used as an objective target or outcome measure in clinical trials, Dr. Coates said at the meeting.

“Minimal disease activity is a concept that has been defined by the Outcome Measures in Rheumatoid Arthritis Clinical Trials group as a state of disease activity deemed a useful target of treatment by both the patient and physician, given current treatment possibilities and limitations,” explained Dr. Coates of the University of Leeds (England).

Dr. Coates and her associates have recently developed minimal disease activity (MDA) criteria for psoriatic arthritis using data on 40 patients with the disease and the expert opinions of 60 rheumatologists and dermatologists (Ann. Rheum. Dis. 2010;69:48-53).

For a patient to achieve MDA, five of the following seven criteria must be met:

▸ A tender joint count less than or equal to one.

▸ A swollen joint count less than or equal to one.

▸ A Psoriasis Area and Severity Index score less than or equal to 1 or a body surface area less than or equal to 3.

▸ A patient pain visual analog score (VAS) less than or equal to 15.

▸ A patient global activity VAS less than or equal to 20.

▸ A Heath Assessment Questionnaire score less than or equal to 0.5.

▸ A tender entheseal points count less than one.

Prior studies have shown that one-third of Canadian patients with psoriatic arthritis can consistently meet the new MDA criteria for more than 1 year, and that when they do, there is a lower rate of joint damage assessed using a clinical scoring system.

Dr. Coates presented the findings of a study that is now looking at the effects of achieving MDA on radiologic outcomes. Data on 220 patients in the IMPACT [Infliximab Multinational Psoriatic Arthritis Clinical Trial] and IMPACT II trials of infliximab therapy vs. placebo were used. Patients in these trials had active psoriatic arthritis and had failed treatment with at least one disease-modifying antirheumatic drug or NSAID. Radiologic progression in the hands and feet was found to be significantly less in patients who achieved MDA with infliximab therapy.

Looking at the data from the original IMPACT trial (n = 63), investigators found that 48% of patients treated with infliximab achieved MDA, compared with 3% of placebo patients (P less than .0001). At week 52, by which time all patients were being treated with the anti-TNF agent, 42% of patients achieved MDA, the majority (96%) of whom had no signs of radiologic progression, compared with two-thirds (67%) of those who did not achieve MDA (P = .012). After 104 weeks of follow-up, 30% were in MDA. None of those who achieved MDA had signs of radiologic progression, compared with 58% of those who did not achieve MDA.

In IMPACT II (n =157), 52% of infliximab patients and 21% of placebo patients achieved MDA after 24 weeks of study (P = .001). At 1 year, when all patients were receiving infliximab, 40% of patients were in MDA. Again, comparing the patients who were in MDA at week 52 with those who were not showed that 78% and 57% showed no signs of radiologic progression (P = .009).

“Around 40%-50% of patients with psoriatic arthritis can achieve MDA” with anti-TNF therapy, Dr. Coates said. She noted that the placebo response was low and that patients who achieve MDA “are more likely to halt their radiographic progression.”

A limitation of the study was that little radiographic progression occurred in the cohort of patients studied.

“This is the only composite disease activity measure that has been developed for psoriatic arthritis to date,” Dr. Coates said. “It encompasses measures of joint disease, skin disease, entheses, and patient-related outcomes, so it really does cover a wide variety of psoriatic disease.”

One of the advantages of using the measure, Dr. Coates noted, is that it can be used “cross-sectionally” and on any day to determine whether MDA is achieved. Furthermore, it confirms a satisfactory level of disease activity, not just a response to treatment, as the current American College of Rheumatology or Psoriatic Arthritis Response Criteria do.

The x-ray shows distal phalangeal joint damage from psoriatic arthritis.

Source © 2010 National Medical Slide Bank/Custom Medical Stock Photo, All Rights Reserved

Major Finding: For every 10-year increase in age, the chance of a patient with RA receiving more intensive treatment reduces by approximately 22%.

Data Source: Repeat cross-sectional study of 290 patients with RA.

Disclosures: Dr. Ma and Dr. Deighton declared no conflicts.

BIRMINGHAM, ENGLAND — Elderly patients with rheumatoid arthritis are treated less intensively than their younger counterparts, despite experiencing similar levels of disease activity.

Data from a cross-sectional study that was conducted at two centers in the United Kingdom show that for every 10-year increase in age, the chance of an RA patient's receiving more intensive treatment is reduced by approximately 22%.

“Unfortunately, the elderly population is not well represented in clinical studies,” said Dr. Margaret H.Y. Ma, a clinical research fellow at King's College Hospital in London.

“In routine clinical practice, we see a much larger proportion of elderly patients, and it is unclear currently how well we treat this population,” Dr. Ma said at the annual meeting of the British Society for Rheumatology.

The incidence and prevalence of RA increases with age, and it is in the elderly (aged 65 years and older) that disease-related disabilities usually have the greatest impact. Therefore, the aim of the study was to examine the effects of age and other variables on the treatment of RA.

Dr. Ma reported that the study, performed in 2009-2010 and involving 290 participants, was a repeat of a similar investigation that was performed in 2007-2008 and involved 236 people. The original and repeat cohorts of patients were similar in terms of age (58 and 59 years, respectively), sex (79% vs. 81% female), and ethnicity (70% vs. 72% white; 20% vs. 19% Afro-Caribbean). Treatment plans also were similar between the cohorts (80% vs. 81% taking disease-modifying antirheumatic drugs [DMARDs]; 11% vs. 11% taking steroids; 15% vs. 17% taking biologics). Patients in the repeat study, however, were more likely to have longer disease duration (10 years vs. 8.3 years) as well as a lower 28-joint disease activity score, or DAS28 (4.1 vs. 3.78), than did those who took part in the original study.

Both studies showed that there was a significant effect of age and disease activity on the chances that patients would be given more intensive therapy. While older patients were less likely to receive treatment increases (odds ratio, 0.83 in the original study and 0.82 in the repeat study), higher disease activity was associated with more intensive therapy (OR, 2.15 and 2.39, respectively).

Adjustment for possible confounding factors revealed that age and disease activity were the only determinants of treatment changes.

In the 2009-2010 cohort, the percentage of patients aged 65 years and older on DMARDs, steroids, and biologics was 77%, 11%, and 11%, whereas the percentage of those younger than 65 years who took these drugs was 83%, 19%, and 19%. When investigators compared patients aged 65 years or older vs. those younger than 65 years, they found that there were no differences in disease activity, with both age groups exhibiting a similar spectrum of disease activity in both the original and repeat studies. However, for the same DAS28, elderly patients were less likely than younger patients to receive an increase in therapy if they had more moderate disease, Dr. Ma reported.

Physicians treat very active disease more aggressively, Dr. Chris Deighton, consultant rheumatologist at the Derbyshire Royal Infirmary, Derby, England, commented. “If they have moderate disease, then there is probably more of a negotiation that takes place” between the patient and physician, he said.

Major Finding: For every 10-year increase in age, the chance of a patient with RA receiving more intensive treatment reduces by approximately 22%.

Data Source: Repeat cross-sectional study of 290 patients with RA.

Disclosures: Dr. Ma and Dr. Deighton declared no conflicts.

BIRMINGHAM, ENGLAND — Elderly patients with rheumatoid arthritis are treated less intensively than their younger counterparts, despite experiencing similar levels of disease activity.

Data from a cross-sectional study that was conducted at two centers in the United Kingdom show that for every 10-year increase in age, the chance of an RA patient's receiving more intensive treatment is reduced by approximately 22%.

“Unfortunately, the elderly population is not well represented in clinical studies,” said Dr. Margaret H.Y. Ma, a clinical research fellow at King's College Hospital in London.

“In routine clinical practice, we see a much larger proportion of elderly patients, and it is unclear currently how well we treat this population,” Dr. Ma said at the annual meeting of the British Society for Rheumatology.

The incidence and prevalence of RA increases with age, and it is in the elderly (aged 65 years and older) that disease-related disabilities usually have the greatest impact. Therefore, the aim of the study was to examine the effects of age and other variables on the treatment of RA.

Dr. Ma reported that the study, performed in 2009-2010 and involving 290 participants, was a repeat of a similar investigation that was performed in 2007-2008 and involved 236 people. The original and repeat cohorts of patients were similar in terms of age (58 and 59 years, respectively), sex (79% vs. 81% female), and ethnicity (70% vs. 72% white; 20% vs. 19% Afro-Caribbean). Treatment plans also were similar between the cohorts (80% vs. 81% taking disease-modifying antirheumatic drugs [DMARDs]; 11% vs. 11% taking steroids; 15% vs. 17% taking biologics). Patients in the repeat study, however, were more likely to have longer disease duration (10 years vs. 8.3 years) as well as a lower 28-joint disease activity score, or DAS28 (4.1 vs. 3.78), than did those who took part in the original study.

Both studies showed that there was a significant effect of age and disease activity on the chances that patients would be given more intensive therapy. While older patients were less likely to receive treatment increases (odds ratio, 0.83 in the original study and 0.82 in the repeat study), higher disease activity was associated with more intensive therapy (OR, 2.15 and 2.39, respectively).

Adjustment for possible confounding factors revealed that age and disease activity were the only determinants of treatment changes.

In the 2009-2010 cohort, the percentage of patients aged 65 years and older on DMARDs, steroids, and biologics was 77%, 11%, and 11%, whereas the percentage of those younger than 65 years who took these drugs was 83%, 19%, and 19%. When investigators compared patients aged 65 years or older vs. those younger than 65 years, they found that there were no differences in disease activity, with both age groups exhibiting a similar spectrum of disease activity in both the original and repeat studies. However, for the same DAS28, elderly patients were less likely than younger patients to receive an increase in therapy if they had more moderate disease, Dr. Ma reported.

Physicians treat very active disease more aggressively, Dr. Chris Deighton, consultant rheumatologist at the Derbyshire Royal Infirmary, Derby, England, commented. “If they have moderate disease, then there is probably more of a negotiation that takes place” between the patient and physician, he said.

Major Finding: For every 10-year increase in age, the chance of a patient with RA receiving more intensive treatment reduces by approximately 22%.

Data Source: Repeat cross-sectional study of 290 patients with RA.

Disclosures: Dr. Ma and Dr. Deighton declared no conflicts.

BIRMINGHAM, ENGLAND — Elderly patients with rheumatoid arthritis are treated less intensively than their younger counterparts, despite experiencing similar levels of disease activity.

Data from a cross-sectional study that was conducted at two centers in the United Kingdom show that for every 10-year increase in age, the chance of an RA patient's receiving more intensive treatment is reduced by approximately 22%.

“Unfortunately, the elderly population is not well represented in clinical studies,” said Dr. Margaret H.Y. Ma, a clinical research fellow at King's College Hospital in London.

“In routine clinical practice, we see a much larger proportion of elderly patients, and it is unclear currently how well we treat this population,” Dr. Ma said at the annual meeting of the British Society for Rheumatology.

The incidence and prevalence of RA increases with age, and it is in the elderly (aged 65 years and older) that disease-related disabilities usually have the greatest impact. Therefore, the aim of the study was to examine the effects of age and other variables on the treatment of RA.

Dr. Ma reported that the study, performed in 2009-2010 and involving 290 participants, was a repeat of a similar investigation that was performed in 2007-2008 and involved 236 people. The original and repeat cohorts of patients were similar in terms of age (58 and 59 years, respectively), sex (79% vs. 81% female), and ethnicity (70% vs. 72% white; 20% vs. 19% Afro-Caribbean). Treatment plans also were similar between the cohorts (80% vs. 81% taking disease-modifying antirheumatic drugs [DMARDs]; 11% vs. 11% taking steroids; 15% vs. 17% taking biologics). Patients in the repeat study, however, were more likely to have longer disease duration (10 years vs. 8.3 years) as well as a lower 28-joint disease activity score, or DAS28 (4.1 vs. 3.78), than did those who took part in the original study.

