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Relatable Rheumatology: From Stories to Studies

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Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

 were at a higher risk of developing ischemia heart disease (IHD), particularly between the 6th and 9th year post-SLE diagnosis, according to a study published in 

 Investigators believe advanced cardiac health examinations, as well as a health education plan, should be recommended for this patient population prior to the 6th year after SLE diagnosis.

IHD, a major cause of mortality worldwide, is a serious disease with a high likelihood of sudden death. In 2020, 20,457 patients died of IHD, more than half of which were men (n = 11,809), who were frequently the primary breadwinners.

“Even though healthcare quality has improved for SLE and IHD in the last century, SLE progression to IHD is still unavoidable,” wrote a group of Taiwanese investigators. “The major difference between today and the previous century is air pollution.”

A retrospective cohort study utilized data from Taiwan’s National Health Insurance Research Database (NHIRD) and Taiwan Air Quality Monitoring. Outpatient data, admission, pharmaceutical information, physical examination, and medical records were collected from the NHIRD.

The primary endpoints were to determine the hazard ratio (HR) of IHD after SLE diagnosis and to evaluate the effects of air pollution exposure on IHD in SLE for 12 years.

Adult patients (aged ≥20 years) who were diagnosed with SLE in 2006 without IHD were used as the SLE group. Investigators then randomly selected a sex-matched, non-SLE cohort, 4 times larger than the SLE cohort, as controls. Air pollution indices by residence city per period were used to calculate the exposure.

Life-table method analysis with log-rank tests evaluated the differences in SLE between male and female patients, while Cox proportional hazard regression analyses were used to examine the HR of IHD in both SLE and control groups.

A total of 4842 patients (male n = 1644, female n = 3198) were placed in the SLE group and 19,368 (male n = 5,624, female n = 13,744) were identified as controls.

At the end of 2018, the risk of IHD was significantly higher in the SLE cohort when compared with controls, with risks peaking between the 6th and 9th year post-diagnosis. IHD incidence rate during the follow-up period was 9.2% and 4.8% for men and women in the SLE cohort, respectively, compared with 2.3% and 3.5%, respectively, in the control cohort.

The HR of incidence of IHD for patients with SLE was 2.42 times higher compared with controls. The risk of developing IHD in both groups was significantly correlated with male sex (SLE group: HR = 1.817, 

 <.01; control group: HR = 1.609, 

 <.01), age, and PM10 exposure (SLE group: HR = 66.197, 

 <.01; control group: HR = 108.945, 

The log-rank test demonstrated a statistically significant difference in IHD incidence between the SLE and control cohorts (

Investigators noted using the health insurance database may have limited results as patients were only recruited using the International Statistical Classification of Diseases and Related Health Problems (ICD-9) code. The database did not include information on smoking and drinking status, family history, medication adherence, and psychosocial data, including depression and anxiety diagnoses.

Additionally, residence status may have been partly inaccurate as patients may have moved during the follow-up period. Lastly, both direct and second-hand smokers are at risk of nicotine exposure, one of the risk factors for atherosclerosis. Investigators urge future studies to evaluate whether carbon monoxide in exhaled breath can be used in non-smokers to determine smoking status.

“Case managers should make sure that education on diet and exercise is included in the health education plan for first-diagnosed SLE patients,” investigators concluded. “The health education plan could promote a healthier lifestyle for SLE patients to reduce the risk of atherosclerosis or IHD.”

Chen PY, Tsan YT, Yang CT, et al. Prediction of risk of ischemic heart disease in first-diagnosed systemic lupus erythematosus patients in taiwan: is air pollution exposure a risk factor?. 

. 2023;7(1):14. Published 2023 Jun 8. doi:10.1186/s41927-023-00337-8

Ministry of Health and Welfare., M. Statistics on the causes of death of Taiwan in 2020. 2021.

Articles

The risk of ischemia heart disease was significantly higher in the SLE cohort when compared with controls, with risks peaking between the 6th and 9th year post-diagnosis.

Lupus

News

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Rheumatology condition center page is a comprehensive resource for clinical news and insights on rheumatologic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for arthritis, gout, nr-AxSpA, and more.

