Dr. Belza also touched on issues related to the environment, models of care and the work force in rheumatology and telehealth. She encouraged those in the audience to find ways to add the environment into their conversations with patients, especially how to avoid exposure to harmful elements in daily life.
One takeaway on the work force in rheumatology that Dr. Belza provided from a conversation with the publication’s author is that trust, communication and support from leadership are key to effective team integration. Also, she noted that it’s important to allow for ramp-up time for nurse practitioners and physician’s assistants entering rheumatology. “They often need at least a year of training,” Dr. Belza offered, to acquire skills and knowledge needed in rheumatology, considering that patient cases are complex.
The use of telehealth blossomed during the COVID-19 pandemic “Now there’s a question about how we can help move it forward,” Dr. Belza said. Observation and feedback on actual telehealth sessions can improve efficiency and identify areas for change and improve website manner and other aspects of the patient online experience.
She encouraged audience members to visit the ACR legislation action website to learn more about efforts to get legislation passed to support continuous telehealth.
“Each of us, whether we are advanced practice providers or other individuals in the care of patients with rheumatic diseases, really play important roles” in many aspects of rheumatology, such as recruiting more students into the field; having a hand in models of care development, implementation and evaluation; or working on guidelines and legislation, Dr. Belza said.
Epidemiology
Dr. Hannan
Always remember that patients are the reason for research, advised Marian Hannan, DSc, MPH, professor of medicine at Harvard Medical School and senior scientist of the Marcus Institute for Aging Research, Hebrew SeniorLife, Boston.
Dr. Hannan reviewed several papers related to epidemiology and highlighted a study that drove home the message that patient involvement improves and changes research. The authors pointed out that every patient partner brings a different set of experiences, skills and perspective.
“So, what you get from one person you may not be getting from another person but recognizing that and recognizing the input from all players on the team is really key,” noted Dr. Hannan.
The days of tokenism that ignores patient input should be a thing of the past, she said. “In my view that’s sort of where current research is and we need to change this,” she said.
Dr. Hannan called for a paradigm shift toward better patient involvement because, as the authors note, it improves many aspects of research, including how it is disseminated and actually put into practice. “This paper did a great job of talking about how to do that in a positive way as opposed to saying shame on us for the way that we’ve done it for decades and we need to improve.”
Another article she presented revealed a detailed analysis of health records from a large United Kingdom dataset that showed adults over 65 years old who took acetaminophen had more adverse events, such as ulcerations and bowel perforations, than those who didn’t.1 This finding is something rheumatologists may want to consider when discussing choices of pain medicine with patients, she said.
On the topic of osteoarthritis (OA), a study in Canada highlighted how the disease is often overlooked in younger adults, especially people who had symptoms when they were under the age of 35.2 They had longer time to diagnosis even though they had the same symptoms compared with people who had later onset or later recognition of their OA, Dr. Hannan said.
It’s as though younger adults with OA and their disease are invisible not only to rheumatologists but to themselves as well, she said. Authors of the study did well to point out that recognition from both could lead to treatment sooner. “We need to help with symptoms,” Dr. Hannan said, “and we need to think about approaches to care earlier in the disease course rather than waiting decades until they get diagnosed at age 55, 60, 70 [years old].”
Dr. Hannan also reviewed a study that focused on the high burden of low back pain that affects people worldwide. A key takeaway is that the global obesity problem is affecting the prevalence of low back pain, which is greatly increasing among people with high body mass index, especially females.
Rehabilitation Science
Dr. Oatis
Carol Oatis, PhD, a physical therapist at Arcadia University, Glenside, Pa., discussed several studies in her lecture about rehabilitation science, which she noted has shifted from a practice that was opinion-based to one that is evidence-driven.
Two randomized trials looked at whether gait training would have an effect on patients with knee osteoarthritis.3,4 One study used an intervention group where patients were trained to modify the angle of foot progression and the other had patients walk as lightly as possible to decrease their load intensity, explained Dr. Oatis.
In the first study both the intervention and control groups improved but the patients given interventions showed a statistically significant decrease in pain and a reduced knee adduction moment, which is linked to knee pain. Both the control group and the intervention group in the second study also had less pain but no significant change in the loading parameters were seen in the intervention group.
The bottom line from both studies is that walking helps, Dr. Oatis said. “That wasn’t a terribly big surprise but the case for changing gait is still unclear,” she added. “It is, however, pretty promising and I think we’re left with a few more questions going forward. Who might benefit from changing their gait?”
Dr. Oatis also reviewed research on various aspects of physical therapy, such as exercise, the timing of physical therapy referrals and intra-articular injections post-diagnosis of knee OA, and a study on cost effectiveness.
Overall, the research shows that rehabilitation therapies are beneficial and have economic value in clinical practice, she said. One study showed a negligible uptake of 2022 ACR guidelines for exercise, rehabilitation, diet and other integrative interventions for patients with RA, indicating room for improvement.5
Dr. Steinbarger summed up an overall trend she noted of presentations that recognize the importance of lifestyle medicine, which is pivotal to ARP professions, she said. “This and other sessions mentioned over and over again how important things like sleep, environment, diet, physical activity, mental health, workplace health, and community education are to our patients as a whole,” Dr. Steinbarger said in an email after the conference.
“Medication is important, but the success or failure of a carefully crafted medication regimen can be determined by lifestyle factors,” she said. “This highlights the importance of the ARP and the professions it represents, which are sorely underutilized. PTs [physical therapists], OTs [occupational therapists], social workers, dietitians, etc., are the go-to experts for these lifestyle factors, and we need to do better.”
Catherine Kolonko is a medical writer based in Oregon.
References
- Kaur J, Nakafero G, Abhishek A, et al. Incidence of side effects associated with acetaminophen in people aged 65 years or more: A prospective cohort study using data from the Clinical Practice Research Datalink. Arthritis Care Res (Hoboken). 2025 May;77(5):666–675.
- Wilfong JM, Badley EM, Perruccio AV. Old before their time? The impact of osteoarthritis on younger adults. Arthritis Care Res (Hoboken). 2024 Oct;76(10):1400–1408.
- Uhlrich SD, Mazzoli V, Silder A, et al. Personalised gait retraining for medial compartment knee osteoarthritis: A randomised controlled trial. Lancet Rheumatol. 2025 Oct;7(10):e708-e718.
- James KA, Corrigan P, Huang CH, et al. Gait retraining to reduce tibial acceleration versus a standard walking program for reducing knee pain and loading in adults with knee osteoarthritis: A randomized feasibility trial. ACR Open Rheumatol. 2025 Aug;7(8):e70079.
- England BR, Smith BJ, Baker NA, et al. 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis. Arthritis Rheumatol. 2023 Aug;75(8):1299–1311.