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American College of Rheumatology (ACR): Annual Scientific Meeting
VIDEO: No need to stop running for fear of knee osteoarthritis
BOSTON– Current running or a history of running did not raise the odds of knee osteoarthritis in the first population-based study of runners.
Until this cross-sectional analysis of participants in the Osteoarthritis Initiative, most studies examining the risk of knee osteoarthritis from running analyzed elite runners and other high-level runners, making them less generalizable to a larger population, according to Dr. Grace Hsiao-Wei Lo of Baylor College of Medicine, Houston.
The findings of no higher odds of symptomatic knee osteoarthritis, compared with nonrunners, were largely consistent across age groupings of runners from 12-18 years of age up to 50 years and older, Dr. Lo said in a video interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON– Current running or a history of running did not raise the odds of knee osteoarthritis in the first population-based study of runners.
Until this cross-sectional analysis of participants in the Osteoarthritis Initiative, most studies examining the risk of knee osteoarthritis from running analyzed elite runners and other high-level runners, making them less generalizable to a larger population, according to Dr. Grace Hsiao-Wei Lo of Baylor College of Medicine, Houston.
The findings of no higher odds of symptomatic knee osteoarthritis, compared with nonrunners, were largely consistent across age groupings of runners from 12-18 years of age up to 50 years and older, Dr. Lo said in a video interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON– Current running or a history of running did not raise the odds of knee osteoarthritis in the first population-based study of runners.
Until this cross-sectional analysis of participants in the Osteoarthritis Initiative, most studies examining the risk of knee osteoarthritis from running analyzed elite runners and other high-level runners, making them less generalizable to a larger population, according to Dr. Grace Hsiao-Wei Lo of Baylor College of Medicine, Houston.
The findings of no higher odds of symptomatic knee osteoarthritis, compared with nonrunners, were largely consistent across age groupings of runners from 12-18 years of age up to 50 years and older, Dr. Lo said in a video interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE ACR ANNUAL MEETING
RA draft guidelines: Treat to target
BOSTON – Treat to target in both early and established rheumatoid arthritis, recommended the authors of American College of Rheumatology draft guidelines on the management of RA.
The new ACR guidelines, expected to be finalized and published by the spring of 2015, also focus on the care of those patients whom most rheumatologists see in day-to-day practice, and they call for patience when trying a new therapy or new dose of an existing drug, Dr. Jasvinder Singh, of the division of clinical immunology and rheumatology at the University of Alabama, Birmingham, said to a standing-room-only crowd at the annual meeting of the American College of Rheumatology.
One of the guiding principles of the proposed recommendations is that “if a patient is doing well and the RA is under control, switching from one therapy to another should be done by a physician in consultation and agreement with the patient, and arbitrary switching between therapies should not be done,” he said.
Overall, the evidence-based guidelines emphasize several important aspects of RA care, including the following:
• Focus on the common patient and not exceptional cases.
• Give optimal doses of medications for 3 months before escalating or switching therapy.
• Assess disease activity using one of ACR’s recommended measures at a majority of encounters with RA patients.
• Consider methotrexate as the initial therapy in most RA patients.
• Methotrexate is the preferred monotherapy with a disease-modifying antirheumatic drug (DMARD), but other options include sulfasalazine, hydroxychloroquine, or leflunomide.
• A rheumatologist is the clinician of first choice for all patients with RA.
• Limit glucocorticoid treatment to the lowest possible dose for the shortest possible time to offer the best ratio of benefit to risk.
• Routinely assess patients’ functional status with standardized validated measures at least once yearly, or more frequently when RA is active.
The draft guidelines strongly recommend “using a treat-to-target strategy rather than a nontargeted approach” in both early and established RA.
Ideally, the target to be determined by the clinician and patient, should be remission or low disease activity. The guidelines acknowledge, however, that in some cases risk tolerance or comorbidities may require choice of a different and presumably less aggressive target.
Early RA
For early RA in treatment-naive patients, the guidelines offer an algorithm suggesting DMARD monotherapy for patients with low disease activity and, if the disease flares, recourse to short-term glucocorticoids.
For patients with moderately or highly active early RA, DMARD monotherapy can be followed with either short-term glucocorticoids, or in the case of DMARD failure, to either combination traditional DMARDs, a tumor necrosis factor inhibitor (TNFi) with or without methotrexate, or a non-TNF biologic agent with or without methotrexate, and with or without low-dose glucocorticoids. If the above therapies fail, the clinician and patient should consider a treatment course used for established RA.
Established RA
As with early RA, DMARD-naive patients with low disease activity may be started on DMARD monotherapy and proceed to traditional DMARD combinations, a TNFi with/without methotrexate, or non-TNF biologic with/without methotrexate, or tofacitinib with methotrexate. The guidelines offer a less robust recommendation about adding low-dose glucocorticoids, or short-term glucocorticoids for flares.
Patients who have not responded to treatment with single TNFi can move to a non-TNF biologic plus or minus methotrexate, or a different TNFi with/without methotrexate.
Patients who have not responded to treatment with multiple TNFi can try a non-TNF biologic plus/minus methotrexate, or tofacitinib with or without methotrexate.
Patients who have not responded to treatment with a single non-TNF biologic agent can try a different non-TNF biologic with/without methotrexate.
When both a TNFi and non-TNF biologic fail to help, the patient can try another non-TNF biologic plus/minus methotrexate, or tofacitinib plus/minus methotrexate.
Patients for whom multiple non-TNF biologic agents have failed can try either tofacitinib plus/minus methotrexate, or, if the patient is TNFi naive, a TNFi plus/minus methotrexate.
Special considerations
The guidelines make recommendations about treating patients with previously treated or untreated melanoma (TNFi preferable to tofacitinib) or nonmelanoma skin cancer (combination DMARD or non-TNF biologic preferable to TNFi) or a previously treated lymphoproliferative disorder (combination DMARD or non-TNF biologic such as abatacept, tocilizumab or rituximab over a TNFi). Patients with treated solid-organ malignancies, however, can be treated as other patients with RA are treated.
For patients with active hepatitis B or C virus infection who are receiving effective antiviral therapy, a DMARD, TNFi, non-TNF biologic, or tofacitinib can be prescribed, based on American Association for the Study of Liver Diseases case series and clinical experience, Dr. Singh said.
For patients with established RA and heart failure (HF), the guidelines recommend combination DMARD, non-TNF biologic, or tofacitinib over a TNFi, and if the patient has established or worsening HF on a TNFi, the three drug options above are preferable to switching the patient to another TNFi.
For patients with previous serious infections, however, there was less agreement on the optimal course. The guidelines, as currently planned, recommend a DMARD combination or abatacept over a TNFi in these patients, but there was no consensus about either rituximab or tocilizumab over a TNFi, Dr. Singh noted.
Tapering therapy
Finally, the proposed guidelines deal with therapeutic tapers. Specifically, for patients with established RA and low disease activity on maintenance methotrexate, the guidelines strongly recommend continuing on a traditional DMARD, TNFi, non-TNF biologic, or tofacitinib.
There is a conditional recommendation that patients with established RA in remission continuing on methotrexate can taper traditional DMARD therapy, TNFi, non-TNF biologic, or tofacitinib. But the guidelines strongly recommend against discontinuing all therapies in these patients, Dr. Singh emphasized.
“The strong recommendation is based on clinical experience that only a very small minority of patients are able to discontinue all therapies. Conditional recommendations here, supported by low-level evidence, are largely based upon expert opinion and clinical experience,” said Dr. Singh, who disclosed financial relationships with Allergan, Regeneron, Savient, and Takeda.
Join the queue
The proposed guidelines follow up on ACR’s 2012 guidelines, and will join an already crowded field of clinical practice recommendations, including those published in 2013 by the European League Against Rheumatism.
BOSTON – Treat to target in both early and established rheumatoid arthritis, recommended the authors of American College of Rheumatology draft guidelines on the management of RA.
The new ACR guidelines, expected to be finalized and published by the spring of 2015, also focus on the care of those patients whom most rheumatologists see in day-to-day practice, and they call for patience when trying a new therapy or new dose of an existing drug, Dr. Jasvinder Singh, of the division of clinical immunology and rheumatology at the University of Alabama, Birmingham, said to a standing-room-only crowd at the annual meeting of the American College of Rheumatology.
One of the guiding principles of the proposed recommendations is that “if a patient is doing well and the RA is under control, switching from one therapy to another should be done by a physician in consultation and agreement with the patient, and arbitrary switching between therapies should not be done,” he said.
Overall, the evidence-based guidelines emphasize several important aspects of RA care, including the following:
• Focus on the common patient and not exceptional cases.
• Give optimal doses of medications for 3 months before escalating or switching therapy.
• Assess disease activity using one of ACR’s recommended measures at a majority of encounters with RA patients.
• Consider methotrexate as the initial therapy in most RA patients.
• Methotrexate is the preferred monotherapy with a disease-modifying antirheumatic drug (DMARD), but other options include sulfasalazine, hydroxychloroquine, or leflunomide.
• A rheumatologist is the clinician of first choice for all patients with RA.
• Limit glucocorticoid treatment to the lowest possible dose for the shortest possible time to offer the best ratio of benefit to risk.
• Routinely assess patients’ functional status with standardized validated measures at least once yearly, or more frequently when RA is active.
The draft guidelines strongly recommend “using a treat-to-target strategy rather than a nontargeted approach” in both early and established RA.
