The 83rd Annual Meeting of the American College of Rheumatology
The annual meeting of the American College of Rheumatology was held from Nov. 8 to 13 in Atlanta and attracted approximately 17,000 participants from around the world, including rheumatology specialists, physicians, scientists, and other health care professionals. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases.
In one study, Medha Barbhaiya, M.D., of the Hospital for Special Surgery in New York City, and colleagues evaluated outcomes in systemic lupus erythematosus (SLE) after coronary revascularization and calculated rates and relative risks of 30-day mortality after coronary revascularization procedures in three groups: SLE patients, diabetes mellitus (DM) patients, and the general population.
“We conducted our study in the Medicaid population, which is the largest U.S. health insurance program for low-income individuals,” Barbhaiya said. “We employed an administrative Medicaid database containing all billing claims for Medicaid patients from the 29 most populated states in the United States between 2007 and 2010 for greater than 60 million patients.”
Barbhaiya and colleagues identified adults 18 to 65 years of age with existing SLE or DM, including approximately 40,000 SLE patients and 80,000 DM patients. In addition, approximately 160,000 patients without SLE or DM were selected for the general population cohort. Within these three patient groups, the investigators identified patients who underwent coronary revascularization procedures and were followed for death within 30 days after coronary revascularization.
“Our results were based on coronary revascularization procedures among 608 SLE patients, 1,185 DM patients, and 628 general population patients. In these populations, there were few deaths within 30 days, but we found that SLE patients had the highest 30-day postrevascularization mortality rate (351) per 1,000 person-years of observation compared to 210 in the DM group and 190 in the general population,” Barbhaiya said. “In adjusted models, this translated into 2.4 times higher odds of death within 30 days after coronary revascularization in SLE compared to patients with DM.”
The investigators found a similar, but nonsignificant, result for SLE patients compared with the general population, but this analysis was limited by very few deaths in the general population group.
“To our knowledge, this is the first study to look at post-coronary procedural deaths in SLE patients and to quantify the magnitude of the risk compared to patients with DM, who are known to be at risk for cardiovascular disease,” Barbhaiya said. “Future studies accounting for health care utilization, the complexity and indications of the procedures performed, SLE and cardiac disease severity, and investigating causes of postprocedural deaths are required. Additionally, given the few coronary revascularization procedures, this may suggest that access to care may be an issue for SLE and DM patients in Medicaid.”
In another study, Sadao Jinno, M.D., of the Kobe University School of Medicine in Japan, and colleagues evaluated whether the efficacy and safety of biologics differ between patients with elderly-onset and young-onset rheumatoid arthritis (RA).
“There were no significant differences in Clinical Disease Activity Index scores at 48 weeks between elderly-onset and young-onset RA. We also found there was no difference in adverse-event discontinuation rates between the two groups,” Jinno said. “Biologics can be used for those with elderly-onset RA as effectively and safely as for those with young-onset RA.”
Sabina Sandigursky, M.D., of the New York University Langone Medical Center in New York City, and colleagues found that patients with cancer receiving immune checkpoint inhibitors who had a preexisting autoimmune disease are likely to experience a flare; however, their rate of experiencing an immune-related adverse event is similar to that seen in patients without an autoimmune disease.
Of the study population, RA flares occurred in 55 percent of patients with RA and concomitant malignancy treated with immune checkpoint inhibitors. The investigators also found that 32 percent of patients experienced adverse events that were distinct from their symptoms of RA flare, and 83 percent of RA flares were adequately managed with oral prednisone.
“For patients in whom immune checkpoint inhibitors are indicated for their primary malignancy, the diagnosis of RA should not be a contraindication,” Sandigursky said. “Rheumatologists should be involved in the care of patients with rheumatic preexisting autoimmune diseases with intercurrent malignancy treated with immune checkpoint inhibitors.”
Christian Roux, M.D., of Cote d’Azur University in France, and colleagues found that methotrexate was not superior to placebo for reducing pain in patients with erosive hand osteoarthritis.
“Methotrexate seems to reduce the progression of joint damage compared to placebo and significantly facilitate bone remodeling. However, methotrexate had no appreciable improved effect on pain and function over the placebo at three months (our main outcome), and the same applies at 12 months,” Roux said. “Methotrexate failed to show any superiority over placebo on pain in erosive hand osteoarthritis, but our structural results suggest a structural effect of methotrexate; we will conduct additional studies with methotrexate to confirm this. It is the first step necessary to the realization of future studies with higher methotrexate doses and early treatment in the process of the disease (before the structural lesions will be too advanced).”
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