Inflammatory Arthritis: Trends, Risk Factors, and What Rheumatologists Need to Know

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Rheumatology Network interviewed Bahar Moghaddam, MD, Assistant Professor of Medicine in the Division of Rheumatology, Mount Sinai Health System, to discuss the impact of arthritis in the United States and worldwide, recent drug approvals, and the importance of early diagnosis and management of rheumatic diseases. Refresh your knowledge of arthritis with this professional insight.

Rheumatology Network: How common is arthritis in the US and worldwide? Are there certain patient populations and/or specific conditions that are increasing at an accelerated rate?

Bahar Moghaddam, MD: As a rheumatologist, I think of arthritis in 2 major categories: osteoarthritis and inflammatory arthritis. Osteoarthritis impacts the hands, hips, knees, and the spine. This is the most common form of arthritis that is estimated to impact 528 million people globally, and around 50 million patients in the United States. This type of arthritis is associated with aging, obesity, prior injuries, and occupational risk factors, among other causes. The prevalence of osteoarthritis has risen significantly in the last 20 years with an aging population and increasing trends of obesity.

Inflammatory arthritis is typically associated with autoimmune conditions causing inflammation, stiffness, and swelling in the joints. This occurs in diseases like rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, and lupus to name a few. These categories of arthritis are much less common than osteoarthritis and cumulatively affect 1-3% of the population. The incidence and prevalence of these conditions has not changed over time.

RN: Why is it important for people to be aware of this?

BM: Awareness of symptoms of arthritis, whether inflammatory or osteoarthritis, are important for several reasons. Early detection and diagnosis of arthritis is important to prevent chronic pain, joint damage, and associated disability.

RN: What are some of the biggest risk factors for developing some form of arthritis?

BM: The biggest risk factors for osteoarthritis are age, obesity, and joint injury. Aging is the clearest risk factor for osteoarthritis, as cartilage sustains wear and tear over time, with loss of elasticity and hydration. Obesity can increase risk of osteoarthritis due to the added load on weight bearing joints, but also more complex mechanisms that can cause joint damage on a molecular and structural level. Joint injuries that cause fractures, and ligamentous or meniscal tears can also increase the risk of osteoarthritis. Risk factors for inflammatory arthritis include genetics, smoking, exposure to UV light, possible environmental stressors, or a prior history of infections.

RN: What trends have you noticed in the treatment of rheumatic disease in 2022?

BM: I think the most important trends in treatment of rheumatic diseases in the most recent years are our emphasis on early diagnosis and treatment. Additionally, in management of certain rheumatic diseases including vasculitis, where long-term treatment with corticosteroids was typically required, approval of new treatment options has allowed us to taper steroids faster and to reduce steroid related side effects.

RN: What are your opinions on the recent US Food and Drug Administration (FDA) approvals that we’ve seen over the past year? How will this impact both patients and rheumatologists alike?

BM: There have been several FDA approvals in the last year and it's been exciting to have new options for treatment of several diseases. Two new medications were approved for treatment of lupus, anafrolumab and voclosporin, which are used for treatment of lupus nephritis. Belimumab, which was previously approved for treatment of moderately severe lupus, now has a new indication for treatment of lupus nephritis. Avacapone is a new medication approved for treatment of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis. Risankizumab was approved for treatment of psoriatic arthritis. Upadacitinib was approved for treatment of ankylosing spondylitis.

It's wonderful to have more options for treatment of complex disease, from both a patient and rheumatologist perspective. Often, many patients may not respond to the first treatment option or may have side effects to certain medication, so having more treatment options allows us to better customize a care plan.