BSR Annual Conference 2011

BRIGHTON, ENGLAND – Rituximab is an effective treatment for established rheumatoid arthritis in routine clinical practice, with response predicted by baseline disease activity and functional status, based on data from the British Society for Rheumatology Biologics Register.

Rituximab has been licensed for use in combination with methotrexate since 2006 in both the United States and the United Kingdom, and is generally used after treatment failure with traditional nonbiologic disease-modifying antirheumatic drugs (DMARDs) and at least one anti–tumor necrosis factor–alpha (anti-TNF-alpha) agent.

Two analyses, presented at the annual meeting of the British Society for Rheumatology (BSR) by Moetaza Soliman and her associates, highlighted the real-world use of the biologic agent in patients with severe, active rheumatoid arthritis.

Coauthors of the research included the two principal investigators of the BSRBR – Dr. Deborah Symmons and Dr. Kimmie Hyrich, both of the arthritis research U.K. epidemiology unit at the University of Manchester (England).

"Rituximab has been shown to have good efficacy in clinical trials," said Ms. Soliman, a doctoral researcher at the university. Whether the same can be said in everyday practice was the focus of the first evaluation of data from the BSR Biologics Register (BSRBR).

The overall efficacy of rituximab was examined in 550 patients treated with the drug up until a data cutoff of October 2010. The analysis involved all patients who were treated with the biologic agent, and looked at clinical and patient-reported outcomes 6 months after treatment was started.

The mean age of patients was 59 years, 78% were female, and the mean disease duration was 15 years. One-third of the cohort was seronegative for rheumatoid factor.

The majority (84%) of patients had been treated with anti-TNF therapy, with 53% failing one, 37% two, and 6% three prior anti-TNF drugs.

The most common nonbiologic DMARD used was methotrexate (52%), with some patients receiving up to seven DMARDs.

According to European League Against Rheumatism criteria, 43% of patients showed a "moderate" response to rituximab after 6 months, despite all their prior therapies, with 16% even achieving a "good" response. However, the remaining 41% did not respond to treatment with rituximab.

The mean 28-joint disease activity score (DAS28) at baseline was 6.2 for the whole cohort, which fell to 4.8 at 6 months, a mean change of –1.4. Health Assessment Questionnaire (HAQ) scores also fell, by a mean of –0.1 over the same time period, indicating improved physical function.

Patients who had not received prior anti-TNF therapy (16% of the cohort) appeared to fare better than those who had received such treatment before rituximab, with a mean change in DAS28 of –1.7 compared with –1.3 for anti-TNF failures (P = .05).

The second analysis, presented at a poster session, looked more specifically for baseline factors that might predict which patients were likely to have a better response than others to rituximab.

The analysis involved 463 patients and found that those with higher baseline DAS28 scores were significantly more likely to respond to rituximab than those with lower DAS28 scores.

In addition, rheumatoid factor–positive patients were more likely to achieve disease remission than seronegative patients, but those with higher functional disability (that is, higher HAQ scores) or higher baseline DAS28 scores were less likely to achieve remission by 6 months.

"Rituximab is proven effective in the routine management of RA patients," Ms. Soliman commented. "Response to rituximab was influenced by baseline disease activity and baseline physical function."

The BSRBR is funded by a grant from the BSR. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme, Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and runs the BSRBR. All decisions concerning data analysis, interpretation, and publications are made autonomously of any industrial contribution. Ms. Soliman said she had no relevant financial disclosures.

BRIGHTON, ENGLAND – Rituximab is an effective treatment for established rheumatoid arthritis in routine clinical practice, with response predicted by baseline disease activity and functional status, based on data from the British Society for Rheumatology Biologics Register.

Rituximab has been licensed for use in combination with methotrexate since 2006 in both the United States and the United Kingdom, and is generally used after treatment failure with traditional nonbiologic disease-modifying antirheumatic drugs (DMARDs) and at least one anti–tumor necrosis factor–alpha (anti-TNF-alpha) agent.

Two analyses, presented at the annual meeting of the British Society for Rheumatology (BSR) by Moetaza Soliman and her associates, highlighted the real-world use of the biologic agent in patients with severe, active rheumatoid arthritis.

Coauthors of the research included the two principal investigators of the BSRBR – Dr. Deborah Symmons and Dr. Kimmie Hyrich, both of the arthritis research U.K. epidemiology unit at the University of Manchester (England).

"Rituximab has been shown to have good efficacy in clinical trials," said Ms. Soliman, a doctoral researcher at the university. Whether the same can be said in everyday practice was the focus of the first evaluation of data from the BSR Biologics Register (BSRBR).

The overall efficacy of rituximab was examined in 550 patients treated with the drug up until a data cutoff of October 2010. The analysis involved all patients who were treated with the biologic agent, and looked at clinical and patient-reported outcomes 6 months after treatment was started.

The mean age of patients was 59 years, 78% were female, and the mean disease duration was 15 years. One-third of the cohort was seronegative for rheumatoid factor.

The majority (84%) of patients had been treated with anti-TNF therapy, with 53% failing one, 37% two, and 6% three prior anti-TNF drugs.

The most common nonbiologic DMARD used was methotrexate (52%), with some patients receiving up to seven DMARDs.

According to European League Against Rheumatism criteria, 43% of patients showed a "moderate" response to rituximab after 6 months, despite all their prior therapies, with 16% even achieving a "good" response. However, the remaining 41% did not respond to treatment with rituximab.

The mean 28-joint disease activity score (DAS28) at baseline was 6.2 for the whole cohort, which fell to 4.8 at 6 months, a mean change of –1.4. Health Assessment Questionnaire (HAQ) scores also fell, by a mean of –0.1 over the same time period, indicating improved physical function.

Patients who had not received prior anti-TNF therapy (16% of the cohort) appeared to fare better than those who had received such treatment before rituximab, with a mean change in DAS28 of –1.7 compared with –1.3 for anti-TNF failures (P = .05).

The second analysis, presented at a poster session, looked more specifically for baseline factors that might predict which patients were likely to have a better response than others to rituximab.

The analysis involved 463 patients and found that those with higher baseline DAS28 scores were significantly more likely to respond to rituximab than those with lower DAS28 scores.

In addition, rheumatoid factor–positive patients were more likely to achieve disease remission than seronegative patients, but those with higher functional disability (that is, higher HAQ scores) or higher baseline DAS28 scores were less likely to achieve remission by 6 months.

"Rituximab is proven effective in the routine management of RA patients," Ms. Soliman commented. "Response to rituximab was influenced by baseline disease activity and baseline physical function."

The BSRBR is funded by a grant from the BSR. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme, Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and runs the BSRBR. All decisions concerning data analysis, interpretation, and publications are made autonomously of any industrial contribution. Ms. Soliman said she had no relevant financial disclosures.

BRIGHTON, ENGLAND – Rituximab is an effective treatment for established rheumatoid arthritis in routine clinical practice, with response predicted by baseline disease activity and functional status, based on data from the British Society for Rheumatology Biologics Register.

Rituximab has been licensed for use in combination with methotrexate since 2006 in both the United States and the United Kingdom, and is generally used after treatment failure with traditional nonbiologic disease-modifying antirheumatic drugs (DMARDs) and at least one anti–tumor necrosis factor–alpha (anti-TNF-alpha) agent.

Two analyses, presented at the annual meeting of the British Society for Rheumatology (BSR) by Moetaza Soliman and her associates, highlighted the real-world use of the biologic agent in patients with severe, active rheumatoid arthritis.

Coauthors of the research included the two principal investigators of the BSRBR – Dr. Deborah Symmons and Dr. Kimmie Hyrich, both of the arthritis research U.K. epidemiology unit at the University of Manchester (England).

"Rituximab has been shown to have good efficacy in clinical trials," said Ms. Soliman, a doctoral researcher at the university. Whether the same can be said in everyday practice was the focus of the first evaluation of data from the BSR Biologics Register (BSRBR).

The overall efficacy of rituximab was examined in 550 patients treated with the drug up until a data cutoff of October 2010. The analysis involved all patients who were treated with the biologic agent, and looked at clinical and patient-reported outcomes 6 months after treatment was started.

The mean age of patients was 59 years, 78% were female, and the mean disease duration was 15 years. One-third of the cohort was seronegative for rheumatoid factor.

The majority (84%) of patients had been treated with anti-TNF therapy, with 53% failing one, 37% two, and 6% three prior anti-TNF drugs.

The most common nonbiologic DMARD used was methotrexate (52%), with some patients receiving up to seven DMARDs.

According to European League Against Rheumatism criteria, 43% of patients showed a "moderate" response to rituximab after 6 months, despite all their prior therapies, with 16% even achieving a "good" response. However, the remaining 41% did not respond to treatment with rituximab.

