Highlights from ACR 2015, Day Two – ACR Annual Meeting Continues at Full Steam in San Francisco!
Our team is still here on-site at ACR 2015 and we continue to absorb new and intriguing information stemming from the latest research around arthritis and other rheumatic diseases. Highlights of what we heard over the course of Day 2 are below!
Several presentations on treatments for knee OA were on offer: First, good news for people with OA who take corticosteroid injections in the knee; a study presented by Dr. Tim McAlindon from Tufts University Medical Center found that getting injections every three months over the course of two years did not significantly increase structural damage to the cartilage as previously feared. Chondroitin got a nod thanks to a Canadian study led by Dr. Jean-Pierre Pelletier at the University of Montreal. His study found that chondroitin sulfate was as good as celecoxib (Celebrex) at controlling pain. But – bonus – the chondroitin seemed to slow the progression of cartilage damage by some measures during the two-year study period. Even if the benefit was small, it could mean a delay in knee surgery down the road, said Dr. Pelletier. Another study, also out of Tufts, found that Tai Chi helped pain and function in knee OA as much as physical therapy. But Tai Chi, because it is a mind/body practice also helped improve depression, which is a big problem for people with all different types of arthritis. And a small study out of Brazil of 98 OA patients found that once-a-week ozone injections into the knee for eight weeks seem to help with pain and joint function compared placebo – but larger studies are needed.
And a couple of new studies addressed the issue of switching or discontinuing a biologic. One of the biggest questions is, what to do if an anti-TNF biologic doesn’t work for a person with RA—switch to another anti-TNF (as had traditionally been encouraged), or move on to a biologic with a different mode of action. A large study out of France led by Jacques-Eric Gottenberg found that more patients did better on a non-anti-TNF biologic than on a second anti-TNF. "There was clear superiority at any time,” said Dr. Gottenberg. An unrelated study found that patients who are stable on their current biologic but switch to another biologic or discontinue it for non-medical reasons – usually financial or insurance-related – do worse than those who stick to their regimen. Switchers and discontinuers had poorer responses than those who didn’t; they were less likely to have well-controlled disease and they used more health care resources, said lead study author Dr. Douglas Wolf.
Another presentation looked at modifiable and non-modifiable risk factors: genes are thought to account for an estimated 50-60% of rheumatoid arthritis (RA) risk, with the balance blamed on environmental exposures. Several studies presented looked at salt intake, smoking, BMI, diet, alcohol use and other lifestyle habits in the years before people developed RA. The findings were fascinating. None is airtight conclusive but taken together, with previous findings, they make the point that lifestyle matters. A Swedish study found that women who were heavy smokers and had high sodium intake were at increased risk of having anti-CCP (anti-cyclic citrullinated peptide), an antibody and early biomarker for inflammatory arthritis, including RA. Studies in the past have found that people can test positive for anti-CCP up to 15 years before symptoms appear. A UK study looked for lifestyle factors and biomarkers that increased risk of RA in first degree relatives of people with RA. Just having a first degree relative with RA doubles a person’s risk of RA, but other factors tip the odds. Those who had high alcohol intake were more likely to be rheumatoid factor-positive (RF) and those who were overweight were more likely to have an elevated c-reactive protein level (a measure on inflammation). A third study found women who are anti-CCP positive and overweight (BMI of 25 or greater) showed increase risk of RA but also a shorter time to disease onset compared to controls.
And finally, another great debate today. This one centered on opioid prescribing. Opioids are a tool, they can be used well or dangerously, said debater Dr. John Markman, from the University of Rochester Medical Center. But, says Dr. Daniel Clauw, from the University of Michigan, while opioids work fairly well for acute pain that doesn’t necessarily translate for chronic pain, so other treatments should be used. At issue: whether the drug’s benefits outweigh the risks.
Stay tuned for more highlights!
