Rheumatology Month in Review: March 2024

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This month’s rheumatology month in review showcases the efficacy of various medications for the treatment of psoriatic arthritis, underscores the importance of addressing workforce challenges, and explores non-pharmacological interventions.

This month’s rheumatology month in review showcases the efficacy and tolerability of various medications for the treatment of psoriatic arthritis (PsA), underscores the importance of addressing workforce challenges and implementing preventive strategies for managing rheumatic diseases effectively, and explores non-pharmacological interventions.

Updates in the Management of Psoriatic Arthritis

This month, several articles have highlighted the ongoing research and development efforts to find effective treatments for PsA and improve outcomes for patients.

Risankizumab Effective Through 100 Weeks in Improving Signs, Symptoms of Psoriatic Arthritis

Treatment with risankizumab is efficacious and well-tolerated through 100 weeks in patients with PsA, with most patients maintaining their response as far as signs and symptoms. Overall, the investigators found minimal disease activity (MDA) responders at the 52-week point showed a maintenance of MDA response among an observed percent of 83.6% for continuous and 73.0% for placebo/risankizumab. The drug was confirmed to have been well-tolerated through to 100 weeks.

These findings were the conclusion of the KEEPsAKE 2 randomized clinical trial (RCT), a global and phase 3 study on risankizumab’s efficacy and tolerability among this patient population.

Deucravacitinib Improves Patient-Reported Outcomes in Active Psoriatic Arthritis

Deucravacitinib may be a viable tool for improving patient-reported outcomes (PROs) in patients with active PsA.

In the phase 2, double-blind trial, investigators randomly assigned patients with active PsA in a 1:1:1 ratio to deucravacitinib 6 mg once daily (QD), 12 mg QD, or placebo for 16 weeks. Investigators noted statistically significant and clinically meaningful improvements were reported for the key secondary endpoints Health Assessment Questionnaire-Disability Index (HAQ-DI) and the physical component score of the Short Form Health Survey-36 (SF-36 PCS) by patients treated with deucravacitinib 6 mg QD or 12 mg QD versus placebo from baseline to week 16.

Investigators concluded: “The present analysis representing a broad range of PROs important to patients demonstrated that deucravacitinib improved physical and social functioning, mental health, fatigue, and pain in a phase 2 trial in patients with active PsA.”

Bimekizumab Demonstrates Similar, Greater Efficacy Compared with Guselkumab in PsA

Compared with guselkumab, treatment with bimekizumab demonstrated a more favorable likelihood of achieving treatment outcomes in patients with PsA who were biologic disease-modifying antirheumatic drug (bDMARD)-naïve or had an intolerance or inadequate response to tumor necrosis factor inhibitors (TNF-IR) at week 48/52.

“The results of this analysis should be viewed in the context of the limitations for an indirect comparison, yet the use of individual patient data and established matching-adjusted indirect comparison (MAIC) methodology provides comparative evidence in the absence of a confirmatory head-to-head RCT,” wrote lead investigator Richard B Warren, PhD, professor of Dermatology and Therapeutics and Honorary Consultant Dermatologist at the University of Manchester, UK.

Trends in Rheumatology

Data this month underscored the importance of addressing workforce challenges in rheumatology and implementing preventive strategies for managing rheumatic diseases effectively.

Number of Rheumatologists Increased More Than 20% Over Last Decade

The number of clinically active rheumatologists grew 23% within the last decade, reaching a high of 6046 in 2019, according to a study published in Arthritis and Rheumatology; however, this growth seems to be flattening off in recent years.

“Even with the growth of the rheumatology workforce supply identified in this analysis, there remains a greater demand for rheumatologic care that may need to be solved with more efficient care through digital health tools such as remote therapeutic monitoring, precision medicine, and others,” investigators noted. “The results of this analysis can be used to inform additional studies and future policies to promote growth of the adult rheumatology workforce and alternative solutions to providing rheumatologic care to the US adult population.

At-Risk RA Individuals Have Different Views on Preventive Measures

A new study identified 3 types of at-risk patients with rheumatoid arthritis (RA) based on their perspectives on taking preventative measures to curb or stop the development of RA. The types were characterized as “proactive preventers, change considerers, and fearful avoiders.”

Not only can preventative interventions regulate the immune response, they can also target other risk factors such as smoking, elevated body mass index (BMI), and dyslipidemia. Preventive measures can be anything from taking medication to lifestyle changes including a healthy diet, more exercise, and quitting smoking.

Certain factors influenced the willingness to engage with preventive interventions, including symptom severity, personal risk level, co-morbidities, and experiences of taking other medications or supplements. Furthermore, people were more likely to engage with preventive measures if they had knowledge of RA, risk factors, and medications.

Alternative Treatment, Management Options for Rheumatic Diseases

Studies this month considered non-pharmacological interventions, including exercise and probiotics, in the management of autoimmune diseases, offering complementary approaches to traditional pharmacotherapy.

Bodyweight Exercises Improve Strength, Patient-Reported Outcomes in Female Patients with RA

Results showed adhering to a 6-week bodyweight exercise program improved muscle strength, range of motion, and subsequent Timed Up-and-Go (TUG) test results in a cohort of 42 female patients with RA, further highlighting the role of the HAQ for assessing fall risk and prescribing exercise.

Although many people with RA avoid exercise out of fear of worsened joint pain, exercise is a key treatment for reducing disability by boosting strength and flexibility, subsequently leading to better joint support and function. However, low-impact exercises may be necessary in cases of severely damaged joints. Bodyweight exercises offer a convenient low-impact option for these patients, although little is known about their impact or potential benefit in RA.

Probiotics May Effectively Treat Autoimmune Diseases

Gut microbiota-based therapies may be able to improve a variety of autoimmune diseases, including fibromyalgia, psoriasis, juvenile idiopathic arthritis (JIA), lupus nephritis, systematic lupus erythematosus, ulcerative colitis, and Crohn’s disease.

Previous data has shown a link between autoimmune diseases and genetic, environmental, intestinal flora, among other factors. In addition, “fecal transplantation” has formerly been used in the treatment of ulcerative colitis as it can change the diversity and composition of intestinal flora, although this treatment option is still in its early stages.

“Probiotics are a general term for a class of active microorganisms that can colonize the host intestine and have beneficial effects on the body,” wrote a group of Chinese investigators. “By interacting with host cells, they affect the composition and structural integrity of the intestinal flora, thereby affecting their metabolism and immunity.”