The mean 28-joint disease activity score (DAS28) at baseline was 6.2 for the whole cohort, which fell to 4.8 at 6 months, a mean change of –1.4. Health Assessment Questionnaire (HAQ) scores also fell, by a mean of –0.1 over the same time period, indicating improved physical function.

Patients who had not received prior anti-TNF therapy (16% of the cohort) appeared to fare better than those who had received such treatment before rituximab, with a mean change in DAS28 of –1.7 compared with –1.3 for anti-TNF failures (P = .05).

The second analysis, presented at a poster session, looked more specifically for baseline factors that might predict which patients were likely to have a better response than others to rituximab.

The analysis involved 463 patients and found that those with higher baseline DAS28 scores were significantly more likely to respond to rituximab than those with lower DAS28 scores.

In addition, rheumatoid factor–positive patients were more likely to achieve disease remission than seronegative patients, but those with higher functional disability (that is, higher HAQ scores) or higher baseline DAS28 scores were less likely to achieve remission by 6 months.

"Rituximab is proven effective in the routine management of RA patients," Ms. Soliman commented. "Response to rituximab was influenced by baseline disease activity and baseline physical function."

The BSRBR is funded by a grant from the BSR. The BSR receives funding from Abbott Laboratories, Biovitrum/SOBI, Merck Sharp & Dohme, Pfizer, Roche, and UCB. This income finances a separate contract between the BSR and the University of Manchester that provides and runs the BSRBR. All decisions concerning data analysis, interpretation, and publications are made autonomously of any industrial contribution. Ms. Soliman said she had no relevant financial disclosures.

BRIGHTON, ENGLAND – Use of the 2010 classification criteria for rheumatoid arthritis that were developed jointly by the American College of Rheumatology and the European League Against Rheumatism could result in overdiagnosis and subsequent overtreatment of early disease.

Although the 2010 ACR/EULAR criteria for RA classification allow for the more rapid identification of patients early in the course of the disease, their widespread use could also mean that some people with an essentially self-limiting illness could be given unnecessary – and perhaps too aggressive – treatment.

Study findings that were presented April 12 at the annual meeting of the British Society for Rheumatology found that more than 30% of 265 patients with early synovitis were identified as having RA via the 2010 ACR/EULAR criteria only (Arthritis Rheum. 2010;62:2569-81). In comparison, around half the number of patients (17.7%) were identified using the 1987 ACR criteria (Arthritis Rheum. 1988;31:315-24) alone.

"When we look at the early, and often undifferentiated phase, of arthritis, this poses a potential dilemma to clinicians," study author Dr. Zaeem Cader of the Rheumatology Research Group at the University of Birmingham (England) commented.

"The disease of many patients will resolve without ever requiring treatment," he observed, "whilst others progress to a persistent arthritis. And within this category, some patients may convert to an established rheumatoid phenotype, with others developing a non-RA, but persistent, arthropathy."

It is within the latter group that the 1987 ACR classification criteria were originally developed, Dr. Cader explained; those criteria aimed to help differentiate RA from other rheumatologic joint conditions of several years’ duration.

In recent years, however, it has become clear that the earlier RA is treated, the better the outcome in terms of radiologic progression, which can be halted or prevented with the use of DMARDs (disease-modifying antirheumatic drugs) very early on in the course of the disease.

With this in mind, Dr. Cader and associates looked at whether the updated 2010 ACR/EULAR criteria could better identify patients within the first 3 months of symptom onset in their early RA cohort.

In all, 265 patients with clinically apparent synovial swelling in one or more joint were studied; they had a mean age of 49 years and median symptom duration of 42 days. The percentage of patients meeting 2010 criteria only at baseline was 17.4%, whereas 2.3% met ACR criteria only, 15.5% met both, 42.2% neither, and 22.6% had a clear, alternative diagnosis to RA.

After 18 months of treatment, however, reassessment of patients showed that only 6% and 7%, respectively, still met either the 2010 or 1987 criteria, with 28.8% fulfilling both sets of criteria, 29.9% fulfilling neither, and 27.9% not being diagnosed with RA.

Application of the new criteria vs. the old at baseline also detected significantly more patients who would later require methotrexate or another DMARD, but the use of the new criteria also detected significantly more patients whose disease spontaneously resolved (in both, P less than .01).

"Classification is not the same as diagnosis," Dr. Cader conceded. "However, two core goals of the new criteria were to identify patients who were at risk of progressing to persistent disease, and [to identify] patients who will require treatment with drugs such as methotrexate."

Although the authors of the 2010 criteria resisted a direct comparison, or even basing the new criteria on the old, Dr. Cader argued that this was an important comparison to make. Indeed, if the 2010 criteria are more widely used, it’s important to know if they do indeed meet the goal of more rapidly identifying patients. In addition, it might be hard to translate findings from epidemiologic and clinical research based on these old criteria.

"The early identification of patients at risk of developing RA will allow for the early institution of treatment and improved clinical outcomes," the senior author of the study Dr. Karim Raza said separately in a press statement.

Dr. Raza, a senior lecturer and honorary consultant rheumatologist at the University of Birmingham, cautioned however, that the use of the updated RA criteria could lead to the overdiagnosis and subsequent overtreatment of patients.

"The new 2010 ACR/EULAR criteria represent an important step in that direction. However, detailed testing of these criteria in other cohorts is needed to fully assess to what extent ‘overtreatment’ would be a problem if these were widely applied."

Dr. Cader stated that he had no conflicts of interest. Dr. Raza and other coauthors disclosed receiving research grants from Cellzome, UCB, and Wyeth.

BRIGHTON, ENGLAND – Use of the 2010 classification criteria for rheumatoid arthritis that were developed jointly by the American College of Rheumatology and the European League Against Rheumatism could result in overdiagnosis and subsequent overtreatment of early disease.

Although the 2010 ACR/EULAR criteria for RA classification allow for the more rapid identification of patients early in the course of the disease, their widespread use could also mean that some people with an essentially self-limiting illness could be given unnecessary – and perhaps too aggressive – treatment.

Study findings that were presented April 12 at the annual meeting of the British Society for Rheumatology found that more than 30% of 265 patients with early synovitis were identified as having RA via the 2010 ACR/EULAR criteria only (Arthritis Rheum. 2010;62:2569-81). In comparison, around half the number of patients (17.7%) were identified using the 1987 ACR criteria (Arthritis Rheum. 1988;31:315-24) alone.

"When we look at the early, and often undifferentiated phase, of arthritis, this poses a potential dilemma to clinicians," study author Dr. Zaeem Cader of the Rheumatology Research Group at the University of Birmingham (England) commented.

"The disease of many patients will resolve without ever requiring treatment," he observed, "whilst others progress to a persistent arthritis. And within this category, some patients may convert to an established rheumatoid phenotype, with others developing a non-RA, but persistent, arthropathy."

It is within the latter group that the 1987 ACR classification criteria were originally developed, Dr. Cader explained; those criteria aimed to help differentiate RA from other rheumatologic joint conditions of several years’ duration.

In recent years, however, it has become clear that the earlier RA is treated, the better the outcome in terms of radiologic progression, which can be halted or prevented with the use of DMARDs (disease-modifying antirheumatic drugs) very early on in the course of the disease.

With this in mind, Dr. Cader and associates looked at whether the updated 2010 ACR/EULAR criteria could better identify patients within the first 3 months of symptom onset in their early RA cohort.

In all, 265 patients with clinically apparent synovial swelling in one or more joint were studied; they had a mean age of 49 years and median symptom duration of 42 days. The percentage of patients meeting 2010 criteria only at baseline was 17.4%, whereas 2.3% met ACR criteria only, 15.5% met both, 42.2% neither, and 22.6% had a clear, alternative diagnosis to RA.

After 18 months of treatment, however, reassessment of patients showed that only 6% and 7%, respectively, still met either the 2010 or 1987 criteria, with 28.8% fulfilling both sets of criteria, 29.9% fulfilling neither, and 27.9% not being diagnosed with RA.

Application of the new criteria vs. the old at baseline also detected significantly more patients who would later require methotrexate or another DMARD, but the use of the new criteria also detected significantly more patients whose disease spontaneously resolved (in both, P less than .01).

"Classification is not the same as diagnosis," Dr. Cader conceded. "However, two core goals of the new criteria were to identify patients who were at risk of progressing to persistent disease, and [to identify] patients who will require treatment with drugs such as methotrexate."

Although the authors of the 2010 criteria resisted a direct comparison, or even basing the new criteria on the old, Dr. Cader argued that this was an important comparison to make. Indeed, if the 2010 criteria are more widely used, it’s important to know if they do indeed meet the goal of more rapidly identifying patients. In addition, it might be hard to translate findings from epidemiologic and clinical research based on these old criteria.

