In The News: September 2013
Joint Replacement Often Beneficial for RA Patients
Two recent studies challenge the belief that rheumatoid arthritis (RA) patients donít benefit from knee or hip replacement surgery as much as their osteoarthritis counterparts. The preliminary results for both studies were presented at the European League Against Rheumatismís Congress of Rheumatology (June 2013). The first analyzed joint registry data to identify 178 RA patients and more than 5,200 OA patients who underwent knee replacement surgery. Even though the RA patients had worse pain and function before knee surgery than the OA patients, both groups had similar satisfaction rates after surgery. The second study compared outcomes of 202 RA patients and more than 5,800 OA patients who underwent hip replacement. While the RA patients began with worse function before surgery and had worse pain and function scores after surgery, they were as likely as those with OA to experience an overall improvement after hip replacement.
Combination Therapy Aids Mobility for RA Patients
The combination therapy of methotrexate plus adalimumab (Humira) inhibited narrowing of joint spaces in early rheumatoid arthritis (RA), leading to less physical disability and patientsí continued employment, a post-hoc analysis of a randomized trial found. Published in the Annals of Rheumatic Diseases (July 2013), the study analyzed data from a clinical trial called PREMIER, which randomized 800 patients to methotrexate alone, adalimumab alone, or both. Joint radiographs of the hands and feet taken at baseline and after one and two years of treatment were available for 638 of the participants. Changes in disease activity score in 28 joints were greater in the combination group at years one and two, with decreases of 3.6 and 3.8 points, respectively, compared with decreases of 2.8 and 3.1 points in both monotherapy groups.
High Cholesterol and Triglycerides Elevate Psoriatic Arthritis Activity
High disease activity in psoriatic arthritis patients is linked to elevated total cholesterol and triglycerides, according to preliminary research. The study, presented at the European League Against Rheumatismís Congress of Rheumatology, adds further evidence to a growing body of proof tying psoriatic arthritis metabolically with dyslipidemia and obesity. Patients in the study were considered to have high disease activity due to scores of 10 or higher on the Clinical Disease Activity Index, or the presence of enthesitis (inflammation of the sites where tendons or ligaments insert into the bone) or dactylitis (inflammation of fingers or toes). They were also significantly more likely to have total cholesterol levels above 200 mg/dL, in addition to be more likely to have triglyceride levels above 150 mg/dL. To determine their findings, the researchers analyzed data from the prospective Consortium of Rheumatology Researchers of North America (CORRONA) registry, which currently includes 4,500 patients with psoriatic arthritis.
Spinal Injections Tied to Fracture Risk
Spinal injections of steroids increased bone fragility in the vertebrae of older patients, a retrospective analysis found. Published online in the Journal of Bone and Joint Surgery, the study showed each successive translaminar lumbar epidural steroid injection (LESI) increased the risk of vertebral fracture by a factor of 21 percent after adjustment for covariates. A second analysis that allowed for the possibility of more than one fracture in a single patient produced similar results, with a hazard ratio of 29 percent. The researchers reviewed the records of 3,000 patients, ages 50 and older, which had received at least one translaminar LESI in the Henry Ford Health System for compressive neuropathic pain. They compared this group to 3,000 patients who had received a LESI for pain. The findings are of clinical concern, as many elderly patients are at increased risk of skeletal fragility.