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RA, cardiovascular disease, and diabetes links highlight conference

RA, cardiovascular disease, and diabetes links highlight conference

 

 

 

 

Links between rheumatoid arthritis (RA) and cardiovascular disease (CVD) and diabetes mellitus (DM) highlighted the research findings reported at the recent American College of Rheumatology (ACR) Annual Scientific Meeting in San Francisco. Age, sex, and traditional risk factors (eg, hypertension, DM, and high body mass index [BMI]) were found to be more important predictors of heart attack in patients with RA than the use of disease-modifying antirheumatic drugs and corticosteroids, and lipid-lowering medications may reduce the risk of heart attack.The findings suggested that managing both RA and traditional CVD risk factors (eg, a high cholesterol level) is important in trying to reduce the number of heart attacks in these patients.

 

Other studies found that a person's risk of heart attack nearly doubles within the first 10 years after a diagnosis of RA is made and that after a heart attack, patients with RA experience greater heart-related complications-including an increased risk of death-than other patients with heart attack. In addition, the risk of CVD in persons with RA is just as high as the risk in those with type 2 DM, and the use of hydroxychloroquine may prevent DM in patients with RA. For other ACR research findings about RA, see the Box, "RA drug developments."

RA drug developments

Many of the rheumatoid arthritis (RA)-related research findings at the recent American College of Rheumatology Annual Scientific Meeting focused on new developments in drug therapy. They include the following:
  • Early and aggressive treatment with a combination of a tumor necrosis factor α (TNF-α) inhibitor and a disease-modifying antirheumatic drug (DMARD) could result in RA remission.
  • Initial treatment with a combination of DMARDs may be effective in slowing RA progression.
  • TNF-α inhibitors do not seem to be associated with n increased risk of cancer.
  • Certain genes may explain why some patients with RA respond better to therapy with TNF-α inhibitors  than other patients.
  • Syk kinase inhibitors, which inhibit kinase proteins, appear to be effective in treating patients with RA.
  • Anakinra may be effective in the treatment of children with systemic onset juvenile idiopathic arthritis (JIA); children with JIA may miss fewer days of school when treated with abatacept; etanercept and methotrexate have been shown to be safe and effective for long-term, continuous treatment of  patients with JIA.

 

 

 

 

 

 

 

 

 

 

 

 

 

Other rheumatologic study findings reported at the ACR meeting include the following:

 

Osteoarthritis

 

  • Treatment every 8 weeks with tanezumab, a new drug, significantly reduces pain in patients with knee osteoarthritis (OA). 
  • Ayurvedic drugs may be safer and just as effective as glucosamine and celecoxib in treating knee OA.
  • Tai chi is effective in managing pain and physical impairment in persons with severe knee OA.
  • Being overweight may increase a person's risk of severe hip and knee OA, particularly if he or she has a higher-than-average BMI.

Systemic lupus erythematosus

  • Hydroxychloroquine, originally used to prevent and manage malaria and often used to manage skin and joint disease associated with systemic lupus erythematosus (SLE), may prevent kidney damage in patients with SLE. Researchers suggested that the drug be prescribed for all patients with SLE very early in the disease course to prevent renal damage.
  • As racial and ethnic disparities in SLE and kidney failure continue to grow in the United States, the number of new cases of kidney failure resulting from lupus occurring in African Americans has surpassed that occurring in whites; a high proportion occur in African American women.
  • Becoming pregnant when SLE is clinically stable may be the key to fewer flares and a safer pregnancy.
  • Mycophenolate mofetil and intravenous cyclophosphamide both appear to be safe and effective for treatinglupus nephritis in adolescents.
  • Both direct health care costs and costs associated with decreased work productivity are substantial for persons with SLE.

Osteoporosis

  •  Denosumab, a biologic inhibitor of the activation of bone-resorbing osteoclasts that is administered twice a year, is an effective agent for increasing bone mass in postmenopausal women.
  • Teriparatide is an added treatment option for patients at risk for corticosteroid-induced osteoporosis to prevent bone loss and fractures.
  • Future federally mandated decreases in dual-energy x-ray absorptiometry reimbursement could lead to increased hip fractures among senior citizens.Women showed a greater decrease in hip fracture hospitalization than men.

Other rheumatologic conditions

  • Pegloticase (PEGylated recombinant mammalian uricase) reduces urate levels and improves clinical outcomes in patients with gout for whom treatment has not been successful.
  • Tadalafil, a drug used for erectile dysfunction treatment, is effective and well tolerated in treating patients with secondary Raynaud phenomenon when used in addition to other treatments. Study results suggested that tadalafil may improve survival in patients with scleroderma.

For more information on these and other research findings, visit the ACR Web site at www.rheumatology.org. Or, contact the organization at ACR, 1800 Century Place, Suite 250, Atlanta, GA 30345-4300; telephone: (404) 633-3777; fax: (404) 633-1870.

 

 

 
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