European League Against Rheumatism, June 10-13
The annual meeting of the European League Against Rheumatism (EULAR) was held from June 10 to 13 in Rome and attracted approximately 15,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in rheumatology. The conference highlighted recent advances in the prevention, detection, and treatment of rheumatic diseases.
In what the researchers call the first study to show that ultrasound-defined tenosynovitis is a strong predictor of early rheumatoid arthritis (RA), Andrew Filer, M.D., of the University of Birmingham in the United Kingdom, and colleagues determined that ultrasound diagnosis of tenosynovitis is superior to clinical symptoms and signs, such as early morning stiffness, symmetrical arthritis, and hand joint arthritis, in predicting early RA.
The researchers systematically scanned 14 tendons (including wrist, hand, shoulder, and ankle regions) in 107 patients with clinically apparent synovitis involving at least one joint and symptom duration of less than three months.
"When we analyzed which tendons were inflamed at baseline compared to final diagnostic outcome, extensor carpi ulnaris tendons and the finger flexor tendons emerged as specific for RA compared to other diagnoses," Filer said. "This minimal scanning protocol only takes four to five minutes and can be translated rapidly into a clinic setting. Like all tests, it does need to be fully validated in a broader range of early arthritis clinics, but even the data presented at EULAR will increase rheumatologists' confidence in treating very early RA. The main barrier to incorporating in clinics is the provision of enough accessible ultrasound machines, and targeted training of rheumatologists and sonographers. This is a challenge for rheumatologists and health care providers the world over."
In another study, Elena Nikiphorou, M.D., of the Saint Albans City Hospital in the United Kingdom, and colleagues found that patients with moderate disease activity in the first five years after diagnosis (based on average levels) have similar risk of joint surgery as those with high disease activity.
"It is important to identify patients with moderate disease activity and optimize/intensify their treatment aiming for remission or at least low disease activity in order to reduce their risk of joint surgery," Nikiphorou said. "Hopefully, this study will inform guidelines and recommendations, especially in health systems where restrictions exist in the use of more intensive treatments like biologic disease-modifying antirheumatic drugs (DMARDs), which are based on disease activity levels and exclude patients with moderate disease."
Angelique Weel, M.D., of Maasstad Hospital in the Rotterdam, Netherlands, and colleagues found that patients who have been diagnosed with RA in an early stage have a 50 percent chance of going into sustained remission after two years of therapy.
"However, patients who started on a combination of conventional DMARDs reached remission slightly earlier and had a better functional ability compared to patients who started methotrexate monotherapy," Weel said. "Rheumatologists have to be aware that starting a combination of conventional DMARDs helps patients reach the target low disease activity and low functional disability more rapidly compared to monotherapy with methotrexate."
In a sizable population-based cohort study, Thorvardur Love, M.D., of the Landspitali University Hospital in Reykjavk, Iceland, and colleagues found that injuries increase the risk of psoriatic arthritis in people who have psoriasis, particularly injuries involving bone and/or joints.
The study included information collected between 1995 and 2013 from 70,646 psoriasis patients, including 15,416 who suffered physical injury. During that time, 1,010 cases of psoriatic arthritis were diagnosed. The incidence rate of psoriatic arthritis was 30 per 10,000 person-years among those who had a physical injury. In people without injury, the rate of psoriatic arthritis was 22 per 10,000 person-years. The increased risk of psoriatic arthritis associated with injury was even greater when the injury involved bone and/or joints, according to the researchers.
"Our findings highlight the importance of further study into the complex factors that lead to arthritis in psoriasis patients, as we may find ways to modify the risk once we fully understand it," Love said in a EULAR news release.