Ideally, the target to be determined by the clinician and patient, should be remission or low disease activity. The guidelines acknowledge, however, that in some cases risk tolerance or comorbidities may require choice of a different and presumably less aggressive target.
Early RA
For early RA in treatment-naive patients, the guidelines offer an algorithm suggesting DMARD monotherapy for patients with low disease activity and, if the disease flares, recourse to short-term glucocorticoids.
For patients with moderately or highly active early RA, DMARD monotherapy can be followed with either short-term glucocorticoids, or in the case of DMARD failure, to either combination traditional DMARDs, a tumor necrosis factor inhibitor (TNFi) with or without methotrexate, or a non-TNF biologic agent with or without methotrexate, and with or without low-dose glucocorticoids. If the above therapies fail, the clinician and patient should consider a treatment course used for established RA.
Established RA
As with early RA, DMARD-naive patients with low disease activity may be started on DMARD monotherapy and proceed to traditional DMARD combinations, a TNFi with/without methotrexate, or non-TNF biologic with/without methotrexate, or tofacitinib with methotrexate. The guidelines offer a less robust recommendation about adding low-dose glucocorticoids, or short-term glucocorticoids for flares.
Patients who have not responded to treatment with single TNFi can move to a non-TNF biologic plus or minus methotrexate, or a different TNFi with/without methotrexate.
Patients who have not responded to treatment with multiple TNFi can try a non-TNF biologic plus/minus methotrexate, or tofacitinib with or without methotrexate.
Patients who have not responded to treatment with a single non-TNF biologic agent can try a different non-TNF biologic with/without methotrexate.
When both a TNFi and non-TNF biologic fail to help, the patient can try another non-TNF biologic plus/minus methotrexate, or tofacitinib plus/minus methotrexate.
Patients for whom multiple non-TNF biologic agents have failed can try either tofacitinib plus/minus methotrexate, or, if the patient is TNFi naive, a TNFi plus/minus methotrexate.
Special considerations
The guidelines make recommendations about treating patients with previously treated or untreated melanoma (TNFi preferable to tofacitinib) or nonmelanoma skin cancer (combination DMARD or non-TNF biologic preferable to TNFi) or a previously treated lymphoproliferative disorder (combination DMARD or non-TNF biologic such as abatacept, tocilizumab or rituximab over a TNFi). Patients with treated solid-organ malignancies, however, can be treated as other patients with RA are treated.
For patients with active hepatitis B or C virus infection who are receiving effective antiviral therapy, a DMARD, TNFi, non-TNF biologic, or tofacitinib can be prescribed, based on American Association for the Study of Liver Diseases case series and clinical experience, Dr. Singh said.
For patients with established RA and heart failure (HF), the guidelines recommend combination DMARD, non-TNF biologic, or tofacitinib over a TNFi, and if the patient has established or worsening HF on a TNFi, the three drug options above are preferable to switching the patient to another TNFi.
For patients with previous serious infections, however, there was less agreement on the optimal course. The guidelines, as currently planned, recommend a DMARD combination or abatacept over a TNFi in these patients, but there was no consensus about either rituximab or tocilizumab over a TNFi, Dr. Singh noted.
Tapering therapy
Finally, the proposed guidelines deal with therapeutic tapers. Specifically, for patients with established RA and low disease activity on maintenance methotrexate, the guidelines strongly recommend continuing on a traditional DMARD, TNFi, non-TNF biologic, or tofacitinib.
There is a conditional recommendation that patients with established RA in remission continuing on methotrexate can taper traditional DMARD therapy, TNFi, non-TNF biologic, or tofacitinib. But the guidelines strongly recommend against discontinuing all therapies in these patients, Dr. Singh emphasized.
“The strong recommendation is based on clinical experience that only a very small minority of patients are able to discontinue all therapies. Conditional recommendations here, supported by low-level evidence, are largely based upon expert opinion and clinical experience,” said Dr. Singh, who disclosed financial relationships with Allergan, Regeneron, Savient, and Takeda.
Join the queue
The proposed guidelines follow up on ACR’s 2012 guidelines, and will join an already crowded field of clinical practice recommendations, including those published in 2013 by the European League Against Rheumatism.
BOSTON – Treat to target in both early and established rheumatoid arthritis, recommended the authors of American College of Rheumatology draft guidelines on the management of RA.
The new ACR guidelines, expected to be finalized and published by the spring of 2015, also focus on the care of those patients whom most rheumatologists see in day-to-day practice, and they call for patience when trying a new therapy or new dose of an existing drug, Dr. Jasvinder Singh, of the division of clinical immunology and rheumatology at the University of Alabama, Birmingham, said to a standing-room-only crowd at the annual meeting of the American College of Rheumatology.
One of the guiding principles of the proposed recommendations is that “if a patient is doing well and the RA is under control, switching from one therapy to another should be done by a physician in consultation and agreement with the patient, and arbitrary switching between therapies should not be done,” he said.
Overall, the evidence-based guidelines emphasize several important aspects of RA care, including the following:
• Focus on the common patient and not exceptional cases.
• Give optimal doses of medications for 3 months before escalating or switching therapy.
• Assess disease activity using one of ACR’s recommended measures at a majority of encounters with RA patients.
• Consider methotrexate as the initial therapy in most RA patients.
• Methotrexate is the preferred monotherapy with a disease-modifying antirheumatic drug (DMARD), but other options include sulfasalazine, hydroxychloroquine, or leflunomide.
• A rheumatologist is the clinician of first choice for all patients with RA.
• Limit glucocorticoid treatment to the lowest possible dose for the shortest possible time to offer the best ratio of benefit to risk.
• Routinely assess patients’ functional status with standardized validated measures at least once yearly, or more frequently when RA is active.
The draft guidelines strongly recommend “using a treat-to-target strategy rather than a nontargeted approach” in both early and established RA.
Ideally, the target to be determined by the clinician and patient, should be remission or low disease activity. The guidelines acknowledge, however, that in some cases risk tolerance or comorbidities may require choice of a different and presumably less aggressive target.
Early RA
For early RA in treatment-naive patients, the guidelines offer an algorithm suggesting DMARD monotherapy for patients with low disease activity and, if the disease flares, recourse to short-term glucocorticoids.
For patients with moderately or highly active early RA, DMARD monotherapy can be followed with either short-term glucocorticoids, or in the case of DMARD failure, to either combination traditional DMARDs, a tumor necrosis factor inhibitor (TNFi) with or without methotrexate, or a non-TNF biologic agent with or without methotrexate, and with or without low-dose glucocorticoids. If the above therapies fail, the clinician and patient should consider a treatment course used for established RA.
Established RA
As with early RA, DMARD-naive patients with low disease activity may be started on DMARD monotherapy and proceed to traditional DMARD combinations, a TNFi with/without methotrexate, or non-TNF biologic with/without methotrexate, or tofacitinib with methotrexate. The guidelines offer a less robust recommendation about adding low-dose glucocorticoids, or short-term glucocorticoids for flares.
Patients who have not responded to treatment with single TNFi can move to a non-TNF biologic plus or minus methotrexate, or a different TNFi with/without methotrexate.
Patients who have not responded to treatment with multiple TNFi can try a non-TNF biologic plus/minus methotrexate, or tofacitinib with or without methotrexate.
Patients who have not responded to treatment with a single non-TNF biologic agent can try a different non-TNF biologic with/without methotrexate.
When both a TNFi and non-TNF biologic fail to help, the patient can try another non-TNF biologic plus/minus methotrexate, or tofacitinib plus/minus methotrexate.
Patients for whom multiple non-TNF biologic agents have failed can try either tofacitinib plus/minus methotrexate, or, if the patient is TNFi naive, a TNFi plus/minus methotrexate.
Special considerations
The guidelines make recommendations about treating patients with previously treated or untreated melanoma (TNFi preferable to tofacitinib) or nonmelanoma skin cancer (combination DMARD or non-TNF biologic preferable to TNFi) or a previously treated lymphoproliferative disorder (combination DMARD or non-TNF biologic such as abatacept, tocilizumab or rituximab over a TNFi). Patients with treated solid-organ malignancies, however, can be treated as other patients with RA are treated.
For patients with active hepatitis B or C virus infection who are receiving effective antiviral therapy, a DMARD, TNFi, non-TNF biologic, or tofacitinib can be prescribed, based on American Association for the Study of Liver Diseases case series and clinical experience, Dr. Singh said.
For patients with established RA and heart failure (HF), the guidelines recommend combination DMARD, non-TNF biologic, or tofacitinib over a TNFi, and if the patient has established or worsening HF on a TNFi, the three drug options above are preferable to switching the patient to another TNFi.
For patients with previous serious infections, however, there was less agreement on the optimal course. The guidelines, as currently planned, recommend a DMARD combination or abatacept over a TNFi in these patients, but there was no consensus about either rituximab or tocilizumab over a TNFi, Dr. Singh noted.
Tapering therapy
Finally, the proposed guidelines deal with therapeutic tapers. Specifically, for patients with established RA and low disease activity on maintenance methotrexate, the guidelines strongly recommend continuing on a traditional DMARD, TNFi, non-TNF biologic, or tofacitinib.
There is a conditional recommendation that patients with established RA in remission continuing on methotrexate can taper traditional DMARD therapy, TNFi, non-TNF biologic, or tofacitinib. But the guidelines strongly recommend against discontinuing all therapies in these patients, Dr. Singh emphasized.
