Updates in Clinical and Stem Cell Research in Rheumatic Diseases

Nehad Soloman, MD: Gout is yet another condition that has been rather frustrating to treat, partially because of the lack of effective treatments, partially because of the nature of our understanding and treatment of disease, and partially because of the compliance factor of patients with gout. But as we start to change our minds about this being a more chronic systemic disease as opposed to an episodic disease, and start to implement therapies that are chronic, advise patients to come in regularly, we're going to start to see improved management of disease, improved outcomes of disease. It's exciting to see mechanisms of actions of old come back and be utilized in more aggressive fashion, especially in those patients who are tophaceous or who have erosive disease. It's also exciting to see newer mechanisms of action in development targeting URAT1 or at the level of the renal tubules to give us an option alternative to probenecid and can be used either in combination or alone with other xanthine oxidase inhibitors. That's kind of on the horizon now and we're rather excited.

Recently there has been an expansion in the label according to the FDA based on new scientific evidence in both ankylosing spondylitis as well as non-radiographic axSpA. This gives us even more tools in our belt, if you will, to help against the fight. Non-radiographic axSpA which has been a disease that has been better defined since about 2009, clearly differentiating itself from ankylosing spondylitis, requiring more aggressive therapies because of the real burden of disease for our patients. Traditionally just the TNF initially, and then ultimately a couple of IL17s with an approval within the past couple of years and now expanded label for JAK inhibitors. It's very exciting for us to have yet another tool especially when one of the most common diseases within rheumatology is osteoarthritis. In fact, it affects the greatest number of patients in the world within our panel of patients, osteoarthritis of the hands, osteoarthritis of the knees, the CMC joints. Aside from nonsteroidal anti-inflammatories, we've not had any effective options. We've got some topical over-the-counter therapies, and we dabble in a variety of different remedies. However, stem cell research now is starting to emerge specifically for osteoarthritis of the knees. We've been talking about stem cells and their ability to regenerate. We're excited. We have a couple of trials now looking specifically at stem cell injections into the knees. My expectation is as the data emerges and hopefully, the trial is successful, that within the next year or so as these trials end and submission to the FDA happens that we could within the next2 to 3 years, have a viable therapeutic option for osteoarthritis of the knees that doesn't require surgical intervention. That's where we are with osteoarthritis.

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