Rheumatology Month in Review: February 2024

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The rheumatology month in review highlights cognitive dysfunction in patients with fibromyalgia, explores the impact of obesity on treatment response in rheumatoid arthritis, and evaluates work-related challenges faced by patients with psoriatic arthritis.

The rheumatology month in review sheds light on the broader consequences of chronic health conditions beyond their clinical manifestations, emphasizing the need for comprehensive care addressing both physical and psychosocial aspects. This month’s articles include research on cognitive dysfunction and quality of life in patients with fibromyalgia, the impact of obesity on rheumatoid arthritis (RA) disease activity and treatment response, and work-related challenges faced by patients with psoriatic arthritis (PsA).

Specific Fibromyalgia Symptoms Effect Quality of Life

Recent research has demonstrated the significant impact of cognitive dysfunction on the quality of life of patients with fibromyalgia. While first article emphasizes how patients express their experiences of cognitive dysfunction in online support groups, the second explores the link between fibromyalgia, sleep disturbance, and poor accuracy for divided attention, underlining the importance of addressing psychosocial factors, including sleep disturbance, to understand cognitive performance differences in this patient population.

Patients with Fibromyalgia, Cognitive Dysfunction Report Significantly Reduced Quality of Life

To better understand how patients with fibromyalgia experience cognitive dysfunction, investigators from the University of New Brunswick, Canada, identified posts referencing cognitive symptoms within 2 Facebook fibromyalgia peer support groups at 2 timepoints, exactly 2 years apart. Key discussion themes were established and compared across both time and groups using inductive Thematic Analysis.

Results of the analysis identified 4 themes among patients in the online support groups: understanding and describing their cognitive dysfunction experiences, their distrust of cognitive abilities, having to choose between pain and medication side effects, and a feeling of misunderstanding and judgement from others.

“Based on these findings, health providers are encouraged to discuss cognitive dysfunction symptoms with patients to help understand and prioritize treatment targets and accommodate cognitive difficulties,” they concluded.

Fibromyalgia, Sleep Disturbance Linked to Poor Accuracy for Divided Attention

A primary analysis found patients with fibromyalgia demonstrated impaired cognitive performance compared with healthy controls. Sleep disturbance, anxiety, and depression—all common conditions for patients with fibromyalgia—are also linked with impaired cognitive performance. Investigators then evaluated differences in cognitive performance between patients with fibromyalgia and healthy controls to determine if psychosocial factors caused these differences.

After conducting a mediation analysis, investigators found a significant indirect effect of group difference on divided attention through sleep disturbance. However, the group difference in divided attention was no longer significant when including sleep disturbance in the model, suggesting patients with fibromyalgia have poorer accuracy for divided attention, mediated by sleep disturbance.

Obesity’s Influence on Rheumatoid Arthritis Disease Activity, Treatment

According to the US Centers for Disease Control and Prevention, being obese can increase the risk of developing RA. Additionally, a growing body of research has suggested disease outcomes and response to therapy may differ in patients with RA and obesity compared to patients who are normal weight, including greater rates of chronic pain and elevated inflammatory markers.

Obesity Linked to Increased Disease Activity in ACPA-Positive Rheumatoid Arthritis

To determine the effect of obesity on disease activity in relation to anti-citrullinated protein autoantibody (ACPA), investigators examined patient data for Leiden Early Arthritis Clinic participants, a Netherlands population-based inception cohort consecutively including all newly presenting patients with recent onset arthritis ≥ 1 joint and a symptom duration < 2 years.

Upon analysis, patients with obesity had a significantly greater disease activity score (DAS) course compared to normal-weight patients. All DAS courses significantly decreased during follow-up, but patients with obesity had a 0.31 higher DAS compared to normal-weight patients at diagnosis and during the entire follow-up.

In ACPA-positive RA, patients with obesity had a significantly higher DAS during the entire 5-year follow-up compared to normal weight patients, whereas in ACPA-negative RA, this difference was smaller and not statistically significant. Investigators pointed out the association between obesity and greater DAS scores in RA patients appeared to be predominantly present in ACPA-positive RA patients.

Remission Rates Similar Among Patients with RA Receiving Adalimumab, Other Biologics

In patients with RA, no differences in the 28-joint Disease Activity Score (DAS28)-remission were observed between those receiving adalimumab as the first biologic and those receiving other biologics, such as etanercept, infliximab, and abatacept.

The study included 1243 (49.4%) normal weight, 829 (33.0%) overweight, and 443 (17.6%) obese patients with RA. Although obesity is linked to lower treatment response in this patient population, results were independent of body mass index (BMI).

However, etanercept was linked to a reduced odds of achieving Rheumatoid Arthritis Disease Activity Index-Five (RADAI-5) remission in overweight patients.

Positive Impact of Treatment on Enhancing Work Productivity

An estimated 20—50% of patients with PsA experience unemployment, with up to 4 in 10 reporting some degree of work disability. These patients may also experience substantial costs related to work absences, sick leaves, and short-term work disability in the United States.

This month’s articles highlight the significant impact of PsA on employment and work-related outcomes, as well as the potential improvements in work productivity and daily activities with certain treatments.

Guselkumab Improves Work Productivity, Daily Activity in Psoriatic Arthritis

A total of 739 patients with active PsA were randomized in DISCOVER-2, and 652 (88.2%) completed treatment over 2 years. Upon analysis, those randomized to guselkumab exhibited significantly better improvement in work productivity and nonwork daily activity impairment, compared with placebo, through week 24 in both Q4W and Q8W treatment regimens. These improvements were maintained through week 52.

“Rates of employment increased in patients treated with guselkumab who were not employed at baseline and observed improvements in work productivity were estimated to result in substantial yearly indirect work productivity-related cost savings,” noted the team of investigators led by Jeffrey R. Curtis, MD, MPH.

DMARD Therapy Improves Work Capacity in Patients with PsA

“The consequences of PsA on work are important and include deleterious effects such as hours of missed work (absenteeism), diminished productivity while at work (presenteeism), and increased economic burden due to indirect costs,” wrote Laure Gossec, MD, PhD, professor of rheumatology at Sorbonne Université and Pitié-Salpêtrière Hospital, Paris, France, and colleagues.

To understand the course of work productivity and leisure activity in patients with PsA treated with b/tsDMARDs, investigators identified all eligible trials and observational studies related to work productivity and WPAI published between January 1, 2010, and October 22, 2021.

A total of 12 studies evaluated patients treated with adalimumab, bimekizumab, ixekizumab, risankizumab, secukinumab, bimekizumab, and upadacitinib. Among patients who were employed (n = 3741), the overall mean baseline scores were 11.4% for absenteeism, 38.7% for presenteeism, 42.7% for total work productivity impairment, and 48.9% for activity impairment.

The estimated absolute mean improvements to week 24 were 2.4 percentage points (0.6, 4.1), 17.8%p (16.2,19.3), 17.6%p (15.9,19.4), and 19.3%p (17.6, 21.0) respectively. These results led to a mean relative improvement of 41% for total work productivity. Changes in work outcomes among the b/tsDMARDs were comparable.