Both studies showed that there was a significant effect of age and disease activity on the chances that patients would be given more intensive therapy. While older patients were less likely to receive treatment increases (odds ratio, 0.83 in the original study and 0.82 in the repeat study), higher disease activity was associated with more intensive therapy (OR, 2.15 and 2.39, respectively).

Adjustment for possible confounding factors revealed that age and disease activity were the only determinants of treatment changes.

In the 2009-2010 cohort, the percentage of patients aged 65 years and older on DMARDs, steroids, and biologics was 77%, 11%, and 11%, whereas the percentage of those younger than 65 years who took these drugs was 83%, 19%, and 19%. When investigators compared patients aged 65 years or older vs. those younger than 65 years, they found that there were no differences in disease activity, with both age groups exhibiting a similar spectrum of disease activity in both the original and repeat studies. However, for the same DAS28, elderly patients were less likely than younger patients to receive an increase in therapy if they had more moderate disease, Dr. Ma reported.

Physicians treat very active disease more aggressively, Dr. Chris Deighton, consultant rheumatologist at the Derbyshire Royal Infirmary, Derby, England, commented. “If they have moderate disease, then there is probably more of a negotiation that takes place” between the patient and physician, he said.

BIRMINGHAM, ENGLAND — Two-thirds of rheumatoid arthritis patients in the United Kingdom do not receive any foot care, despite a high prevalence of foot pathology known to be associated with the disease, according to new study findings.

Conservative foot treatment is often bypassed, with many patients going straight to surgery if foot problem develops, judging from data from the Early Rheumatoid Arthritis Study (ERAS), which has been collecting data since 1987 and now has over 9 years of follow-up data available.

“This is the largest study to date to look at patients with rheumatoid arthritis and conservative foot care and foot surgery on a national level,” said Michael R. Backhouse, a doctoral student in musculoskeletal disease at the University of Leeds (England).

“The striking finding that two-thirds of patients did not receive any foot care is unfortunately consistent with previously described suboptimal service provision across the country,” he reported.

Foot pathology is estimated to occur in up to 90% of RA patients (Foot Ankle Int. 1994;15:608-13; Acta Orthop. 2008;79:257-61), with about 10% developing foot ulcers (Arthritis Rheum. 2008;15;59:200-5) and almost half unable to perform basic foot care themselves (Musculoskeletal Care. 2009;7:57-65). Few data exist on the value of conservative and surgical foot interventions, however, with little randomized, controlled trial evidence.

Using data from the ERAS inception cohort, Mr. Backhouse and associates aimed to describe the use of foot care services and surgery in patients with early RA.

The mean age of the 1,237 patients they studied was 54 years at the onset of disease, with a median disease activity score of 4.09, and with 82% ever identified as being rheumatoid factor positive.

Erosions were identified on x-ray in 79% of patients, with 34% showing evidence of rheumatoid nodules.

Follow-up data were available for all recruited patients at 3 years, for 1,123 patients (91%) at 5 years, and for 680 (55%) at 9 years.

Overall, only 36% (n = 444) of patients received foot care, of which the majority (82%) had consulted a podiatrist. The remainder had seen an orthotist or had surgery.

Within the first 9 years of follow-up, 54 foot operations were performed in 38 patients (3%). The time to surgery ranged from 7 months to 81 months, with a median of 51 months. Over half (n = 22) of the patients who received surgery, however, had never seen a podiatrist.

Over the more than 9 years of follow-up, 101 operations were performed on the feet of 71 patients (6%), with 47 patients having one operation, 19 patients having two procedures, 4 patients undergoing three surgeries, and 1 patient requiring four interventions.

The time to the first operation ranged from 7 months to 221 months, with a median time to surgery of 79 months. The location of surgery was the metatarsophalangeal joint in the majority of patients (67%), with the other locations being the soft tissue (24%), and ankle or hindfoot (9%).

More women than men accessed podiatry and surgical services, and younger patients were more likely than were older patients to undergo surgery instead of conservative therapy, “although there is no real justification for the latter,” Mr. Backhouse observed.

He noted that one limitation of the study was that patient recruitment began before the publication of the U.K. guidelines on RA treatment and before the routine use of biologic therapies. However, the timing also meant that there are now long-term data on the development of foot problems and their management in this RA population.

Disclosures: Arthritis Research UK and the Bupa Foundation funded the ERAS study. Mr. Backhouse had no conflicts of interest to declare.

Foot pathology is estimated to occur in up to 90% of patients with RA, with about 10% developing foot ulcers and close to half unable to care for their own feet.

Source © Joe_Potato/iStockphoto.com

BIRMINGHAM, ENGLAND — Two-thirds of rheumatoid arthritis patients in the United Kingdom do not receive any foot care, despite a high prevalence of foot pathology known to be associated with the disease, according to new study findings.

Conservative foot treatment is often bypassed, with many patients going straight to surgery if foot problem develops, judging from data from the Early Rheumatoid Arthritis Study (ERAS), which has been collecting data since 1987 and now has over 9 years of follow-up data available.

“This is the largest study to date to look at patients with rheumatoid arthritis and conservative foot care and foot surgery on a national level,” said Michael R. Backhouse, a doctoral student in musculoskeletal disease at the University of Leeds (England).

“The striking finding that two-thirds of patients did not receive any foot care is unfortunately consistent with previously described suboptimal service provision across the country,” he reported.

Foot pathology is estimated to occur in up to 90% of RA patients (Foot Ankle Int. 1994;15:608-13; Acta Orthop. 2008;79:257-61), with about 10% developing foot ulcers (Arthritis Rheum. 2008;15;59:200-5) and almost half unable to perform basic foot care themselves (Musculoskeletal Care. 2009;7:57-65). Few data exist on the value of conservative and surgical foot interventions, however, with little randomized, controlled trial evidence.

Using data from the ERAS inception cohort, Mr. Backhouse and associates aimed to describe the use of foot care services and surgery in patients with early RA.

The mean age of the 1,237 patients they studied was 54 years at the onset of disease, with a median disease activity score of 4.09, and with 82% ever identified as being rheumatoid factor positive.

Erosions were identified on x-ray in 79% of patients, with 34% showing evidence of rheumatoid nodules.

Follow-up data were available for all recruited patients at 3 years, for 1,123 patients (91%) at 5 years, and for 680 (55%) at 9 years.

Overall, only 36% (n = 444) of patients received foot care, of which the majority (82%) had consulted a podiatrist. The remainder had seen an orthotist or had surgery.

Within the first 9 years of follow-up, 54 foot operations were performed in 38 patients (3%). The time to surgery ranged from 7 months to 81 months, with a median of 51 months. Over half (n = 22) of the patients who received surgery, however, had never seen a podiatrist.

Over the more than 9 years of follow-up, 101 operations were performed on the feet of 71 patients (6%), with 47 patients having one operation, 19 patients having two procedures, 4 patients undergoing three surgeries, and 1 patient requiring four interventions.

The time to the first operation ranged from 7 months to 221 months, with a median time to surgery of 79 months. The location of surgery was the metatarsophalangeal joint in the majority of patients (67%), with the other locations being the soft tissue (24%), and ankle or hindfoot (9%).

More women than men accessed podiatry and surgical services, and younger patients were more likely than were older patients to undergo surgery instead of conservative therapy, “although there is no real justification for the latter,” Mr. Backhouse observed.

He noted that one limitation of the study was that patient recruitment began before the publication of the U.K. guidelines on RA treatment and before the routine use of biologic therapies. However, the timing also meant that there are now long-term data on the development of foot problems and their management in this RA population.

Disclosures: Arthritis Research UK and the Bupa Foundation funded the ERAS study. Mr. Backhouse had no conflicts of interest to declare.

Foot pathology is estimated to occur in up to 90% of patients with RA, with about 10% developing foot ulcers and close to half unable to care for their own feet.

Source © Joe_Potato/iStockphoto.com

BIRMINGHAM, ENGLAND — Two-thirds of rheumatoid arthritis patients in the United Kingdom do not receive any foot care, despite a high prevalence of foot pathology known to be associated with the disease, according to new study findings.

Conservative foot treatment is often bypassed, with many patients going straight to surgery if foot problem develops, judging from data from the Early Rheumatoid Arthritis Study (ERAS), which has been collecting data since 1987 and now has over 9 years of follow-up data available.

“This is the largest study to date to look at patients with rheumatoid arthritis and conservative foot care and foot surgery on a national level,” said Michael R. Backhouse, a doctoral student in musculoskeletal disease at the University of Leeds (England).

“The striking finding that two-thirds of patients did not receive any foot care is unfortunately consistent with previously described suboptimal service provision across the country,” he reported.

Foot pathology is estimated to occur in up to 90% of RA patients (Foot Ankle Int. 1994;15:608-13; Acta Orthop. 2008;79:257-61), with about 10% developing foot ulcers (Arthritis Rheum. 2008;15;59:200-5) and almost half unable to perform basic foot care themselves (Musculoskeletal Care. 2009;7:57-65). Few data exist on the value of conservative and surgical foot interventions, however, with little randomized, controlled trial evidence.

Using data from the ERAS inception cohort, Mr. Backhouse and associates aimed to describe the use of foot care services and surgery in patients with early RA.

The mean age of the 1,237 patients they studied was 54 years at the onset of disease, with a median disease activity score of 4.09, and with 82% ever identified as being rheumatoid factor positive.

Erosions were identified on x-ray in 79% of patients, with 34% showing evidence of rheumatoid nodules.

Follow-up data were available for all recruited patients at 3 years, for 1,123 patients (91%) at 5 years, and for 680 (55%) at 9 years.

Overall, only 36% (n = 444) of patients received foot care, of which the majority (82%) had consulted a podiatrist. The remainder had seen an orthotist or had surgery.

Within the first 9 years of follow-up, 54 foot operations were performed in 38 patients (3%). The time to surgery ranged from 7 months to 81 months, with a median of 51 months. Over half (n = 22) of the patients who received surgery, however, had never seen a podiatrist.

Over the more than 9 years of follow-up, 101 operations were performed on the feet of 71 patients (6%), with 47 patients having one operation, 19 patients having two procedures, 4 patients undergoing three surgeries, and 1 patient requiring four interventions.

The time to the first operation ranged from 7 months to 221 months, with a median time to surgery of 79 months. The location of surgery was the metatarsophalangeal joint in the majority of patients (67%), with the other locations being the soft tissue (24%), and ankle or hindfoot (9%).

More women than men accessed podiatry and surgical services, and younger patients were more likely than were older patients to undergo surgery instead of conservative therapy, “although there is no real justification for the latter,” Mr. Backhouse observed.

He noted that one limitation of the study was that patient recruitment began before the publication of the U.K. guidelines on RA treatment and before the routine use of biologic therapies. However, the timing also meant that there are now long-term data on the development of foot problems and their management in this RA population.

Disclosures: Arthritis Research UK and the Bupa Foundation funded the ERAS study. Mr. Backhouse had no conflicts of interest to declare.

Foot pathology is estimated to occur in up to 90% of patients with RA, with about 10% developing foot ulcers and close to half unable to care for their own feet.