“The strong recommendation is based on clinical experience that only a very small minority of patients are able to discontinue all therapies. Conditional recommendations here, supported by low-level evidence, are largely based upon expert opinion and clinical experience,” said Dr. Singh, who disclosed financial relationships with Allergan, Regeneron, Savient, and Takeda.
Join the queue
The proposed guidelines follow up on ACR’s 2012 guidelines, and will join an already crowded field of clinical practice recommendations, including those published in 2013 by the European League Against Rheumatism.
AT THE ACR ANNUAL MEETING
Running history doesn’t contribute to knee OA risk
BOSTON– A history of current or past running did not contribute to a higher odds of developing knee osteoarthritis and may even have a slight protective effect, researchers found in a cross-sectional study of participants in the Osteoarthritis Initiative.
“Although this study does not address the question of whether or not running is harmful in people who do have preexisting knee OA [osteoarthritis], among people who do not have knee OA, [the study indicates that] there is no reason to restrict participation in habitual running at any time in life from the perspective that it does not appear to be harmful to the knee joint,” lead author Dr. Grace Hsiao-Wei Lo said at a press briefing at the annual meeting of the American College of Rheumatology.
Physical activities guidelines from the Centers for Disease Control and Prevention recommend that adults get at least 75 minutes per week of physical activity at a vigorous intensity, which includes running or jogging, noted Dr. Lo of the section of immunology, allergy, and rheumatology at Baylor College of Medicine, Houston.
The study, which is among the first to examine the potential relationship between running and OA in a population-based study of nonelite or high-level runners, included 2,683 participants (44% male) with a mean age of 64 years and mean body-mass index (BMI) of 28 kg/m2. The investigators found that 29% self-identified as runners as some point in their life up to their inclusion into study, with running history occurring in 49% of those aged older than 50 years, 31% in those aged 35-49 years, 15% in those aged 19-34 years, and 9% in those aged 12-18 years. Patients were identified as runners if they listed it as one of their top three activities during those periods. Runners were slightly younger than the overall population with a mean age of 62 years and were more often male (62%). Nonrunners had a mean age of 65 years and were less often male (36%). BMI did not differ between the two.
Knee pain was significantly less prevalent in runners than in nonrunners (35% vs. 42%, respectively), and runners were 13% less likely to have knee pain (odds ratio, 0.87). The relationship did not change after controlling for age, sex, and BMI.
Radiographic knee OA with a Kellgren-Lawrence grade of 2 or more also was significantly less common among runners than among nonrunners (54% vs. 60%), but the relationship was not significant after controlling for the same variables.
Symptomatic radiographic OA – defined as having at least one knee with both radiographic knee OA and frequent knee pain – occurred in 23% of runners and 30% of nonrunners. The significantly lower likelihood for runners to develop symptomatic knee OA than non-runners (OR, 0.83) was slightly attenuated after controlling for age, sex, and BMI, but remained statistically significant.
“When we did look at each individual age range, the results were very similar. Some of the results were no longer statistically significant, but the results were generally in the same direction,” Dr. Lo noted.
Previous studies that have examined the relationship between running and the development of knee OA have been limited in their generalizability to the general population because of the inclusion of elite runners and those with a high level of running as well as small sample size, Dr. Lo said. Self-selection as runners is an important limitation of this cross-sectional, observational study because “there’s always the possibility that people stopped running because they developed knee symptoms,” she said.
Dr. Lo said that her work on the study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. None of the other authors had disclosures.
BOSTON– A history of current or past running did not contribute to a higher odds of developing knee osteoarthritis and may even have a slight protective effect, researchers found in a cross-sectional study of participants in the Osteoarthritis Initiative.
“Although this study does not address the question of whether or not running is harmful in people who do have preexisting knee OA [osteoarthritis], among people who do not have knee OA, [the study indicates that] there is no reason to restrict participation in habitual running at any time in life from the perspective that it does not appear to be harmful to the knee joint,” lead author Dr. Grace Hsiao-Wei Lo said at a press briefing at the annual meeting of the American College of Rheumatology.
Physical activities guidelines from the Centers for Disease Control and Prevention recommend that adults get at least 75 minutes per week of physical activity at a vigorous intensity, which includes running or jogging, noted Dr. Lo of the section of immunology, allergy, and rheumatology at Baylor College of Medicine, Houston.
The study, which is among the first to examine the potential relationship between running and OA in a population-based study of nonelite or high-level runners, included 2,683 participants (44% male) with a mean age of 64 years and mean body-mass index (BMI) of 28 kg/m2. The investigators found that 29% self-identified as runners as some point in their life up to their inclusion into study, with running history occurring in 49% of those aged older than 50 years, 31% in those aged 35-49 years, 15% in those aged 19-34 years, and 9% in those aged 12-18 years. Patients were identified as runners if they listed it as one of their top three activities during those periods. Runners were slightly younger than the overall population with a mean age of 62 years and were more often male (62%). Nonrunners had a mean age of 65 years and were less often male (36%). BMI did not differ between the two.
Knee pain was significantly less prevalent in runners than in nonrunners (35% vs. 42%, respectively), and runners were 13% less likely to have knee pain (odds ratio, 0.87). The relationship did not change after controlling for age, sex, and BMI.
Radiographic knee OA with a Kellgren-Lawrence grade of 2 or more also was significantly less common among runners than among nonrunners (54% vs. 60%), but the relationship was not significant after controlling for the same variables.
Symptomatic radiographic OA – defined as having at least one knee with both radiographic knee OA and frequent knee pain – occurred in 23% of runners and 30% of nonrunners. The significantly lower likelihood for runners to develop symptomatic knee OA than non-runners (OR, 0.83) was slightly attenuated after controlling for age, sex, and BMI, but remained statistically significant.
“When we did look at each individual age range, the results were very similar. Some of the results were no longer statistically significant, but the results were generally in the same direction,” Dr. Lo noted.
Previous studies that have examined the relationship between running and the development of knee OA have been limited in their generalizability to the general population because of the inclusion of elite runners and those with a high level of running as well as small sample size, Dr. Lo said. Self-selection as runners is an important limitation of this cross-sectional, observational study because “there’s always the possibility that people stopped running because they developed knee symptoms,” she said.
Dr. Lo said that her work on the study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. None of the other authors had disclosures.
BOSTON– A history of current or past running did not contribute to a higher odds of developing knee osteoarthritis and may even have a slight protective effect, researchers found in a cross-sectional study of participants in the Osteoarthritis Initiative.
“Although this study does not address the question of whether or not running is harmful in people who do have preexisting knee OA [osteoarthritis], among people who do not have knee OA, [the study indicates that] there is no reason to restrict participation in habitual running at any time in life from the perspective that it does not appear to be harmful to the knee joint,” lead author Dr. Grace Hsiao-Wei Lo said at a press briefing at the annual meeting of the American College of Rheumatology.
Physical activities guidelines from the Centers for Disease Control and Prevention recommend that adults get at least 75 minutes per week of physical activity at a vigorous intensity, which includes running or jogging, noted Dr. Lo of the section of immunology, allergy, and rheumatology at Baylor College of Medicine, Houston.
The study, which is among the first to examine the potential relationship between running and OA in a population-based study of nonelite or high-level runners, included 2,683 participants (44% male) with a mean age of 64 years and mean body-mass index (BMI) of 28 kg/m2. The investigators found that 29% self-identified as runners as some point in their life up to their inclusion into study, with running history occurring in 49% of those aged older than 50 years, 31% in those aged 35-49 years, 15% in those aged 19-34 years, and 9% in those aged 12-18 years. Patients were identified as runners if they listed it as one of their top three activities during those periods. Runners were slightly younger than the overall population with a mean age of 62 years and were more often male (62%). Nonrunners had a mean age of 65 years and were less often male (36%). BMI did not differ between the two.
Knee pain was significantly less prevalent in runners than in nonrunners (35% vs. 42%, respectively), and runners were 13% less likely to have knee pain (odds ratio, 0.87). The relationship did not change after controlling for age, sex, and BMI.
Radiographic knee OA with a Kellgren-Lawrence grade of 2 or more also was significantly less common among runners than among nonrunners (54% vs. 60%), but the relationship was not significant after controlling for the same variables.
Symptomatic radiographic OA – defined as having at least one knee with both radiographic knee OA and frequent knee pain – occurred in 23% of runners and 30% of nonrunners. The significantly lower likelihood for runners to develop symptomatic knee OA than non-runners (OR, 0.83) was slightly attenuated after controlling for age, sex, and BMI, but remained statistically significant.
“When we did look at each individual age range, the results were very similar. Some of the results were no longer statistically significant, but the results were generally in the same direction,” Dr. Lo noted.
Previous studies that have examined the relationship between running and the development of knee OA have been limited in their generalizability to the general population because of the inclusion of elite runners and those with a high level of running as well as small sample size, Dr. Lo said. Self-selection as runners is an important limitation of this cross-sectional, observational study because “there’s always the possibility that people stopped running because they developed knee symptoms,” she said.
Dr. Lo said that her work on the study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. None of the other authors had disclosures.
AT THE ACR ANNUAL MEETING
Key clinical point: There’s no need to restrict habitual running in people who don’t already have knee OA.
Major finding: Symptomatic radiographic OA occurred in 23% of runners and 30% of nonrunners
Data source: A cross-sectional study of 2,683 community-dwelling participants in the Osteoarthritis Initiative.
