1. Achieving remission improves survival in RA. Dr. Ajeganova presented a follow-up of the BARFOT study (OP0183). Those who achieved remission actually had improved survival compared to those who did not. BARFOT was a 2-year trial that randomized early RA patients to steroids (prednisone 7.5 mg/d) daily or placebo in addition to DMARDs. This is another justification for tight control and something to even discuss with peers and patients to change behaviour.
2. New kid on the block for PsA seems safe and very effective for both skin and joints. Several talks on Secukinumab were presented at this meeting for both psoriatic arthritis and SpA (THU0421, THU0418, THU0210, THU0433, THU0411, THU0414, THU0233, THU0425, OP0168). To me, ACR response rates looked like they were in the range of TNF inhibitors but PASI scores were also extremely high with PASI 90 in the high dose group (300 mg sc loading for 4 weeks given weekly then every 4 weeks) at nearly 50% at 24 weeks. The safety data were really good with no increase in infections (I. B. McInnes, THU0425) when sc dosing was studied. Secukinumab is a human anti–IL-17A monoclonal antibody. This looks like a drug that can work very effectively for both skin and joints. The dose for PsA may be the lower dose at 150 mg. This is one that will help us to treat our PsA patients.
3. Abatacept seems to have the same rate of new or recurrent cancers as Rituximab in large combined registries from the French Society of Rheumatology (FRI0154, Gottenberg JE).
The vast majority was post-TNFi use for both products with nearly 3000 patients followed. In patients with no previous cancer, the rate was 0.8/100 patient-years for rituximab and 1.3 for abatacept, which was not statistically significantly different.
The rate of recurrent cancer, was 2.9/100 patient-years for rituximab and 2.6 for abatacept.
4. Weight loss can improve active RA. We know that those with a BMI in the overweight category have worse RA, higher DAS28, lower response to treatment, and worse outcomes. One study recommended a diet for those with active RA aiming at more than 5% decrease in weight at 6 months (Gigante MR, #FRI0021). Without a change in background therapy, those who lost weight had improved outcomes (DAS28, SDAI, HAQ). There was a dose-dependent response – the more weight loss, the better the outcome. Those who did not lose weight did not improve. This is another reason to measure weight and try to encourage a healthy caloric intake.
5. Low vitamin D at onset of RA has an association with more X-ray progression at 12 months. We don't know if supplementation will change this but why not give vitamin D? Dr. Gamon presented this data from the French ESPOIR ERA cohort following more than 800 patients (#FRI0038).
6. If a patient says they are flaring between appointments – LISTEN to them as they are more likely to have joint damage, especially if they have persistent reports of joint pain and swelling compared to those who report no interim pain. This is what Kuettel et al reported (#OP0132) in their study of prevalent RA patients who were in DAS(CRP) remission and followed for 2 years. If patients said they had no flares there was virtually no X-ray progression, whereas those with transient joint complaints had some X-ray progression and those who had persistent joint complaints had the most X-ray progression.
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio