Key Highlights and Takeaways from the 2016 ACR Annual Meeting
The American College of Rheumatology’s (ACR) Annual Meeting, which just wrapped up in Washington, D.C., saw record attendance, with about 17,000 attendees from around the world, upward of 3,000 abstracts and more than 250 scientific sessions. It is not possible to capture everything that happened in one blog post, but we do want to share some of the interesting highlights we saw and heard there.
One common theme was how patients with inflammatory arthritis (IA) – such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) – are undertreated for risk factors for cardiovascular disease , such as high cholesterol and high blood pressure. Several studies showed this, prompting calls for more coordination between rheumatologists and primary care docs. Treating these risk factors can help people with IA lead healthier and longer lives. One study found that statin therapy may lower the risk of all-cause mortality by a third in AS and PsA patients.
Another big area of interest: biologics – how to find the right one on the first try and whether they should be tapered in stable patients. Several researchers are zeroing in on genes and other markers to predict response to a tumor necrosis factor (TNF) inhibitor, which will potentially help patients avoid months of delay (and wasted dollars) before getting the right treatment. When that happens, personalized medicine will be one step closer to reality. As for tapering biologics, a select very few patients may be able to go off them entirely, but a larger portion may be able to reduce their dose or frequency, say Dr. Paul Emery, from Arthritis Research UK, and Arthur Kavanaugh, MD, from the University of California, San Diego. Again, as rheumatologists better understand the signs that might predict a relapse or that a patient is not quite at remission, the field will be one step closer to truly personalized medicine.
Also a hot topic: whether disease-modifying antirheumatic drugs (DMARDs), both conventional and biologic, should be stopped prior to surgery. The debate is about the risk of post-surgery infection due to immune suppression and risk of a disease flare due to a break in treatment. A large study from the University of Washington School of Medicine in Seattle used data from the Veterans Administration and found that staying on DMARDs and/or TNF-inhibitor biologics before surgery does not raise the risk of infection. But jointly issued guidelines recently released by the ACR and the American Association of Hip and Knee Surgeons rank the consequences of a perioperative infection as worse than those of a flare, thus they recommend discontinuing certain medications before elective orthopedic surgery, including hip and knee replacements.
The role of the microbiome in sickness and in health continues to draw huge interest. One study out of Yale University looked at whether gut bacteria trigger antiphospholipid syndrome, a sometimes deadly autoimmune disease that mostly affects younger women who have an autoimmune condition. Another lab at Yale is trying to identify the types of gut bacteria that cause autoimmune disease and how healthy gut microbiota differ from those of people with autoimmune diseases.
And finally, a congratulatory shout-out to three doctors who always go above and beyond to help out the Arthritis Foundation, Dr. David Pisetsky, from Duke University School of Medicine, who received ACR’s Presidential Gold Medal, its top award; Dr. Charles Helmick, from the Centers for Disease Control and Prevention, who received the Arthritis and Related Health Professions’ President’s Award; and Dr. Jasvinder Singh, from UAB, who received the ACR Young Investigator Award.
Author: Andrea Kane
Cardiovascular Risks
One common theme was how patients with inflammatory arthritis (IA) – such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) – are undertreated for risk factors for cardiovascular disease , such as high cholesterol and high blood pressure. Several studies showed this, prompting calls for more coordination between rheumatologists and primary care docs. Treating these risk factors can help people with IA lead healthier and longer lives. One study found that statin therapy may lower the risk of all-cause mortality by a third in AS and PsA patients.
Biologics
Another big area of interest: biologics – how to find the right one on the first try and whether they should be tapered in stable patients. Several researchers are zeroing in on genes and other markers to predict response to a tumor necrosis factor (TNF) inhibitor, which will potentially help patients avoid months of delay (and wasted dollars) before getting the right treatment. When that happens, personalized medicine will be one step closer to reality. As for tapering biologics, a select very few patients may be able to go off them entirely, but a larger portion may be able to reduce their dose or frequency, say Dr. Paul Emery, from Arthritis Research UK, and Arthur Kavanaugh, MD, from the University of California, San Diego. Again, as rheumatologists better understand the signs that might predict a relapse or that a patient is not quite at remission, the field will be one step closer to truly personalized medicine.
DMARDs and Surgery
Also a hot topic: whether disease-modifying antirheumatic drugs (DMARDs), both conventional and biologic, should be stopped prior to surgery. The debate is about the risk of post-surgery infection due to immune suppression and risk of a disease flare due to a break in treatment. A large study from the University of Washington School of Medicine in Seattle used data from the Veterans Administration and found that staying on DMARDs and/or TNF-inhibitor biologics before surgery does not raise the risk of infection. But jointly issued guidelines recently released by the ACR and the American Association of Hip and Knee Surgeons rank the consequences of a perioperative infection as worse than those of a flare, thus they recommend discontinuing certain medications before elective orthopedic surgery, including hip and knee replacements.
Microbiome
The role of the microbiome in sickness and in health continues to draw huge interest. One study out of Yale University looked at whether gut bacteria trigger antiphospholipid syndrome, a sometimes deadly autoimmune disease that mostly affects younger women who have an autoimmune condition. Another lab at Yale is trying to identify the types of gut bacteria that cause autoimmune disease and how healthy gut microbiota differ from those of people with autoimmune diseases.
Other News You Should Know
- Parents of kids with juvenile idiopathic arthritis (JIA) can be reassured, despite a black-box warning, that TNF inhibitors do not appear to increase the risk of cancer in children with JIA, according to research by Timothy Beukelman, MD, of the University of Alabama at Birmingham (UAB).
- Long-awaited results from the large PRECISION trial show that celecoxib ( Celebrex ), a selective COX-2 inhibitor (a type of nonsteroidal anti-inflammatory drug), does not increase cardiovascular events, such as heart attack and stroke, more than ibuprofen or naproxen do, and it is kinder to the gastrointestinal tract.
- A crisis looms in the field of rheumatology: The shrinking rheumatology workforce is expected to fall short of the growing demand created by growth in the number of patients with arthritis and rheumatic diseases. Experts call for innovation to close the gap before a “tsunami of retirements” hits this country.
Other Studies Worth Noting
- Boston University School of Medicine researchers found that gout patients starting allopurinol to keep uric acid in check do not appear to have a higher risk of developing or exacerbating chronic kidney disease because of the drug.
- Tocilizumab ( Actemra ) is a promising treatment for giant cell arteritis that doesn’t require long-term steroid use, according to John Stone, MD, from Massachusetts General Hospital. Giant cell arteritis often occurs with polymyalgia rheumatic .
- In patients with axial spondyloarthritis, women are more likely to have disease beyond joints – in the eyes (uveitis) and the gut (inflammatory bowel disease), according to a study conducted at St. James’s Hospital in Dublin, Ireland.
- Maintenance therapy with rituximab ( Rituxan ) is better than azathioprine ( Imuran ) for patients with ANCA-associated vasculitis, in terms of relapse and survival, according to five-year results from an international study. (These types of vasculitis are associated with autoimmune inflammation caused by antineutrophil cytoplasmic autoantibodies [ANCA].)
Award-Winning Docs
And finally, a congratulatory shout-out to three doctors who always go above and beyond to help out the Arthritis Foundation, Dr. David Pisetsky, from Duke University School of Medicine, who received ACR’s Presidential Gold Medal, its top award; Dr. Charles Helmick, from the Centers for Disease Control and Prevention, who received the Arthritis and Related Health Professions’ President’s Award; and Dr. Jasvinder Singh, from UAB, who received the ACR Young Investigator Award.
Author: Andrea Kane