Disclosures: Dr. Lo said that her work on the study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. None of the other authors had disclosures.
Treat-to-target approach cuts mortality risk in RA patients
BOSTON – Aggressive treatment of rheumatoid arthritis patients aimed at achieving Disease Activity Scores of 2.4 or less was associated with mortality rates that were not significantly different from those seen in the general population, based on the results of a 10-year Dutch study.
Irrespective of the treatment regimen, keeping the DAS (Disease Activity Score) at 2.4 or below is associated with lower inflammation, according to Dr. Iris Markusse of Leiden University Medical Center. “Historically, mortality risk in RA was significantly increased when inflammation was not as effectively suppressed ... [but with intensified treatment] inflammation can be so well controlled that it no longer affects overall survival.”
In the Behandel Strategieen (BeST) study, 508 patients with recent active-onset RA were randomized to one of four treatment approaches. Patients received either sequential monotherapy with methotrexate, step-up therapy with methotrexate, methotrexate plus sulfasalazine and prednisone, or methotrexate and infliximab. For all patients, the treatment target was a DAS of 2.4 or less, and follow-up occurred at 3-month intervals.
Patients who started on methotrexate monotherapy and had a DAS exceeding 2.4 received the next step in therapy, which included adding or switching to other therapies as needed. Conversely, if low disease activity was seen for at least 6 consecutive months, combination therapy was tapered to maintenance monotherapy. After the third year of the trial, patients who had at least 6 consecutive months on maintenance monotherapy had to stop that drug as well.
Over the course of the study, 80% of participants had low disease activity, 45% were in remission, and 15% were in drug-free remission, she reported at a press conference during the annual meeting of the American College of Rheumatology.
Of the 508 patients, 72 died at a mean age of 75 years; the deaths occurred in 16 of 126 patients on methotrexate monotherapy, 15 of 121 on step-up methotrexate, 21 of 133 on methotrexate plus sulfasalazine and prednisone, and 20 of 128 on methotrexate and infliximab. Based on the general Dutch population, 62 deaths would have been expected.
While mortality risk was not significantly different among the treatment arms; mortality risk was higher for patients who were older at baseline, male, smokers, and those with poorer scores on a baseline health assessment questionnaire. The most significant risk factor was smoking at baseline (hazard ratio, 5.19; 95% confidence interval, 3.08-8.75).
Encouraging patients to quit smoking might be effective for reducing mortality, she added.
Dr. Markusse declared having no relevant financial disclosures. Funding for the study included a government grant from the Dutch College of Health Insurance Companies, with additional funding from Schering-Plough/MSD and Centocor/Janssen.
BOSTON – Aggressive treatment of rheumatoid arthritis patients aimed at achieving Disease Activity Scores of 2.4 or less was associated with mortality rates that were not significantly different from those seen in the general population, based on the results of a 10-year Dutch study.
Irrespective of the treatment regimen, keeping the DAS (Disease Activity Score) at 2.4 or below is associated with lower inflammation, according to Dr. Iris Markusse of Leiden University Medical Center. “Historically, mortality risk in RA was significantly increased when inflammation was not as effectively suppressed ... [but with intensified treatment] inflammation can be so well controlled that it no longer affects overall survival.”
In the Behandel Strategieen (BeST) study, 508 patients with recent active-onset RA were randomized to one of four treatment approaches. Patients received either sequential monotherapy with methotrexate, step-up therapy with methotrexate, methotrexate plus sulfasalazine and prednisone, or methotrexate and infliximab. For all patients, the treatment target was a DAS of 2.4 or less, and follow-up occurred at 3-month intervals.
Patients who started on methotrexate monotherapy and had a DAS exceeding 2.4 received the next step in therapy, which included adding or switching to other therapies as needed. Conversely, if low disease activity was seen for at least 6 consecutive months, combination therapy was tapered to maintenance monotherapy. After the third year of the trial, patients who had at least 6 consecutive months on maintenance monotherapy had to stop that drug as well.
Over the course of the study, 80% of participants had low disease activity, 45% were in remission, and 15% were in drug-free remission, she reported at a press conference during the annual meeting of the American College of Rheumatology.
Of the 508 patients, 72 died at a mean age of 75 years; the deaths occurred in 16 of 126 patients on methotrexate monotherapy, 15 of 121 on step-up methotrexate, 21 of 133 on methotrexate plus sulfasalazine and prednisone, and 20 of 128 on methotrexate and infliximab. Based on the general Dutch population, 62 deaths would have been expected.
While mortality risk was not significantly different among the treatment arms; mortality risk was higher for patients who were older at baseline, male, smokers, and those with poorer scores on a baseline health assessment questionnaire. The most significant risk factor was smoking at baseline (hazard ratio, 5.19; 95% confidence interval, 3.08-8.75).
Encouraging patients to quit smoking might be effective for reducing mortality, she added.
Dr. Markusse declared having no relevant financial disclosures. Funding for the study included a government grant from the Dutch College of Health Insurance Companies, with additional funding from Schering-Plough/MSD and Centocor/Janssen.
BOSTON – Aggressive treatment of rheumatoid arthritis patients aimed at achieving Disease Activity Scores of 2.4 or less was associated with mortality rates that were not significantly different from those seen in the general population, based on the results of a 10-year Dutch study.
Irrespective of the treatment regimen, keeping the DAS (Disease Activity Score) at 2.4 or below is associated with lower inflammation, according to Dr. Iris Markusse of Leiden University Medical Center. “Historically, mortality risk in RA was significantly increased when inflammation was not as effectively suppressed ... [but with intensified treatment] inflammation can be so well controlled that it no longer affects overall survival.”
In the Behandel Strategieen (BeST) study, 508 patients with recent active-onset RA were randomized to one of four treatment approaches. Patients received either sequential monotherapy with methotrexate, step-up therapy with methotrexate, methotrexate plus sulfasalazine and prednisone, or methotrexate and infliximab. For all patients, the treatment target was a DAS of 2.4 or less, and follow-up occurred at 3-month intervals.
Patients who started on methotrexate monotherapy and had a DAS exceeding 2.4 received the next step in therapy, which included adding or switching to other therapies as needed. Conversely, if low disease activity was seen for at least 6 consecutive months, combination therapy was tapered to maintenance monotherapy. After the third year of the trial, patients who had at least 6 consecutive months on maintenance monotherapy had to stop that drug as well.
Over the course of the study, 80% of participants had low disease activity, 45% were in remission, and 15% were in drug-free remission, she reported at a press conference during the annual meeting of the American College of Rheumatology.
Of the 508 patients, 72 died at a mean age of 75 years; the deaths occurred in 16 of 126 patients on methotrexate monotherapy, 15 of 121 on step-up methotrexate, 21 of 133 on methotrexate plus sulfasalazine and prednisone, and 20 of 128 on methotrexate and infliximab. Based on the general Dutch population, 62 deaths would have been expected.
While mortality risk was not significantly different among the treatment arms; mortality risk was higher for patients who were older at baseline, male, smokers, and those with poorer scores on a baseline health assessment questionnaire. The most significant risk factor was smoking at baseline (hazard ratio, 5.19; 95% confidence interval, 3.08-8.75).
Encouraging patients to quit smoking might be effective for reducing mortality, she added.
Dr. Markusse declared having no relevant financial disclosures. Funding for the study included a government grant from the Dutch College of Health Insurance Companies, with additional funding from Schering-Plough/MSD and Centocor/Janssen.
AT THE ACR ANNUAL MEETING
Key clinical point: Keeping Disease Activity Scores low, irrespective of the treatment regimen selected, is associated with reduced mortality risk.
Major finding: The most significant risk factor for mortality was smoking at baseline (HR 5.19, 95% CI 3.08-8.75).
Data source: The Behandel Strategieen (BeST) study of 508 patients with recent active-onset RA followed for 10 years.
Disclosures: Dr. Markusse declared having no relevant financial disclosures. Funding for the study included a government grant from the Dutch College of Health Insurance Companies, with additional funding from Schering-Plough/MSD and Centocor/Janssen.
Novel program improves RA care, cuts costs
BOSTON– A bundle of eight measures was effective in improving the quality of rheumatoid arthritis care while reducing costs, Dr. Eric D. Newman reported at the annual meeting of the American College of Rheumatology.
At the start of the program, 22% of roughly 2,400 RA patients had achieved all of the applicable quality measures that were integrated into the program. After 22 months in the program, 40% had met all of the measures.
Using routine disease measures, the program was successful for de-escalating use of biologics among the patients. After 1 year, the associated savings came to $720,000; a savings estimate of $1.2 million is projected for 2014.
“We recognized the importance of objectively and routinely measuring disease activity, and using that information to engage our patients and drive a new systematic strategic approach to rheumatoid arthritis care,” said Dr. Newman, director of rheumatology for the Geisinger Health System, Wilkes-Barre, Penn., and the program’s designer.
The AIM FARTHER (Attribution, Integration, Measurement, Finances and Reporting of Therapies) model was designed and implemented for about 2,400 RA patients cared for by the 17 rheumatologists within the Geisinger Health System. The eight measures included disease activity measures (RA on DMARD, active RA on DMARD, RA with CDAI [Clinical Disease Activity Index], and RA at low disease activity); drug safety measures (TB testing if on a biologic agent, yearly influenza vaccination, and pneumococcal vaccination), and a comorbidity measure (check of LDL cholesterol).
