Rheumatology Month in Review: April 2024

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This month's review showcases the ongoing efforts to enhance patient care through innovative treatments and comprehensive management strategies.

This month’s review showcases alternative approaches and advancements in managing chronic conditions like fibromyalgia, psoriatic arthritis (PsA), and gout, underscoring the ongoing efforts to enhance patient care through innovative treatments and comprehensive management strategies.

Studies on fibromyalgia explored the benefits of prolonged medical fasting and the use of medical cannabis, highlighting the need for further research on these alternative treatments. Additionally, research on risankizumab in PsA emphasized the importance of long-term management strategies. Gout headlines this month highlighted a patient-centric approach and the role of healthcare provider education in optimizing treatment outcomes.

Alternative Approaches to Fibromyalgia Symptoms

Two studies on fibromyalgia treatment alternatives were explored this month, both of which stressed the need for clinician education on alternative treatments for fibromyalgia management. They accentuate the potential benefits and patient preferences in seeking symptom relief beyond traditional therapies.

Prolonged Medical Fasting May Benefit Pain Symptoms in Fibromyalgia

The Fibromyalgia Impact Questionnaire (FIQ), a validated questionnaire specifically used for the symptomatic presentations of fibromyalgia, was used to determine the feasibility and effectiveness of prolonged therapeutic fasting in fibromyalgia management.

Upon analysis, investigators identified a significant improvement in fibromyalgia manifestations in the FIQ. The FIQ total score dropped from 58.3 ± 11.1 to 44.6 ± 15.5 between admission and discharge, a reduction of 13.7 ± 13.9 points (P <.001). Translating to a decrease of 23.5%, investigators noted the marked reduction in the total score is larger than the minimal clinically important difference (MCID) of 14%.

Additionally, safety data showed no serious adverse events were reported during the inpatient stay for any participant. Given the potential for positive effects on presentations of fibromyalgia, the team suggested the need to study prolonged medical fasting in outpatient settings and whether the duration of the fast could show similar effects.

Survey Finds Many Fibromyalgia Patients Finding Symptom Relief with Medical Cannabis

Results of an online survey of more than 1300 patients with fibromyalgia created by investigators at the Mayo Clinic revealed nearly half of all patients reported using cannabis since receiving their fibromyalgia diagnosis, with 82% reporting perceived improvements in symptoms for pain with use. Investigators believe these results underscore the growing need for clinician awareness and knowledge on use of medical cannabis for symptom management in fibromyalgia and other chronic pain disorders.

“Considering that cannabis is a popular choice among patients for managing fibromyalgia symptoms, clinicians should have adequate knowledge of cannabis when discussing therapeutic options for fibromyalgia with their patients,” wrote investigators.

Risankizumab Excels in PsA Treatment

Despite a wide range of treatments available to help clinicians obtain and sustain joint and skin improvement among their patients, a substantial proportion of patients are still unable to achieve stable remission. Treatment with risankizumab, a fully humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin (IL)-23 by binding to the p19 subunit, was shown to improve a variety of skin and joint symptoms among patients with PsA and psoriasis.

Risankizumab Significantly Improves Skin, Joint Symptoms in PsA

In this multicenter study set in 8 Italian centers, investigators prospectively evaluated risankizumab treatment using both rheumatologic and dermatologic assessments, including joint and entheses ultrasound, at baseline and between 28—40 weeks of continuous therapy.

Post-treatment, disease activity, Psoriasis Area and Severity Index (PASI) scores, and Physician Global Assessment (PGA) score significantly decreased among patients receiving the drug.

Long-term Risankizumab Treatment Outperforms Placebo in PsA

A post hoc analysis of the phase 3 KEEPsAKE 1 and KEEPsAKE 2 trials evaluating risankizumab treatment in patients with PsA showed greater efficacy when compared with placebo.

Throughout the long-term study, improvements were observed among efficacy measures, including those evaluating skin response criteria, composite measures of overall disease activity, and PsA-related symptoms. Treatment with risankizumab was shown to be an effective strategy among patients with PsA regardless of varying demographic and psoriatic disease characteristics through 1 year.

“These efficacy results support long-term use of risankizumab for patients with active PsA across multiple patient and psoriatic disease characteristics,” wrote lead investigator Joseph Merola, MD, MMSc, of the Department of Dermatology at Brigham and Women’s Hospital, Harvard Medical School.

Improvements in Gout Management

This month’s gout headlines focused on strategies and interventions aimed at improving gout management and patient outcomes. This involved aspects such as self-monitoring, technology, and healthcare provider roles in enhancing treatment compliance, health knowledge, and medication adherence among this patient population.

Self-Monitoring of Urate Concentration Could Benefit Gout Management

Self-monitoring of urate concentration using a point-of-care (POC) device for blood glucose may improve adherence to urate-lowering therapy (ULT) among individuals with gout.

Despite the effectiveness of ULT, such as allopurinol, for long-term management of gout, up to half of patients discontinue therapy within the first 6 months in Australia. Factors impacting adherence to ULT include education for its role in preventing gout flares and the experiences of healthcare providers in providing gout management advice. Self-monitoring is recognized by global health organizations, including the World Health Organization (WHO), for allowing active patient participation in their health care.

“The evaluation of urate self-monitoring in people with gout who are initiating or reinitiating ULT would be of interest because real-time feedback on urate control may assist in encouraging people with gout to persist with ULT, particularly when the risk of gout flares is high,” wrote a team of investigators led by Sophie L Stocker, PhD, school of pharmacy, faculty of medicine and health, University of Sydney.

Mobile Health App Improves Treatment Compliance, Health Knowledge in Gout

Continuous care with the help of a mobile health (mHealth) app was shown to improve knowledge levels and treatment compliance among a cohort of patients with gout.

Participants in the intervention group were given continuous care using the mHealth app for 24 weeks. The app included modules for health records, education materials, and interactive support. Controls received face-to-face health education, paper-based education materials, and patient-initiated telephone consultations.

Patients using the mHealth app reported significant improvements in gout knowledge levels over time compared with controls. Although there was no significant difference in treatment adherence at 12 weeks among groups, a statistical difference was noted in the intervention group at week 24.

Nurse-Led Gout Care Linked to Better Medication Adherence

“Currently, gout management, particularly ULT, is often suboptimal,” wrote a team of investigators led by Claus Rasmussen, MD, associated with the Department of Rheumatology, North Denmark Regional Hospital in Hjorring, Denmark. “Nurses successfully manage various diseases including gout. As gout prevalence is rising, and rheumatologists and general practitioners face shortages, a new approach is imperative.”

In the real-life prospective cohort study, investigators assessed the effectiveness of a nurse-led care program that used a treat-to-target strategy for the management of gout. The targeted approach was linked to a higher uptake of and adherence to ULT over a span of 2 years compared with usual care.