"The early identification of patients at risk of developing RA will allow for the early institution of treatment and improved clinical outcomes," the senior author of the study Dr. Karim Raza said separately in a press statement.

Dr. Raza, a senior lecturer and honorary consultant rheumatologist at the University of Birmingham, cautioned however, that the use of the updated RA criteria could lead to the overdiagnosis and subsequent overtreatment of patients.

"The new 2010 ACR/EULAR criteria represent an important step in that direction. However, detailed testing of these criteria in other cohorts is needed to fully assess to what extent ‘overtreatment’ would be a problem if these were widely applied."

Dr. Cader stated that he had no conflicts of interest. Dr. Raza and other coauthors disclosed receiving research grants from Cellzome, UCB, and Wyeth.

BRIGHTON, ENGLAND – Use of the 2010 classification criteria for rheumatoid arthritis that were developed jointly by the American College of Rheumatology and the European League Against Rheumatism could result in overdiagnosis and subsequent overtreatment of early disease.

Although the 2010 ACR/EULAR criteria for RA classification allow for the more rapid identification of patients early in the course of the disease, their widespread use could also mean that some people with an essentially self-limiting illness could be given unnecessary – and perhaps too aggressive – treatment.

Study findings that were presented April 12 at the annual meeting of the British Society for Rheumatology found that more than 30% of 265 patients with early synovitis were identified as having RA via the 2010 ACR/EULAR criteria only (Arthritis Rheum. 2010;62:2569-81). In comparison, around half the number of patients (17.7%) were identified using the 1987 ACR criteria (Arthritis Rheum. 1988;31:315-24) alone.

"When we look at the early, and often undifferentiated phase, of arthritis, this poses a potential dilemma to clinicians," study author Dr. Zaeem Cader of the Rheumatology Research Group at the University of Birmingham (England) commented.

"The disease of many patients will resolve without ever requiring treatment," he observed, "whilst others progress to a persistent arthritis. And within this category, some patients may convert to an established rheumatoid phenotype, with others developing a non-RA, but persistent, arthropathy."

It is within the latter group that the 1987 ACR classification criteria were originally developed, Dr. Cader explained; those criteria aimed to help differentiate RA from other rheumatologic joint conditions of several years’ duration.

In recent years, however, it has become clear that the earlier RA is treated, the better the outcome in terms of radiologic progression, which can be halted or prevented with the use of DMARDs (disease-modifying antirheumatic drugs) very early on in the course of the disease.

With this in mind, Dr. Cader and associates looked at whether the updated 2010 ACR/EULAR criteria could better identify patients within the first 3 months of symptom onset in their early RA cohort.

In all, 265 patients with clinically apparent synovial swelling in one or more joint were studied; they had a mean age of 49 years and median symptom duration of 42 days. The percentage of patients meeting 2010 criteria only at baseline was 17.4%, whereas 2.3% met ACR criteria only, 15.5% met both, 42.2% neither, and 22.6% had a clear, alternative diagnosis to RA.

After 18 months of treatment, however, reassessment of patients showed that only 6% and 7%, respectively, still met either the 2010 or 1987 criteria, with 28.8% fulfilling both sets of criteria, 29.9% fulfilling neither, and 27.9% not being diagnosed with RA.

Application of the new criteria vs. the old at baseline also detected significantly more patients who would later require methotrexate or another DMARD, but the use of the new criteria also detected significantly more patients whose disease spontaneously resolved (in both, P less than .01).

"Classification is not the same as diagnosis," Dr. Cader conceded. "However, two core goals of the new criteria were to identify patients who were at risk of progressing to persistent disease, and [to identify] patients who will require treatment with drugs such as methotrexate."

Although the authors of the 2010 criteria resisted a direct comparison, or even basing the new criteria on the old, Dr. Cader argued that this was an important comparison to make. Indeed, if the 2010 criteria are more widely used, it’s important to know if they do indeed meet the goal of more rapidly identifying patients. In addition, it might be hard to translate findings from epidemiologic and clinical research based on these old criteria.

"The early identification of patients at risk of developing RA will allow for the early institution of treatment and improved clinical outcomes," the senior author of the study Dr. Karim Raza said separately in a press statement.

Dr. Raza, a senior lecturer and honorary consultant rheumatologist at the University of Birmingham, cautioned however, that the use of the updated RA criteria could lead to the overdiagnosis and subsequent overtreatment of patients.

"The new 2010 ACR/EULAR criteria represent an important step in that direction. However, detailed testing of these criteria in other cohorts is needed to fully assess to what extent ‘overtreatment’ would be a problem if these were widely applied."

Dr. Cader stated that he had no conflicts of interest. Dr. Raza and other coauthors disclosed receiving research grants from Cellzome, UCB, and Wyeth.

BRIGHTON, ENGLAND – Use of the 2010 classification criteria for rheumatoid arthritis that were developed jointly by the American College of Rheumatology and the European League Against Rheumatism could result in overdiagnosis and subsequent overtreatment of early disease.

Although the 2010 ACR/EULAR criteria for RA classification allow for the more rapid identification of patients early in the course of the disease, their widespread use could also mean that some people with an essentially self-limiting illness could be given unnecessary – and perhaps too aggressive – treatment.

Study findings that were presented April 12 at the annual meeting of the British Society for Rheumatology found that more than 30% of 265 patients with early synovitis were identified as having RA via the 2010 ACR/EULAR criteria only (Arthritis Rheum. 2010;62:2569-81). In comparison, around half the number of patients (17.7%) were identified using the 1987 ACR criteria (Arthritis Rheum. 1988;31:315-24) alone.

"When we look at the early, and often undifferentiated phase, of arthritis, this poses a potential dilemma to clinicians," study author Dr. Zaeem Cader of the Rheumatology Research Group at the University of Birmingham (England) commented.

"The disease of many patients will resolve without ever requiring treatment," he observed, "whilst others progress to a persistent arthritis. And within this category, some patients may convert to an established rheumatoid phenotype, with others developing a non-RA, but persistent, arthropathy."

It is within the latter group that the 1987 ACR classification criteria were originally developed, Dr. Cader explained; those criteria aimed to help differentiate RA from other rheumatologic joint conditions of several years’ duration.

In recent years, however, it has become clear that the earlier RA is treated, the better the outcome in terms of radiologic progression, which can be halted or prevented with the use of DMARDs (disease-modifying antirheumatic drugs) very early on in the course of the disease.

With this in mind, Dr. Cader and associates looked at whether the updated 2010 ACR/EULAR criteria could better identify patients within the first 3 months of symptom onset in their early RA cohort.

In all, 265 patients with clinically apparent synovial swelling in one or more joint were studied; they had a mean age of 49 years and median symptom duration of 42 days. The percentage of patients meeting 2010 criteria only at baseline was 17.4%, whereas 2.3% met ACR criteria only, 15.5% met both, 42.2% neither, and 22.6% had a clear, alternative diagnosis to RA.

After 18 months of treatment, however, reassessment of patients showed that only 6% and 7%, respectively, still met either the 2010 or 1987 criteria, with 28.8% fulfilling both sets of criteria, 29.9% fulfilling neither, and 27.9% not being diagnosed with RA.

Application of the new criteria vs. the old at baseline also detected significantly more patients who would later require methotrexate or another DMARD, but the use of the new criteria also detected significantly more patients whose disease spontaneously resolved (in both, P less than .01).

"Classification is not the same as diagnosis," Dr. Cader conceded. "However, two core goals of the new criteria were to identify patients who were at risk of progressing to persistent disease, and [to identify] patients who will require treatment with drugs such as methotrexate."

Although the authors of the 2010 criteria resisted a direct comparison, or even basing the new criteria on the old, Dr. Cader argued that this was an important comparison to make. Indeed, if the 2010 criteria are more widely used, it’s important to know if they do indeed meet the goal of more rapidly identifying patients. In addition, it might be hard to translate findings from epidemiologic and clinical research based on these old criteria.

"The early identification of patients at risk of developing RA will allow for the early institution of treatment and improved clinical outcomes," the senior author of the study Dr. Karim Raza said separately in a press statement.

Dr. Raza, a senior lecturer and honorary consultant rheumatologist at the University of Birmingham, cautioned however, that the use of the updated RA criteria could lead to the overdiagnosis and subsequent overtreatment of patients.

"The new 2010 ACR/EULAR criteria represent an important step in that direction. However, detailed testing of these criteria in other cohorts is needed to fully assess to what extent ‘overtreatment’ would be a problem if these were widely applied."