Individual patient scorecards were developed via patient responses on a touch-screen questionnaire and input from physicians, nurses, and the electronic health record. The data were used to measure RA patient care gaps to be resolved. The measures were shared and analyzed to close care gaps as well as create provider and department performance reports.
Before the start of the program, measures were high for the percentage of RA patients and the percentage of patients with active RA on a DMARD as well as the percentage of patients who had their LDLs checked. As a result, only modest further improvements were seen after 22 months of the program (from 88% at baseline to 90% for the percentage of RA patients on a DMARD, from 92% to 93% for RA patients with active disease on a DMARD, and from 93% to 95 for LDL checks).
Significant improvements in other measures were seen, however, including a rise in the use of CDAI measures from 52% to 84%, a rise in TB testing for those on a biologic from 83% to 93%, an increase in yearly influenza vaccination from 59% to 75%, and a rise in pneumococcal vaccination from 59% to 72%.
As a care model, AIM FARTHER seeks to employ provider engagement, process redesign, measurement, and information technology, Dr. Newman said. The components of the program include establishing a registry, defining roles and attribution, integrating primary and specialty care, defining a strategic approach to RA care, developing an RA quality measure bundle, task management and performance reporting, and a financial incentive model.
The success of AIM FARTHER “is not due to any one individual, but [relies on] meaningful involvement of all members of the rheumatology team, holding ourselves accountable, dedicating the time needed to perform the work, and creating an internal forum to discuss quality improvement on a regular basis. This approach moved our rheumatology team from engagement to buy-in to ownership. The result is an RA population management program that is sustainable yet evolving, as we challenge ourselves to continuously improve the quality of care for our patients with rheumatic disease,” Dr. Newman said.
The authors had no disclosures. The work was internally funded by the Geisinger Health System.
BOSTON– A bundle of eight measures was effective in improving the quality of rheumatoid arthritis care while reducing costs, Dr. Eric D. Newman reported at the annual meeting of the American College of Rheumatology.
At the start of the program, 22% of roughly 2,400 RA patients had achieved all of the applicable quality measures that were integrated into the program. After 22 months in the program, 40% had met all of the measures.
Using routine disease measures, the program was successful for de-escalating use of biologics among the patients. After 1 year, the associated savings came to $720,000; a savings estimate of $1.2 million is projected for 2014.
“We recognized the importance of objectively and routinely measuring disease activity, and using that information to engage our patients and drive a new systematic strategic approach to rheumatoid arthritis care,” said Dr. Newman, director of rheumatology for the Geisinger Health System, Wilkes-Barre, Penn., and the program’s designer.
The AIM FARTHER (Attribution, Integration, Measurement, Finances and Reporting of Therapies) model was designed and implemented for about 2,400 RA patients cared for by the 17 rheumatologists within the Geisinger Health System. The eight measures included disease activity measures (RA on DMARD, active RA on DMARD, RA with CDAI [Clinical Disease Activity Index], and RA at low disease activity); drug safety measures (TB testing if on a biologic agent, yearly influenza vaccination, and pneumococcal vaccination), and a comorbidity measure (check of LDL cholesterol).
Individual patient scorecards were developed via patient responses on a touch-screen questionnaire and input from physicians, nurses, and the electronic health record. The data were used to measure RA patient care gaps to be resolved. The measures were shared and analyzed to close care gaps as well as create provider and department performance reports.
Before the start of the program, measures were high for the percentage of RA patients and the percentage of patients with active RA on a DMARD as well as the percentage of patients who had their LDLs checked. As a result, only modest further improvements were seen after 22 months of the program (from 88% at baseline to 90% for the percentage of RA patients on a DMARD, from 92% to 93% for RA patients with active disease on a DMARD, and from 93% to 95 for LDL checks).
Significant improvements in other measures were seen, however, including a rise in the use of CDAI measures from 52% to 84%, a rise in TB testing for those on a biologic from 83% to 93%, an increase in yearly influenza vaccination from 59% to 75%, and a rise in pneumococcal vaccination from 59% to 72%.
As a care model, AIM FARTHER seeks to employ provider engagement, process redesign, measurement, and information technology, Dr. Newman said. The components of the program include establishing a registry, defining roles and attribution, integrating primary and specialty care, defining a strategic approach to RA care, developing an RA quality measure bundle, task management and performance reporting, and a financial incentive model.
The success of AIM FARTHER “is not due to any one individual, but [relies on] meaningful involvement of all members of the rheumatology team, holding ourselves accountable, dedicating the time needed to perform the work, and creating an internal forum to discuss quality improvement on a regular basis. This approach moved our rheumatology team from engagement to buy-in to ownership. The result is an RA population management program that is sustainable yet evolving, as we challenge ourselves to continuously improve the quality of care for our patients with rheumatic disease,” Dr. Newman said.
The authors had no disclosures. The work was internally funded by the Geisinger Health System.
BOSTON– A bundle of eight measures was effective in improving the quality of rheumatoid arthritis care while reducing costs, Dr. Eric D. Newman reported at the annual meeting of the American College of Rheumatology.
At the start of the program, 22% of roughly 2,400 RA patients had achieved all of the applicable quality measures that were integrated into the program. After 22 months in the program, 40% had met all of the measures.
Using routine disease measures, the program was successful for de-escalating use of biologics among the patients. After 1 year, the associated savings came to $720,000; a savings estimate of $1.2 million is projected for 2014.
“We recognized the importance of objectively and routinely measuring disease activity, and using that information to engage our patients and drive a new systematic strategic approach to rheumatoid arthritis care,” said Dr. Newman, director of rheumatology for the Geisinger Health System, Wilkes-Barre, Penn., and the program’s designer.
The AIM FARTHER (Attribution, Integration, Measurement, Finances and Reporting of Therapies) model was designed and implemented for about 2,400 RA patients cared for by the 17 rheumatologists within the Geisinger Health System. The eight measures included disease activity measures (RA on DMARD, active RA on DMARD, RA with CDAI [Clinical Disease Activity Index], and RA at low disease activity); drug safety measures (TB testing if on a biologic agent, yearly influenza vaccination, and pneumococcal vaccination), and a comorbidity measure (check of LDL cholesterol).
Individual patient scorecards were developed via patient responses on a touch-screen questionnaire and input from physicians, nurses, and the electronic health record. The data were used to measure RA patient care gaps to be resolved. The measures were shared and analyzed to close care gaps as well as create provider and department performance reports.
Before the start of the program, measures were high for the percentage of RA patients and the percentage of patients with active RA on a DMARD as well as the percentage of patients who had their LDLs checked. As a result, only modest further improvements were seen after 22 months of the program (from 88% at baseline to 90% for the percentage of RA patients on a DMARD, from 92% to 93% for RA patients with active disease on a DMARD, and from 93% to 95 for LDL checks).
Significant improvements in other measures were seen, however, including a rise in the use of CDAI measures from 52% to 84%, a rise in TB testing for those on a biologic from 83% to 93%, an increase in yearly influenza vaccination from 59% to 75%, and a rise in pneumococcal vaccination from 59% to 72%.
As a care model, AIM FARTHER seeks to employ provider engagement, process redesign, measurement, and information technology, Dr. Newman said. The components of the program include establishing a registry, defining roles and attribution, integrating primary and specialty care, defining a strategic approach to RA care, developing an RA quality measure bundle, task management and performance reporting, and a financial incentive model.
The success of AIM FARTHER “is not due to any one individual, but [relies on] meaningful involvement of all members of the rheumatology team, holding ourselves accountable, dedicating the time needed to perform the work, and creating an internal forum to discuss quality improvement on a regular basis. This approach moved our rheumatology team from engagement to buy-in to ownership. The result is an RA population management program that is sustainable yet evolving, as we challenge ourselves to continuously improve the quality of care for our patients with rheumatic disease,” Dr. Newman said.
The authors had no disclosures. The work was internally funded by the Geisinger Health System.
AT THE ACR ANNUAL MEETING
Key clinical point: Quality programs can improve care and save costs for rheumatoid arthritis patients.
Major finding: After 1 year, the savings came to $720,000; a savings estimate of $1.2 million is projected for 2014.
Data source: Nearly 2,400 RA patients receiving care in central Pennsylvania through the Geisinger Health Care system.
Disclosures: The authors declared no financial disclosures. The work was internally funded by the Geisinger Health System.
OA patients benefit long term from exercise or manual therapy
BOSTON – Improvements in pain, stiffness, and physical function that occur with the addition of exercise therapy or manual therapy to usual care for patients at all stages of osteoarthritis extended out to 2 years in a randomized, controlled trial.
Although evidence already supports the use of exercise therapy or manual therapy for improving the symptoms and physical function of patients with osteoarthritis (OA), the trial is the first to show that either intervention provides benefits over and above that of usual care during the course of 2 years of follow-up.
The investigators, led by Dr. Haxby Abbott of the University of Otago, Dunedin, New Zealand, randomized 206 patients who met American College of Rheumatology criteria for knee or hip OA to usual care alone, exercise therapy plus usual care, manual therapy plus usual care, or both interventions plus usual care.
Those who received one or both of the interventions underwent 10 treatment sessions, including 7 sessions within the first 9 weeks plus 3 booster sessions (2 at 4 months and 1 at 13 months). Between and after those sessions, participants carried out the interventions on their own.
Mean age of the patients was 66 years. The spectrum of OA ranged from mild to severe, with a mean Western Ontario and McMaster Universities (WOMAC) OA index score of 100.8. The patients had been recruited to the trial from primary care and orthopedic services, the investigators reported at the annual meeting of the American College of Rheumatology.