Increased Risk of Ischemic Heart Disease in Patients With Systemic Lupus Erythematosus

Connor Iapoce is an associate editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

A ranibizumab biosimilar may be the most cost-effective treatment option compared with other available anti-VEGF therapies by both treat-and-extend (TAE) and pro re nata (PRN) regimens for patients with 

neovascular age-related macular degeneration (nAMD)

The study, based in Japan, suggested ranibizumab biosimilar TAE was dominant to aflibercept TAE, and cost-saving compared to both ranibizumab TAE and PRN; in addition, ranibizumab biosimilar was dominant to best supportive care in both TAE and PRN regimens.

“Based on the currently available evidence, our analyses show with a high degree of certainty that ranibizumab biosimilar can be the most cost-saving treatment option compared with the existing anti-VEGF agents by both TAE and PRN regimens in patients with nAMD from a Japanese societal perspective,” wrote the investigative team, led by Yasuo Yanagi, MD, PhD, from the department of ophthalmology and microtechnology at Yokohama City University.

Global estimates suggest the number of people with AMD is projected to reach 288 million by 2040; as Japan has one of the most aged populations in the world, the number of AMD patients is expected to grow concurrently with the aging population.

 Vascular endothelial growth factor inhibitors are first-line treatments for nAMD, but their cost and need for repeated injections to maintain visual acuity can be prohibitive. In September 2021, a ranibizumab biosimilar was approved in Japan and served as the first biosimilar of an ophthalmic VEGF inhibitor in the country.

With a lower price compared to the originator, ranibizumab biosimilar may reduce the economic burden on both patients with nAMD and society. The current analysis assessed the cost-effectiveness of the anti-VEGF therapy using both TAE and PRN regimens in patients with nAMD from a Japanese societal perspective. Investigators developed a Markov model to simulate the lifetime transitions of a cohort of treatment-naive patients with nAMD through health states based on the involvement of nAMD (single-eye vs. both eyes), the treatment status of the patient, and decimal best-corrected visual acuity (BCVA).

For the purpose of analysis, the cost-effectiveness model compared long-term healthcare costs and quality-adjusted life-years (QALYs) of patients treated with ranibizumab biosimilar versus other active anti-VEGF treatments and best supportive care. In TAE regimens, investigators compared ranibizumab biosimilar TAE with ranibizumab TAE, aflibercept tAE, aflibercept as the loading dose, as well as best supportive care. In PRN regimens, the team compared ranibizumab biosimilar PRN with ranibizumab PRN and best supportive care.

Upon analysis, investigators found ranibizumab biosimilar TAE accumulated 8.081 quality-adjusted life-years (QALYs) compared to 8.067, 8.072, and 7.772 QALYs on aflibercept TAE, aflibercept to ranibizumab biosimilar TAE, and BSC, respectively. Data showed the incremental difference in QALYs was 0.015, 0.009, and 0.310 QALYs, with ranibizumab biosimilar TAE relative to aflibercept TAE, aflibercept to ranibizumab biosimilar TAE, and best supportive care, respectively.

Meanwhile, the total treatment costs over a lifetime determined ranibizumab biosimilar TAE was dominant to ranibizumab TAE, aflibercept TAE, aflibercept to ranibizumab biosimilar TAE, and best supportive care. Ranibizumab biosimilar TAE was associated with a lower total cost relative to the reference product TAE. Overall, investigators suggested treatment with ranibizumab biosimilar TAE was dominant over anti-VEGF treatment, as well as best supportive care, by slightly higher or equal incremental QALYs at a lower total cost.

The team noted that with the comparison with best supportive care, although best supportive care did not incur drug and administration costs, the higher societal costs due to daily care for best supportive care led to a lower total cost for ranibizumab biosimilar TAE. Similar to TAE regimens, ranibizumab biosimilar was considered cost-saving compared to ranibizumab PRN and was dominant to best supportive care in PRN regimens. Results were considered robust, regardless of whether clinical data were taken from the direct head-to-head clinical trial or from in-direct treatment comparison, according to investigators.

“These findings provide valuable insights into the treatment of nAMD and the cost-effective treatment option in treatment-naive patients with nAMD following the advent of ranibizumab biosimilar,” the team wrote.

Yanagi, Y., Takahashi, K., Iida, T. et al. Cost-Effectiveness Analysis of Ranibizumab Biosimilar for Neovascular Age-Related Macular Degeneration in Japan. Ophthalmol Ther (2023). https://doi.org/10.1007/s40123-023-00715-y

Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(2):e106–16.