Source © Joe_Potato/iStockphoto.com

BIRMINGHAM, ENGLAND — Foot and ankle pain affects more women than men after age 45 years, when osteoarthritis often manifests.

A systematic review of available literature from eight studies from around the world estimated that foot and ankle pain occurs in 15%-30% of women and 10%-20% of men.

It is not clear what proportion of people who have pain have OA, said Martin J. Thomas, a research physiotherapist at the Arthritis Research UK National Primary Care Centre of Keele (England) University.

Mr. Thomas added that the aim of this review was to establish the baseline prevalence of ankle pain in the community in order to have a point of comparison for future work on the prevalence of symptomatic foot and ankle OA.

“Foot pain and foot problems are very common in primary care,” said Dr. Edward Roddy, a consultant rheumatologist at the Haywood Hospital in Stoke-on-Trent, England, and part of the research team at Keele University.

Compared with other regional pain sites, such as the knee and hand, the foot has been studied less and “is just generally less well understood,” Dr. Roddy observed.

The researchers therefore plan to undertake a longitudinal study to better characterize the epidemiology of foot and ankle OA in primary care and determine the likely causes of foot pain.

Already, the team has discovered that foot pain is the most common reason for older adults to consult a general physician.

Dr. Roddy and associates looked at the reasons for musculoskeletal foot consultations in a primary care cohort of people older than 50 years.

They identified 5,706 people who were taking part in the North Staffordshire Osteoarthritis Project (NorStOP), a 3-year, population-based cohort study in which participants from three local general practices had first completed a general health survey.

Patients who reported experiencing any pain in the hands, hips, knees, or feet in the previous 12 months then completed a more specific survey about their regional pain, and their permission was sought for researchers to assess their medical records and to recontact them.

For the current analysis, the team looked at only those patients who reported foot pain or foot problems in the preceding 12 months.

After the exclusion of patients who had not actually consulted in the 18 months before being surveyed, there were 4,402 (71%) people who consented to allowing their medical records to be reviewed.

Linking the NorStOP data to an electronic consultations database revealed that 350 of 3,858 (9%) people in the general population cohort studied actually consulted for foot pain or problems after completing the regional pain survey, whereas 3,508 (91%) who had completed the survey did not subsequently consult.

Looking at the reasons why 9% of people consulted while the remainder who had completed the survey and reported foot pain or problems did not, the researchers found that experiencing foot pain was the most common reason for presenting to a primary care doctor for a musculoskeletal problem (odds ratio, 2.04).

Frequent consultations for other health problems was another significant predictor of consulting for foot pain or problems (OR, 1.65), as was the belief that treatments were effective in controlling disease (OR, 1.54).

“We've only looked at musculoskeletal consultations, so we may have underestimated consultations,” said Dr. Roddy. However, he conceded that the definition of foot pain used was very broad and that further research is needed.

Dr. Roddy said that the next challenge was to try to work out what exactly is causing the foot pain and whether this resulted from OA, another musculoskeletal condition, or perhaps another reason entirely.

The Keele researchers will be performing a study asking people who consult their primary care practitioner to not only complete a questionnaire about their foot problems, but also attend the hospital for clinical examination.

Disclosures: Arthritis Research UK provided financial support for the studies. Dr. Thomas and Dr. Roddy had no relevant financial disclosure or conflicts of interest.

BIRMINGHAM, ENGLAND — Foot and ankle pain affects more women than men after age 45 years, when osteoarthritis often manifests.

A systematic review of available literature from eight studies from around the world estimated that foot and ankle pain occurs in 15%-30% of women and 10%-20% of men.

It is not clear what proportion of people who have pain have OA, said Martin J. Thomas, a research physiotherapist at the Arthritis Research UK National Primary Care Centre of Keele (England) University.

Mr. Thomas added that the aim of this review was to establish the baseline prevalence of ankle pain in the community in order to have a point of comparison for future work on the prevalence of symptomatic foot and ankle OA.

“Foot pain and foot problems are very common in primary care,” said Dr. Edward Roddy, a consultant rheumatologist at the Haywood Hospital in Stoke-on-Trent, England, and part of the research team at Keele University.

Compared with other regional pain sites, such as the knee and hand, the foot has been studied less and “is just generally less well understood,” Dr. Roddy observed.

The researchers therefore plan to undertake a longitudinal study to better characterize the epidemiology of foot and ankle OA in primary care and determine the likely causes of foot pain.

Already, the team has discovered that foot pain is the most common reason for older adults to consult a general physician.

Dr. Roddy and associates looked at the reasons for musculoskeletal foot consultations in a primary care cohort of people older than 50 years.

They identified 5,706 people who were taking part in the North Staffordshire Osteoarthritis Project (NorStOP), a 3-year, population-based cohort study in which participants from three local general practices had first completed a general health survey.

Patients who reported experiencing any pain in the hands, hips, knees, or feet in the previous 12 months then completed a more specific survey about their regional pain, and their permission was sought for researchers to assess their medical records and to recontact them.

For the current analysis, the team looked at only those patients who reported foot pain or foot problems in the preceding 12 months.

After the exclusion of patients who had not actually consulted in the 18 months before being surveyed, there were 4,402 (71%) people who consented to allowing their medical records to be reviewed.

Linking the NorStOP data to an electronic consultations database revealed that 350 of 3,858 (9%) people in the general population cohort studied actually consulted for foot pain or problems after completing the regional pain survey, whereas 3,508 (91%) who had completed the survey did not subsequently consult.

Looking at the reasons why 9% of people consulted while the remainder who had completed the survey and reported foot pain or problems did not, the researchers found that experiencing foot pain was the most common reason for presenting to a primary care doctor for a musculoskeletal problem (odds ratio, 2.04).

Frequent consultations for other health problems was another significant predictor of consulting for foot pain or problems (OR, 1.65), as was the belief that treatments were effective in controlling disease (OR, 1.54).

“We've only looked at musculoskeletal consultations, so we may have underestimated consultations,” said Dr. Roddy. However, he conceded that the definition of foot pain used was very broad and that further research is needed.

Dr. Roddy said that the next challenge was to try to work out what exactly is causing the foot pain and whether this resulted from OA, another musculoskeletal condition, or perhaps another reason entirely.

The Keele researchers will be performing a study asking people who consult their primary care practitioner to not only complete a questionnaire about their foot problems, but also attend the hospital for clinical examination.

Disclosures: Arthritis Research UK provided financial support for the studies. Dr. Thomas and Dr. Roddy had no relevant financial disclosure or conflicts of interest.

BIRMINGHAM, ENGLAND — Foot and ankle pain affects more women than men after age 45 years, when osteoarthritis often manifests.

A systematic review of available literature from eight studies from around the world estimated that foot and ankle pain occurs in 15%-30% of women and 10%-20% of men.

It is not clear what proportion of people who have pain have OA, said Martin J. Thomas, a research physiotherapist at the Arthritis Research UK National Primary Care Centre of Keele (England) University.

Mr. Thomas added that the aim of this review was to establish the baseline prevalence of ankle pain in the community in order to have a point of comparison for future work on the prevalence of symptomatic foot and ankle OA.

“Foot pain and foot problems are very common in primary care,” said Dr. Edward Roddy, a consultant rheumatologist at the Haywood Hospital in Stoke-on-Trent, England, and part of the research team at Keele University.

Compared with other regional pain sites, such as the knee and hand, the foot has been studied less and “is just generally less well understood,” Dr. Roddy observed.

The researchers therefore plan to undertake a longitudinal study to better characterize the epidemiology of foot and ankle OA in primary care and determine the likely causes of foot pain.

Already, the team has discovered that foot pain is the most common reason for older adults to consult a general physician.

Dr. Roddy and associates looked at the reasons for musculoskeletal foot consultations in a primary care cohort of people older than 50 years.

They identified 5,706 people who were taking part in the North Staffordshire Osteoarthritis Project (NorStOP), a 3-year, population-based cohort study in which participants from three local general practices had first completed a general health survey.

Patients who reported experiencing any pain in the hands, hips, knees, or feet in the previous 12 months then completed a more specific survey about their regional pain, and their permission was sought for researchers to assess their medical records and to recontact them.

For the current analysis, the team looked at only those patients who reported foot pain or foot problems in the preceding 12 months.

After the exclusion of patients who had not actually consulted in the 18 months before being surveyed, there were 4,402 (71%) people who consented to allowing their medical records to be reviewed.

Linking the NorStOP data to an electronic consultations database revealed that 350 of 3,858 (9%) people in the general population cohort studied actually consulted for foot pain or problems after completing the regional pain survey, whereas 3,508 (91%) who had completed the survey did not subsequently consult.

Looking at the reasons why 9% of people consulted while the remainder who had completed the survey and reported foot pain or problems did not, the researchers found that experiencing foot pain was the most common reason for presenting to a primary care doctor for a musculoskeletal problem (odds ratio, 2.04).

Frequent consultations for other health problems was another significant predictor of consulting for foot pain or problems (OR, 1.65), as was the belief that treatments were effective in controlling disease (OR, 1.54).

“We've only looked at musculoskeletal consultations, so we may have underestimated consultations,” said Dr. Roddy. However, he conceded that the definition of foot pain used was very broad and that further research is needed.

Dr. Roddy said that the next challenge was to try to work out what exactly is causing the foot pain and whether this resulted from OA, another musculoskeletal condition, or perhaps another reason entirely.

The Keele researchers will be performing a study asking people who consult their primary care practitioner to not only complete a questionnaire about their foot problems, but also attend the hospital for clinical examination.

Disclosures: Arthritis Research UK provided financial support for the studies. Dr. Thomas and Dr. Roddy had no relevant financial disclosure or conflicts of interest.

BIRMINGHAM, ENGLAND — Young people and children with juvenile idiopathic arthritis need better and faster access to arthritis care services, according to the first standards-of-care document to be issued for the condition in the United Kingdom.

“Standards of Care for Children and Young People With Juvenile Idiopathic Arthritis,” developed by the U.K.-based Arthritis and Musculoskeletal Alliance (ARMA), was made public for the first time at the meeting.

Central to the standards is the need for a holistic treatment approach: not only managing disease activity, but also considering the impact that arthritis has on young patients' overall health, mental well-being, educational and employment prospects, and social integration.

“Rarely a day has gone by when I haven't been frustrated by the lack of service that I feel able to provide, and the knowledge that with the appropriate resources I could provide a much better experience for these young people,” said Dr. Karen Davies, a consultant pediatric rheumatologist at New Cross Hospital in Wolverhampton, England. “I think these standards of care are very timely.”

The document consists of 44 statements that are aimed at improving the care of young people with juvenile idiopathic arthritis (JIA). The first—and perhaps most important—standard states that all health care professionals who are likely to come into contact with a young person with JIA should have the necessary skills to recognize the condition.

“I was diagnosed with juvenile idiopathic arthritis in 1993, or JCA [juvenile chronic arthritis] as it was called then, when I was 11,” said Sally Watt, who was involved in developing the standards.

Despite having repeated fractures from about the age of 5 years, Ms. Watt said it took several years for her condition to be recognized as JIA. She repeatedly heard from primary care physicians that “kids don't get arthritis,” and “you're too young for arthritis.” She started to receive expert care only when her family eventually paid to see a rheumatologist.

“As I have got older, it has become very apparent that my life is very different” from that of friends, Ms. Watt said. Now 28 years old, she commented that one of the main problems she had with the health care system was obtaining information and getting access to available support services, which the standards of care also address.

