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American College of Rheumatology, Oct. 24-29, 2008

American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting

The American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting took place Oct. 24 to 29 in San Francisco and attracted 14,800 attendees from around the world. Highlights included updates on the link between rheumatoid arthritis and cardiovascular disease, and promising data on a new class of oral rheumatoid arthritis medications: syk kinase inhibitors.

"There was a lot of interest in the association between rheumatoid arthritis, inflammatory arthritis, and heart disease," said Eric Ruderman, M.D., of Northwestern University, a member of the communications/marketing committee. "It's not a new theme, but there was some really good data presented this year that expanded on the idea that rheumatoid arthritis leads to increased heart disease risk that is associated with the disease itself and the usual underlying risk factors for cardiovascular disease. There was some good information presented that treating both can improve patient outcomes."

Michael T. Nurmohamed, M.D., of the VU University Medical Center in Amsterdam, the Netherlands, presented a study that compared the three-year incidence of cardiovascular disease in 335 rheumatoid arthritis patients and 1,852 participants in a population-based cohort study. Compared to healthy subjects, he and his colleagues found that rheumatoid arthritis patients had an elevated risk of cardiovascular disease similar to that of type 2 diabetics (risk ratios, 2.02 and 2.22, respectively), which was not explained by traditional cardiovascular disease risk factors.


Christopher J. Edwards, M.D., of Southampton University Hospitals in Southampton, U.K., presented a study that compared 34,364 rheumatoid arthritis patients who were matched with 103,089 controls. He and his colleagues found that rheumatoid arthritis was associated with an increased risk of myocardial infarction (Incident Rate Ratio, 2.23), an effect that remained significant even after adjustment for age, sex, hypertension, diabetes, smoking, body mass index, anti-hypertensive drugs, lipid-lowering drugs and use of DMARDs/prednisolone. However, they also found that treatment with lipid-lowering medications was associated with a 25 percent reduction in the incidence of heart attacks.

"This suggests that treating rheumatoid arthritis and traditional cardiovascular risk factors, such as high cholesterol, are both important in trying to reduce the number of heart attacks in our patients with rheumatoid arthritis," Edwards said in a statement. "We have known for a while that rheumatoid arthritis is associated with an increased risk of heart attacks. This work gives an insight into the relative importance of different risk factors in this process. The presence of rheumatoid arthritis appears to be the most important factor, followed by traditional cardiovascular risk factors and then prednisolone use. Importantly, the use of treatments to lower cholesterol may reduce this risk."

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"There are a number of new small-molecule agents to treat rheumatoid arthritis," Ruderman said. "There was a lot more data on several different drugs that seem to be as effective as the current standard of care -- methotrexate and biologic agents -- with a reasonable side effect profile. It's been a long time coming. People are excited about these compounds because they offer the promise of oral treatments that are potentially as effective as the kinds of drugs we now give by injection."

Michael E. Weinblatt, M.D., of Brigham and Women's Hospital in Boston, presented a phase II study in which 189 patients on methotrexate were randomly assigned to receive either an ascending dose of R788 -- a syk kinase inhibitor developed by Rigel Pharmaceuticals -- or placebo. He and his colleagues found that R788 produced a clinical effect as early as week one, and significantly decreased serum biomarkers such as IL-6 and MMP-3. They found that the major side effects associated with R788 -- diarrhea and low white blood cell count -- were dose-related and reversible.

"Developing new treatments for this disease offers great hope for our patients," Weinblatt said in a statement. "This study has also identified a new pathway to block as we continue to look for new therapies for the treatment of rheumatoid arthritis."

All three of the researchers involved in the study reported financial support from Rigel Pharmaceuticals.

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