Exercise therapy consisted of strengthening, range-of-motion, neuromuscular coordination, and aerobics activities; manual therapy consisted of skilled passive movement to joints applied by external force. Physical therapists guided both interventions in one-on-one visits.
The 1-year results, which were published in 2013, showed significant decreases in pain and improvements in physical function in both single-intervention groups, but no significant improvement in the combined therapy group (Osteoarthritis Cartilage 2013;21:525-34).
Among the 186 patients who still remained in the study at 2 years of follow-up, scores on the WOMAC – the trial’s primary outcome – improved by 31.7 points in those who received exercise therapy plus usual care, compared with usual care alone, while patients receiving manual therapy in addition to usual care showed a relative improvement of 30.1 points. While the difference in WOMAC improvement for participants receiving combined exercise therapy and manual therapy in addition to usual care did not meet the a priori threshold for clinical significance (28 points), there was a trend toward benefit, with this group improving 26.2 points more than usual care only.
In all three intervention groups, Dr. Abbott noted that those changes represented greater than 20% declines in WOMAC scores from baseline.
In a planned subanalysis that did not include the approximately 20% of patients in each group who had joint replacement surgery, there was still an improvement in scores from baseline to 2 years, whereas those who received usual care alone were 20% worse, he said.
The effect sizes in the exercise group (0.57), manual therapy group (0.55), and combined therapy group (0.55) were substantially better than were the effect sizes of 0.30-0.35 normally attributed to nonsteroidal anti-inflammatory drugs, Dr. Abbott said. When patients with joint surgery were dropped from the analysis, those effect sizes grew to as high as 0.70 in the manual therapy group.
On the second primary outcome of several physical performance tests (timed up-and-go, 40-meter fast-paced walk, and 30-second sit-to-stand), the participants in the exercise therapy group showed greater mean changes than did patients in the other groups.
The Health Research Council of New Zealand funded the trial. None of the investigators had disclosures.
BOSTON – Improvements in pain, stiffness, and physical function that occur with the addition of exercise therapy or manual therapy to usual care for patients at all stages of osteoarthritis extended out to 2 years in a randomized, controlled trial.
Although evidence already supports the use of exercise therapy or manual therapy for improving the symptoms and physical function of patients with osteoarthritis (OA), the trial is the first to show that either intervention provides benefits over and above that of usual care during the course of 2 years of follow-up.
The investigators, led by Dr. Haxby Abbott of the University of Otago, Dunedin, New Zealand, randomized 206 patients who met American College of Rheumatology criteria for knee or hip OA to usual care alone, exercise therapy plus usual care, manual therapy plus usual care, or both interventions plus usual care.
Those who received one or both of the interventions underwent 10 treatment sessions, including 7 sessions within the first 9 weeks plus 3 booster sessions (2 at 4 months and 1 at 13 months). Between and after those sessions, participants carried out the interventions on their own.
Mean age of the patients was 66 years. The spectrum of OA ranged from mild to severe, with a mean Western Ontario and McMaster Universities (WOMAC) OA index score of 100.8. The patients had been recruited to the trial from primary care and orthopedic services, the investigators reported at the annual meeting of the American College of Rheumatology.
Exercise therapy consisted of strengthening, range-of-motion, neuromuscular coordination, and aerobics activities; manual therapy consisted of skilled passive movement to joints applied by external force. Physical therapists guided both interventions in one-on-one visits.
The 1-year results, which were published in 2013, showed significant decreases in pain and improvements in physical function in both single-intervention groups, but no significant improvement in the combined therapy group (Osteoarthritis Cartilage 2013;21:525-34).
Among the 186 patients who still remained in the study at 2 years of follow-up, scores on the WOMAC – the trial’s primary outcome – improved by 31.7 points in those who received exercise therapy plus usual care, compared with usual care alone, while patients receiving manual therapy in addition to usual care showed a relative improvement of 30.1 points. While the difference in WOMAC improvement for participants receiving combined exercise therapy and manual therapy in addition to usual care did not meet the a priori threshold for clinical significance (28 points), there was a trend toward benefit, with this group improving 26.2 points more than usual care only.
In all three intervention groups, Dr. Abbott noted that those changes represented greater than 20% declines in WOMAC scores from baseline.
In a planned subanalysis that did not include the approximately 20% of patients in each group who had joint replacement surgery, there was still an improvement in scores from baseline to 2 years, whereas those who received usual care alone were 20% worse, he said.
The effect sizes in the exercise group (0.57), manual therapy group (0.55), and combined therapy group (0.55) were substantially better than were the effect sizes of 0.30-0.35 normally attributed to nonsteroidal anti-inflammatory drugs, Dr. Abbott said. When patients with joint surgery were dropped from the analysis, those effect sizes grew to as high as 0.70 in the manual therapy group.
On the second primary outcome of several physical performance tests (timed up-and-go, 40-meter fast-paced walk, and 30-second sit-to-stand), the participants in the exercise therapy group showed greater mean changes than did patients in the other groups.
The Health Research Council of New Zealand funded the trial. None of the investigators had disclosures.
BOSTON – Improvements in pain, stiffness, and physical function that occur with the addition of exercise therapy or manual therapy to usual care for patients at all stages of osteoarthritis extended out to 2 years in a randomized, controlled trial.
Although evidence already supports the use of exercise therapy or manual therapy for improving the symptoms and physical function of patients with osteoarthritis (OA), the trial is the first to show that either intervention provides benefits over and above that of usual care during the course of 2 years of follow-up.
The investigators, led by Dr. Haxby Abbott of the University of Otago, Dunedin, New Zealand, randomized 206 patients who met American College of Rheumatology criteria for knee or hip OA to usual care alone, exercise therapy plus usual care, manual therapy plus usual care, or both interventions plus usual care.
Those who received one or both of the interventions underwent 10 treatment sessions, including 7 sessions within the first 9 weeks plus 3 booster sessions (2 at 4 months and 1 at 13 months). Between and after those sessions, participants carried out the interventions on their own.
Mean age of the patients was 66 years. The spectrum of OA ranged from mild to severe, with a mean Western Ontario and McMaster Universities (WOMAC) OA index score of 100.8. The patients had been recruited to the trial from primary care and orthopedic services, the investigators reported at the annual meeting of the American College of Rheumatology.
Exercise therapy consisted of strengthening, range-of-motion, neuromuscular coordination, and aerobics activities; manual therapy consisted of skilled passive movement to joints applied by external force. Physical therapists guided both interventions in one-on-one visits.
The 1-year results, which were published in 2013, showed significant decreases in pain and improvements in physical function in both single-intervention groups, but no significant improvement in the combined therapy group (Osteoarthritis Cartilage 2013;21:525-34).
Among the 186 patients who still remained in the study at 2 years of follow-up, scores on the WOMAC – the trial’s primary outcome – improved by 31.7 points in those who received exercise therapy plus usual care, compared with usual care alone, while patients receiving manual therapy in addition to usual care showed a relative improvement of 30.1 points. While the difference in WOMAC improvement for participants receiving combined exercise therapy and manual therapy in addition to usual care did not meet the a priori threshold for clinical significance (28 points), there was a trend toward benefit, with this group improving 26.2 points more than usual care only.
In all three intervention groups, Dr. Abbott noted that those changes represented greater than 20% declines in WOMAC scores from baseline.
In a planned subanalysis that did not include the approximately 20% of patients in each group who had joint replacement surgery, there was still an improvement in scores from baseline to 2 years, whereas those who received usual care alone were 20% worse, he said.
The effect sizes in the exercise group (0.57), manual therapy group (0.55), and combined therapy group (0.55) were substantially better than were the effect sizes of 0.30-0.35 normally attributed to nonsteroidal anti-inflammatory drugs, Dr. Abbott said. When patients with joint surgery were dropped from the analysis, those effect sizes grew to as high as 0.70 in the manual therapy group.
On the second primary outcome of several physical performance tests (timed up-and-go, 40-meter fast-paced walk, and 30-second sit-to-stand), the participants in the exercise therapy group showed greater mean changes than did patients in the other groups.
The Health Research Council of New Zealand funded the trial. None of the investigators had disclosures.
AT THE ACR ANNUAL MEETING
Key clinical point: Prescribing exercise therapy or manual therapy to patients in various stages of OA can provide long-term benefit in addition to usual care.
Major finding: At 2 years, relative to usual care alone, scores on the WOMAC had improved by 31.7 points in those who received exercise therapy plus usual care, 30.1 points in patients on manual therapy in addition to usual care, and 26.2 points in those who received combined exercise therapy and manual therapy in addition to usual care.
Data source: A trial of 206 patients with OA who were randomized to usual care alone, exercise therapy plus usual care, manual therapy plus usual care, or both interventions plus usual care.
Disclosures: The Health Research Council of New Zealand funded the trial. None of the investigators had disclosures.
VIDEO: Exercise, manual therapy for OA add incremental benefits to usual care
BOSTON – Exercise therapy or manual therapy provide benefits for improving osteoarthritis symptoms and physical function that go over and above what is obtained with usual care alone, according to results from a randomized, controlled trial.
The trial is the first to show the additive effect of manual therapy or exercise therapy on top of usual care. The results of the trial, which had 2 years of follow-up, indicate that in the absence of predictive factors, clinicians should prescribe either one of the interventions based on patient preference in addition to the usual care of NSAIDs and other adjunctive treatments such as massage therapy or specialized footwear, lead investigator Dr. Haxby Abbott of the University of Otago, Dunedin, New Zealand, said in an interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Exercise therapy or manual therapy provide benefits for improving osteoarthritis symptoms and physical function that go over and above what is obtained with usual care alone, according to results from a randomized, controlled trial.
The trial is the first to show the additive effect of manual therapy or exercise therapy on top of usual care. The results of the trial, which had 2 years of follow-up, indicate that in the absence of predictive factors, clinicians should prescribe either one of the interventions based on patient preference in addition to the usual care of NSAIDs and other adjunctive treatments such as massage therapy or specialized footwear, lead investigator Dr. Haxby Abbott of the University of Otago, Dunedin, New Zealand, said in an interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Exercise therapy or manual therapy provide benefits for improving osteoarthritis symptoms and physical function that go over and above what is obtained with usual care alone, according to results from a randomized, controlled trial.
The trial is the first to show the additive effect of manual therapy or exercise therapy on top of usual care. The results of the trial, which had 2 years of follow-up, indicate that in the absence of predictive factors, clinicians should prescribe either one of the interventions based on patient preference in addition to the usual care of NSAIDs and other adjunctive treatments such as massage therapy or specialized footwear, lead investigator Dr. Haxby Abbott of the University of Otago, Dunedin, New Zealand, said in an interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE ACR ANNUAL MEETING
VIDEO: BeST: Does a treat-to-target approach reduce RA mortality?
BOSTON - With follow up every 3 months, the survival rates of RA patients were comparable to those of the general population in a 10-year study of patients in the Netherlands. Dr. Iris Markusse of Leiden University Medical Center credits regimens that were tailored to keep the Disease Activity Score at levels of 2.4 or lower. Further, the medications used in this strategy did not increase patient mortality. Dr. Markusse discusses the findings of BeST in an exclusive interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON - With follow up every 3 months, the survival rates of RA patients were comparable to those of the general population in a 10-year study of patients in the Netherlands. Dr. Iris Markusse of Leiden University Medical Center credits regimens that were tailored to keep the Disease Activity Score at levels of 2.4 or lower. Further, the medications used in this strategy did not increase patient mortality. Dr. Markusse discusses the findings of BeST in an exclusive interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON - With follow up every 3 months, the survival rates of RA patients were comparable to those of the general population in a 10-year study of patients in the Netherlands. Dr. Iris Markusse of Leiden University Medical Center credits regimens that were tailored to keep the Disease Activity Score at levels of 2.4 or lower. Further, the medications used in this strategy did not increase patient mortality. Dr. Markusse discusses the findings of BeST in an exclusive interview at the annual meeting of the American College of Rheumatology.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ACR 2014
VIDEO: RA linked to increased mortality in Nurses’ Health Study
BOSTON – Rheumatoid arthritis has been linked to increased risk for death in one of the first studies to directly compare RA patients with controls over a prolonged period of time. In women who developed RA after enrollment in the Nurses’ Health Study, seropositive disease was strongly associated with worse outcomes. Also, some surprising findings emerged about RA and the risk for fatal respiratory disease in women.
In our exclusive interview, one of the study’s lead authors, Dr. Jeffrey A. Sparks of Brigham and Women’s Hospital, Boston, discusses how the findings may begin to influence the clinical management of women with RA.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Rheumatoid arthritis has been linked to increased risk for death in one of the first studies to directly compare RA patients with controls over a prolonged period of time. In women who developed RA after enrollment in the Nurses’ Health Study, seropositive disease was strongly associated with worse outcomes. Also, some surprising findings emerged about RA and the risk for fatal respiratory disease in women.
In our exclusive interview, one of the study’s lead authors, Dr. Jeffrey A. Sparks of Brigham and Women’s Hospital, Boston, discusses how the findings may begin to influence the clinical management of women with RA.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Rheumatoid arthritis has been linked to increased risk for death in one of the first studies to directly compare RA patients with controls over a prolonged period of time. In women who developed RA after enrollment in the Nurses’ Health Study, seropositive disease was strongly associated with worse outcomes. Also, some surprising findings emerged about RA and the risk for fatal respiratory disease in women.
In our exclusive interview, one of the study’s lead authors, Dr. Jeffrey A. Sparks of Brigham and Women’s Hospital, Boston, discusses how the findings may begin to influence the clinical management of women with RA.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ACR 2014
Evidence builds for importance of CVD, new drug targets at ACR
It’s difficult to highlight the most striking studies or topic areas out of the bounty of research that will be presented at the annual meeting of the American College of Rheumatology, but a few noteworthy studies caught the eye of Dr. Eric L. Matteson, the meeting’s planning subcommittee abstract selection cochair for clinical research.
Some of the studies and topic areas that deserve attention include growing knowledge about the risk of cardiovascular disease in many rheumatic conditions; the conditions in which rheumatoid arthritis (RA) treatment can be cost-effective, and de-escalation of disease-modifying antirheumatic drugs (DMARDs) may be possible; promising clinical results with new drug targets; according to Dr. Matteson, professor of medicine and chair of the department of rheumatology at the Mayo Clinic, Rochester, Minn.
Cardiovascular disease in spondyloarthritis, RA
“One major area in rheumatic diseases is looking at the emerging field of cardiovascular disease. We’ve known that there’s increased risk for heart disease in rheumatoid arthritis patients, not necessarily what to do about it. Now increasingly we’re finding that there’s the same risk in some other inflammatory arthritis diseases,” Dr. Matteson said. A Canadian study to be presented on Tuesday (abstract 2829) is the first population-based cohort study to show that patients with spondyloarthritis are at increased risk for heart disease, although at 40%-50% increased risk of cardiovascular death in comparison to people without spondyloarthritis, it is not at the same magnitude of risk as what is observed for RA, where risk for CV death is doubled in some subgroups, such as women with rheumatoid factor-positive disease.
“I think that’s something that’s new and is significant,” Dr. Matteson said.
Another interesting study to be reported on Sunday provides some initial evidence to suggest that reducing disease activity in RA might reduce the risk of heart failure, which has been shown to be elevated in RA patients. The prospective, cross-sectional study (abstract 945) of patients from a clinic in Germany found progressively lower prevalence of heart failure as 28-joint Disease Activity Score declined, independent of treatment type.
De-escalating DMARDs in RA
Another “hot-button” issue in RA is whether it is possible to reduce therapy, Dr. Matteson noted. On Sunday, German investigators will present a multicenter, randomized controlled trial (abstract 940) showing that while DMARDs can be successfully de-escalated, it’s not clear whether starting the de-escalation process is better done first with a conventional DMARD or a biologic. The presence of anticitrullinated peptide antibodies turned out to be the only predictor of recurrent disease. Another study in the same session (abstract 941) indicated that an attempt to de-escalate biologic treatment was successful in 87% of the selected patients who tried to do so and provided substantial cost savings.
New drug targets in clinical research
One of the unique therapeutic approaches being tried is using autologous dendritic cell immunotherapy to treat RA patients, Dr. Matteson said. “The dendritic cell is an important immune-mediating cell actually not just in rheumatoid arthritis but a lot of other systemic inflammatory conditions including even giant cell arteritis.” A phase I, open-label study (abstract 946) that will be presented on Sunday demonstrated that five vaccinations with high or low doses of the cells over 2- to 4-week intervals in 12 RA patients yielded good to moderate European League Against Rheumatism (EULAR) responses in 7 patients while 12 adverse events occurred in 8 patients.
After not-so-encouraging studies of interleukin-17 as a drug target in RA, its potential in seronegative inflammatory arthritis appears much more promising. The results of a 1-year, phase III trial of secukinumab, a monoclonal antibody to IL-17A, in patients with psoriatic arthritis is “quite hopeful” because there were improvements in clinical parameters of disease and an indication of inhibition of joint erosion (abstract 954). Another phase III study of the drug showed “quite promising effects” in controlling ankylosing spondylitis over the course of 1 year (abstract 819). Both studies will be presented on Sunday.
Noteworthy plenary presentations
“One of the hot areas in lung disease in rheumatic diseases” involves controversy over the value of lung transplantation in patients with systemic sclerosis (SSc) and end-stage lung disease, Dr. Matteson said. A study to be presented in Monday’s plenary session suggests that new methods must be developed to determine which SSc patients can successfully undergo lung transplantation rather than to deny all patients with the condition the chance to undergo the procedure. While the study (abstract 1797) confirmed that patients with SSc have a nearly 50% increased risk of death at 1 year posttransplant when compared with interstitial lung disease patients without SSc, there was no difference in mortality for SSc patients, compared with patients with pulmonary arterial hypertension not caused by SSc.
In Tuesday’s plenary session, investigators will report on the cost-effectiveness of triple therapy, compared with biologics. The results of the study (abstract 2781) suggest that added costs associated with using etanercept prior to a triple-therapy regimen may not be ideal in RA patients for whom methotrexate is not working. Because etanercept has only a small probability of being cost-effective, compared with triple therapy, more health care dollars could be freed up, the authors argue, by adopting the triple regimen prior to etanercept.
Dr. Matteson has received research support from many companies marketing drugs for rheumatic diseases.
It’s difficult to highlight the most striking studies or topic areas out of the bounty of research that will be presented at the annual meeting of the American College of Rheumatology, but a few noteworthy studies caught the eye of Dr. Eric L. Matteson, the meeting’s planning subcommittee abstract selection cochair for clinical research.
Some of the studies and topic areas that deserve attention include growing knowledge about the risk of cardiovascular disease in many rheumatic conditions; the conditions in which rheumatoid arthritis (RA) treatment can be cost-effective, and de-escalation of disease-modifying antirheumatic drugs (DMARDs) may be possible; promising clinical results with new drug targets; according to Dr. Matteson, professor of medicine and chair of the department of rheumatology at the Mayo Clinic, Rochester, Minn.
Cardiovascular disease in spondyloarthritis, RA
“One major area in rheumatic diseases is looking at the emerging field of cardiovascular disease. We’ve known that there’s increased risk for heart disease in rheumatoid arthritis patients, not necessarily what to do about it. Now increasingly we’re finding that there’s the same risk in some other inflammatory arthritis diseases,” Dr. Matteson said. A Canadian study to be presented on Tuesday (abstract 2829) is the first population-based cohort study to show that patients with spondyloarthritis are at increased risk for heart disease, although at 40%-50% increased risk of cardiovascular death in comparison to people without spondyloarthritis, it is not at the same magnitude of risk as what is observed for RA, where risk for CV death is doubled in some subgroups, such as women with rheumatoid factor-positive disease.
“I think that’s something that’s new and is significant,” Dr. Matteson said.
Another interesting study to be reported on Sunday provides some initial evidence to suggest that reducing disease activity in RA might reduce the risk of heart failure, which has been shown to be elevated in RA patients. The prospective, cross-sectional study (abstract 945) of patients from a clinic in Germany found progressively lower prevalence of heart failure as 28-joint Disease Activity Score declined, independent of treatment type.
De-escalating DMARDs in RA
Another “hot-button” issue in RA is whether it is possible to reduce therapy, Dr. Matteson noted. On Sunday, German investigators will present a multicenter, randomized controlled trial (abstract 940) showing that while DMARDs can be successfully de-escalated, it’s not clear whether starting the de-escalation process is better done first with a conventional DMARD or a biologic. The presence of anticitrullinated peptide antibodies turned out to be the only predictor of recurrent disease. Another study in the same session (abstract 941) indicated that an attempt to de-escalate biologic treatment was successful in 87% of the selected patients who tried to do so and provided substantial cost savings.
New drug targets in clinical research
One of the unique therapeutic approaches being tried is using autologous dendritic cell immunotherapy to treat RA patients, Dr. Matteson said. “The dendritic cell is an important immune-mediating cell actually not just in rheumatoid arthritis but a lot of other systemic inflammatory conditions including even giant cell arteritis.” A phase I, open-label study (abstract 946) that will be presented on Sunday demonstrated that five vaccinations with high or low doses of the cells over 2- to 4-week intervals in 12 RA patients yielded good to moderate European League Against Rheumatism (EULAR) responses in 7 patients while 12 adverse events occurred in 8 patients.
After not-so-encouraging studies of interleukin-17 as a drug target in RA, its potential in seronegative inflammatory arthritis appears much more promising. The results of a 1-year, phase III trial of secukinumab, a monoclonal antibody to IL-17A, in patients with psoriatic arthritis is “quite hopeful” because there were improvements in clinical parameters of disease and an indication of inhibition of joint erosion (abstract 954). Another phase III study of the drug showed “quite promising effects” in controlling ankylosing spondylitis over the course of 1 year (abstract 819). Both studies will be presented on Sunday.
Noteworthy plenary presentations
“One of the hot areas in lung disease in rheumatic diseases” involves controversy over the value of lung transplantation in patients with systemic sclerosis (SSc) and end-stage lung disease, Dr. Matteson said. A study to be presented in Monday’s plenary session suggests that new methods must be developed to determine which SSc patients can successfully undergo lung transplantation rather than to deny all patients with the condition the chance to undergo the procedure. While the study (abstract 1797) confirmed that patients with SSc have a nearly 50% increased risk of death at 1 year posttransplant when compared with interstitial lung disease patients without SSc, there was no difference in mortality for SSc patients, compared with patients with pulmonary arterial hypertension not caused by SSc.
In Tuesday’s plenary session, investigators will report on the cost-effectiveness of triple therapy, compared with biologics. The results of the study (abstract 2781) suggest that added costs associated with using etanercept prior to a triple-therapy regimen may not be ideal in RA patients for whom methotrexate is not working. Because etanercept has only a small probability of being cost-effective, compared with triple therapy, more health care dollars could be freed up, the authors argue, by adopting the triple regimen prior to etanercept.
Dr. Matteson has received research support from many companies marketing drugs for rheumatic diseases.
It’s difficult to highlight the most striking studies or topic areas out of the bounty of research that will be presented at the annual meeting of the American College of Rheumatology, but a few noteworthy studies caught the eye of Dr. Eric L. Matteson, the meeting’s planning subcommittee abstract selection cochair for clinical research.
Some of the studies and topic areas that deserve attention include growing knowledge about the risk of cardiovascular disease in many rheumatic conditions; the conditions in which rheumatoid arthritis (RA) treatment can be cost-effective, and de-escalation of disease-modifying antirheumatic drugs (DMARDs) may be possible; promising clinical results with new drug targets; according to Dr. Matteson, professor of medicine and chair of the department of rheumatology at the Mayo Clinic, Rochester, Minn.
Cardiovascular disease in spondyloarthritis, RA
“One major area in rheumatic diseases is looking at the emerging field of cardiovascular disease. We’ve known that there’s increased risk for heart disease in rheumatoid arthritis patients, not necessarily what to do about it. Now increasingly we’re finding that there’s the same risk in some other inflammatory arthritis diseases,” Dr. Matteson said. A Canadian study to be presented on Tuesday (abstract 2829) is the first population-based cohort study to show that patients with spondyloarthritis are at increased risk for heart disease, although at 40%-50% increased risk of cardiovascular death in comparison to people without spondyloarthritis, it is not at the same magnitude of risk as what is observed for RA, where risk for CV death is doubled in some subgroups, such as women with rheumatoid factor-positive disease.
“I think that’s something that’s new and is significant,” Dr. Matteson said.
Another interesting study to be reported on Sunday provides some initial evidence to suggest that reducing disease activity in RA might reduce the risk of heart failure, which has been shown to be elevated in RA patients. The prospective, cross-sectional study (abstract 945) of patients from a clinic in Germany found progressively lower prevalence of heart failure as 28-joint Disease Activity Score declined, independent of treatment type.
De-escalating DMARDs in RA
Another “hot-button” issue in RA is whether it is possible to reduce therapy, Dr. Matteson noted. On Sunday, German investigators will present a multicenter, randomized controlled trial (abstract 940) showing that while DMARDs can be successfully de-escalated, it’s not clear whether starting the de-escalation process is better done first with a conventional DMARD or a biologic. The presence of anticitrullinated peptide antibodies turned out to be the only predictor of recurrent disease. Another study in the same session (abstract 941) indicated that an attempt to de-escalate biologic treatment was successful in 87% of the selected patients who tried to do so and provided substantial cost savings.
New drug targets in clinical research
One of the unique therapeutic approaches being tried is using autologous dendritic cell immunotherapy to treat RA patients, Dr. Matteson said. “The dendritic cell is an important immune-mediating cell actually not just in rheumatoid arthritis but a lot of other systemic inflammatory conditions including even giant cell arteritis.” A phase I, open-label study (abstract 946) that will be presented on Sunday demonstrated that five vaccinations with high or low doses of the cells over 2- to 4-week intervals in 12 RA patients yielded good to moderate European League Against Rheumatism (EULAR) responses in 7 patients while 12 adverse events occurred in 8 patients.
After not-so-encouraging studies of interleukin-17 as a drug target in RA, its potential in seronegative inflammatory arthritis appears much more promising. The results of a 1-year, phase III trial of secukinumab, a monoclonal antibody to IL-17A, in patients with psoriatic arthritis is “quite hopeful” because there were improvements in clinical parameters of disease and an indication of inhibition of joint erosion (abstract 954). Another phase III study of the drug showed “quite promising effects” in controlling ankylosing spondylitis over the course of 1 year (abstract 819). Both studies will be presented on Sunday.
Noteworthy plenary presentations
“One of the hot areas in lung disease in rheumatic diseases” involves controversy over the value of lung transplantation in patients with systemic sclerosis (SSc) and end-stage lung disease, Dr. Matteson said. A study to be presented in Monday’s plenary session suggests that new methods must be developed to determine which SSc patients can successfully undergo lung transplantation rather than to deny all patients with the condition the chance to undergo the procedure. While the study (abstract 1797) confirmed that patients with SSc have a nearly 50% increased risk of death at 1 year posttransplant when compared with interstitial lung disease patients without SSc, there was no difference in mortality for SSc patients, compared with patients with pulmonary arterial hypertension not caused by SSc.
In Tuesday’s plenary session, investigators will report on the cost-effectiveness of triple therapy, compared with biologics. The results of the study (abstract 2781) suggest that added costs associated with using etanercept prior to a triple-therapy regimen may not be ideal in RA patients for whom methotrexate is not working. Because etanercept has only a small probability of being cost-effective, compared with triple therapy, more health care dollars could be freed up, the authors argue, by adopting the triple regimen prior to etanercept.
Dr. Matteson has received research support from many companies marketing drugs for rheumatic diseases.
