Poor Treatment Adherence in RA and Lupus Reported at Conference

Persons who have a rheumatologic disease, such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), often do not take their medication on a regular basis, according to research findings presented recently at the American College of Rheumatology (ACR) Annual Scientific Meeting held in Atlanta. In many cases, patients' lack of adherence to their treatment plan leads to poor outcomes.

Researchers used MEMS caps to monitor treatment adherence among persons with RA and SLE in 2 studies. Adherence rates in both study groups were low-the rate for doses taken on schedule each day or week was 59% for RA study participants taking disease-modifying antirheumatic drugs and 64% for SLE study participants taking prednisone. Only 61% of RA study participants and 46% to 62% of SLE study participants took their medications correctly. In addition, only 1 of 5 participants in both studies had an average adherence rate of 80% or higher; those who did reported better health.

In the RA study, participants who had worse overall health and better mental health were more adherent to their treatment plans. In the lupus study, depression was associated with lower adherence rates, and better mental health increased the likelihood that participants would follow treatment plans. Researchers noted lower levels of disease activity among participants who adhered to the correct dosages of their medication.

For more on treatment adherence, go to “Featured Articles” in the “Rheumatoid Arthritis Resource Center” on http://www.musculoskeletalnetwork.com to see “Improving treatment adherence in patients with rheumatologic disease” [October 12, 2010].

Other RA study findings reported at the ACR meeting include the following:
•Systemic inflammation and RA disease activity may contribute to the progression of atherosclerosis in persons who have RA. This progression may be modified favorably by tumor necrosis factor α (TNF-α) inhibitors and detrimentally by corticosteroids.

•RA researchers are using the 2010 ACR/European League Against Rheumatism (EULAR) Rheumatoid Arthritis Classification Criteria in an effort to improve the identification of persons with RA even before they receive the diagnosis in a clinical setting. In a group of 1790 study participants, 21 without a previous diagnosis of RA were found to have “definite RA” with use of the new criteria.

•Persons who have newly developed RA or undifferentiated arthritis may be able to achieve remission with continued drug therapy after 4 months of treatment with methotrexate and prednisone. In a study of 261 persons with RA and 161 persons with undifferentiated arthritis, remission was achieved in 63% of patients.

•Anti–TNF-α therapies frequently used to treat patients with RA may reduce the risk of Alzheimer dementia among persons with RA.

•Bacteria in the human mouth and intestines can trigger RA.

•Common adult vaccinations are not associated with an increased risk of RA.

•Joint damage caused by RA can lead to difficulties in typing. As a result, persons may seek alternative typing strategies, such as the hunt-and-peck style, that may increase rather than reduce existing problems by placing additional stress on affected joints.

In a study of 13,492 patients, those who have SLE were found to be 1.15 times as likely to have cancer as the general population and more than 2.5 times as likely to have hematological malignancies, such as lymphoma and leukemia. Study participants also demonstrated an increased likelihood of having lung, cervical, vulvovaginal, and liver cancer (1.2, 1.6, 2.8, and 2.2 times more likely than the general population, respectively).

Other SLE study findings included the following:
•Although statins help prevent the progression of atherosclerosis, they should not be prescribed routinely for children and adolescents who have SLE, even though they are at increased risk for premature atherosclerosis.

•Women with anti-SSA/Ro antibodies and a previous child who has heart block may decrease their risk of delivering another child with life-threatening heart disease by taking hydroxychloroquine.

The prevalences of gout and of related cases of hyperuricema have increased over the past 2 decades, according to the results of 2 National Health and Nutrition Examination Surveys. In 2007 to 2008, gout was identified in 8.3 million US adults (3.9%), a 1.2% increase over the 1988-1994 period that is attributed to a higher prevalence among men and senior citizens. Over the same period, the prevalence of hyperuricemia increased by 3.2%, to 21.4%. The researchers concluded that the simultaneous increases in gout and hyperuricemia rates reconfirm the connection between them and that better management of additional risk factors, such as obesity and hypertension, could slow the growth of gout and associated complications.

Other gout findings included the following:
•The results of another study showed that the prevalence of hyperuricemia increases with age-it occurs less frequently in persons aged 20 to 29 years than in those who are 80 years or older.

•Persons with hyperuricemia are at an increased risk for high blood pressure. Medications that lower uric acid levels in the blood may be useful in preventing or managing hypertension.

•The use of urate-lowering therapy may prevent death caused by cardiovascular disease in persons who have gout.

•Drinking caffeinated beverages may increase the risk of recurrent gout attacks.

•Women who consume fructose-rich beverages, such as sugar-sweetened soft drinks and orange juice, are at increased risk for gout.

The use of ultrasonographic needle guidance improves the performance, outcomes, and cost-effectiveness of knee injections in persons with osteoarthritis (OA) compared with the palpation-guided method, researchers found. Improved results included a 107% increase in the number of persons who responded to treatment and a 51.6% reduction in the number of persons who did not. The researchers noted a 47% reduction in pain during the procedure, a 41.7% reduction in pain 2 weeks after the injection, and a 35.5% increase in the length of time the participants experienced pain relief after the injection. The ultrasonographic method led to a 14.6% reduction in cost per participant per year and a 58.8% reduction in the cost per hospital outpatient participant who responded to the treatment.

Other OA study findings included the following:
•The use of vitamin D as a supplement does not appear to lessen the symptoms or slow the progression of knee OA.

•The use of special mobility shoes may help ease knee pain and slow disease progression in persons with OA.

As part of the Framingham Foot Study, researchers documented the high probability that common foot disorders, such as hallux valgus and pes cavus, can be inherited. They noted that the high degree of heritability is of great interest, especially for younger patients, because interventions are most effective in the early stages. In another study, researchers found that chronic lower back pain may be linked to axial spondyloarthritis, a recently defined form of inflammatory arthritis.

For more information on these and other research findings, visit the ACR Web site at http://www.rheumatology.org. Or, contact the organization at ACR, 2200 Lake Boulevard NE, Atlanta, GA 30319-5312; telephone: (404) 633-3777; fax: (404) 633-1870.