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EULAR 2008, June 11-14, 2008

European League Against Rheumatism Annual Congress

EULAR 2008: The European League Against Rheumatism Annual Congress took place June 11-14 in Paris, France, and attracted scientists, physicians and allied health professionals. The Congress featured oral presentations and posters that covered the spectrum of many different rheumatologic conditions.

Significant research included studies showing that patients newly diagnosed with rheumatoid arthritis can achieve remission and avoid high doses of prednisolone by adopting a tightly controlled step-up strategy that starts with low-dose methotrexate followed by administration with other traditional disease-modifying antirheumatic drugs or an anti-tumor necrosis factor-alpha inhibitor.

Ina Kuper, M.D., of the Medisch Spectrum Twente in Enschede, the Netherlands, and colleagues studied 169 patients who started on 15 mg/week of methotrexate, which was increased to 25 mg/week if they did not achieve remission after eight weeks. Subjects who did not achieve remission by week 12 were given 2 g/day of sulfasalazine. Subjects who did not achieve remission by 20 weeks received a 3 g/day dose of sulfasalazine, and those who did not achieve remission by 24 weeks received adalimumab.

Under the step-up strategy, the researchers found 15.5 percent of patients in remission at 8 weeks, 22.2 percent at 12 weeks, 30.7 percent at 20 weeks, 38.8 percent at 24 weeks, 52.1 at 36 weeks and between weeks 48-52, they found that the overall remission rate was 51 percent.

"In many large clinical trials, remission can be considered a realistic goal," Kuper and a colleague said in a statement. "We set out to determine whether all patients presenting in daily clinical practice can reasonably expect to achieve a state free of signs and symptoms, if a strict treatment schedule was followed. Our results show that remission is indeed achievable in as many as half of clinical practice patients following this schedule, which could indicate that remission is a realistic treatment goal of daily clinical practice."

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Other significant research demonstrated that joint distraction -- the use of a surgical frame around a degenerated joint to strengthen and promote repair -- can promote cartilage repair in severe end-stage knee osteoarthritis.

In one study, Floris Lafeber, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues treated 19 patients under age 60 with an external fixation frame that was distracted by 5 mm over a period of two months to relieve mechanical stress on the knee. They found that WOMAC scores improved from 30-40 percent to more than 80 percent -- which was equivalent to normalization. After one year, MRI and digital X-ray showed a 40-50 percent increase in the subjects' cartilage volume and subchondral bone covered with cartilage.

"We are delighted to report such an impressive outcome in the use of joint distraction for severe osteoarthritis of the knee," Lafeber said in a statement. "Positive results have been sustained over the two-year follow-up period, suggesting the potential for joint distraction to delay the need for a joint prosthesis in these relatively young patients. Our data are very promising, demonstrating the clinical efficacy and potential for structural repair. The logical next step should be the implementation of a prolonged prospective multi-center study on the procedure."

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Other research suggested that adalimumab therapy benefits patients with ankylosing spondylitis, rheumatoid arthritis and psoriatic arthritis who haven't responded to anti-tumor necrosis factor therapies, such as etanercept and infliximab.

In one study, G.R. Burmester of Berlin University Hospital in Germany, and colleagues found that 12 weeks of treatment with adalimumab was associated with significant reductions in the Bath Ankylosing Spondylitis Disease Activity Index and the Disease Activity Scale 28 for rheumatoid arthritis.

"An increasing number of patients with rheumatic diseases, such as ankylosing spondylitis, rheumatoid arthritis and psoriatic arthritis, are experiencing an inadequate response to, or are intolerant of, treatment with existing anti-TNFs including etanercept or infliximab," Burmester said in a statement. "The results of our study show that adalimumab offers new hope for those who have tried, but not responded well, to other treatment options for their diseases."

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EULAR: Drug Regimen May Help Preserve Fertility in Lupus

TUESDAY, June 17 (HealthDay News) -- A shorter course of cyclophosphamide followed by mycophenolate mofetil (MMF) controls disease and preserves ovarian function in women with systemic lupus erythematosus, according to study findings presented at the European League Against Rheumatism Congress 2008, held June 11-14 in San Francisco.

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EULAR and FDA Announce Fibromyalgia Advancements

MONDAY, June 16 (HealthDay News) -- Milnacipran, a norepinephrine serotonin reuptake inhibitor, is an effective treatment for fibromyalgia syndrome, according to a study presented at the European League Against Rheumatism Congress 2008, held June 11 to 14 in Paris. And Eli Lilly's antidepressant Cymbalta (duloxetine) has now been approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia. Like milnacipran, it has been shown to reduce pain levels compared to placebo.

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EULAR: Tocilizumab Effective for Rheumatoid Arthritis

MONDAY, June 16 (HealthDay News) -- Treating rheumatoid arthritis patients with tocilizumab combined with methotrexate is safe and effective, regardless of previous failed anti-tumor necrosis factor (TNF) treatment, according to a study presented at the European League Against Rheumatism Congress 2008, held June 11 to 14 in Paris.

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