An analysis based in Japan suggests ranibizumab biosimilar is dominant to other anti-VEGF treatments in patients with nAMD in both treat-and-extend and PRN regimens. 

Biosimilars

Age-Related Macular Degeneration

age-related macular degeneration condition center page is a comprehensive resource for clinical news and insights on retina disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for patients with AMD.

Analysis Suggests Cost-Effectiveness of Ranibizumab Biosimilar for nAMD Treatment 

Sleep studies provide a wealth of physiological information that can advance many aspects of clinical practice. In an interview at SLEEP 2023, Reena Mehra, MD, MS, director and professor of medicine at the Sleep Disorders Center, Cleveland Clinic, highlighted the potential offered by endophenotypes yielded from sleep studies in predicting clinical outcomes, including conditions like atrial fibrillation (AF).

"It can be helpful in terms of screening, in terms of prediction of outcomes which helps you then risk stratify populations, and also for treatment responsiveness," she said. "So, these biomarkers from the sleep studies can be useful to us in a variety of ways."

Much of sleep apnea treatment is focused on managing patient symptoms. In recent years, the field of endophenotyping has garnered significant attention, signaling a growing recognition of the need to move beyond simplistic measures.

"Integrating (clinical symptom management) with the objective data that you get from a sleep study is important," she explained.

Mehra and her team from the Cleveland Clinic received a Discovery Accelerator Award which will allow them to collaborate with IBM to further examine how different facets of sleep apnea pathophysiology contribute to AF.  CPAP therapy is the first-line treatment, but the optimal option depends on the individual.

Advancements had led to additional treatment avenues like hypoglossal nerve stimulation and oral appliances and Mehra shared her motivation to find a way to determine which specific treatment strategy is best for each patient.

"I think there's opportunity to look at it more, or even doing cluster analyses where you can see if there are groupings of symptoms, and polysomnographic findings, endophenotypes, from the sleep studies–that when you take them together-do a better job of figuring out who's going to derive benefit from maybe a specific therapy."

Videos

In recent years, the field of endophenotyping has garnered significant attention in sleep health, signaling a growing recognition of the need to move beyond simplistic measures.

Obstructive Sleep Apnea

Sleep

On the HCPLive sleep page, resources on the topics of medical news and expert insight into sleep medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sleep apnea, insomnia, narcolepsy, and more.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Reena Mehra, MD: Biomarkers and Endophenotypes for Personalized Patient Care

The rheumatology month in review highlights a program developed by Janssen to support health equity in patients with psoriatic disease, the increased risks pregnant women with rheumatic diseases face, and trends in fibromyalgia management.

Fibromyalgia impacts patients in a variety of ways, including an increased risk of comorbidities, such as celiac disease and irritable bowel syndrome (IBS), as well as an increased likelihood of developing anxiety and depression. Results of a recent study showed patients with fibromyalgia tended to have lower physical activity levels when compared with healthy controls, in part due to pain. However, programs, such as the telerehabilitation intervention highlighted below, have been proven to improve quality of life in this patient population.

Fibromyalgia Significantly Linked to Benign Gastrointestinal Disorders

Investigators performed a study using data from the largest health maintenance organization in Israel. The link between fibromyalgia and benign gastrointestinal disorders, including IBS, peptic ulcer disease (PUD), celiac disease, gastroesophageal reflux disease (GERD), ulcerative colitis, and Crohn’s disease, as well as gastrointestinal malignancies such as stomach, liver, pancreatic, colorectal, and bile duct cancers, was evaluated.

 diagnosis was significantly associated with GERD, PUD, IBS, Crohn’s disease, ulcerative colitis, and celiac disease. Compared with controls, patients with fibromyalgia had a higher prevalence of IBS (4.8% vs 1.1%, respectively), celiac disease (.7 vs .4%, respectively), Crohn’s disease (.8% vs .4%, respectively), and ulcerative colitis (.6% vs .4%, respectively).

However, no significant differences were observed regarding gastrointestinal malignancies between patients with fibromyalgia compared with the controls.

Reduced Physical Activity Levels Observed in Patients With Fibromyalgia

While exercise has been deemed beneficial in the management of fibromyalgia, the symptoms of the condition can create barriers that discourage exercise, including the belief that exercise may intensify symptoms. Other anecdotal data also showed that most patients with fibromyalgia lead a sedentary lifestyle.

