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American College of Rheumatology, Nov. 5-9

hands of a person with arthritis

The annual meeting of the American College of Rheumatology was held virtually this year from Nov. 5 to 9 and attracted participants from around the world, including rheumatology specialists, physicians, scientists, and other health 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, Priyanka Ballal, M.D., of the Boston University Medical Center, and colleagues found that individuals with atrial fibrillation on warfarin had a higher risk for hip or knee replacement compared with individuals on direct oral anticoagulants (DOACs), and the association increased with duration of use.

The investigators performed a nested, case-control study using the Health Improvement Network, a U.K. general practitioner-based electronic medical record database. They followed patients aged 40 to 89 years of age with atrial fibrillation on warfarin or DOACs and identified those who had a hip or knee replacement. The researchers found that warfarin users had a 57 percent increased risk for having a knee replacement or hip replacement compared with DOAC users. In addition, the investigators found an increasing risk for knee or hip replacement surgery with the duration of warfarin use compared with DOAC use.

"This latter observation is particularly relevant since people with atrial fibrillation often require lifelong anticoagulation. Our research supports the importance of adequate vitamin K and dependent proteins for limiting progression of osteoarthritis," Ballal said. "Given these potential adverse effects of warfarin on joint health, our study suggests that DOACs could be considered for managing atrial fibrillation among patients who have osteoarthritis."

Two authors disclosed financial ties to the pharmaceutical industry.

Abstract No. 0934

In another study, Milena Gianfrancesco, Ph.D., of the University of California in San Francisco, and colleagues found that racial/ethnic-minority patients with rheumatic disease and COVID-19 had increased odds of hospitalization and need for ventilatory support.

The authors evaluated data from the COVID-19 Global Rheumatology Alliance Provider survey (launched late March 2020), analyzing details for more than 1,300 patients with rheumatic disease in the United States diagnosed with COVID-19. The researchers found that Black, Latinx, and Asian patients with rheumatic disease diagnosed with COVID-19 had approximately two to three times higher odds of hospitalization compared with White patients.

"Among hospitalized patients, Latinx patients with rheumatic disease and COVID-19 had three times higher odds of requiring ventilatory support. In contrast, we found no differences in COVID-19 mortality by race/ethnicity among patients with rheumatic disease," Gianfrancesco said. "Further studies examining interventions to reduce disparities will help shed light on ways we can improve the health of all patients diagnosed with rheumatic disease, especially those who experience inequitable outcomes."

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract No. 0006

Elizabeth Park, M.D., of the Columbia University Vagelos College of Physicians and Surgeons in New York City, and colleagues found that the use of hydroxychloroquine (HCQ), a disease-modifying antirheumatic drug (DMARD), did not affect QTc length even when adjusting for critical confounding factors, namely the use of other QTc-prolonging medications.

The authors performed a cross-sectional analysis of one systemic lupus erythematosus (SLE) cohort (retrospective electronic medical record review) and two rheumatoid arthritis (RA) cohorts (prospective cohort studies). The primary outcome measure was QTc length and the primary predictor was HCQ use, adjusted for several covariates, including RA and SLE disease factors, cardiovascular risk factors, and other QTc-prolonging medications. The researchers found that adjusted QTc length was comparable between HCQ users and nonusers.

"Although 44 percent of RA/SLE patients demonstrated QTc length greater than 440 ms, no cardiac arrhythmic events were reported. HCQ remains a safe, effective long-term DMARD for our rheumatic patients. We did not, however, assess dose of HCQ, length of HCQ therapy, or compliance in our analysis and excluded those with known cardiovascular disease," Park said. "Therefore, treatment decisions (i.e., whether to start/stop/modify HCQ therapy) in patients with other risk factors of QT prolongation or coexisting cardiovascular disease, still should be an individualized approach or case-by-case review."

Two authors disclosed financial ties to the pharmaceutical industry.

Abstract No. 0431

ACR: Osteoporosis Underdiagnosed, Undertreated in Older Men

TUESDAY, Nov. 17, 2020 (HealthDay News) -- In the older male population, there is a high level of underdiagnosis and undertreatment of osteoporosis, according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9.

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ACR Previews New Pharmacotherapy Guidelines for RA

MONDAY, Nov. 16, 2020 (HealthDay News) -- The American College of Rheumatology (ACR) previewed its 2020 Guideline for the Management of Rheumatoid Arthritis at ACR Convergence, the College's annual meeting, held virtually from Nov. 5 to 9.

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ACR: Warfarin Tied to Increased Risk for Knee, Hip Replacement in OA

MONDAY, Nov. 16, 2020 (HealthDay News) -- For adults with atrial fibrillation, warfarin is associated with an increased risk for knee and hip replacements for osteoarthritis, according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9.

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ACR: Corticosteroid Injections Do Not Speed Progression of Knee OA

FRIDAY, Nov. 13, 2020 (HealthDay News) -- For patients with knee osteoarthritis, corticosteroid injections do not speed progression compared with hyaluronic acid injections, according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9.

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ACR: Incidence of COVID-19 Low in Patients With Rheumatic Disease

FRIDAY, Nov. 13, 2020 (HealthDay News) -- Patients with rheumatic disease have a low incidence of COVID-19 and most have mild disease, according to research presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9.

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