The annual meeting of the American College of Rheumatology was held from Oct. 19 to 24 in Chicago and attracted approximately 17,000 participants from around the world, including rheumatology specialists, physicians, scientists, and other health professionals. The conference featured presentations focused on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases.
In one study, Allen P. Anandarajah, M.B.B.S., of the University of Rochester School of Medicine and Dentistry in New York, and colleagues found that specifically designed programs that use multi-dimensional approaches to help patients with systemic lupus erythematosus (SLE) navigate the health care system can decrease the number of avoidable hospitalizations and 30-day readmissions.
“There is a group of SLE patients who are at high risk for hospitalization. Most of these patients come from ethnic or racial minorities and from lower socioeconomic backgrounds. In this group of patients, in addition to disease being more severe disease, social and behavioral factors also play a role in the increased risk for hospitalizations,” said Anandarajah. “Therefore, adopting measures to help overcome these social and behavioral issues can help decrease some of the avoidable hospitalizations and 30-day readmissions. Taking care of the disadvantaged or underserved populations can not only help improve the health of our communities but can help decrease health care costs over time.”
In another study, Perez Ruiz, M.D., Ph.D., of the Hospital Universitario Cruces in Spain, and colleagues found that gout patients who fail to reach the recommended European League Against Rheumatism and American College of Rheumatology serum urate target of less than 6 mg/dl have a more than twofold increased risk for premature mortality.
“We, as clinicians, should make any reasonable effort to get to target therapeutic serum urate levels, as we do for diabetes, hypertension, and hyperlipidemia to properly treat gout and also to reduce the risk of premature mortality,” said Ruiz.
Several authors disclosed ties to pharmaceutical companies.
Anthony M. Sammel, M.D., of Royal North Shore Hospital in Sydney, and colleagues evaluated the performance of positron emission tomography (PET)/computed tomography (CT) compared to temporal artery biopsy for the diagnosis of giant cell arteritis (GCA). The investigators found that a PET/CT scan including the head, neck, and chest arteries had high diagnostic accuracy for GCA.
“The diagnostic accuracy was high with a sensitivity of 92 percent, specificity of 85 percent, and negative predictive value of 98 percent. This performance compares well with recent large ultrasound and high-resolution scalp magnetic resonance imaging studies,” said Sammel.
The investigators also found that PET/CT had the benefit of detecting clinically relevant alternative diagnoses in one in five patients. These included seven acute infections, five malignancies, and one case of subacute thyroiditis.
“This scan could be used as a first-line test in patients newly suspected of having GCA and may be particularly useful to exclude the condition in lower-risk patients. It may obviate the need for biopsy in a significant number of patients. Clinicians should be aware that the accuracy was not perfect, and biopsy is still suggested if PET/CT is inconclusive or the result is discordant with the pre-test clinical suspicion of GCA,” said Sammel.
Michael L. Whitfield, M.D., of the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, and colleagues developed a machine learning classifier that uses gene expression data from patients to put them into intrinsic gene expression subsets. The investigators then tested the hypothesis that a systemic sclerosis (SSc) patient’s intrinsic gene expression subset (e.g., molecular signature) in peripheral blood mononuclear cells (PBMCs) would predict response to either cyclophosphamide (CYC) or myeloablative autologous hematopoietic stem cell transplant (HSCT).
“We have previously shown that patients with SSc can be divided into ‘intrinsic’ molecular subsets using gene expression,” said Whitfield. “There are three subsets of diffuse cutaneous SSc (dcSSc) that can be defined based on the molecular ‘fingerprint’ of genes expressed in their tissues. These are the fibroproliferative, inflammatory, and normal-like subsets. These patients are indistinguishable clinically, and we have shown their disease is driven by distinct pathways. We analyzed the genome-wide gene expression data in PBMCs from SCOT (Scleroderma: Cyclophosphamide or Transplantation) trial participants followed by intrinsic subset assignment using the machine learning classifier. We then analyzed the patients to examine event-free survival by intrinsic subset. “
The investigators found that the HSCT arm showed substantially larger changes in gene expression than the CYC arm. Participants assigned to the fibroproliferative subset who received HSCT were more likely to benefit than those in the fibroproliferative subset who received CYC. This finding was in contrast to those of previous studies in which the fibroproliferative subset tended not to improve on immunosuppressive therapy (e.g., mycophenolate mofetil).
ACR: Walking Each Day May Cut Risk for TKA Over Five Years
MONDAY, Oct. 22, 2018 — For individuals with knee osteoarthritis (OA), replacing time not walking with walking at moderate-to-vigorous intensity is associated with reduced risk for total knee arthroplasty (TKA) over five years, according to a study presented at the annual meeting of the American College of Rheumatology, held from Oct. 19 to 24 in Chicago.
ACR: Ixekizumab Tops Placebo in Axial Spondyloarthritis
MONDAY, Oct. 22, 2018 — For patients with active radiographic axial spondyloarthritis (r-axSpA) and prior inadequate response or intolerance to one or two tumor necrosis factor inhibitors (TNFi), ixekizumab treatment results in significant improvements versus placebo, according to a study published online Oct. 20 in Arthritis & Rheumatology. The research was published to coincide with the annual meeting of the American College of Rheumatology, held from Oct. 19 to 24 in Chicago.
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Posted: October 2018