“This might be a very manageable way of managing a very difficult disease,” Dr. Cush said.
MAS in sJIA
Dr. Cush next presented a late-breaking study from Italy, “Interferon-Gamma (IFN-γ) Neutralization with Emapalumab and Time to Response in Patients with Macrophage Activation Syndrome (MAS) Complicating Systemic Juvenile Idiopathic Arthritis (sJIA) Who Failed High-Dose Glucocorticoids.” In the study, researchers examined patients with patients with MAS on a background of sJIA and inadequate response to high-dose glucocorticoids.
“They were given a number of different injections of emapalumab, twice weekly up to four weeks,” Dr. Cush said. “All six patients receiving emapalumab achieved complete response. There was progressive improvement, their dependency on steroids dropped dramatically and subsequent normalization of all clinical and laboratory parameters occurred.”
Burnout
For Dr. Kavanaugh’s next choice, he admits he was a little biased because he co-authored the study, “Prevalence of Burnout in Rheumatology Professionals.”
The study measured the pervasiveness of burnout in a 129 rheumatology professionals using the Maslach Burnout Inventory (MBI); a 22-item questionnaire that includes three domains, emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Just over half the respondents (51%) reported burnout in at least one MBI classification; 37.5% of all respondents reported EE burnout, 30.5% DP burnout and 21% PA burnout. Twenty percent had burnout in one domain only, while 22.7% had burnout in two, and 7.8% had burnout in all three.
“It’s an important topic,” he said. “It affects all of us. It’s a problem we usually only whisper about and [don’t] admit to.”
Pregnancy
Both doctors liked two studies dealing with pregnancy, “Disease Flares Of Rheumatoid Arthritis [RA] During Pregnancy: 1) “What Is the Impact of Stopping bDMARDs at the Beginning of Pregnancy?” and 2) “Pregnancy in Rheumatoid Arthritis—Continue, Reduce or Stop TNF Inhibitors—a Prospective Observational Study.”
In the first study, based on acohort of 73 pregnancies in 63 RA patients, 37% experienced at least one flare during pregnancy despite the majority of the patients being in remission prior to conception. Researchers reported a threefold-increased chance of flare in patients who were on bDMARDs (and stopped the treatment early in pregnancy) compared with those who did not receive them. The researchers concluded that women may benefit from continuing treatment beyond conception.
Because women with active RA are more prone to relapses and complications during pregnancy, in the second study, based in Germany, of 70 completed pregnancies, subjects were grouped according to their decision to stop or continue TNF inhibitor (TNFi) therapy during their pregnancies. Researchers concluded that women with RA who discontinue TNFi at conception face a higher risk of flares during pregnancy and often have an increased demand for steroids to control disease activity.
