Readers Pick the Best of Rheumatology for 2020

Coronavirus as Risk Factor for Rheumatoid Arthritis: Respiratory viral infections can be a novel environmental risk factor for the development of rheumatoid arthritis, find Korean researchers writing in Arthritis Research and Therapy. The study, which was led by Yune-Jung Park, a rheumatologist with St. Vincent’s Hospital, the Catholic University of Korea, Seoul, and published on August 30 in the journal, found that ambient respiratory viral infections, such as the parainfluenza, coronavirus, and metapneumovirus, were associated with an increased number of incident rheumatoid arthritis cases most often affecting women and older patients.

Diet Has a Limited Role in Managing Gout: Dr. Bradley Marder, medical director of nephrology with Horizon Therapeutics, explains the role of diet in managing gout: "There is a miconception about how effective diet is in managing gout. Certainly diet is important in managing disease conditions---including gout, hypertension, diabetes, chronic kidney disease---you name it. There is a limited amount of influence that diet can have in really maintaining and treating a patient with gout. So like I said before, you really need to get the uric acid less than 6 mg per dL. And, if diet can get it there, great. But in most patients, the amount of uric acid lowering that you can get from dietary changes, such as eliminating tomatoes or any of the other high uric acids foods, can realy only improve by about 1 to 2 mg per dL.

EULAR Report: Physicians Increasingly Pass on Biosimilars: Rheumatologists still lack confidence in prescribing biosimilars, shows study presented at EULAR. Despite good knowledge of biosimilars, some rheumatologists do not switch to these agents due to lack of confidence, according to results from French study presented at the European Congress of Rheumatology (EULAR) annual meeting. While biosimilars for subcutaneous tumor necrosis factor (TNF) inhibitors have been available in France since 2015, French health agencies do not legally oblige rheumatologists to first prescribe or switch to biosimilars.Elisabeth Gervais, of Poitiers University Hospital in France, and colleagues assessed the knowledge and beliefs of French rheumatologists about biosimilars via a questionnaire that also looked at demographic data, professional practice and confidence.

Source of Pain in Fibromyalgia Identified: Patients with fibromyalgia syndrome may present with elevated intramuscular pressure, which might represent a diagnostic aid in fibromyalgia syndrome and a target for treatment to reduce muscle pressure, according to a study recently published in The Journal of Rheumatology. “This study directs attention to a peripheral target for both diagnosis and treatment that is not routinely monitored in clinical practice; intramuscular pressure, and hopefully provides a revised roadmap for a better understanding of pain in fibromyalgia syndrome,” wrote the authors, led by Robert S. Katz M.D., of Rush Medical College in Chicago.

Talking Gout and Myths with Dr. Christopher Parker: In this week's news roundup from Rheumatology Network we continue our series on gout. Last week we featured a discussion with Dr. John D. Fitzgerald focusing on ACR's new gout treatment guidelines and this week, we talk with Dr. Christopher Parker, chief of rheumatology at Austin Diagnostic Clinic in Texas. Dr. Parker addresses mythbusters and patient engagement. Dr. Parker also serves as the lead rheumatologist for the Alliance for Gout Awareness-a nonprofit profit organization that serves as an information source for gout patients. Years ago, he and patient Gary Ho, identified a need for trustworthy medical information about gout and they launched “The Gout Support Group of America” on Facebook. They quickly amassed thousands of followers and the group eventually became the Alliance.

EULAR Issues Recommendations for Knee OA Platelet-Rich Plasma Injections: An expert consensus on the first clinical practice recommendations for platelet-rich plasma (PRP) injections in knee osteoarthritis was presented at the European Congress of Rheumatology (EULAR) annual meeting. “There has been much debate regarding the use of intra-articular injections of platelet-rich plasma as symptomatic treatment for knee osteoarthritis,” said Florent Eymard, M.D., of the Henri Mondor Hospital in Créteil, France. “The heterogeneity of the preparation and injection protocols limits the extrapolation of data from randomized controlled trials and meta-analyses.”

First COVID-19, then Kawasaki-like Disease in Children: Children with COVID-19 can develop pediatric, inflammatory multisystemic syndrome, or PIMS, which can lead to symptoms similar to that of a painful vasculitis condition called Kawasaki disease. Today we talk with Jagadeesh Bayry, Ph.D., and Caroline Galeotti, M.D., of the University of Paris who recently described in Nature Reviews Rheumatology related pediatric cases they saw in their clinic.

Vitamin D and Fish Oil Fail Osteoarthritis Trial: New research published in Arthritis and Rheumatology shows that vitamin D and marine omega‐3 fatty acids (n‐3 FA) do not offer long-term relief from knee pain, stiffness or function in older adults with chronic knee pain. The two supplements have been promoted commercially as possible treatments for knee pain. In theory, it seemed plausible because vitamin D promotes bone resorption and bone strength and has anti-inflammatory properties. Omega-3 fatty acids have anti-inflammatory effects and they promote cartilage degradation. But, apparently, neither treatment is associated with statistically significant improvements in pain, improved function or mobility.

Exercise Types Essential in Rheumatic Disease: Patients with inflammatory arthritis and osteoarthritis should be participating in four different types of exercise: cardiovascular, strength, flexibility, and balance. But a new study shows that patients are overly focused on cardiovascular exercise and not enough on exercise types designed to strengthen and protect joints and bones. In this interview, Dr. Lauren Freid, a rheumatologist with the University of California Los Angeles and the lead investigator of a study on physical activity in people with inflammatory arthritis and osteoarthritis, addresses exercise essentials for inflammatory rheumatic disease.

Treatment Combinations in RA May Not Be So Unique After All: In an interview with Rheumatology Network, Dr. Beate Wieseler compares the effectiveness of biologic drugs used to treat rheumatoid arthritis after methotrexate fails. Methotrexate is the standard initial treatment for patients with rheumatoid arthritis, but if it fails to control the disease, adding a biologic is one of the options. But which one to choose? German researchers have conducted a systematic review and network meta-analysis to try to answer this question. Their findings, published in The BMJ, show that in most cases the choice makes little difference: they found little difference between the benefits and harms of different methotrexate/biologic combinations.