Highlights of 3 recent studies that can affect your practice: a novel procedure for knee pain, cardiovascular risk in RA, and febuxostat in early gout.
References:1. Davis T, Loudermilk E, DePalma M, et al. Prospective, multicenter, randomized, crossover clinical trial comparing the safety and effectiveness of cooled radiofrequency ablation with corticosteroid injection in the management of knee pain from osteoarthritis. Reg Anesth Pain Med. 2018;43:84-91. doi: 10.1097/AAP.0000000000000690.2. Curtis JR, Xie F, Chen L, et al. Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based study. Ann Rheum Dis. 2017 Dec 21. doi: 10.1136/annrheumdis-2017-211727.3. Dalbeth N, et al. Effects of febuxostat in early gout. Arthritis Rheumatol. 2017;69:2386-2395. doi:10.1002/art.40233
Findings from 3 new studies in rheumatologic diseases that can affect your practice include1-3:
• A noninvasive procedure is superior to corticosteroid injections for painful knee osteoarthritis
• Patients with rheumatoid arthritis (RA) may be at increased risk for serious infections, myocardial infarction (MI), and coronary heart disease (CHD)
• Febuxostat, a non-purine-selective inhibitor of xanthine oxidase, prevents gout flares
A prospective, multicenter, randomized trial included 151 patients with chronic knee pain of 6 or more months' duration that was unresponsive to conservative modalities.1 At 6 months, 74% of the CRFA group had pain reduction of 50% or greater, compared with 16.2% who received intra-articular corticosteroid injections. In addition, 40% of those in the CRFA group rated their knee function "satisfactory" compared with just 3% in the steroid group, and 91% of the CRFA group felt their overall health had improved compared with 24% in the steroid group. (©Stasique/Shutterstock.com)
"This study demonstrates that CRFA is an effective long-term therapeutic option for managing pain, and improving physical function and quality of life, for patients suffering from painful knee osteoarthritis when compared with intra-articular steroid injection," stated the researchers, led by Leonardo Kapural, MD, PhD, of the Center for Clinical Research, Winston-Salem, NC, and colleagues. They noted that pain may return as the treated nerve regenerates, and if it does then repeating the CRFA procedure is a "reasonable and sensible" option.
Using Medicare fee-for-service claims data for 2010 to 2014, researchers examined hospitalization for pneumonia/sepsis serious infection events (SIEs), MI, and CHD.2 They analyzed data from 17,433 patients eligible for the SIE and 16,796 patients eligible for the MI/CHD analyses. In all, 452 SIE events, 132 MIs, and 181 CHD events occurred during 16,424 person-years of follow-up.
Higher activity scores were significantly associated with SIEs (adjusted hazard ratio, 1.32). Higher RA disease activity was linked with higher adjusted hazard ratios for MI (1.52) and CHD (1.54). (©martan/Shutterstock.com)
"Higher disease activity as measured by a panel of biomarkers was associated with higher rates of hospitalized infections, MI and CHD events. These findings add to the growing body of evidence that further strengthens the argument to strive for lower disease activity in RA," state the researchers, led by Jeffrey R. Curtis, MD, of the University of Alabama at Birmingham.
A double-blind, placebo-controlled trial of 314 adults with early gout randomized patients to receive once-daily febuxostat 40 mg (increased to 80 mg if the serum uric acid [UA] level was ≥ 6.0 mg/dL on day 14) or placebo.3
Febuxostat significantly improved synovitis score at 24 months as compared with placebo treatment, with a change from baseline of −0.43 versus −0.07, respectively. It also decreased the overall incidence of gout flares and improved serum UA control. (©Jarun Ontakrai/Shutterstock.com)
"Current clinical practice guidelines do not recommend routine use of urate-lowering therapy for people after the first gout flare. This study indicates that even for people who have had only 1 or 2 prior gout flares, urate-lowering therapy to reduce serum urate below 6 mg/dL may have benefit in reducing future flares," said lead author Nicola Dalbeth, MD, of the University of Auckland, New Zealand.