These are some of the key rheumatologic research findings presented at the American College of Rheumatology (ACR) Annual Scientific Meeting held this week in Chicago. The ACR conference offers a comprehensive, evidence-based educational program designed to help clinicians improve their care of patients with rheumatologic conditions.
Close to 6.5 million Americans aged 35 to 84 years are expected to receive a diagnosis of knee OA in the next 10 years, according to the Brigham and Women’s Hospital researchers who conducted the study. The increase in younger persons with knee OA will increase the need for total knee replacements and place an additional burden on the US health care system, they noted.
Other OA research findings reported at the meeting include the following:
• The risk of bone fracture is 20% higher in postmenopausal women who have OA than in those who do not, and postmenopausal women with OA experience almost 30% more falls.
• Since rofecoxib(Drug information on rofecoxib) was removed from the market in 2004, resulting in the increased use of narcotic analgesics, there has been an increase in falls and fractures among older persons. Falls occur 4 times more frequently in patients who take narcotic pain killers than in those who take other types of pain relief for OA, regardless of health status or age. Researchers concluded that prescribing narcotic pain relievers before or instead of other types of pain relievers—as recommended in several practice guidelines—has the unintended consequence of increasing the risk of falls and fractures in older persons. (Hear a podcast featuring the presenter of this study.)
• Weight loss combined with exercise reduces pain and improves mobility in persons who have knee OA.
• The risk of knee OA may increase with participation in sports such as soccer; elite long-distance running, weight lifting, and wrestling. (But there's also some good news in a podcast by the lead researcher.)
In the study of the immune system vaccine for patients with RA, those who had lower levels of disease activity before receiving the vaccine continued to have low disease activity and those who started with higher levels of disease activity showed improvements after the vaccine. The researchers noted that with the use of this concept, similar strategies may be developed and tested for RA prevention and treatment.
Other RA research findings reported at the meeting include the following:
• Women with RA—who are at increased risk for fractures—also are at increased risk for experiencing a fracture before age 50 years.
• Patients with RA who have low levels of inflammatory disease activity are at lower risk for heart complications and stroke.
• Patients who receive anti–tumor necrosis factor α (anti–TNF-α) therapy for RA are at higher risk for malignant melanoma. However, such therapy does not increase the overall risk of solid cancer in persons with RA.
• Physicians appear to be stopping anti–TNF-α for patients with RA before they undergo surgery but may be doing so far sooner than is necessary, according to researchers at the Hospital for Special Surgery (HSS) in New York.
• Patients with RA who undergo total knee replacement surgery have lower expectations about their postsurgical outcomes than patients with OA.
• Treatment with a biologic agent reduces fatigue in persons with RA.
• Early and appropriate treatment provided by a rheumatologist may decrease costly interventions, such as orthopedic surgery, in persons with RA.