Dr. Cader stated that he had no conflicts of interest. Dr. Raza and other coauthors disclosed receiving research grants from Cellzome, UCB, and Wyeth.

BRIGHTON, ENGLAND – Use of the 2010 classification criteria for rheumatoid arthritis that were developed jointly by the American College of Rheumatology and the European League Against Rheumatism could result in overdiagnosis and subsequent overtreatment of early disease.

Although the 2010 ACR/EULAR criteria for RA classification allow for the more rapid identification of patients early in the course of the disease, their widespread use could also mean that some people with an essentially self-limiting illness could be given unnecessary – and perhaps too aggressive – treatment.

Study findings that were presented April 12 at the annual meeting of the British Society for Rheumatology found that more than 30% of 265 patients with early synovitis were identified as having RA via the 2010 ACR/EULAR criteria only (Arthritis Rheum. 2010;62:2569-81). In comparison, around half the number of patients (17.7%) were identified using the 1987 ACR criteria (Arthritis Rheum. 1988;31:315-24) alone.

"When we look at the early, and often undifferentiated phase, of arthritis, this poses a potential dilemma to clinicians," study author Dr. Zaeem Cader of the Rheumatology Research Group at the University of Birmingham (England) commented.

"The disease of many patients will resolve without ever requiring treatment," he observed, "whilst others progress to a persistent arthritis. And within this category, some patients may convert to an established rheumatoid phenotype, with others developing a non-RA, but persistent, arthropathy."

It is within the latter group that the 1987 ACR classification criteria were originally developed, Dr. Cader explained; those criteria aimed to help differentiate RA from other rheumatologic joint conditions of several years’ duration.

In recent years, however, it has become clear that the earlier RA is treated, the better the outcome in terms of radiologic progression, which can be halted or prevented with the use of DMARDs (disease-modifying antirheumatic drugs) very early on in the course of the disease.

With this in mind, Dr. Cader and associates looked at whether the updated 2010 ACR/EULAR criteria could better identify patients within the first 3 months of symptom onset in their early RA cohort.

In all, 265 patients with clinically apparent synovial swelling in one or more joint were studied; they had a mean age of 49 years and median symptom duration of 42 days. The percentage of patients meeting 2010 criteria only at baseline was 17.4%, whereas 2.3% met ACR criteria only, 15.5% met both, 42.2% neither, and 22.6% had a clear, alternative diagnosis to RA.

After 18 months of treatment, however, reassessment of patients showed that only 6% and 7%, respectively, still met either the 2010 or 1987 criteria, with 28.8% fulfilling both sets of criteria, 29.9% fulfilling neither, and 27.9% not being diagnosed with RA.

Application of the new criteria vs. the old at baseline also detected significantly more patients who would later require methotrexate or another DMARD, but the use of the new criteria also detected significantly more patients whose disease spontaneously resolved (in both, P less than .01).

"Classification is not the same as diagnosis," Dr. Cader conceded. "However, two core goals of the new criteria were to identify patients who were at risk of progressing to persistent disease, and [to identify] patients who will require treatment with drugs such as methotrexate."

Although the authors of the 2010 criteria resisted a direct comparison, or even basing the new criteria on the old, Dr. Cader argued that this was an important comparison to make. Indeed, if the 2010 criteria are more widely used, it’s important to know if they do indeed meet the goal of more rapidly identifying patients. In addition, it might be hard to translate findings from epidemiologic and clinical research based on these old criteria.

"The early identification of patients at risk of developing RA will allow for the early institution of treatment and improved clinical outcomes," the senior author of the study Dr. Karim Raza said separately in a press statement.

Dr. Raza, a senior lecturer and honorary consultant rheumatologist at the University of Birmingham, cautioned however, that the use of the updated RA criteria could lead to the overdiagnosis and subsequent overtreatment of patients.

"The new 2010 ACR/EULAR criteria represent an important step in that direction. However, detailed testing of these criteria in other cohorts is needed to fully assess to what extent ‘overtreatment’ would be a problem if these were widely applied."

Dr. Cader stated that he had no conflicts of interest. Dr. Raza and other coauthors disclosed receiving research grants from Cellzome, UCB, and Wyeth.

BRIGHTON, ENGLAND – Use of the 2010 classification criteria for rheumatoid arthritis that were developed jointly by the American College of Rheumatology and the European League Against Rheumatism could result in overdiagnosis and subsequent overtreatment of early disease.

Although the 2010 ACR/EULAR criteria for RA classification allow for the more rapid identification of patients early in the course of the disease, their widespread use could also mean that some people with an essentially self-limiting illness could be given unnecessary – and perhaps too aggressive – treatment.

Study findings that were presented April 12 at the annual meeting of the British Society for Rheumatology found that more than 30% of 265 patients with early synovitis were identified as having RA via the 2010 ACR/EULAR criteria only (Arthritis Rheum. 2010;62:2569-81). In comparison, around half the number of patients (17.7%) were identified using the 1987 ACR criteria (Arthritis Rheum. 1988;31:315-24) alone.

"When we look at the early, and often undifferentiated phase, of arthritis, this poses a potential dilemma to clinicians," study author Dr. Zaeem Cader of the Rheumatology Research Group at the University of Birmingham (England) commented.

"The disease of many patients will resolve without ever requiring treatment," he observed, "whilst others progress to a persistent arthritis. And within this category, some patients may convert to an established rheumatoid phenotype, with others developing a non-RA, but persistent, arthropathy."

It is within the latter group that the 1987 ACR classification criteria were originally developed, Dr. Cader explained; those criteria aimed to help differentiate RA from other rheumatologic joint conditions of several years’ duration.

In recent years, however, it has become clear that the earlier RA is treated, the better the outcome in terms of radiologic progression, which can be halted or prevented with the use of DMARDs (disease-modifying antirheumatic drugs) very early on in the course of the disease.

With this in mind, Dr. Cader and associates looked at whether the updated 2010 ACR/EULAR criteria could better identify patients within the first 3 months of symptom onset in their early RA cohort.

In all, 265 patients with clinically apparent synovial swelling in one or more joint were studied; they had a mean age of 49 years and median symptom duration of 42 days. The percentage of patients meeting 2010 criteria only at baseline was 17.4%, whereas 2.3% met ACR criteria only, 15.5% met both, 42.2% neither, and 22.6% had a clear, alternative diagnosis to RA.

After 18 months of treatment, however, reassessment of patients showed that only 6% and 7%, respectively, still met either the 2010 or 1987 criteria, with 28.8% fulfilling both sets of criteria, 29.9% fulfilling neither, and 27.9% not being diagnosed with RA.

Application of the new criteria vs. the old at baseline also detected significantly more patients who would later require methotrexate or another DMARD, but the use of the new criteria also detected significantly more patients whose disease spontaneously resolved (in both, P less than .01).

"Classification is not the same as diagnosis," Dr. Cader conceded. "However, two core goals of the new criteria were to identify patients who were at risk of progressing to persistent disease, and [to identify] patients who will require treatment with drugs such as methotrexate."

Although the authors of the 2010 criteria resisted a direct comparison, or even basing the new criteria on the old, Dr. Cader argued that this was an important comparison to make. Indeed, if the 2010 criteria are more widely used, it’s important to know if they do indeed meet the goal of more rapidly identifying patients. In addition, it might be hard to translate findings from epidemiologic and clinical research based on these old criteria.

"The early identification of patients at risk of developing RA will allow for the early institution of treatment and improved clinical outcomes," the senior author of the study Dr. Karim Raza said separately in a press statement.

Dr. Raza, a senior lecturer and honorary consultant rheumatologist at the University of Birmingham, cautioned however, that the use of the updated RA criteria could lead to the overdiagnosis and subsequent overtreatment of patients.

"The new 2010 ACR/EULAR criteria represent an important step in that direction. However, detailed testing of these criteria in other cohorts is needed to fully assess to what extent ‘overtreatment’ would be a problem if these were widely applied."

Dr. Cader stated that he had no conflicts of interest. Dr. Raza and other coauthors disclosed receiving research grants from Cellzome, UCB, and Wyeth.

BRIGHTON, ENGLAND – Very obese patients with early rheumatoid arthritis appear to have higher disease activity at presentation, according to recent data presented at the annual meeting of the British Society for Rheumatology.

In a study of 216 individuals with early, clinically diagnosed rheumatoid arthritis (RA), those with a body mass index (BMI) of 35 kg/m² or higher were more likely than those with lower BMIs to have higher 28-joint count disease activity scores (DAS28), mainly because of higher erythrocyte sedimentation rates (ESRs).

Photo credit: ©geronimo/Fotolia.com

As a result, use of the DAS28 to guide clinical decision-making could result in disease-modifying antirheumatic drug (DMARD) therapy being given early on, suggested Stephanie Ling, who presented the findings.

Ms. Ling, a fifth-year medical student at the University of Liverpool, England, noted that earlier, more aggressive treatment of obese RA patients might explain why some studies have suggested that obesity, somewhat paradoxically, is actually beneficial in some patients with RA.

Indeed, studies have linked obesity with reduced mortality (Arch. Intern. Med. 2005;165:1624-9; Ann. Rheum. Dis. 2010;69:i61-4) and protection against radiographic joint damage (Ann. Rheum. Dis. 2008;67:769-74), although high levels of adiponectin – secreted from the fat tissue – are associated with increased joint inflammation (Arthritis Rheum. 2009;61:1248-56).

"Physiologically, obesity is characterized by the expansion of white adipose tissue, which is not a benign tissue," Ms. Ling explained. White adipose tissue secretes fatty acids, and its constituent cells, the adipocytes, also secrete proinflammatory proteins, or adipokines.

"Obesity can be thought of as a chronic inflammatory state," said Ms. Ling, adding that studies also indicate that "obesity could have adverse effect on RA disease activity."

In the current study, patients’ baseline disease characteristics, including DAS28 scores, rheumatoid factor status, and anti-cyclic citrullinated protein antibody status, were assessed according to BMI at presentation. All patients had early RA diagnosed by a consultant rheumatologist and had symptoms lasting for less than 1 year. The mean age of participants was 57 years and 57% of the cohort was female.

Patients were grouped according to their BMI category, as defined by World Health Organization (WHO) criteria. One-third fulfilled criteria for obesity, with approximately 22% in the obese I category (BMI more than 30 kg/m² but less than 35 kg/m²) and just over 11% in the obese II–III category (BMI of more than 35 kg/m²). One-third of patients were overweight and the remaining third were either normal weight or underweight.

Results showed that obese II–III patients were more likely to present with elevated (5.1 or higher) DAS28 scores than their lighter counterparts. Odds ratios (OR) adjusted for age, gender, and smoking status were 4.1 for DAS28 and 3.67 for ESR when comparing the very obese patients with the other BMI groups.

Considering each component of the DAS28 separately, a high ESR (32 mm/h or more) was the main factor that appeared to be significantly higher as body weight increased. There was no association with tender or swollen joint counts, global visual analog scale, symptom duration, or rheumatoid factor/anti-cyclic citrullinated protein antibody status, Ms. Ling said.

"There is a need for well-designed longitudinal studies to examine the effect of obesity on the extent of RA disease progression," she suggested.

Ms. Ling reported no conflicts of interest.

BRIGHTON, ENGLAND – Very obese patients with early rheumatoid arthritis appear to have higher disease activity at presentation, according to recent data presented at the annual meeting of the British Society for Rheumatology.

In a study of 216 individuals with early, clinically diagnosed rheumatoid arthritis (RA), those with a body mass index (BMI) of 35 kg/m² or higher were more likely than those with lower BMIs to have higher 28-joint count disease activity scores (DAS28), mainly because of higher erythrocyte sedimentation rates (ESRs).

Photo credit: ©geronimo/Fotolia.com

As a result, use of the DAS28 to guide clinical decision-making could result in disease-modifying antirheumatic drug (DMARD) therapy being given early on, suggested Stephanie Ling, who presented the findings.

Ms. Ling, a fifth-year medical student at the University of Liverpool, England, noted that earlier, more aggressive treatment of obese RA patients might explain why some studies have suggested that obesity, somewhat paradoxically, is actually beneficial in some patients with RA.

Indeed, studies have linked obesity with reduced mortality (Arch. Intern. Med. 2005;165:1624-9; Ann. Rheum. Dis. 2010;69:i61-4) and protection against radiographic joint damage (Ann. Rheum. Dis. 2008;67:769-74), although high levels of adiponectin – secreted from the fat tissue – are associated with increased joint inflammation (Arthritis Rheum. 2009;61:1248-56).

"Physiologically, obesity is characterized by the expansion of white adipose tissue, which is not a benign tissue," Ms. Ling explained. White adipose tissue secretes fatty acids, and its constituent cells, the adipocytes, also secrete proinflammatory proteins, or adipokines.

"Obesity can be thought of as a chronic inflammatory state," said Ms. Ling, adding that studies also indicate that "obesity could have adverse effect on RA disease activity."

In the current study, patients’ baseline disease characteristics, including DAS28 scores, rheumatoid factor status, and anti-cyclic citrullinated protein antibody status, were assessed according to BMI at presentation. All patients had early RA diagnosed by a consultant rheumatologist and had symptoms lasting for less than 1 year. The mean age of participants was 57 years and 57% of the cohort was female.

Patients were grouped according to their BMI category, as defined by World Health Organization (WHO) criteria. One-third fulfilled criteria for obesity, with approximately 22% in the obese I category (BMI more than 30 kg/m² but less than 35 kg/m²) and just over 11% in the obese II–III category (BMI of more than 35 kg/m²). One-third of patients were overweight and the remaining third were either normal weight or underweight.

Results showed that obese II–III patients were more likely to present with elevated (5.1 or higher) DAS28 scores than their lighter counterparts. Odds ratios (OR) adjusted for age, gender, and smoking status were 4.1 for DAS28 and 3.67 for ESR when comparing the very obese patients with the other BMI groups.

Considering each component of the DAS28 separately, a high ESR (32 mm/h or more) was the main factor that appeared to be significantly higher as body weight increased. There was no association with tender or swollen joint counts, global visual analog scale, symptom duration, or rheumatoid factor/anti-cyclic citrullinated protein antibody status, Ms. Ling said.

"There is a need for well-designed longitudinal studies to examine the effect of obesity on the extent of RA disease progression," she suggested.

Ms. Ling reported no conflicts of interest.

BRIGHTON, ENGLAND – Very obese patients with early rheumatoid arthritis appear to have higher disease activity at presentation, according to recent data presented at the annual meeting of the British Society for Rheumatology.

In a study of 216 individuals with early, clinically diagnosed rheumatoid arthritis (RA), those with a body mass index (BMI) of 35 kg/m² or higher were more likely than those with lower BMIs to have higher 28-joint count disease activity scores (DAS28), mainly because of higher erythrocyte sedimentation rates (ESRs).

Photo credit: ©geronimo/Fotolia.com

As a result, use of the DAS28 to guide clinical decision-making could result in disease-modifying antirheumatic drug (DMARD) therapy being given early on, suggested Stephanie Ling, who presented the findings.

Ms. Ling, a fifth-year medical student at the University of Liverpool, England, noted that earlier, more aggressive treatment of obese RA patients might explain why some studies have suggested that obesity, somewhat paradoxically, is actually beneficial in some patients with RA.

Indeed, studies have linked obesity with reduced mortality (Arch. Intern. Med. 2005;165:1624-9; Ann. Rheum. Dis. 2010;69:i61-4) and protection against radiographic joint damage (Ann. Rheum. Dis. 2008;67:769-74), although high levels of adiponectin – secreted from the fat tissue – are associated with increased joint inflammation (Arthritis Rheum. 2009;61:1248-56).

"Physiologically, obesity is characterized by the expansion of white adipose tissue, which is not a benign tissue," Ms. Ling explained. White adipose tissue secretes fatty acids, and its constituent cells, the adipocytes, also secrete proinflammatory proteins, or adipokines.

"Obesity can be thought of as a chronic inflammatory state," said Ms. Ling, adding that studies also indicate that "obesity could have adverse effect on RA disease activity."

In the current study, patients’ baseline disease characteristics, including DAS28 scores, rheumatoid factor status, and anti-cyclic citrullinated protein antibody status, were assessed according to BMI at presentation. All patients had early RA diagnosed by a consultant rheumatologist and had symptoms lasting for less than 1 year. The mean age of participants was 57 years and 57% of the cohort was female.

Patients were grouped according to their BMI category, as defined by World Health Organization (WHO) criteria. One-third fulfilled criteria for obesity, with approximately 22% in the obese I category (BMI more than 30 kg/m² but less than 35 kg/m²) and just over 11% in the obese II–III category (BMI of more than 35 kg/m²). One-third of patients were overweight and the remaining third were either normal weight or underweight.

Results showed that obese II–III patients were more likely to present with elevated (5.1 or higher) DAS28 scores than their lighter counterparts. Odds ratios (OR) adjusted for age, gender, and smoking status were 4.1 for DAS28 and 3.67 for ESR when comparing the very obese patients with the other BMI groups.

Considering each component of the DAS28 separately, a high ESR (32 mm/h or more) was the main factor that appeared to be significantly higher as body weight increased. There was no association with tender or swollen joint counts, global visual analog scale, symptom duration, or rheumatoid factor/anti-cyclic citrullinated protein antibody status, Ms. Ling said.

"There is a need for well-designed longitudinal studies to examine the effect of obesity on the extent of RA disease progression," she suggested.

Ms. Ling reported no conflicts of interest.

BRIGHTON, ENGLAND – Very obese patients with early rheumatoid arthritis appear to have higher disease activity at presentation, according to recent data presented at the annual meeting of the British Society for Rheumatology.

In a study of 216 individuals with early, clinically diagnosed rheumatoid arthritis (RA), those with a body mass index (BMI) of 35 kg/m² or higher were more likely than those with lower BMIs to have higher 28-joint count disease activity scores (DAS28), mainly because of higher erythrocyte sedimentation rates (ESRs).

Photo credit: ©geronimo/Fotolia.com

As a result, use of the DAS28 to guide clinical decision-making could result in disease-modifying antirheumatic drug (DMARD) therapy being given early on, suggested Stephanie Ling, who presented the findings.

Ms. Ling, a fifth-year medical student at the University of Liverpool, England, noted that earlier, more aggressive treatment of obese RA patients might explain why some studies have suggested that obesity, somewhat paradoxically, is actually beneficial in some patients with RA.

Indeed, studies have linked obesity with reduced mortality (Arch. Intern. Med. 2005;165:1624-9; Ann. Rheum. Dis. 2010;69:i61-4) and protection against radiographic joint damage (Ann. Rheum. Dis. 2008;67:769-74), although high levels of adiponectin – secreted from the fat tissue – are associated with increased joint inflammation (Arthritis Rheum. 2009;61:1248-56).

"Physiologically, obesity is characterized by the expansion of white adipose tissue, which is not a benign tissue," Ms. Ling explained. White adipose tissue secretes fatty acids, and its constituent cells, the adipocytes, also secrete proinflammatory proteins, or adipokines.

"Obesity can be thought of as a chronic inflammatory state," said Ms. Ling, adding that studies also indicate that "obesity could have adverse effect on RA disease activity."

In the current study, patients’ baseline disease characteristics, including DAS28 scores, rheumatoid factor status, and anti-cyclic citrullinated protein antibody status, were assessed according to BMI at presentation. All patients had early RA diagnosed by a consultant rheumatologist and had symptoms lasting for less than 1 year. The mean age of participants was 57 years and 57% of the cohort was female.

Patients were grouped according to their BMI category, as defined by World Health Organization (WHO) criteria. One-third fulfilled criteria for obesity, with approximately 22% in the obese I category (BMI more than 30 kg/m² but less than 35 kg/m²) and just over 11% in the obese II–III category (BMI of more than 35 kg/m²). One-third of patients were overweight and the remaining third were either normal weight or underweight.

Results showed that obese II–III patients were more likely to present with elevated (5.1 or higher) DAS28 scores than their lighter counterparts. Odds ratios (OR) adjusted for age, gender, and smoking status were 4.1 for DAS28 and 3.67 for ESR when comparing the very obese patients with the other BMI groups.

Considering each component of the DAS28 separately, a high ESR (32 mm/h or more) was the main factor that appeared to be significantly higher as body weight increased. There was no association with tender or swollen joint counts, global visual analog scale, symptom duration, or rheumatoid factor/anti-cyclic citrullinated protein antibody status, Ms. Ling said.

"There is a need for well-designed longitudinal studies to examine the effect of obesity on the extent of RA disease progression," she suggested.

Ms. Ling reported no conflicts of interest.

BRIGHTON, ENGLAND – Very obese patients with early rheumatoid arthritis appear to have higher disease activity at presentation, according to recent data presented at the annual meeting of the British Society for Rheumatology.

In a study of 216 individuals with early, clinically diagnosed rheumatoid arthritis (RA), those with a body mass index (BMI) of 35 kg/m² or higher were more likely than those with lower BMIs to have higher 28-joint count disease activity scores (DAS28), mainly because of higher erythrocyte sedimentation rates (ESRs).

Photo credit: ©geronimo/Fotolia.com

As a result, use of the DAS28 to guide clinical decision-making could result in disease-modifying antirheumatic drug (DMARD) therapy being given early on, suggested Stephanie Ling, who presented the findings.

Ms. Ling, a fifth-year medical student at the University of Liverpool, England, noted that earlier, more aggressive treatment of obese RA patients might explain why some studies have suggested that obesity, somewhat paradoxically, is actually beneficial in some patients with RA.

Indeed, studies have linked obesity with reduced mortality (Arch. Intern. Med. 2005;165:1624-9; Ann. Rheum. Dis. 2010;69:i61-4) and protection against radiographic joint damage (Ann. Rheum. Dis. 2008;67:769-74), although high levels of adiponectin – secreted from the fat tissue – are associated with increased joint inflammation (Arthritis Rheum. 2009;61:1248-56).

"Physiologically, obesity is characterized by the expansion of white adipose tissue, which is not a benign tissue," Ms. Ling explained. White adipose tissue secretes fatty acids, and its constituent cells, the adipocytes, also secrete proinflammatory proteins, or adipokines.

"Obesity can be thought of as a chronic inflammatory state," said Ms. Ling, adding that studies also indicate that "obesity could have adverse effect on RA disease activity."

In the current study, patients’ baseline disease characteristics, including DAS28 scores, rheumatoid factor status, and anti-cyclic citrullinated protein antibody status, were assessed according to BMI at presentation. All patients had early RA diagnosed by a consultant rheumatologist and had symptoms lasting for less than 1 year. The mean age of participants was 57 years and 57% of the cohort was female.

Patients were grouped according to their BMI category, as defined by World Health Organization (WHO) criteria. One-third fulfilled criteria for obesity, with approximately 22% in the obese I category (BMI more than 30 kg/m² but less than 35 kg/m²) and just over 11% in the obese II–III category (BMI of more than 35 kg/m²). One-third of patients were overweight and the remaining third were either normal weight or underweight.

Results showed that obese II–III patients were more likely to present with elevated (5.1 or higher) DAS28 scores than their lighter counterparts. Odds ratios (OR) adjusted for age, gender, and smoking status were 4.1 for DAS28 and 3.67 for ESR when comparing the very obese patients with the other BMI groups.

Considering each component of the DAS28 separately, a high ESR (32 mm/h or more) was the main factor that appeared to be significantly higher as body weight increased. There was no association with tender or swollen joint counts, global visual analog scale, symptom duration, or rheumatoid factor/anti-cyclic citrullinated protein antibody status, Ms. Ling said.

"There is a need for well-designed longitudinal studies to examine the effect of obesity on the extent of RA disease progression," she suggested.

Ms. Ling reported no conflicts of interest.

BRIGHTON, ENGLAND – Very obese patients with early rheumatoid arthritis appear to have higher disease activity at presentation, according to recent data presented at the annual meeting of the British Society for Rheumatology.

In a study of 216 individuals with early, clinically diagnosed rheumatoid arthritis (RA), those with a body mass index (BMI) of 35 kg/m² or higher were more likely than those with lower BMIs to have higher 28-joint count disease activity scores (DAS28), mainly because of higher erythrocyte sedimentation rates (ESRs).

Photo credit: ©geronimo/Fotolia.com

As a result, use of the DAS28 to guide clinical decision-making could result in disease-modifying antirheumatic drug (DMARD) therapy being given early on, suggested Stephanie Ling, who presented the findings.

Ms. Ling, a fifth-year medical student at the University of Liverpool, England, noted that earlier, more aggressive treatment of obese RA patients might explain why some studies have suggested that obesity, somewhat paradoxically, is actually beneficial in some patients with RA.

Indeed, studies have linked obesity with reduced mortality (Arch. Intern. Med. 2005;165:1624-9; Ann. Rheum. Dis. 2010;69:i61-4) and protection against radiographic joint damage (Ann. Rheum. Dis. 2008;67:769-74), although high levels of adiponectin – secreted from the fat tissue – are associated with increased joint inflammation (Arthritis Rheum. 2009;61:1248-56).

"Physiologically, obesity is characterized by the expansion of white adipose tissue, which is not a benign tissue," Ms. Ling explained. White adipose tissue secretes fatty acids, and its constituent cells, the adipocytes, also secrete proinflammatory proteins, or adipokines.

"Obesity can be thought of as a chronic inflammatory state," said Ms. Ling, adding that studies also indicate that "obesity could have adverse effect on RA disease activity."

In the current study, patients’ baseline disease characteristics, including DAS28 scores, rheumatoid factor status, and anti-cyclic citrullinated protein antibody status, were assessed according to BMI at presentation. All patients had early RA diagnosed by a consultant rheumatologist and had symptoms lasting for less than 1 year. The mean age of participants was 57 years and 57% of the cohort was female.

