In The News: June 2013
Joint Damage Restrained with Oral JAK Drug
Oral tofacitinib (Xeljanz) has been shown to inhibit structural progression and joint damage in patients with rheumatoid arthritis (RA), according to an international phase III trial published in Arthritis & Rheumatism (March 2013). The 12-month analysis examined the effects of two years of treatment on joint preservation, RA disease activity and physical function in 797 patients with active disease, and at least three joint erosions or serologic evidence of rheumatoid factor or antibodies to cyclic citrullinated peptide. Investigators report at six months, patients receiving 10 milligrams of tofacitinib twice daily had less progression of their RA, based on X-rays. Lowering the dose to five milligrams twice daily decreased the effectiveness, which was not a statistically significant difference compared with placebo. Overall, both groups of patients saw improvements in radiographic and clinical parameters, in addition to reporting “clinically meaningful” benefits from pain and fatigue.
Physical Therapy Equal to Knee Surgery
In patients with arthritis and meniscus tears in the knee, physical therapy offered as much functional improvement as surgery, according to a new study. In a multicenter, randomized, controlled trial, 351 patients ages 45 or older were randomly assigned to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). After evaluation at six and 12 months, there was no significant difference between the groups in functional improvement six months after randomization, researchers report in The New England Journal of Medicine (March 2013). Physical therapy consisted of nine sessions on average, in addition to home exercises. Thirty percent of those assigned to physical therapy alone underwent surgery within six months, although their overall end result was the same as patients who underwent surgery right away and those who continued physical therapy.
Ultrasound Offers Inflammation Insight for Late-Onset RA Diagnosis
The overall clinical disease activity of late-onset rheumatoid arthritis (RA) does not appear different than the activity that occurs in younger RA patients, but ultrasound images show more inflammation in the older patient’s joints, according to a study published in Arthritis Care & Research (March 2013). In the first study to compare ultrasonographic studies of patients with elderly-onset RA (EORA, onset at age 60 or above) and younger-onset RA (YORA), researchers reviewed 145 patients and assessed 22 joints in both groups. The 70 EORAs (median age of 71), exhibited more synovial hypertrophy/effusion (bulging of the joint due to inflammation) than the 75 YORAs (mean age of 47). Ultrasound has been used extensively in Europe and is now being used in the United States.
RA Treatment Success Linked to Reduced Surgery
The prevalence of total knee replacement (TKR) and cervical spine fusion among patients with rheumatoid arthritis (RA) has declined in the past few decades, according to two studies presented at the American Academy of Orthopaedic Surgeons meeting in Chicago (March 2013). Researchers from the COXA Hospital for Joint Replacement in Tampere, Finland and Johns Hopkins Medicine both credit dramatic improvements in drug treatments for RA, specifically related to the use of biologic disease-modifying antirheumatic drugs (DMARDs). Data in the Finnish Arthroplasty Register from 1980 through 2010 shows the annual incidence of TKRs among RA patients has been gradually decreasing, most notably among patients over the age of 60, since 2005. The John Hopkins study reports a similar trend in utilization of cervical spine fusions. Data from the U.S. National Inpatient Sample between 1992 and 2008 shows cervical fusions declined by 1.6 percent each year in those with a diagnosis of RA.