The case-control study included 70 patients with fibromyalgia and 50 age- and gender-matched controls. Patients with fibromyalgia reported significantly less recreational, transportation-related, and total physical activity levels when compared with controls., They also reported significantly less time spent walking and in vigorous activities when compared with healthy individuals.

Telerehabilitation Improves Quality of Life in Patients With Fibromyalgia

Pooled results of a systematic review of randomized controlled trials proved that telerehabilitation improved the Fibromyalgia Impact Questionnaire (FIQ) score and quality of life in patients with fibromyalgia when compared with controls. The intervention also improved depression levels, pain intensity, and pain catastrophizing in this patient population.

“Telerehabilitation can provide accessible and continuous rehabilitation medical services for patients with fibromyalgia who cannot attend traditional face-to-face services or are geographically remote, and it could enable patients to manage their disease at any time and place in a timely and appropriate manner,” wrote Mao-Yuan Wang, PhD, Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, China, and colleagues.

Janssen Develops Programs to Support Health Equity in Psoriatic Disease

Soumya Chakravarty, MD, PhD, FACP, FACR, Senior Director, Strategic Lead, Janssen Rheumatology, and Daphne Chan, PhD, Head of Dermatology Medical Affairs, Janssen, highlighted Janssen’s recent programs designed to reduce health inequity in patients living with psoriatic disease.

The team developed 2 potential solutions collaboratively with the community. The first is a patient navigation program and the second is a concept called "Beyond the Textbook," which provides healthcare providers with culturally inclusive resources to navigate conversations around psoriatic disease in patients of color.

Chan and Chakravarty discovered a lack of information and representation regarding simple images of psoriatic disease, including plaques and psoriatic arthritis in patients of color.

Pregnancy Outcomes in Women With Rheumatic Disease

Pregnant women with rheumatic disease are at an increased risk of a multitude of adverse events, including preeclampsia and placental disorders. These risks may also extend to the fetus and child, including new research that maternal rheumatoid arthritis is linked to an increased risk of Autism Spectrum Disorder (ASD).

However, recent data demonstrated that monitoring 25-hydropxy vitamin D levels can lower the risk of miscarriage and premature delivery in pregnant women with lupus.

CCR East: Study Offers Overview of Pregnancy Outcomes in Takayasu Arteritis

Described by the American College of Rheumatology as a rare form of vasculitis disease characterized by inflammation of the aorta and main branches, Takayasu arteritis poses a significant threat to quality of life for patients.

Raksadawan and Sabahat Usmani, MD, of Louis A. Weiss Memorial Hospital, launched the current study with the intent of exploring the effect of Takayasu arteritis on delivery outcomes as a follow-up to a previous research examining effects on other outcomes.

“While [Takayasu arteritis] patients had a significantly higher rate of comorbidities: gestational hypertension, thyroid disorders, and increased incidence of genitourinary infections, [the condition] does not seem to cause adverse outcomes during the delivery period,” wrote investigators.

Vitamin D Levels Can Influence Risk of Miscarriage, Premature Delivery in Women with Lupus

Congress of Clinical Rheumatology (CCR) East 2023 annual meeting

, which examined the role of 25-hydroxy vitamin D insufficiency and BMI on adverse pregnancy outcomes in 

, describe the presence of a U-shaped curve association between maternal serum 25-hydropxy vitamin D level and adverse pregnancy outcomes. The lowest prevalence of adverse pregnancy outcomes observed among those with a maternal vitamin D level of 40-59 ng/dL.

Further analysis suggested the same trend was present when miscarriage and premature deliveries were examined separately but this 

 value failed to reach statistical significance, which investigators attribute to smaller numbers.

Maternal RA Linked to Increased Risk of Autism Spectrum Disorder in Children

 diagnosis before delivery was linked to an increased risk of offspring ASD. The association between maternal arthralgia and ASD indicated other pathways of risk than autoimmunity and inflammation, acting jointly or independently of RA.

The prospective, population-based cohort study included all children born alive in Sweden between 1995 and 2015, with a follow-up period through 2017. Of the 3629 children born to mothers with an RA diagnosis, 1.94% (n = 70) were ultimately diagnoses with ASD, compared with 1.92% (n = 28,892) of 1,503,908 children born to mothers without RA.

A maternal RA diagnosis before delivery was linked to an increased risk of offspring with ASD (HR = 1.43, 95% CI 1.11–1.84), particularly for those with seronegative RA (HR = 1.61, 95% CI 1.12–2.30).