Patients were grouped according to their BMI category, as defined by World Health Organization (WHO) criteria. One-third fulfilled criteria for obesity, with approximately 22% in the obese I category (BMI more than 30 kg/m² but less than 35 kg/m²) and just over 11% in the obese II–III category (BMI of more than 35 kg/m²). One-third of patients were overweight and the remaining third were either normal weight or underweight.

Results showed that obese II–III patients were more likely to present with elevated (5.1 or higher) DAS28 scores than their lighter counterparts. Odds ratios (OR) adjusted for age, gender, and smoking status were 4.1 for DAS28 and 3.67 for ESR when comparing the very obese patients with the other BMI groups.

Considering each component of the DAS28 separately, a high ESR (32 mm/h or more) was the main factor that appeared to be significantly higher as body weight increased. There was no association with tender or swollen joint counts, global visual analog scale, symptom duration, or rheumatoid factor/anti-cyclic citrullinated protein antibody status, Ms. Ling said.

"There is a need for well-designed longitudinal studies to examine the effect of obesity on the extent of RA disease progression," she suggested.

Ms. Ling reported no conflicts of interest.

BRIGHTON, ENGLAND – The use of biologic agents in adults with juvenile idiopathic arthritis needs guidance, a situation that the British Society for Rheumatology and British Society for Pediatric and Adolescent Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen Foster at the annual meeting of the British Society for Rheumatology (BSR).

Dr. Foster, professor of pediatric rheumatology at Newcastle University, England, commented that the current use of biologics in adult JIA patients is based on a paucity of data, with only one biologic agent, etanercept, currently approved for use by the National Institute for Health and Clinical Excellence (NICE).

"Clearly adults with JIA are receiving biologic treatments, and data so far, albeit from registries, are actually quite encouraging of a good response," Dr. Foster said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495 patients registered in adulthood one third had disease onset reported before the age of 16 years, with one fifth (21%) officially diagnosed with JIA. Importantly, Dr. Foster noted that these data showed that disease flares were still possible after many years of remission, at a median of 20 years for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of biologic drugs to treat inflammatory diseases in the United Kingdom. In the report, the estimated need for biologic agents in adults who had JIA was just 15% – a likely underestimate, Dr. Foster suggested.

"Undoubtedly, the proportion of patients with JIA who reach adulthood and who will require either ongoing treatment with a biologic agent or de novo treatment for disease flares is going to increase," she observed.

However, despite the need for continued or first-time biologic use in adults with JIA, these patients often fall into a gap between pediatric and adult care. Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.

With this in mind, better links between juvenile and adult rheumatology services are sorely needed. The new BSR/British Society for Paediatric and Adolescent Rheumatology (BSPAR) statement will note that patients transferring to adult care are likely to need continued treatment with a biologic agent and that treatment should not be stopped solely on the basis of age. The process of ongoing funding needs to be in place before transfer, Dr. Foster said.

The BSR/BSPAR statement will also comment on eligibility for biologic agents, noting that appropriate tools for adults with JIA are specifically needed. Currently, the only guidance on use of biologics in JIA is for etanercept in the pediatric population and, clearly, adults with JIA are a distinct patient population.

"The management of JIA has changed dramatically in the last decade, and it’s going to change again towards a more individualized approach in the future," Dr. Foster said. She added that the choice of biologic is very much down to a variety of factors – clinician’s experience, patient choice, and clinical scenario, but that there is an obvious need for consensus on which agent or agents to use.

There is also a need for improved surveillance, and existing juvenile and adult biologics registries provide important information about the long-term safety of these agents, and these need to be linked up, both in the United Kingdom and in Europe.

"Optimal care requires adult rheumatologists who have experience or training in adolescent rheumatology," Dr. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.

Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.

BRIGHTON, ENGLAND – The use of biologic agents in adults with juvenile idiopathic arthritis needs guidance, a situation that the British Society for Rheumatology and British Society for Pediatric and Adolescent Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen Foster at the annual meeting of the British Society for Rheumatology (BSR).

Dr. Foster, professor of pediatric rheumatology at Newcastle University, England, commented that the current use of biologics in adult JIA patients is based on a paucity of data, with only one biologic agent, etanercept, currently approved for use by the National Institute for Health and Clinical Excellence (NICE).

"Clearly adults with JIA are receiving biologic treatments, and data so far, albeit from registries, are actually quite encouraging of a good response," Dr. Foster said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495 patients registered in adulthood one third had disease onset reported before the age of 16 years, with one fifth (21%) officially diagnosed with JIA. Importantly, Dr. Foster noted that these data showed that disease flares were still possible after many years of remission, at a median of 20 years for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of biologic drugs to treat inflammatory diseases in the United Kingdom. In the report, the estimated need for biologic agents in adults who had JIA was just 15% – a likely underestimate, Dr. Foster suggested.

"Undoubtedly, the proportion of patients with JIA who reach adulthood and who will require either ongoing treatment with a biologic agent or de novo treatment for disease flares is going to increase," she observed.

However, despite the need for continued or first-time biologic use in adults with JIA, these patients often fall into a gap between pediatric and adult care. Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.

With this in mind, better links between juvenile and adult rheumatology services are sorely needed. The new BSR/British Society for Paediatric and Adolescent Rheumatology (BSPAR) statement will note that patients transferring to adult care are likely to need continued treatment with a biologic agent and that treatment should not be stopped solely on the basis of age. The process of ongoing funding needs to be in place before transfer, Dr. Foster said.

The BSR/BSPAR statement will also comment on eligibility for biologic agents, noting that appropriate tools for adults with JIA are specifically needed. Currently, the only guidance on use of biologics in JIA is for etanercept in the pediatric population and, clearly, adults with JIA are a distinct patient population.

"The management of JIA has changed dramatically in the last decade, and it’s going to change again towards a more individualized approach in the future," Dr. Foster said. She added that the choice of biologic is very much down to a variety of factors – clinician’s experience, patient choice, and clinical scenario, but that there is an obvious need for consensus on which agent or agents to use.

There is also a need for improved surveillance, and existing juvenile and adult biologics registries provide important information about the long-term safety of these agents, and these need to be linked up, both in the United Kingdom and in Europe.

"Optimal care requires adult rheumatologists who have experience or training in adolescent rheumatology," Dr. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.

Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.

BRIGHTON, ENGLAND – The use of biologic agents in adults with juvenile idiopathic arthritis needs guidance, a situation that the British Society for Rheumatology and British Society for Pediatric and Adolescent Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen Foster at the annual meeting of the British Society for Rheumatology (BSR).

Dr. Foster, professor of pediatric rheumatology at Newcastle University, England, commented that the current use of biologics in adult JIA patients is based on a paucity of data, with only one biologic agent, etanercept, currently approved for use by the National Institute for Health and Clinical Excellence (NICE).

"Clearly adults with JIA are receiving biologic treatments, and data so far, albeit from registries, are actually quite encouraging of a good response," Dr. Foster said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495 patients registered in adulthood one third had disease onset reported before the age of 16 years, with one fifth (21%) officially diagnosed with JIA. Importantly, Dr. Foster noted that these data showed that disease flares were still possible after many years of remission, at a median of 20 years for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of biologic drugs to treat inflammatory diseases in the United Kingdom. In the report, the estimated need for biologic agents in adults who had JIA was just 15% – a likely underestimate, Dr. Foster suggested.

"Undoubtedly, the proportion of patients with JIA who reach adulthood and who will require either ongoing treatment with a biologic agent or de novo treatment for disease flares is going to increase," she observed.

However, despite the need for continued or first-time biologic use in adults with JIA, these patients often fall into a gap between pediatric and adult care. Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.

With this in mind, better links between juvenile and adult rheumatology services are sorely needed. The new BSR/British Society for Paediatric and Adolescent Rheumatology (BSPAR) statement will note that patients transferring to adult care are likely to need continued treatment with a biologic agent and that treatment should not be stopped solely on the basis of age. The process of ongoing funding needs to be in place before transfer, Dr. Foster said.

The BSR/BSPAR statement will also comment on eligibility for biologic agents, noting that appropriate tools for adults with JIA are specifically needed. Currently, the only guidance on use of biologics in JIA is for etanercept in the pediatric population and, clearly, adults with JIA are a distinct patient population.

"The management of JIA has changed dramatically in the last decade, and it’s going to change again towards a more individualized approach in the future," Dr. Foster said. She added that the choice of biologic is very much down to a variety of factors – clinician’s experience, patient choice, and clinical scenario, but that there is an obvious need for consensus on which agent or agents to use.

