Rheumatology Month in Review: June 2023

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The rheumatology month in review features studies reporting increased depression rates among patients with autoimmune disease, interventions designed to decrease chronic pain symptoms in fibromyalgia, and highlights from the European Congress of Rheumatology (EULAR) 2023.

Alternative Treatments for Fibromyalgia

Fibromyalgia symptoms are often treated using holistic approaches, such as yoga, meditation, and vitamin supplementation. This month, investigators explored a meditation-based lifestyle modification (MBLM) designed to decrease chronic pain among this patient population, as well as land- and water-based exercise programs to improve symptoms of fatigue. An additional study evaluated the effect of tetrahydrocannabinol (THC), the main active ingredient of medical cannabis, on pain and several psychometric variables, including depression and anxiety.

Mind-Body Intervention Improves Chronic Pain Symptoms in Fibromyalgia

The goal of an interdisciplinary multimodal pain therapy (IMPT) approach is to reduce pain while also educating patients to understand their condition on a biopsychosocial level and rebuild social, phycological, and physical functions regardless of pain. Previous studies have endorsed this method as the most important intervention for relieving chronic pain.

An 8-week, mind-body, meditation-based lifestyle modification (MBLM) program, designed by Karin Matko, PhD, Department of Psychology, Chemnitz University of Technology, Germany, and colleagues, demonstrated relative clinical improvements for a variety of chronic pain conditions, including fibromyalgia. The largest effects were shown in areas of pain self-efficacy, average pain intensity, quality of life, and most severe perceived pain. Average pain levels improved for more than half of patients during the treatment phase.

THC Significantly Improves Pain, Quality of Life in Patients With Fibromyalgia

THC improved pain, depression, and quality of life in patients with fibromyalgia and may have the potential to be an effective treatment option for this patient population, according to research performed by a group of German investigators.

Patients with fibromyalgia admitted to a pain ward between 2017 and 2018 received either THC therapy or standard care and were assessed regarding pain intensity, analgesic consumption, and various psychometric parameters. Results indicated pain intensity, quality of life, and depression were significantly improved in the cohort treated with THC during their stay. However, no differences in anxiety were observed between treatment groups.

Land-, Water-Based Exercise Improves Fatigue in Women With Fibromyalgia

More than 80% of patients with fibromyalgia report severe fatigue or significant sleep difficulties. Blanca Gavilán-Carrera, PhD, Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain, and her team, explored the effectiveness of land- and water-based exercise on sleep quality and fatigue in this patient population.

In comparison to the control group, patients in the land-based exercise group reported improved physical fatigue, while patients in the water-based group had improved general fatigue and global sleep quality. However, the changes were not maintained at the 36-week mark.

Anxiety and Depression Among Patients With Rheumatic Disease

A chronic disease diagnosis can lead to anxiety and depression, which can impact disease-related factors such as disease activity, disease duration, and treatment adherence. These variables may impact the quality of life and disease management among these patients.

Sundeep Kumar Upadhyaya, MD, MBBS, DM, Rheumatology, Indraprastha Apollo Hospital, New Delhi, India, noted “The assessment of fibromyalgia and mental health should be incorporated into the routine management of patients with rheumatoid arthritis (RA), not only in extraordinary circumstances but also in everyday clinical practice and randomized controlled trials, since these conditions may represent the tail-ends of the spectrum of a ‘somatic pain—inflammatory arthritis—depression/fatigue continuum.’”

Depression Rates Among Patients With Fibromyalgia Increased During COVID-19

The prevalence of fibromyalgia, depression, and anxiety in 200 adult patients with RA, as well as controls, were analyzed in a cross-sectional, outpatient clinic, observational, non-interventional study conducted in India between June 2020 and June 2021.

Those with concomitant RA and fibromyalgia reported worse functional ability and a poorer quality of life. Additionally, patients with RA and fibromyalgia had significantly higher rates of anxiety and depression (12.5% and 30%, respectively).

Anxiety, Depression Common Among Patients With Lupus Nephritis

A descriptive cross-sectional study evaluated anxiety, depression, and quality of life in patients with lupus nephritis to assess their relationship with disease activity. Investigators used a total enumerative technique to recruit 100 patients with lupus nephritis from a nephrology outpatient department in India.

Most (60.0%) patients with lupus nephritis reported moderate anxiety and 61.0% had moderate depression which impacted their disease activity and quality of life. A deterioration in quality of life due to their disease was also observed using the lupus quality of life (lupus-QoL) questionnaire.

Highlights From EULAR 2023

Results of a study presented at EULAR 2023 suggested the burden of autoimmune disease has continued to rise over time, likely due in part to earlier diagnosis and an increase in awareness.

Other studies focused on novel treatments for gout, including SEL-212 and AR882, aiming to offer improved efficacy and safety when compared with existing therapies across the gout spectrum. SEL-212, a once-monthly, novel 2-component, sequential uricase-based infusion therapy, is designed to inhibit the formation of anti-uricase antibodies without the need for other immunosuppressant therapies. AR882 is a novel, potent, and selective uric acid transporter 1 (URAT1) inhibitor in development for the treatment of gout and tophaceous gout.

Autoimmune Disease Diagnosis Increasing in the UK

Autoimmune diseases currently affect about 1 in 10 individuals in the UK, which have continued to steadily increase over time, according to a study led by Nathalie Conrad, PhD, Department of Public Health and Primary Care at KU Leuven, Belgium. Results demonstrated an increase of 4%, with similar rates observed among men and women. The largest increases were reported in Sjogren’s syndrome, celiac disease, and Graves’ disease, which have doubled over the past 2 decades.

Investigators noted a factor responsible for this escalation could be the increase in awareness of some conditions over the study period, as well as earlier diagnosis and improved coding practices.

SEL-212 Significantly Reduces Serum Uric Acid Levels in Patients With Gout

Patients were randomized to receive either the 2 doses of SEL-212 or placebo, administered intravenously every 28 days for 6 treatments, or placebo. Patients in DISSOLVE I were enrolled in a 6-month blinded extension phase using the initial treatment conditions.

“Despite availability of effective therapies for gout, a small proportion of patients suffer from refractory gout and/or are intolerant to standard therapies,” wrote Herbert S B Baraf, MD, associated with The Center for Rheumatology and Bone Research, Rheumatology, Wheaton, MA, and colleagues.

Response rates in the DISSOLVE I and DISSOLVE II high-dose group were 56% and 47%, respectively. The low-dose group response rates were 48% and 41%, respectively. These rates were significantly different from the placebo group (P ≤.0015).

Investigators believe these results suggest the potential to provide a new uricase-based treatment option for patients with gout refractory to conventional therapies without the need for traditional immunosuppressants.

AR882 Effectively Lowers Serum Urate Levels in Patients With Gout

“Despite gout being the most common inflammatory arthritis, there remains an unmet need for more effective treatment,” wrote Roy Fleischmann, MD, Metroplex Clinical Research Center, Rheumatology, Dallas.

A randomized, multicenter, double-blinded, placebo-controlled, global phase 2b trial aimed to evaluate the safety, tolerability, and efficacy of AR882 compared with placebo in patients with gout. After 12 weeks of treatment, the median serum urate (sUA) levels were reduced from 8.6 mg/dL to 3.6 mg/dL in the AR882 75 mg cohort and 5.0 mg/dL in the AR882 50 mg group. No changes were reported in those receiving the placebo.