American College of Rheumatology, Nov. 7-11, 2010
The annual meeting of the American College of Rheumatology took place Nov. 7 to 11 in Atlanta and attracted approximately 15,000 participants from around the world. The conference highlighted advances in rheumatology research, practice, and policy, with presentations focusing on rheumatoid arthritis, systemic lupus, scleroderma, osteoporosis, and osteoarthritis.
"The results of the first phase III trial evaluating a novel small molecule in rheumatoid arthritis was discussed in a late breaking session. It was exciting, as we now potentially have a new modality, JAK kinase inhibitor, to target this disease. Another presentation focused on maintenance therapy for systemic lupus nephritis. The investigators found that using mycophenolate mofetil instead of the standard of care, azathioprine, was more effective as maintenance therapy after induction of remission by initial treatment," said Carlos Lozada, M.D., of the University of Miami.
Several authors of these studies disclosed financial relationships with various pharmaceutical companies.
Sasha R. Bernatsky, M.D., of McGill UHC/RVH in Montreal, and colleagues found that that systemic lupus erythematosus (SLE) was associated with a higher risk of certain types of cancer, including hematological and gynecological cancers. The investigators estimated cancer incidence rates in SLE compared with the general population.
"We found that patients with lupus had a 15 percent increased risk of cancer overall, versus the general population. This increase was mainly driven by a marked increased risk of lymphoma, which appears to be three-fold higher in SLE versus the general population. Other cancers that were associated with a moderate increased risk among patients with lupus included lung cancer, liver cancer, cervical cancer, and cancers of the vulva and vagina," Bernatsky said.
The investigators also found a decreased risk of hormone-sensitive cancers, including breast, ovarian, and endometrial, among patients with SLE versus the general population.
"In terms of clinical implications, the question remains as to the relative importance of disease activity or drug therapy in driving lymphoma risk for SLE and other autoimmune rheumatic diseases. Our research team is currently evaluating these issues," Bernatsky added.
In another study, Laura E. Schanberg, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues found that the effect of statins on atherosclerosis in children and adolescents with SLE was not significant enough for the drugs to be routinely prescribed. The investigators randomized 221 participants with pediatric lupus, aged 10 to 21 years, to atorvastatin or placebo for three years.
"This study shows that, while statins decrease C-reactive protein and lipid levels in young people with SLE as they do in other populations, statins do not have enough of a positive effect to routinely prescribe them for children with lupus," Schanberg said in a statement. "There are risks with all medications, and [these] data [don't] convince us that the risks are worth it for all children with lupus."
Several study authors disclosed financial relationships with Pfizer Inc.
In another study, James Galloway, M.D., of the University of Manchester in the United Kingdom, and colleagues found that anti-TNF therapy was significantly associated with an increased risk of varicella zoster virus infections, including shingles and chicken pox. The investigators compared 11,864 individuals with rheumatoid arthritis who were undergoing anti-TNF therapy to 3,666 patients who were undergoing treatment with disease-modifying antirheumatic drugs (DMARDs).
"We found that the rate of shingles in the anti-TNF cohort was higher, although this was the same for all the different types of anti-TNF drugs studied. In the anti-TNF cohort, just fewer than 1 percent of the patients experienced shingles every year, which was double the rate of shingles seen in the patients not exposed to the drugs," Galloway said.
The investigators found that 322 herpes zoster infections occurred in patients undergoing treatment with anti-TNF therapy and 46 infections occurred among those taking DMARDs. In addition, 12 cases of chicken pox were reported in patients taking anti-TNF agents but none were found in those undergoing treatment with DMARDs, suggesting that anti-TNF therapy may be associated with both primary and recurrent infections.
"The absolute risk of developing shingles is low among those who are prescribed anti-TNF therapy. Awareness of this risk should help early diagnosis of the condition, should it occur," Galloway added. "In addition, shingles is now a vaccine-preventable disease, and recent U.S. Centers for Disease Control and Prevention guidelines have recommended everyone in the United States over the age of 60 years be vaccinated against this disease. Further research is needed to see whether this vaccine might be of benefit in people on treatments for arthritis."
ACR: Tai Chi Associated With Improvements in Arthritis
FRIDAY, Nov. 12 (HealthDay News) -- A regular Tai Chi practice may reduce symptoms and increase feelings of well-being in people who suffer from all kinds of arthritis, including fibromyalgia, rheumatoid arthritis, and osteoarthritis, according to the largest study to date of the Arthritis Foundation's Tai Chi program presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.
ACR: Gout and Hyperuricemia Up Over Last Two Decades
WEDNESDAY, Nov. 10 (HealthDay News) -- Over the past two decades, the overall prevalence of gout and hyperuricemia appears to have increased among U.S. adults, according to research presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta. In another study published online Nov. 10 in the Journal of the American Medical Association, researchers found that intake of fructose-rich beverages is associated with an increased risk of incident gout in women.
ACR: Vitamin D Provides No Benefit in Knee Osteoarthritis
TUESDAY, Nov. 9 (HealthDay News) -- Vitamin D supplementation does not appear to slow the progression of osteoarthritis of the knee or improve symptoms associated with the condition, according to data presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.
ACR: Mycophenolate Mofetil May Be Inferior to Azathioprine
TUESDAY, Nov. 9 (HealthDay News) -- Mycophenolate mofetil appears to be less effective than azathioprine for maintaining disease remission among patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), according to a study published online Nov. 8 in the Journal of the American Medical Association to coincide with presentation at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.
ACR: Treatment Adherence Low With Rheumatic Diseases
TUESDAY, Nov. 9 (HealthDay News) -- Many individuals with rheumatoid arthritis (RA) and lupus do not adhere to medication regimens, which negatively impacts treatment outcomes, according to research presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.
ACR: New Criteria May Identify Rheumatoid Arthritis Earlier
MONDAY, Nov. 8 (HealthDay News) -- Applying the new 2010 American College of Rheumatology/European League Against Rheumatism Rheumatoid Arthritis (RA) Classification Criteria may help identify patients with early disease, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.
ACR: Chronic Back Pain Tied to Axial Spondyloarthritis
MONDAY, Nov. 8 (HealthDay News) -- Chronic lower back pain might be associated with axial spondyloarthritis, a recently defined form of inflammatory arthritis, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.
ACR: Rheumatoid Arthritis Activity Tied to Atherosclerosis
MONDAY, Nov. 8 (HealthDay News) -- Systemic inflammation associated with rheumatoid arthritis (RA) may contribute to the progression of atherosclerosis, with anti-tumor necrosis factor (TNF) agents and statins potentially reducing atherosclerosis progression and glucocorticoids promoting progression, according to research presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.