There is also a need for improved surveillance, and existing juvenile and adult biologics registries provide important information about the long-term safety of these agents, and these need to be linked up, both in the United Kingdom and in Europe.

"Optimal care requires adult rheumatologists who have experience or training in adolescent rheumatology," Dr. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.

Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.

BRIGHTON, ENGLAND – The use of biologic agents in adults with juvenile idiopathic arthritis needs guidance, a situation that the British Society for Rheumatology and British Society for Pediatric and Adolescent Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen Foster at the annual meeting of the British Society for Rheumatology (BSR).

Dr. Foster, professor of pediatric rheumatology at Newcastle University, England, commented that the current use of biologics in adult JIA patients is based on a paucity of data, with only one biologic agent, etanercept, currently approved for use by the National Institute for Health and Clinical Excellence (NICE).

"Clearly adults with JIA are receiving biologic treatments, and data so far, albeit from registries, are actually quite encouraging of a good response," Dr. Foster said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495 patients registered in adulthood one third had disease onset reported before the age of 16 years, with one fifth (21%) officially diagnosed with JIA. Importantly, Dr. Foster noted that these data showed that disease flares were still possible after many years of remission, at a median of 20 years for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of biologic drugs to treat inflammatory diseases in the United Kingdom. In the report, the estimated need for biologic agents in adults who had JIA was just 15% – a likely underestimate, Dr. Foster suggested.

"Undoubtedly, the proportion of patients with JIA who reach adulthood and who will require either ongoing treatment with a biologic agent or de novo treatment for disease flares is going to increase," she observed.

However, despite the need for continued or first-time biologic use in adults with JIA, these patients often fall into a gap between pediatric and adult care. Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.

With this in mind, better links between juvenile and adult rheumatology services are sorely needed. The new BSR/British Society for Paediatric and Adolescent Rheumatology (BSPAR) statement will note that patients transferring to adult care are likely to need continued treatment with a biologic agent and that treatment should not be stopped solely on the basis of age. The process of ongoing funding needs to be in place before transfer, Dr. Foster said.

The BSR/BSPAR statement will also comment on eligibility for biologic agents, noting that appropriate tools for adults with JIA are specifically needed. Currently, the only guidance on use of biologics in JIA is for etanercept in the pediatric population and, clearly, adults with JIA are a distinct patient population.

"The management of JIA has changed dramatically in the last decade, and it’s going to change again towards a more individualized approach in the future," Dr. Foster said. She added that the choice of biologic is very much down to a variety of factors – clinician’s experience, patient choice, and clinical scenario, but that there is an obvious need for consensus on which agent or agents to use.

There is also a need for improved surveillance, and existing juvenile and adult biologics registries provide important information about the long-term safety of these agents, and these need to be linked up, both in the United Kingdom and in Europe.

"Optimal care requires adult rheumatologists who have experience or training in adolescent rheumatology," Dr. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.

Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.

BRIGHTON, ENGLAND – The use of biologic agents in adults with juvenile idiopathic arthritis needs guidance, a situation that the British Society for Rheumatology and British Society for Pediatric and Adolescent Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen Foster at the annual meeting of the British Society for Rheumatology (BSR).

Dr. Foster, professor of pediatric rheumatology at Newcastle University, England, commented that the current use of biologics in adult JIA patients is based on a paucity of data, with only one biologic agent, etanercept, currently approved for use by the National Institute for Health and Clinical Excellence (NICE).

"Clearly adults with JIA are receiving biologic treatments, and data so far, albeit from registries, are actually quite encouraging of a good response," Dr. Foster said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495 patients registered in adulthood one third had disease onset reported before the age of 16 years, with one fifth (21%) officially diagnosed with JIA. Importantly, Dr. Foster noted that these data showed that disease flares were still possible after many years of remission, at a median of 20 years for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of biologic drugs to treat inflammatory diseases in the United Kingdom. In the report, the estimated need for biologic agents in adults who had JIA was just 15% – a likely underestimate, Dr. Foster suggested.

"Undoubtedly, the proportion of patients with JIA who reach adulthood and who will require either ongoing treatment with a biologic agent or de novo treatment for disease flares is going to increase," she observed.

However, despite the need for continued or first-time biologic use in adults with JIA, these patients often fall into a gap between pediatric and adult care. Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.

With this in mind, better links between juvenile and adult rheumatology services are sorely needed. The new BSR/British Society for Paediatric and Adolescent Rheumatology (BSPAR) statement will note that patients transferring to adult care are likely to need continued treatment with a biologic agent and that treatment should not be stopped solely on the basis of age. The process of ongoing funding needs to be in place before transfer, Dr. Foster said.

The BSR/BSPAR statement will also comment on eligibility for biologic agents, noting that appropriate tools for adults with JIA are specifically needed. Currently, the only guidance on use of biologics in JIA is for etanercept in the pediatric population and, clearly, adults with JIA are a distinct patient population.

"The management of JIA has changed dramatically in the last decade, and it’s going to change again towards a more individualized approach in the future," Dr. Foster said. She added that the choice of biologic is very much down to a variety of factors – clinician’s experience, patient choice, and clinical scenario, but that there is an obvious need for consensus on which agent or agents to use.

There is also a need for improved surveillance, and existing juvenile and adult biologics registries provide important information about the long-term safety of these agents, and these need to be linked up, both in the United Kingdom and in Europe.

"Optimal care requires adult rheumatologists who have experience or training in adolescent rheumatology," Dr. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.

Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.

BRIGHTON, ENGLAND – The use of biologic agents in adults with juvenile idiopathic arthritis needs guidance, a situation that the British Society for Rheumatology and British Society for Pediatric and Adolescent Rheumatology are set to address.

The two British Societies will publish a statement on the use of biologics in adults with juvenile idiopathic arthritis (JIA) very soon, said Dr. Helen Foster at the annual meeting of the British Society for Rheumatology (BSR).

Dr. Foster, professor of pediatric rheumatology at Newcastle University, England, commented that the current use of biologics in adult JIA patients is based on a paucity of data, with only one biologic agent, etanercept, currently approved for use by the National Institute for Health and Clinical Excellence (NICE).

"Clearly adults with JIA are receiving biologic treatments, and data so far, albeit from registries, are actually quite encouraging of a good response," Dr. Foster said.

Indeed, data from the BSR Biologics Register (BSRBR) show that of 495 patients registered in adulthood one third had disease onset reported before the age of 16 years, with one fifth (21%) officially diagnosed with JIA. Importantly, Dr. Foster noted that these data showed that disease flares were still possible after many years of remission, at a median of 20 years for de novo biologic use.

Last year, NICE issued guidance link to on how to improve commissioning of biologic drugs to treat inflammatory diseases in the United Kingdom. In the report, the estimated need for biologic agents in adults who had JIA was just 15% – a likely underestimate, Dr. Foster suggested.

"Undoubtedly, the proportion of patients with JIA who reach adulthood and who will require either ongoing treatment with a biologic agent or de novo treatment for disease flares is going to increase," she observed.

However, despite the need for continued or first-time biologic use in adults with JIA, these patients often fall into a gap between pediatric and adult care. Anecdotal evidence suggests that funding for treatment might be withdrawn when a JIA patient reaches 18 years of age and that if continued treatment is needed, a new application for funding must be made to adult services.

With this in mind, better links between juvenile and adult rheumatology services are sorely needed. The new BSR/British Society for Paediatric and Adolescent Rheumatology (BSPAR) statement will note that patients transferring to adult care are likely to need continued treatment with a biologic agent and that treatment should not be stopped solely on the basis of age. The process of ongoing funding needs to be in place before transfer, Dr. Foster said.

The BSR/BSPAR statement will also comment on eligibility for biologic agents, noting that appropriate tools for adults with JIA are specifically needed. Currently, the only guidance on use of biologics in JIA is for etanercept in the pediatric population and, clearly, adults with JIA are a distinct patient population.

"The management of JIA has changed dramatically in the last decade, and it’s going to change again towards a more individualized approach in the future," Dr. Foster said. She added that the choice of biologic is very much down to a variety of factors – clinician’s experience, patient choice, and clinical scenario, but that there is an obvious need for consensus on which agent or agents to use.

There is also a need for improved surveillance, and existing juvenile and adult biologics registries provide important information about the long-term safety of these agents, and these need to be linked up, both in the United Kingdom and in Europe.

"Optimal care requires adult rheumatologists who have experience or training in adolescent rheumatology," Dr. Foster further advised. Adults with JIA have multiple and often complex issues, she added, and these need to be addressed by appropriately trained staff.

Dr. Foster has received honoraria from Abbott, Pfizer, and Schering-Plough.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ms. Law declared she had no conflicts of interest.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ms. Law declared she had no conflicts of interest.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ms. Law declared she had no conflicts of interest.