The rheumatology month in review highlights a program developed by Janssen to support health equity, the increased risks pregnant women with rheumatic diseases face, and trends in fibromyalgia management.

Gout

On the HCPLive gout page, resources on the topics of medical news and expert insight into gouty arthritis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on gout, and more.

Rheumatology Month in Review: May 2023

Boni Elewski, MD, and Benjamin Kaffenberger, MD, and Carly Elston, MD, provide their recommendations for clinicians who are taking care of patients with rare dermatological disorders in the critical care setting.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Recommendations for Management of Rare Dermatological Disorders in Critical Care Setting

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This new research indicates substantial detection of lower-risk disease among patients who are considered to be health-seeking.


Increased Mortality Risk for Melanoma in Situ Patients, Though Survival Rate Higher Than General Population

The biosimilars month in review highlights infliximab biosimilars data presented at Digestive Disease Week (DDW) 2023, California’s proposed plan to produce and market biosimilar insulin at production-equivalent prices, and new FDA approvals.

Biosimilars Month in Review: May 2023

The analysis of the XPLORE trial suggested XSB-001 showed biosimilarity to reference ranibizumab as assessed by BCVA improvement at 8 weeks. 

XSB-001 Shows Equivalent Efficacy to Ranibizumab in nAMD Treatment

While most patients were interested in an online wellness program for managing their psoriatic arthritis, barriers, such as cost and fatigue, hindered their initiation of lifestyle adaptations.

Psoriatic Arthritis

On the HCPLive psoriatic arthritis page, resources on the topics of medical news and expert insight into PsA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on arthritis, and more.

Shilpa Venkatachalam, PhD, MPH: Patient Perspectives of an Online Wellness Program for PsA Management

Patients participating in the open-label extension trial had a few months for titration, more than 24 months for stable dosing, and a one-week follow up.

Neurology

Neurology condition center page is a comprehensive resource for clinical news and insights on nervous system disorders. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for Alzheimer's disease, brain injury, PTSD, and more.

John Harsh, PhD: Interim Results Show Once-Nightly ON-SXB Dose is Preferred by Patients

An analysis of nationwide data in Singapore suggests obesity is set to become the leading metabolic risk factor underlying acute myocardial infarction onset, overtaking hypertension and hyperlipidemia in the coming decades. 

Heart Failure

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Structural Heart Disease

Analysis Predicts Obesity as Leading Risk Factor for Heart Attacks by 2050

“How can we use these data to harness the power it has to do a better job of predicting clinical outcomes and looking at treatment responsiveness?” Dr. Reena Mehra asks.

Reena Mehra, MD: Exploring Endophenotypes for Predicting Clinical Sleep Outcomes

Podcasts

Amid mass poor air quality exposure due to ongoing Canadian wildfires, Lungcast reviews air quality index, signs and symptoms of acute and long-term poor air exposure, high-risk patient populations, and the concerning future of particle pollution exposure.

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, Rare Disease Report, and Heart Trials.

Pulmonology

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Asthma

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COPD

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Lung Cancer

Lungcast

Join the American Lung Association and HCPLive every month as Dr. Al Rizzo interviews world-leading experts on the great challenges, accomplishments, and stories in respiratory medicine.

Poor Air Quality Across the US: What You Need to Know

This research indicates biologics may be safe for women of childbearing age, to whom they are often prescribed, as they pose an acceptable risk to fetuses/neonates.


Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Psoriasis Biologics Not Associated with Miscarriage or Congenital Malformations During Pregnancy

Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

An analysis of the ORAL Surveillance trial details the efficacy of tofacitinib relative to TNF inhibition based on history of ASCVD and baseline cardiovascular risk.

Rheumatoid Arthritis

The HCPLive rheumatoid arthritis page is a comprehensive resource for clinical news and insights on arthritis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for RA, and more.

Latest News

Increased Risk of Ischemic Heart Disease in Patients With Systemic Lupus Erythematosus

Analysis Suggests Cost-Effectiveness of Ranibizumab Biosimilar for nAMD Treatment

Reena Mehra, MD: Biomarkers and Endophenotypes for Personalized Patient Care

Rheumatology Month in Review: May 2023

Recommendations for Management of Rare Dermatological Disorders in Critical Care Setting