In an overall uplifting assessment of clinical advancements in rheumatology, Paul Emery, MD, director of MSK Biomedical Unit at the Leeds Teaching Hospitals Trust in the United Kingdom, said that a sharpened focus on predisease states has been a major reason for the inroads.
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Explore This IssueAugust 2012
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“The good news is this: The classical features of rheumatoid arthritis are disappearing,” Dr. Emery said. “We’ve understood, in the last few years, that the phenotype of RA isn’t a fixed endpoint, but it’s a continuum of phenotypes that ends up with that of rheumatoid. And because of that, we’ve intervened to make a difference in that endpoint.”
In a second part of the clinical update, Josef Smolen, MD, chair of the department of rheumatology at the Medical University of Vienna in Austria, reviewed the latest work on biologic therapies, which generally shows promise but, in many cases, doesn’t show superior performance to conventional approaches. He also stressed the importance of treat-to-target approaches.
The Goal: Remission
Dr. Emery said the EULAR recommendations on remission, issued in 2010, have helped rheumatologists appreciate the importance, and the feasibility, of remission as a goal.1 The EULAR recommendations suggest that remission or low disease activity (LDA) should be the aim, with monitoring every one to three months until the target is obtained—with targets depending on whether doctors are dealing with early or established RA. The importance of monitoring has been established in recent trials.2
The 2011 ACR/EULAR RA remission criteria have helped standardize the definition of remission, he said, but no set of remission criteria predicts flare.3 In one study, flare was found to be associated with worse baseline function and quality of life. It also found that, in patients with positive Power Doppler imaging, the risk of flare was four times greater.4 “There is independent helpful information provided by imaging in patients with remission,” Dr. Emery said.
He also touched on new insights into cardiovascular (CV) risk associated with RA. Some findings have been contradictory. One study found that RA patients who discontinue statins have a heightened risk of acute myocardial infarction, while another concluded that statin use brings an increased risk of RA.5,6