“The aim of the standards-of-care document is to try to break down the barriers to prompt diagnosis,” said Dr. Penny Davis, cochair of the group that developed the recommendations.

Dr. Davis, a consultant pediatric rheumatologist at Birmingham (England) Children's Hospital, added that the standards also aimed “to ensure equitable access to holistic and multidisciplinary care, and to ensure that every child and young person has the most appropriate treatment.”

Ros Meek, director of ARMA, commented that “there's clearly an immense amount of work needed to take these standards of care forward. Their dissemination and implementation are what is going to make all the difference.”

Disclosures: Dr. Davies and Dr. Davis had no conflicts of interest. The standards of care project was managed by the Arthritis and Musculoskeletal Alliance, working with the British Society of Paediatric Rheumatology. The project received funding from an anonymous donor and an unrestricted educational grant from Wyeth Pharmaceuticals, a wholly owned subsidiary of Pfizer Inc.

BIRMINGHAM, ENGLAND — Young people and children with juvenile idiopathic arthritis need better and faster access to arthritis care services, according to the first standards-of-care document to be issued for the condition in the United Kingdom.

“Standards of Care for Children and Young People With Juvenile Idiopathic Arthritis,” developed by the U.K.-based Arthritis and Musculoskeletal Alliance (ARMA), was made public for the first time at the meeting.

Central to the standards is the need for a holistic treatment approach: not only managing disease activity, but also considering the impact that arthritis has on young patients' overall health, mental well-being, educational and employment prospects, and social integration.

“Rarely a day has gone by when I haven't been frustrated by the lack of service that I feel able to provide, and the knowledge that with the appropriate resources I could provide a much better experience for these young people,” said Dr. Karen Davies, a consultant pediatric rheumatologist at New Cross Hospital in Wolverhampton, England. “I think these standards of care are very timely.”

The document consists of 44 statements that are aimed at improving the care of young people with juvenile idiopathic arthritis (JIA). The first—and perhaps most important—standard states that all health care professionals who are likely to come into contact with a young person with JIA should have the necessary skills to recognize the condition.

“I was diagnosed with juvenile idiopathic arthritis in 1993, or JCA [juvenile chronic arthritis] as it was called then, when I was 11,” said Sally Watt, who was involved in developing the standards.

Despite having repeated fractures from about the age of 5 years, Ms. Watt said it took several years for her condition to be recognized as JIA. She repeatedly heard from primary care physicians that “kids don't get arthritis,” and “you're too young for arthritis.” She started to receive expert care only when her family eventually paid to see a rheumatologist.

“As I have got older, it has become very apparent that my life is very different” from that of friends, Ms. Watt said. Now 28 years old, she commented that one of the main problems she had with the health care system was obtaining information and getting access to available support services, which the standards of care also address.

“The aim of the standards-of-care document is to try to break down the barriers to prompt diagnosis,” said Dr. Penny Davis, cochair of the group that developed the recommendations.

Dr. Davis, a consultant pediatric rheumatologist at Birmingham (England) Children's Hospital, added that the standards also aimed “to ensure equitable access to holistic and multidisciplinary care, and to ensure that every child and young person has the most appropriate treatment.”

Ros Meek, director of ARMA, commented that “there's clearly an immense amount of work needed to take these standards of care forward. Their dissemination and implementation are what is going to make all the difference.”

Disclosures: Dr. Davies and Dr. Davis had no conflicts of interest. The standards of care project was managed by the Arthritis and Musculoskeletal Alliance, working with the British Society of Paediatric Rheumatology. The project received funding from an anonymous donor and an unrestricted educational grant from Wyeth Pharmaceuticals, a wholly owned subsidiary of Pfizer Inc.

BIRMINGHAM, ENGLAND — Young people and children with juvenile idiopathic arthritis need better and faster access to arthritis care services, according to the first standards-of-care document to be issued for the condition in the United Kingdom.

“Standards of Care for Children and Young People With Juvenile Idiopathic Arthritis,” developed by the U.K.-based Arthritis and Musculoskeletal Alliance (ARMA), was made public for the first time at the meeting.

Central to the standards is the need for a holistic treatment approach: not only managing disease activity, but also considering the impact that arthritis has on young patients' overall health, mental well-being, educational and employment prospects, and social integration.

“Rarely a day has gone by when I haven't been frustrated by the lack of service that I feel able to provide, and the knowledge that with the appropriate resources I could provide a much better experience for these young people,” said Dr. Karen Davies, a consultant pediatric rheumatologist at New Cross Hospital in Wolverhampton, England. “I think these standards of care are very timely.”

The document consists of 44 statements that are aimed at improving the care of young people with juvenile idiopathic arthritis (JIA). The first—and perhaps most important—standard states that all health care professionals who are likely to come into contact with a young person with JIA should have the necessary skills to recognize the condition.

“I was diagnosed with juvenile idiopathic arthritis in 1993, or JCA [juvenile chronic arthritis] as it was called then, when I was 11,” said Sally Watt, who was involved in developing the standards.

Despite having repeated fractures from about the age of 5 years, Ms. Watt said it took several years for her condition to be recognized as JIA. She repeatedly heard from primary care physicians that “kids don't get arthritis,” and “you're too young for arthritis.” She started to receive expert care only when her family eventually paid to see a rheumatologist.

“As I have got older, it has become very apparent that my life is very different” from that of friends, Ms. Watt said. Now 28 years old, she commented that one of the main problems she had with the health care system was obtaining information and getting access to available support services, which the standards of care also address.

“The aim of the standards-of-care document is to try to break down the barriers to prompt diagnosis,” said Dr. Penny Davis, cochair of the group that developed the recommendations.

Dr. Davis, a consultant pediatric rheumatologist at Birmingham (England) Children's Hospital, added that the standards also aimed “to ensure equitable access to holistic and multidisciplinary care, and to ensure that every child and young person has the most appropriate treatment.”

Ros Meek, director of ARMA, commented that “there's clearly an immense amount of work needed to take these standards of care forward. Their dissemination and implementation are what is going to make all the difference.”

Disclosures: Dr. Davies and Dr. Davis had no conflicts of interest. The standards of care project was managed by the Arthritis and Musculoskeletal Alliance, working with the British Society of Paediatric Rheumatology. The project received funding from an anonymous donor and an unrestricted educational grant from Wyeth Pharmaceuticals, a wholly owned subsidiary of Pfizer Inc.

BIRMINGHAM, ENGLAND — Musculoskeletal ultrasound of multiple small joints is more accurate than traditional clinical assessment at predicting patient outcomes in very early arthritis, judging from the results of a pilot investigation.

“We know that if we treat patients early they do better, not only in the short term but also in the long term,” said Dr. Andrew Filer.

“The trouble is, not all patients come through the door with a confirmed diagnosis of rheumatoid or psoriatic arthritis,” explained the senior lecturer at the University of Birmingham.

Dr. Filer reported the preliminary results of a prospective study assessing the use of the imaging method. Specifically, the ongoing study is designed to determine whether musculoskeletal ultrasound can help determine which patients with very early arthritis actually develop rheumatoid arthritis (RA) or related conditions.

For the study, the researchers recruited 58 patients who had inflammatory joint symptoms of 3 months or less duration and clinically apparent inflammation of at least one joint.

Half of the cohort (50%, 29) had rheumatoid arthritis, with 48% (14) having detectable anti-citrullinated peptide antibodies. Sixteen (27.6%) patients had resolving arthritis, which was mostly unclassified, and 13 (22.4%) patients had persistent conditions other than RA.

The non-RA group included five patients with psoriatic arthritis, one with reactive arthritis, and two with systemic lupus erythematous. Disease could not be classified in five patients.

Patients were assessed clinically before undergoing musculoskeletal ultrasound within 24 hours, and followed up prospectively for 18 months.

Baseline and follow-up clinical assessments included: 68 tender and 66 swollen joint counts; 28-joint disease activity score; serological data; and conventional radiography of the hands and feet.

An ultrasonographer, who was unaware of the clinical findings, systematically assessed a total of 50 joints using four-point semi-quantitative scales to note the presence of erosions.

Musculoskeletal ultrasound detected significantly more joint involvement than did clinical examination. It also detected more clinically silent involvement of the wrist, elbow, knee, ankle, and metatarsophalangeal (MTP) region.

Sensitivity and specificity analyses showed that ultrasound of the wrist, metacarpophalangeal (MCP) and MTP regions was the best predictor of joint involvement, improving upon clinical predictive models for RA.

Disclosures: Dr. Filer had no conflicts of interest in relation to the study. The study was funded by Arthritis Research UK and the AutoCure Consortium.

Dr. Andrew Filer (left) reported that ultrasound of the wrist, MTP and MCP regions was the best predictor of joint involvement.

Source Courtesy Dr. Andrew Filer

My Take

A Pattern of Early Changes Needs to Be Confirmed

The study provides an indication that systematic evaluation of joints by ultrasound in patients presenting with very early undifferentiated arthritis may be a useful predictor of future diagnosis of rheumatoid arthritis. Ultrasound may detect involvement in more joints than are detected on clinical examination, and it may detect early erosions with greater sensitivity than conventional radiography. Especially in patients who do not have anti-citrullinated peptide antibodies, the presence of poly-arthritis and erosions on ultrasound appears to herald an eventual diagnosis of RA even when patients who do not appear to have polyarthritis on clinical examination.

This approach has promise, but examination of 50 joints is not likely to be efficiently done or reimbursable in routine clinical practice. Further work may yield a profile of specific target joints that may have highest sensitivity and predictability for eventual development of RA when examined by ultrasound, or whether all joints would need to be evaluated. Studies of conventional radiography have failed to reveal a consistent pattern or joints that could be consistently excluded. Magnetic resonance imaging studies of the hands have suggested that involvement of specific joints in the wrists, for example, might best discriminate the eventual diagnosis of RA early in the disease course. Such studies are needed to better define the role of ultrasound in assessment of patients with early undifferentiated inflammatory arthritis and the role of diagnostic ultrasonography in routine clinical practice.

Eric L. Matteson, M.D., is professor of medicine and chief of the division of rheumatology at the Mayo Clinic, Rochester, Minn. He has no relevant financial disclosures.

BIRMINGHAM, ENGLAND — Musculoskeletal ultrasound of multiple small joints is more accurate than traditional clinical assessment at predicting patient outcomes in very early arthritis, judging from the results of a pilot investigation.

“We know that if we treat patients early they do better, not only in the short term but also in the long term,” said Dr. Andrew Filer.

“The trouble is, not all patients come through the door with a confirmed diagnosis of rheumatoid or psoriatic arthritis,” explained the senior lecturer at the University of Birmingham.

Dr. Filer reported the preliminary results of a prospective study assessing the use of the imaging method. Specifically, the ongoing study is designed to determine whether musculoskeletal ultrasound can help determine which patients with very early arthritis actually develop rheumatoid arthritis (RA) or related conditions.

For the study, the researchers recruited 58 patients who had inflammatory joint symptoms of 3 months or less duration and clinically apparent inflammation of at least one joint.

Half of the cohort (50%, 29) had rheumatoid arthritis, with 48% (14) having detectable anti-citrullinated peptide antibodies. Sixteen (27.6%) patients had resolving arthritis, which was mostly unclassified, and 13 (22.4%) patients had persistent conditions other than RA.

The non-RA group included five patients with psoriatic arthritis, one with reactive arthritis, and two with systemic lupus erythematous. Disease could not be classified in five patients.

Patients were assessed clinically before undergoing musculoskeletal ultrasound within 24 hours, and followed up prospectively for 18 months.

