CV risk reduction, pain catastrophizing, inept apps, and 5 other notable developments in RA research and clinical care.
Sources1. Biologics lessen cardiovascular risk2. TNF inhibitors do not increase cancer risk3. RA diagnostic accuracy improves with additional studies4. DMARDs ease pain catastrophizing5. In children, RA risk goes up in smoke6. Poor prognostic factors don’t predict treatment choices7. Vitamin D levels influence RA severity8. Inept RA apps don’t fully applyÂ
Biologics lessen cardiovascular risk, DMARDs ease pain catastrophizing, vitamin D affects RA severity-these are just a few of the latest developments in RA research and clinical care.
Scroll through the slides above to find concise summaries of 8 notable things that happened in RA.
Find links to studies/abstracts below.
Biologics lessen cardiovascular risk. The use of biologic agents is associated with a reduction in major cardiovascular events (CVEs) in patients with inflammatory arthritis. In a prospective national cohort study, CVE risk was reduced in patients with RA, psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who used anti–tumor necrosis factor or other biologic therapies but not in patients who had ceased biologic therapy. No significant difference in CVE risk was observed between participants with RA and those with PsA or AS.
TNF inhibitors do not increase cancer risk. Tumor necrosis factor (TNF) inhibitor treatment was not associated with increased risk of cancer recurrence in patients with RA in a population-based cohort study. Of patients who started TNF inhibitor treatment after cancer diagnosis, 9.0% had cancer recurrences, compared with 7.2% of matched patients with the same cancer history. Meaningful risk increases could not be ruled out.
RA diagnostic accuracy improves with additional studies. Rheumatologists blinded to prior workup could not correctly classify most patients when relying only on medical history and examination. Their ability to identify patients who did or did not have RA increased from 19% after the clinical assessment to 42% after the ultrasonography and to 60% after taking laboratory test results into account. Pretreatment with corticosteroids did not significantly worsen their diagnostic performance.
DMARDs ease pain catastrophizing. Pain catastrophizing-the tendency to describe a pain experience in exaggerated terms, ruminate on it, and feel more helpless about it-decreased in patients with RA after initiation of a new disease-modifying antirheumatic drug. Clinical Disease Activity Index also decreased. Catastrophizing may be a dynamic construct that can be altered with treatment directed at decreasing inflammatory disease activity and pain.
In children, RA risk goes up in smoke. Passive exposure to tobacco during childhood might increase RA risk in future light smokers and probably even in nonsmokers. Early passive exposure to tobacco during childhood also could be associated with an earlier onset of RA, particularly in smokers. Avoiding any tobacco environment in children, especially those with a family history of RA, is recommended. Smoking is the only conventional environmental factor that has reproducibly been linked to increased RA risk.
Poor prognostic factors (PPFs) don’t predict treatment choices. Biologic/targeted synthetic disease-modifying antirheumatic drug (tsDMARD) use was similar in patients with RA who had PPFs and those who did not, even though the former had high disease activity and worse clinical outcomes. Because number of PPFs (eg, functional limitation, extra-articular disease) did not significantly predict use of biologics/tsDMARDs, reconsideration of PPFs’ importance in treat-to-target approaches may be warranted.
Vitamin D levels influence RA severity. Researchers evaluated the relationship between 25-hydroxyvitamin D, or 25(OH)D, levels and disease severity in patients with RA. The levels of 25 (OH) D were lower in patients with RA than in healthy controls. Vitamin D deficiency was associated with clinical disease activity. They concluded that quantification of serum 25 (OH) D levels and use of vitamin D supplementation should be considered in managing patients with RA.
Inept RA apps don’t fully apply. In a review of apps for patients with RA, 50% offered only symptom tracking, 20% provided information only about RA, 20% engaged patients by providing both symptom tracking and educational information, < 50% provided means to contact healthcare providers or link to an online community, and 30% offered security protection. Main areas needing improvement: implementation of smartphone accessibility features and secure methods of protecting individual health information.