Many patients with rheumatoid arthritis (RA) report pain despite excellent control of inflammation with immunotherapies. Variable degrees of coexisting fibromyalgia (FM) may explain this disparity. RA patients who have the highest 2011 ACR FM survey criteria scores appear to share neurobiologic features consistently observed in FM patients. This study is the first to provide neuroimaging evidence that RA is a mixed pain state, with many patients’ symptoms being related to the central nervous system rather than to classic inflammatory mechanisms…
Articles by Arthritis & Rheumatology
Getting Past the Noise to Identify SpA
Objective: Low-grade bone marrow edema (BME) has been reported in the sacroiliac (SI) joints of 25% of healthy individuals and patients with nonspecific mechanical back pain, thus challenging the specificity and predictive value of magnetic resonance imaging (MRI) for the identification of early spondyloarthritis (SpA). It is unknown whether stress injury in competition sports may…
The Science Behind Biosimilars
Although six biosimilar agents have now been approved by the U.S. Food & Drug Administration for use in rheumatology, scientific, clinical, economic and prescribing questions about the use of biosimilars abound. In fact, at the 2017 ACR/ARHP Annual Meeting in San Diego, Joseph Huffstutter, MD, a rheumatologist in private practice in Chattanooga, Tenn., said that…
Arthritis More Common Than Previously Thought
Arthritis prevalence in the U.S. population has been substantially underestimated, especially among adults younger than 65.
Weight Change in Early RA & the Risk of Mortality
Sparks et al set out to investigate whether weight change during the early RA period is associated with subsequent mortality and to evaluate whether there is an RA-specific effect. They investigated weight change during the early RA period, because this is the window of time during which weight change is most likely to be related to RA-specific processes. They found that severe weight loss during the early RA period was associated with a subsequent increased mortality risk both for women with and without RA…
Varus Thrust Is Associated with Progressive Knee OA
To determine if varus thrust, a bowing out of the knee during gait (i.e., the first appearance or worsening of varus alignment during stance), is associated with incident and progressive knee osteoarthritis (OA), these researchers undertook an Osteoarthritis Initiative ancillary study. They also considered hypothesized associations adjusted for static alignment, anticipating some attenuation. Methods: Gait…
Opioid Use in U.S. RA Patients
Nationally, opioid use and addiction are drawing increased scrutiny. An increase in the number of overdoses and addiction to heroin and prescription pain relievers in the past decade has been attributed in part to increased prescribing of opioids for the treatment of pain by physicians. National trends suggest the rate of opioid prescribing plateaued in…
Collaborative Guideline Addresses the Perioperative Use of Antirheumatic Drug Therapy
A new guideline developed by the ACR and the American Association of Hip and Knee Surgeons addresses the perioperative use of antirheumatic drug therapy. Specifically, it provides recommendations on the use of traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib and glucocorticoids in adults with RA; SpA, including ankylosing spondylitis and psoriatic arthritis; JIA; or SLE undergoing elective THA or TKA. The guideline provides recommendations regarding when to continue, when to withhold and when to restart these medications, and the optimal perioperative dosing of glucocorticoids…
Rituximab for Fatigue & Oral Dryness in Primary Sjögren’s Syndrome
These researchers investigated whether rituximab, an anti-B cell therapy, improves symptoms of fatigue and oral dryness in patients with primary Sjögren’s syndrome (SS). The multicenter, randomized, double-blind, placebo-controlled, parallel-group trial included a health economic analysis. There were no significant improvements in any outcome measure with rituximab except for unstimulated salivary flow. The study concludes that rituximab is neither clinically effective nor cost effective in this patient population…
The Biomarkers of Lupus Disease Study
Most SLE clinical trials continue standard background medications being taken by patients at entry, based on assumptions that this minimizes the risk of serious flares and that immunologic interference is minimal. These assumptions are not evidence based, but eliminating polypharmacy in trials studying patients with active lupus remains controversial. These researchers tested the withdrawal of immunosuppressants to make SLE trial results more interpretable…
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