Baseline and follow-up clinical assessments included: 68 tender and 66 swollen joint counts; 28-joint disease activity score; serological data; and conventional radiography of the hands and feet.

An ultrasonographer, who was unaware of the clinical findings, systematically assessed a total of 50 joints using four-point semi-quantitative scales to note the presence of erosions.

Musculoskeletal ultrasound detected significantly more joint involvement than did clinical examination. It also detected more clinically silent involvement of the wrist, elbow, knee, ankle, and metatarsophalangeal (MTP) region.

Sensitivity and specificity analyses showed that ultrasound of the wrist, metacarpophalangeal (MCP) and MTP regions was the best predictor of joint involvement, improving upon clinical predictive models for RA.

Disclosures: Dr. Filer had no conflicts of interest in relation to the study. The study was funded by Arthritis Research UK and the AutoCure Consortium.

Dr. Andrew Filer (left) reported that ultrasound of the wrist, MTP and MCP regions was the best predictor of joint involvement.

Source Courtesy Dr. Andrew Filer

My Take

A Pattern of Early Changes Needs to Be Confirmed

The study provides an indication that systematic evaluation of joints by ultrasound in patients presenting with very early undifferentiated arthritis may be a useful predictor of future diagnosis of rheumatoid arthritis. Ultrasound may detect involvement in more joints than are detected on clinical examination, and it may detect early erosions with greater sensitivity than conventional radiography. Especially in patients who do not have anti-citrullinated peptide antibodies, the presence of poly-arthritis and erosions on ultrasound appears to herald an eventual diagnosis of RA even when patients who do not appear to have polyarthritis on clinical examination.

This approach has promise, but examination of 50 joints is not likely to be efficiently done or reimbursable in routine clinical practice. Further work may yield a profile of specific target joints that may have highest sensitivity and predictability for eventual development of RA when examined by ultrasound, or whether all joints would need to be evaluated. Studies of conventional radiography have failed to reveal a consistent pattern or joints that could be consistently excluded. Magnetic resonance imaging studies of the hands have suggested that involvement of specific joints in the wrists, for example, might best discriminate the eventual diagnosis of RA early in the disease course. Such studies are needed to better define the role of ultrasound in assessment of patients with early undifferentiated inflammatory arthritis and the role of diagnostic ultrasonography in routine clinical practice.

Eric L. Matteson, M.D., is professor of medicine and chief of the division of rheumatology at the Mayo Clinic, Rochester, Minn. He has no relevant financial disclosures.

BIRMINGHAM, ENGLAND — Musculoskeletal ultrasound of multiple small joints is more accurate than traditional clinical assessment at predicting patient outcomes in very early arthritis, judging from the results of a pilot investigation.

“We know that if we treat patients early they do better, not only in the short term but also in the long term,” said Dr. Andrew Filer.

“The trouble is, not all patients come through the door with a confirmed diagnosis of rheumatoid or psoriatic arthritis,” explained the senior lecturer at the University of Birmingham.

Dr. Filer reported the preliminary results of a prospective study assessing the use of the imaging method. Specifically, the ongoing study is designed to determine whether musculoskeletal ultrasound can help determine which patients with very early arthritis actually develop rheumatoid arthritis (RA) or related conditions.

For the study, the researchers recruited 58 patients who had inflammatory joint symptoms of 3 months or less duration and clinically apparent inflammation of at least one joint.

Half of the cohort (50%, 29) had rheumatoid arthritis, with 48% (14) having detectable anti-citrullinated peptide antibodies. Sixteen (27.6%) patients had resolving arthritis, which was mostly unclassified, and 13 (22.4%) patients had persistent conditions other than RA.

The non-RA group included five patients with psoriatic arthritis, one with reactive arthritis, and two with systemic lupus erythematous. Disease could not be classified in five patients.

Patients were assessed clinically before undergoing musculoskeletal ultrasound within 24 hours, and followed up prospectively for 18 months.

Baseline and follow-up clinical assessments included: 68 tender and 66 swollen joint counts; 28-joint disease activity score; serological data; and conventional radiography of the hands and feet.

An ultrasonographer, who was unaware of the clinical findings, systematically assessed a total of 50 joints using four-point semi-quantitative scales to note the presence of erosions.

Musculoskeletal ultrasound detected significantly more joint involvement than did clinical examination. It also detected more clinically silent involvement of the wrist, elbow, knee, ankle, and metatarsophalangeal (MTP) region.

Sensitivity and specificity analyses showed that ultrasound of the wrist, metacarpophalangeal (MCP) and MTP regions was the best predictor of joint involvement, improving upon clinical predictive models for RA.

Disclosures: Dr. Filer had no conflicts of interest in relation to the study. The study was funded by Arthritis Research UK and the AutoCure Consortium.

Dr. Andrew Filer (left) reported that ultrasound of the wrist, MTP and MCP regions was the best predictor of joint involvement.

Source Courtesy Dr. Andrew Filer

My Take

A Pattern of Early Changes Needs to Be Confirmed

The study provides an indication that systematic evaluation of joints by ultrasound in patients presenting with very early undifferentiated arthritis may be a useful predictor of future diagnosis of rheumatoid arthritis. Ultrasound may detect involvement in more joints than are detected on clinical examination, and it may detect early erosions with greater sensitivity than conventional radiography. Especially in patients who do not have anti-citrullinated peptide antibodies, the presence of poly-arthritis and erosions on ultrasound appears to herald an eventual diagnosis of RA even when patients who do not appear to have polyarthritis on clinical examination.

This approach has promise, but examination of 50 joints is not likely to be efficiently done or reimbursable in routine clinical practice. Further work may yield a profile of specific target joints that may have highest sensitivity and predictability for eventual development of RA when examined by ultrasound, or whether all joints would need to be evaluated. Studies of conventional radiography have failed to reveal a consistent pattern or joints that could be consistently excluded. Magnetic resonance imaging studies of the hands have suggested that involvement of specific joints in the wrists, for example, might best discriminate the eventual diagnosis of RA early in the disease course. Such studies are needed to better define the role of ultrasound in assessment of patients with early undifferentiated inflammatory arthritis and the role of diagnostic ultrasonography in routine clinical practice.

Eric L. Matteson, M.D., is professor of medicine and chief of the division of rheumatology at the Mayo Clinic, Rochester, Minn. He has no relevant financial disclosures.

Major Finding: There is some consistent suggestion of a benefit of fish body oil in RA and capsaicin gel in OA, but there is no such support for the use of any oral or topical complementary or alternative medicine in fibromyalgia.

Data Source: Complementary and alternative medicine symposium held at the British Society for Rheumatology annual meeting.

Disclosures: Dr. MacFarlane had no disclosures or conflicts of interest. The research was funded by Arthritis Research UK.

BIRMINGHAM, ENGLAND — The use of complementary or alternative medicines in rheumatoid arthritis, osteoarthritis, and fibromyalgia is not supported by credible evidence, according to an expert review of available data.

The review, which was commissioned by Arthritis Research UK for patients, shows that, although there is some consistent suggestion of a benefit for fish body oil in RA and capsaicin gel in OA, there is no such support for the use of any oral or topical complementary or alternative medicines (CAMs) in fibromyalgia.

“Complementary medicines are popular, but considering particularly those taken orally or applied topically, we have relatively little information for most compounds on efficacy,” Dr. Gary J. MacFarlane said.

“Both positive and negative conclusions are based upon relatively little amounts of evidence,” added Dr. MacFarlane, professor of epidemiology at the University of Aberdeen (Scotland) and head of the Arthritis Research UK working group on complementary and alternative medicines.

The working group looked at the available evidence on 41 CAMs for which there was some evidence from randomized controlled trials. There were a further 38 compounds commonly used by patients for which no suitable trial evidence could be found.

The aim of the review was to determine both the efficacy and safety of the compounds to give patients some idea of which CAMs worked and which probably did not, Dr. MacFarlane said. If a rigid Cochrane Review had been performed, he conceded, the majority of studies that were assessed would probably have been excluded.

“However, patients were saying to us, actually we want you to say something, not just that there is not enough evidence,” Dr. MacFarlane explained.

Efficacy was graded on a 1- to 5-level scale, with level 1 signifying that there is no overall evidence that the compound worked, and level 5 meaning that there was some consistent evidence across several studies.

The only compounds at level 5 were fish body oil for RA and capsaicin gel for OA. Glucosamine sulfate for OA was graded at level 3, meaning that there was some promising evidence, despite its not being recommended for the treatment of OA in the 2008 OA clinical guidelines of the U.K. National Institute for Health and Clinical Excellence. Out of four CAMs used for fibromyalgia, none was graded higher than a level 2.

Dr. MacFarlane said that in his view, “fibromyalgia is a condition that really doesn't have any very effective therapy.” Although there have been a small number of positive CAM studies in fibromyalgia, he added, their lack of replication means that further, higher-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.

The working group's findings on the use of CAM in fibromyalgia have recently been published (Rheumatology 2010;49:1063-8), and publications on OA and RA will follow in the coming months.

Major Finding: There is some consistent suggestion of a benefit of fish body oil in RA and capsaicin gel in OA, but there is no such support for the use of any oral or topical complementary or alternative medicine in fibromyalgia.

Data Source: Complementary and alternative medicine symposium held at the British Society for Rheumatology annual meeting.

Disclosures: Dr. MacFarlane had no disclosures or conflicts of interest. The research was funded by Arthritis Research UK.

BIRMINGHAM, ENGLAND — The use of complementary or alternative medicines in rheumatoid arthritis, osteoarthritis, and fibromyalgia is not supported by credible evidence, according to an expert review of available data.

The review, which was commissioned by Arthritis Research UK for patients, shows that, although there is some consistent suggestion of a benefit for fish body oil in RA and capsaicin gel in OA, there is no such support for the use of any oral or topical complementary or alternative medicines (CAMs) in fibromyalgia.

“Complementary medicines are popular, but considering particularly those taken orally or applied topically, we have relatively little information for most compounds on efficacy,” Dr. Gary J. MacFarlane said.

“Both positive and negative conclusions are based upon relatively little amounts of evidence,” added Dr. MacFarlane, professor of epidemiology at the University of Aberdeen (Scotland) and head of the Arthritis Research UK working group on complementary and alternative medicines.

The working group looked at the available evidence on 41 CAMs for which there was some evidence from randomized controlled trials. There were a further 38 compounds commonly used by patients for which no suitable trial evidence could be found.

The aim of the review was to determine both the efficacy and safety of the compounds to give patients some idea of which CAMs worked and which probably did not, Dr. MacFarlane said. If a rigid Cochrane Review had been performed, he conceded, the majority of studies that were assessed would probably have been excluded.

“However, patients were saying to us, actually we want you to say something, not just that there is not enough evidence,” Dr. MacFarlane explained.

Efficacy was graded on a 1- to 5-level scale, with level 1 signifying that there is no overall evidence that the compound worked, and level 5 meaning that there was some consistent evidence across several studies.

The only compounds at level 5 were fish body oil for RA and capsaicin gel for OA. Glucosamine sulfate for OA was graded at level 3, meaning that there was some promising evidence, despite its not being recommended for the treatment of OA in the 2008 OA clinical guidelines of the U.K. National Institute for Health and Clinical Excellence. Out of four CAMs used for fibromyalgia, none was graded higher than a level 2.

Dr. MacFarlane said that in his view, “fibromyalgia is a condition that really doesn't have any very effective therapy.” Although there have been a small number of positive CAM studies in fibromyalgia, he added, their lack of replication means that further, higher-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.

The working group's findings on the use of CAM in fibromyalgia have recently been published (Rheumatology 2010;49:1063-8), and publications on OA and RA will follow in the coming months.

Major Finding: There is some consistent suggestion of a benefit of fish body oil in RA and capsaicin gel in OA, but there is no such support for the use of any oral or topical complementary or alternative medicine in fibromyalgia.

Data Source: Complementary and alternative medicine symposium held at the British Society for Rheumatology annual meeting.

Disclosures: Dr. MacFarlane had no disclosures or conflicts of interest. The research was funded by Arthritis Research UK.

BIRMINGHAM, ENGLAND — The use of complementary or alternative medicines in rheumatoid arthritis, osteoarthritis, and fibromyalgia is not supported by credible evidence, according to an expert review of available data.

The review, which was commissioned by Arthritis Research UK for patients, shows that, although there is some consistent suggestion of a benefit for fish body oil in RA and capsaicin gel in OA, there is no such support for the use of any oral or topical complementary or alternative medicines (CAMs) in fibromyalgia.

“Complementary medicines are popular, but considering particularly those taken orally or applied topically, we have relatively little information for most compounds on efficacy,” Dr. Gary J. MacFarlane said.

“Both positive and negative conclusions are based upon relatively little amounts of evidence,” added Dr. MacFarlane, professor of epidemiology at the University of Aberdeen (Scotland) and head of the Arthritis Research UK working group on complementary and alternative medicines.

The working group looked at the available evidence on 41 CAMs for which there was some evidence from randomized controlled trials. There were a further 38 compounds commonly used by patients for which no suitable trial evidence could be found.

The aim of the review was to determine both the efficacy and safety of the compounds to give patients some idea of which CAMs worked and which probably did not, Dr. MacFarlane said. If a rigid Cochrane Review had been performed, he conceded, the majority of studies that were assessed would probably have been excluded.

“However, patients were saying to us, actually we want you to say something, not just that there is not enough evidence,” Dr. MacFarlane explained.

Efficacy was graded on a 1- to 5-level scale, with level 1 signifying that there is no overall evidence that the compound worked, and level 5 meaning that there was some consistent evidence across several studies.

The only compounds at level 5 were fish body oil for RA and capsaicin gel for OA. Glucosamine sulfate for OA was graded at level 3, meaning that there was some promising evidence, despite its not being recommended for the treatment of OA in the 2008 OA clinical guidelines of the U.K. National Institute for Health and Clinical Excellence. Out of four CAMs used for fibromyalgia, none was graded higher than a level 2.

Dr. MacFarlane said that in his view, “fibromyalgia is a condition that really doesn't have any very effective therapy.” Although there have been a small number of positive CAM studies in fibromyalgia, he added, their lack of replication means that further, higher-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.

The working group's findings on the use of CAM in fibromyalgia have recently been published (Rheumatology 2010;49:1063-8), and publications on OA and RA will follow in the coming months.

Major Finding: Median overall birth weight was 2,760 g for 121 newborns exposed in the second trimester to chemotherapy and 2,785 g for the 36 newborns not exposed. Median postpartum hemoglobin levels were 16.1 g/dL and 17.2 g/dL, respectively.

Data Source: A German Breast Cancer Group registry of 235 women who were diagnosed while pregnant.

Disclosures: No disclosures were given.

BARCELONA — Women who are diagnosed with breast cancer while pregnant can be treated with standard chemotherapy regimens after the 12th gestational week without endangering the health of the fetus, according to data from a registry established by the German Breast Group.

Fetal outcomes were not significantly different when 121 newborns of women who were treated with chemotherapy were compared with 36 newborns of women who did not receive chemotherapy in pregnancy, according to a poster.

“Breast cancer is among the most common cancers diagnosed during pregnancy,” said lead author Dr. Sibylle Loibl of Johann Wolfgang Goethe University in Frankfurt-am-Main, Germany. Approximately 3% of all breast cancer cases are diagnosed during pregnancy.

In all, 235 women with gestational breast cancer were registered in the German database between April 2003 and October 2008. The investigators' primary aim was to evaluate fetal outcomes 4 weeks after delivery; they also plan to evaluate outcomes in the children and their mothers at 5 years after therapy.

The median age of the women was 33 years (range, 24-46 years). The diagnosis of breast cancer was made during the first trimester in 23.8% of women. Corresponding figures for the second and third trimesters were 39.5% and 36.8%, respectively.

All told, 121 women received cytotoxic chemotherapy during pregnancy. This mostly consisted of anthracyclines in 58.6%, FEC (5-fluorouracil, epirubicin, and cyclophosphamide) in 16.5%, or CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) in 14%. A median of four cycles of chemotherapy was received during pregnancy.

The majority (57.1%) of women had T2 tumors, with T3 tumors found in 25.8%, T1 in 11.5% of cases, and T4 in 4.4%. About half had node-positive disease, and 7.9% had metastatic (M1) disease. Most tumors (93.4%) were described as ductal invasive/other.

Median overall birth weight was unaffected by chemotherapy during pregnancy, at 2,760 g for 121 newborns who were exposed and 2,785 g for the 36 newborns who were not. No significant differences in postpartum hemoglobin levels were found, with median hemoglobin levels of 16.1 g/dL and 17.2 g/dL, respectively.

“I think pregnant women should and can be treated with standard treatments as recommended by the international guidelines,” Dr. Loibl said. Events that occurred in fetal outcome “were similar in both groups, but we need more information on cytotoxic agents that are more commonly used, such as the taxanes.”

These findings suggest that “there is no harm done to the child when women who are pregnant take chemotherapy,” said Ellen Verschuur-van der Voort, vice president of the Dutch Breast Cancer Association and president of the Europa Donna Forum, the Netherlands.

The research gave “a very good and positive conclusion,” offering reassurance to women who are diagnosed with breast cancer while pregnant, she added.

'Pregnant women should and can be treated with standard treatments' for breast cancer.

Source DR. LOIBL

Major Finding: Median overall birth weight was 2,760 g for 121 newborns exposed in the second trimester to chemotherapy and 2,785 g for the 36 newborns not exposed. Median postpartum hemoglobin levels were 16.1 g/dL and 17.2 g/dL, respectively.

Data Source: A German Breast Cancer Group registry of 235 women who were diagnosed while pregnant.

Disclosures: No disclosures were given.

BARCELONA — Women who are diagnosed with breast cancer while pregnant can be treated with standard chemotherapy regimens after the 12th gestational week without endangering the health of the fetus, according to data from a registry established by the German Breast Group.

Fetal outcomes were not significantly different when 121 newborns of women who were treated with chemotherapy were compared with 36 newborns of women who did not receive chemotherapy in pregnancy, according to a poster.

“Breast cancer is among the most common cancers diagnosed during pregnancy,” said lead author Dr. Sibylle Loibl of Johann Wolfgang Goethe University in Frankfurt-am-Main, Germany. Approximately 3% of all breast cancer cases are diagnosed during pregnancy.

In all, 235 women with gestational breast cancer were registered in the German database between April 2003 and October 2008. The investigators' primary aim was to evaluate fetal outcomes 4 weeks after delivery; they also plan to evaluate outcomes in the children and their mothers at 5 years after therapy.

The median age of the women was 33 years (range, 24-46 years). The diagnosis of breast cancer was made during the first trimester in 23.8% of women. Corresponding figures for the second and third trimesters were 39.5% and 36.8%, respectively.

All told, 121 women received cytotoxic chemotherapy during pregnancy. This mostly consisted of anthracyclines in 58.6%, FEC (5-fluorouracil, epirubicin, and cyclophosphamide) in 16.5%, or CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) in 14%. A median of four cycles of chemotherapy was received during pregnancy.

The majority (57.1%) of women had T2 tumors, with T3 tumors found in 25.8%, T1 in 11.5% of cases, and T4 in 4.4%. About half had node-positive disease, and 7.9% had metastatic (M1) disease. Most tumors (93.4%) were described as ductal invasive/other.

Median overall birth weight was unaffected by chemotherapy during pregnancy, at 2,760 g for 121 newborns who were exposed and 2,785 g for the 36 newborns who were not. No significant differences in postpartum hemoglobin levels were found, with median hemoglobin levels of 16.1 g/dL and 17.2 g/dL, respectively.

“I think pregnant women should and can be treated with standard treatments as recommended by the international guidelines,” Dr. Loibl said. Events that occurred in fetal outcome “were similar in both groups, but we need more information on cytotoxic agents that are more commonly used, such as the taxanes.”

These findings suggest that “there is no harm done to the child when women who are pregnant take chemotherapy,” said Ellen Verschuur-van der Voort, vice president of the Dutch Breast Cancer Association and president of the Europa Donna Forum, the Netherlands.

The research gave “a very good and positive conclusion,” offering reassurance to women who are diagnosed with breast cancer while pregnant, she added.

'Pregnant women should and can be treated with standard treatments' for breast cancer.

Source DR. LOIBL

Major Finding: Median overall birth weight was 2,760 g for 121 newborns exposed in the second trimester to chemotherapy and 2,785 g for the 36 newborns not exposed. Median postpartum hemoglobin levels were 16.1 g/dL and 17.2 g/dL, respectively.

Data Source: A German Breast Cancer Group registry of 235 women who were diagnosed while pregnant.

Disclosures: No disclosures were given.

BARCELONA — Women who are diagnosed with breast cancer while pregnant can be treated with standard chemotherapy regimens after the 12th gestational week without endangering the health of the fetus, according to data from a registry established by the German Breast Group.

Fetal outcomes were not significantly different when 121 newborns of women who were treated with chemotherapy were compared with 36 newborns of women who did not receive chemotherapy in pregnancy, according to a poster.

“Breast cancer is among the most common cancers diagnosed during pregnancy,” said lead author Dr. Sibylle Loibl of Johann Wolfgang Goethe University in Frankfurt-am-Main, Germany. Approximately 3% of all breast cancer cases are diagnosed during pregnancy.

In all, 235 women with gestational breast cancer were registered in the German database between April 2003 and October 2008. The investigators' primary aim was to evaluate fetal outcomes 4 weeks after delivery; they also plan to evaluate outcomes in the children and their mothers at 5 years after therapy.

The median age of the women was 33 years (range, 24-46 years). The diagnosis of breast cancer was made during the first trimester in 23.8% of women. Corresponding figures for the second and third trimesters were 39.5% and 36.8%, respectively.

All told, 121 women received cytotoxic chemotherapy during pregnancy. This mostly consisted of anthracyclines in 58.6%, FEC (5-fluorouracil, epirubicin, and cyclophosphamide) in 16.5%, or CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) in 14%. A median of four cycles of chemotherapy was received during pregnancy.

The majority (57.1%) of women had T2 tumors, with T3 tumors found in 25.8%, T1 in 11.5% of cases, and T4 in 4.4%. About half had node-positive disease, and 7.9% had metastatic (M1) disease. Most tumors (93.4%) were described as ductal invasive/other.

Median overall birth weight was unaffected by chemotherapy during pregnancy, at 2,760 g for 121 newborns who were exposed and 2,785 g for the 36 newborns who were not. No significant differences in postpartum hemoglobin levels were found, with median hemoglobin levels of 16.1 g/dL and 17.2 g/dL, respectively.

“I think pregnant women should and can be treated with standard treatments as recommended by the international guidelines,” Dr. Loibl said. Events that occurred in fetal outcome “were similar in both groups, but we need more information on cytotoxic agents that are more commonly used, such as the taxanes.”

These findings suggest that “there is no harm done to the child when women who are pregnant take chemotherapy,” said Ellen Verschuur-van der Voort, vice president of the Dutch Breast Cancer Association and president of the Europa Donna Forum, the Netherlands.

The research gave “a very good and positive conclusion,” offering reassurance to women who are diagnosed with breast cancer while pregnant, she added.

'Pregnant women should and can be treated with standard treatments' for breast cancer.

Source DR. LOIBL

BIRMINGHAM, ENGLAND — Foot and ankle pain affects more women than men after age 45 years, when osteoarthritis often manifests.

A systematic review of available literature from eight studies from around the world estimated that foot and ankle pain occurs in 15%-30% in women and 10%-20% of men.

It is not clear what proportion of people who have pain have OA, said Martin J. Thomas, a research physiotherapist at the Arthritis Research UK National Primary Care Centre of Keele (England) University.

Mr. Thomas, who reported the findings at the annual meeting of the British Society of Rheumatology, said that he aimed to establish the baseline prevalence of ankle pain in order to have a point of comparison for future work on the prevalence of symptomatic foot and ankle OA.

“Foot pain and foot problems are very common in primary care,” said Dr. Edward Roddy, a consultant rheumatologist at the Haywood Hospital in Stoke-on-Trent, England, and part of the research team at Keele University. Compared with other regional pain sites, such as the knee and hand, the foot has been studied less and “is just generally less well understood,” he observed.

The researchers therefore plan to undertake a longitudinal study to better characterize the epidemiology of foot and ankle OA in primary care and determine the likely causes of foot pain. Already, the team has discovered that foot pain is the most common reason for older adults to consult a general physician.

Dr. Roddy and associates looked at the reasons for musculoskeletal foot consultations in a primary care cohort of people older than 50 years. They identified 5,706 people who were taking part in the North Staffordshire Osteoarthritis Project (NorStOP), a 3-year, population-based cohort study in which participants from three local general practices had first completed a general health survey. Patients who reported experiencing any pain in the hands, hips, knees, or feet in the previous 12 months then completed a more specific survey about their regional pain, and their permission was sought for researchers to assess their medical records and to recontact them. The team looked at only those patients who reported foot pain or foot problems in the preceding 12 months. After the exclusion of patients who had not consulted in the 18 months before being surveyed, there were 4,402 (71%) people who consented to allowing their medical records to be reviewed.

Linking the NorStOP data to an electronic consultations database revealed that 350 of 3,858 (9%) people in the general population cohort studied actually consulted for foot pain or problems after completing the regional pain survey, whereas 3,508 (91%) who had completed the survey did not subsequently consult.

Looking at the reasons why 9% of people consulted while the remainder who had completed the survey and reported foot pain or problems did not, the researchers found that experiencing foot pain was the most common reason for presenting to a primary care doctor for a musculoskeletal problem (odds ratio, 2.04). Frequent consultations for other health problems was another significant predictor of consulting for foot pain or problems (OR, 1.65), as was the belief that treatments were effective in controlling disease (OR, 1.54).

“We've only looked at musculoskeletal consultations, so we may have underestimated consultations,” said Dr. Roddy. However, he conceded that the definition of foot pain used was very broad.

Dr. Roddy said that the next challenge was to try to work out what exactly is causing the foot pain and whether this resulted from OA, another musculoskeletal condition, or perhaps another reason entirely. The Keele researchers will be performing a study asking people who consult their primary care practitioner to not only complete a questionnaire about their foot problems, but also attend the hospital for clinical examination.

Disclosures: Arthritis Research UK provided financial support for the studies. Mr. Thomas and Dr. Roddy had no relevant financial disclosure or conflicts of interest.

BIRMINGHAM, ENGLAND — Foot and ankle pain affects more women than men after age 45 years, when osteoarthritis often manifests.

A systematic review of available literature from eight studies from around the world estimated that foot and ankle pain occurs in 15%-30% in women and 10%-20% of men.

It is not clear what proportion of people who have pain have OA, said Martin J. Thomas, a research physiotherapist at the Arthritis Research UK National Primary Care Centre of Keele (England) University.

Mr. Thomas, who reported the findings at the annual meeting of the British Society of Rheumatology, said that he aimed to establish the baseline prevalence of ankle pain in order to have a point of comparison for future work on the prevalence of symptomatic foot and ankle OA.

“Foot pain and foot problems are very common in primary care,” said Dr. Edward Roddy, a consultant rheumatologist at the Haywood Hospital in Stoke-on-Trent, England, and part of the research team at Keele University. Compared with other regional pain sites, such as the knee and hand, the foot has been studied less and “is just generally less well understood,” he observed.

The researchers therefore plan to undertake a longitudinal study to better characterize the epidemiology of foot and ankle OA in primary care and determine the likely causes of foot pain. Already, the team has discovered that foot pain is the most common reason for older adults to consult a general physician.

Dr. Roddy and associates looked at the reasons for musculoskeletal foot consultations in a primary care cohort of people older than 50 years. They identified 5,706 people who were taking part in the North Staffordshire Osteoarthritis Project (NorStOP), a 3-year, population-based cohort study in which participants from three local general practices had first completed a general health survey. Patients who reported experiencing any pain in the hands, hips, knees, or feet in the previous 12 months then completed a more specific survey about their regional pain, and their permission was sought for researchers to assess their medical records and to recontact them. The team looked at only those patients who reported foot pain or foot problems in the preceding 12 months. After the exclusion of patients who had not consulted in the 18 months before being surveyed, there were 4,402 (71%) people who consented to allowing their medical records to be reviewed.

Linking the NorStOP data to an electronic consultations database revealed that 350 of 3,858 (9%) people in the general population cohort studied actually consulted for foot pain or problems after completing the regional pain survey, whereas 3,508 (91%) who had completed the survey did not subsequently consult.

Looking at the reasons why 9% of people consulted while the remainder who had completed the survey and reported foot pain or problems did not, the researchers found that experiencing foot pain was the most common reason for presenting to a primary care doctor for a musculoskeletal problem (odds ratio, 2.04). Frequent consultations for other health problems was another significant predictor of consulting for foot pain or problems (OR, 1.65), as was the belief that treatments were effective in controlling disease (OR, 1.54).

“We've only looked at musculoskeletal consultations, so we may have underestimated consultations,” said Dr. Roddy. However, he conceded that the definition of foot pain used was very broad.

Dr. Roddy said that the next challenge was to try to work out what exactly is causing the foot pain and whether this resulted from OA, another musculoskeletal condition, or perhaps another reason entirely. The Keele researchers will be performing a study asking people who consult their primary care practitioner to not only complete a questionnaire about their foot problems, but also attend the hospital for clinical examination.

Disclosures: Arthritis Research UK provided financial support for the studies. Mr. Thomas and Dr. Roddy had no relevant financial disclosure or conflicts of interest.

BIRMINGHAM, ENGLAND — Foot and ankle pain affects more women than men after age 45 years, when osteoarthritis often manifests.

A systematic review of available literature from eight studies from around the world estimated that foot and ankle pain occurs in 15%-30% in women and 10%-20% of men.

It is not clear what proportion of people who have pain have OA, said Martin J. Thomas, a research physiotherapist at the Arthritis Research UK National Primary Care Centre of Keele (England) University.

Mr. Thomas, who reported the findings at the annual meeting of the British Society of Rheumatology, said that he aimed to establish the baseline prevalence of ankle pain in order to have a point of comparison for future work on the prevalence of symptomatic foot and ankle OA.

“Foot pain and foot problems are very common in primary care,” said Dr. Edward Roddy, a consultant rheumatologist at the Haywood Hospital in Stoke-on-Trent, England, and part of the research team at Keele University. Compared with other regional pain sites, such as the knee and hand, the foot has been studied less and “is just generally less well understood,” he observed.

The researchers therefore plan to undertake a longitudinal study to better characterize the epidemiology of foot and ankle OA in primary care and determine the likely causes of foot pain. Already, the team has discovered that foot pain is the most common reason for older adults to consult a general physician.

Dr. Roddy and associates looked at the reasons for musculoskeletal foot consultations in a primary care cohort of people older than 50 years. They identified 5,706 people who were taking part in the North Staffordshire Osteoarthritis Project (NorStOP), a 3-year, population-based cohort study in which participants from three local general practices had first completed a general health survey. Patients who reported experiencing any pain in the hands, hips, knees, or feet in the previous 12 months then completed a more specific survey about their regional pain, and their permission was sought for researchers to assess their medical records and to recontact them. The team looked at only those patients who reported foot pain or foot problems in the preceding 12 months. After the exclusion of patients who had not consulted in the 18 months before being surveyed, there were 4,402 (71%) people who consented to allowing their medical records to be reviewed.

Linking the NorStOP data to an electronic consultations database revealed that 350 of 3,858 (9%) people in the general population cohort studied actually consulted for foot pain or problems after completing the regional pain survey, whereas 3,508 (91%) who had completed the survey did not subsequently consult.

Looking at the reasons why 9% of people consulted while the remainder who had completed the survey and reported foot pain or problems did not, the researchers found that experiencing foot pain was the most common reason for presenting to a primary care doctor for a musculoskeletal problem (odds ratio, 2.04). Frequent consultations for other health problems was another significant predictor of consulting for foot pain or problems (OR, 1.65), as was the belief that treatments were effective in controlling disease (OR, 1.54).

“We've only looked at musculoskeletal consultations, so we may have underestimated consultations,” said Dr. Roddy. However, he conceded that the definition of foot pain used was very broad.

Dr. Roddy said that the next challenge was to try to work out what exactly is causing the foot pain and whether this resulted from OA, another musculoskeletal condition, or perhaps another reason entirely. The Keele researchers will be performing a study asking people who consult their primary care practitioner to not only complete a questionnaire about their foot problems, but also attend the hospital for clinical examination.

Disclosures: Arthritis Research UK provided financial support for the studies. Mr. Thomas and Dr. Roddy had no relevant financial disclosure or conflicts of interest.

BIRMINGHAM, ENGLAND — Successful reduction of early inflammatory polyarthritis disease measures is accompanied by deterioration of the atherogenic profile, which potentially signals an increased risk of cardiovascular disease in an already at-risk population, judging from findings presented at the annual meeting of the British Society of Rheumatology.

Results from a cardiovascular disease (CVD) subset analysis of data from the Norfolk Arthritis Register (NOAR) suggest that lipid parameters should be assessed and managed carefully in all patients with early arthritic disease. Such assessment and management should be done regardless of any ongoing inflammatory polyarthritis treatment.

“When we look at the HAQ [Health Assessment Questionnaire] scores, patients' disability and the disease severity are improving significantly over the first 2 years, but at the same time we see an overall worsening in their lipid profile,” said clinical research fellow Dr. Hoda Mirjafari of the Arthritis Research UK Epidemiology Unit at the University of Manchester (England).

In her discussion of 2-year follow-up data on 223 patients, Dr. Mirjafari noted that although lipid levels initially seem to decrease in patients with early inflammatory polyarthritis, they creep back to normal levels over time.

“This is worrying on two counts,” Dr. Mirjafari explained. “One is that when you first meet your patient and you are reassured that their lipid levels are low, that is false reassurance. Their true lipids, once their inflammatory disease is sorted out, are actually higher.”

In addition, she said, conventional CV risk factor markers such as LDL and HDL cholesterol measures may not be good enough to track the worsening atherogenic profile and subsequent risk of atherosclerosis. A better measure is the atherogenic index, specifically the ratio of apolipoprotein B to apolipoprotein A-I. This is the only measure that can predict the likelihood of an atherosclerotic plaque's being present upon imaging of the carotid arteries.

Patients were recruited into the NOAR CVD substudy in 2004-2008 if they had evidence of early inflammatory polyarthritis and a disease duration shorter than 2 years. Information was collated at baseline and reassessed at 2 years on conventional CV risk factors (blood pressure, lipids, fasting glucose, height, and weight) and inflammatory polyarthritis risk factors (rheumatoid factor, HAQ, swollen and tender joint counts, and disease-modifying antirheumatic drug and steroid therapy).

Two-thirds (68%) of patients were female; the median age was 50 years, and the median symptom duration was 7 months. The median 28-joint count disease activity score based on C-reactive protein measures (DAS28-CRP) at baseline was 3.8. In all, 44% patients met American College of Rheumatology criteria for early inflammatory polyarthritis, and 48% were positive for rheumatoid factor. Only 5% of patients were receiving statin therapy; 23% were smokers, and 9% had a Framingham risk of CVD event greater than 20% at 10 years. One-fifth (22%) of patients had been exposed to steroids at baseline and 32% at 2 years, whereas 53% and 82%, respectively, had been treated with DMARDs.

Mean HAQ scores at baseline and at 2 years were 0.95 and 0.81, respectively. Mean swollen and tender joint counts were 3.73 at baseline, but decreased to 2.00 at 2 years. Although there was no great change in total cholesterol levels, LDL levels rose slightly and HDL levels decreased, and the atherogenic index increased substantially from a baseline value of 2.38 to 2.60 at 2 years.

Disclosures: The NOAR is supported by a grant from Arthritis Research UK. Dr. Mirjafari reported no conflicts of interest.

'When you first meet your patient and you are reassured that their lipid levels are low, that is false reassurance.'

Source DR. MIRJAFARI

My Take

Questions Remain About Statin Use in RA

Cardiovascular morbidity and mortality are obviously increasingly important in diseases like rheumatoid arthritis. Dr. Mirjafari made some interesting observations from some of the data from the Norfolk Arthritis Register. The findings so far leave a slightly counterintuitive impression. Here, evidence shows that the better we treat RA, not only the better the articular outcomes, but also the better the comorbidity outcomes. Yet the lipid profile seems to be deteriorating despite improvement in the disease.

What is a bit alarming is that this was a cohort of patients with relatively mild disease (only 48% were RF positive). It makes TRACE RA (Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Rheumatoid Arthritis) even more important as a study, so we can try and work out when it's the most appropriate time to use statins—not just with RA, but with a persistent inflammatory arthritis, even if it doesn't fulfill the American College of Rheumatology criteria.

CHRIS DEIGHTON, M.D., is consultant rheumatologist at the Derbyshire Royal Infirmary in Derby, England. He has no financial disclosures to make that are relevant to this piece.

BIRMINGHAM, ENGLAND — Successful reduction of early inflammatory polyarthritis disease measures is accompanied by deterioration of the atherogenic profile, which potentially signals an increased risk of cardiovascular disease in an already at-risk population, judging from findings presented at the annual meeting of the British Society of Rheumatology.

Results from a cardiovascular disease (CVD) subset analysis of data from the Norfolk Arthritis Register (NOAR) suggest that lipid parameters should be assessed and managed carefully in all patients with early arthritic disease. Such assessment and management should be done regardless of any ongoing inflammatory polyarthritis treatment.

“When we look at the HAQ [Health Assessment Questionnaire] scores, patients' disability and the disease severity are improving significantly over the first 2 years, but at the same time we see an overall worsening in their lipid profile,” said clinical research fellow Dr. Hoda Mirjafari of the Arthritis Research UK Epidemiology Unit at the University of Manchester (England).

In her discussion of 2-year follow-up data on 223 patients, Dr. Mirjafari noted that although lipid levels initially seem to decrease in patients with early inflammatory polyarthritis, they creep back to normal levels over time.

“This is worrying on two counts,” Dr. Mirjafari explained. “One is that when you first meet your patient and you are reassured that their lipid levels are low, that is false reassurance. Their true lipids, once their inflammatory disease is sorted out, are actually higher.”

In addition, she said, conventional CV risk factor markers such as LDL and HDL cholesterol measures may not be good enough to track the worsening atherogenic profile and subsequent risk of atherosclerosis. A better measure is the atherogenic index, specifically the ratio of apolipoprotein B to apolipoprotein A-I. This is the only measure that can predict the likelihood of an atherosclerotic plaque's being present upon imaging of the carotid arteries.

Patients were recruited into the NOAR CVD substudy in 2004-2008 if they had evidence of early inflammatory polyarthritis and a disease duration shorter than 2 years. Information was collated at baseline and reassessed at 2 years on conventional CV risk factors (blood pressure, lipids, fasting glucose, height, and weight) and inflammatory polyarthritis risk factors (rheumatoid factor, HAQ, swollen and tender joint counts, and disease-modifying antirheumatic drug and steroid therapy).

Two-thirds (68%) of patients were female; the median age was 50 years, and the median symptom duration was 7 months. The median 28-joint count disease activity score based on C-reactive protein measures (DAS28-CRP) at baseline was 3.8. In all, 44% patients met American College of Rheumatology criteria for early inflammatory polyarthritis, and 48% were positive for rheumatoid factor. Only 5% of patients were receiving statin therapy; 23% were smokers, and 9% had a Framingham risk of CVD event greater than 20% at 10 years. One-fifth (22%) of patients had been exposed to steroids at baseline and 32% at 2 years, whereas 53% and 82%, respectively, had been treated with DMARDs.

Mean HAQ scores at baseline and at 2 years were 0.95 and 0.81, respectively. Mean swollen and tender joint counts were 3.73 at baseline, but decreased to 2.00 at 2 years. Although there was no great change in total cholesterol levels, LDL levels rose slightly and HDL levels decreased, and the atherogenic index increased substantially from a baseline value of 2.38 to 2.60 at 2 years.

Disclosures: The NOAR is supported by a grant from Arthritis Research UK. Dr. Mirjafari reported no conflicts of interest.

'When you first meet your patient and you are reassured that their lipid levels are low, that is false reassurance.'

Source DR. MIRJAFARI

My Take

Questions Remain About Statin Use in RA

Cardiovascular morbidity and mortality are obviously increasingly important in diseases like rheumatoid arthritis. Dr. Mirjafari made some interesting observations from some of the data from the Norfolk Arthritis Register. The findings so far leave a slightly counterintuitive impression. Here, evidence shows that the better we treat RA, not only the better the articular outcomes, but also the better the comorbidity outcomes. Yet the lipid profile seems to be deteriorating despite improvement in the disease.

What is a bit alarming is that this was a cohort of patients with relatively mild disease (only 48% were RF positive). It makes TRACE RA (Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Rheumatoid Arthritis) even more important as a study, so we can try and work out when it's the most appropriate time to use statins—not just with RA, but with a persistent inflammatory arthritis, even if it doesn't fulfill the American College of Rheumatology criteria.

CHRIS DEIGHTON, M.D., is consultant rheumatologist at the Derbyshire Royal Infirmary in Derby, England. He has no financial disclosures to make that are relevant to this piece.

BIRMINGHAM, ENGLAND — Successful reduction of early inflammatory polyarthritis disease measures is accompanied by deterioration of the atherogenic profile, which potentially signals an increased risk of cardiovascular disease in an already at-risk population, judging from findings presented at the annual meeting of the British Society of Rheumatology.

Results from a cardiovascular disease (CVD) subset analysis of data from the Norfolk Arthritis Register (NOAR) suggest that lipid parameters should be assessed and managed carefully in all patients with early arthritic disease. Such assessment and management should be done regardless of any ongoing inflammatory polyarthritis treatment.

“When we look at the HAQ [Health Assessment Questionnaire] scores, patients' disability and the disease severity are improving significantly over the first 2 years, but at the same time we see an overall worsening in their lipid profile,” said clinical research fellow Dr. Hoda Mirjafari of the Arthritis Research UK Epidemiology Unit at the University of Manchester (England).

In her discussion of 2-year follow-up data on 223 patients, Dr. Mirjafari noted that although lipid levels initially seem to decrease in patients with early inflammatory polyarthritis, they creep back to normal levels over time.

“This is worrying on two counts,” Dr. Mirjafari explained. “One is that when you first meet your patient and you are reassured that their lipid levels are low, that is false reassurance. Their true lipids, once their inflammatory disease is sorted out, are actually higher.”

In addition, she said, conventional CV risk factor markers such as LDL and HDL cholesterol measures may not be good enough to track the worsening atherogenic profile and subsequent risk of atherosclerosis. A better measure is the atherogenic index, specifically the ratio of apolipoprotein B to apolipoprotein A-I. This is the only measure that can predict the likelihood of an atherosclerotic plaque's being present upon imaging of the carotid arteries.

Patients were recruited into the NOAR CVD substudy in 2004-2008 if they had evidence of early inflammatory polyarthritis and a disease duration shorter than 2 years. Information was collated at baseline and reassessed at 2 years on conventional CV risk factors (blood pressure, lipids, fasting glucose, height, and weight) and inflammatory polyarthritis risk factors (rheumatoid factor, HAQ, swollen and tender joint counts, and disease-modifying antirheumatic drug and steroid therapy).

Two-thirds (68%) of patients were female; the median age was 50 years, and the median symptom duration was 7 months. The median 28-joint count disease activity score based on C-reactive protein measures (DAS28-CRP) at baseline was 3.8. In all, 44% patients met American College of Rheumatology criteria for early inflammatory polyarthritis, and 48% were positive for rheumatoid factor. Only 5% of patients were receiving statin therapy; 23% were smokers, and 9% had a Framingham risk of CVD event greater than 20% at 10 years. One-fifth (22%) of patients had been exposed to steroids at baseline and 32% at 2 years, whereas 53% and 82%, respectively, had been treated with DMARDs.

Mean HAQ scores at baseline and at 2 years were 0.95 and 0.81, respectively. Mean swollen and tender joint counts were 3.73 at baseline, but decreased to 2.00 at 2 years. Although there was no great change in total cholesterol levels, LDL levels rose slightly and HDL levels decreased, and the atherogenic index increased substantially from a baseline value of 2.38 to 2.60 at 2 years.

Disclosures: The NOAR is supported by a grant from Arthritis Research UK. Dr. Mirjafari reported no conflicts of interest.

'When you first meet your patient and you are reassured that their lipid levels are low, that is false reassurance.'

Source DR. MIRJAFARI

My Take

Questions Remain About Statin Use in RA

Cardiovascular morbidity and mortality are obviously increasingly important in diseases like rheumatoid arthritis. Dr. Mirjafari made some interesting observations from some of the data from the Norfolk Arthritis Register. The findings so far leave a slightly counterintuitive impression. Here, evidence shows that the better we treat RA, not only the better the articular outcomes, but also the better the comorbidity outcomes. Yet the lipid profile seems to be deteriorating despite improvement in the disease.

What is a bit alarming is that this was a cohort of patients with relatively mild disease (only 48% were RF positive). It makes TRACE RA (Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Rheumatoid Arthritis) even more important as a study, so we can try and work out when it's the most appropriate time to use statins—not just with RA, but with a persistent inflammatory arthritis, even if it doesn't fulfill the American College of Rheumatology criteria.

CHRIS DEIGHTON, M.D., is consultant rheumatologist at the Derbyshire Royal Infirmary in Derby, England. He has no financial disclosures to make that are relevant to this piece.