Rheumatoid Arthritis Drugs May Cut Cardiovascular Risk

The researchers found that, when analyzing their entire scleroderma population, each 1-mm Hg increase in RV systolic pressure per year was strongly associated with an increased risk of PAH development and death (P<.0001 each).

“These data are supportive of the current recommendation for performing annual echocardiography in a scleroderma population,” Dr. Shah said. She added that a prospective study is needed to define the optimal screening strategy.

Knee Arthritis

The idea behind the IDEA, or Intensive Diet and Exercise for Arthritis, Trial was to determine if weight loss in older, overweight adults with painful knee osteoarthritis reduces pain and improves function and mobility (abstract 722). This international, prospective, single-blind, randomized controlled trial enrolled 454 patients aged 55 years or older who had a sedentary lifestyle and were overweight or obese.

According to lead author Stephen P. Messier, PhD, professor and director of the J. B. Snow Biomechanics Laboratory at Wake Forest University, patients were randomly assigned to one of three interventions for 18 months. Treatment arms were as follows:

1. Diet only: An energy-intake deficit of 800 to 1,000 kcal.d-1; patients ate up to two meal replacements daily.
2. Diet and exercise: Besides the same diet as in the first treatment arm, patients exercised by walking or doing weight training for an hour three days a week.
3. Exercise-only (control): These patients exercised without dieting.

The goal of both diet groups was to lose at least 10% of their body weight. Participants met in groups, and Dr. Messier said such support contributed to the high retention rate (88%).

“At 18 months, all groups showed improved mobility, pain, and function, but diet and exercise was superior in virtually all measures,” Dr. Messier said.

An intent-to-treat analysis found that the diet–exercise group had about a 50% decrease in pain on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 47% improvement in the WOMAC physical function score. These improvements were significantly better than in the other groups (P<.001 and P<.005, respectively). Participants who both dieted and exercised lost 11.4% of their body weight (mean of 10.6 kg).

Compared with the other groups, the diet–exercise group significantly quickened their walking speed (12% faster; P=.005). “It was faster than healthy, middle-aged women,” Dr. Messier said.

Two audience members called the results “very impressive.”

Juvenile Idiopathic Arthritis

A trial of aggressive multidrug treatment within a year after diagnosis of polyarticular juvenile idiopathic arthritis (JIA) failed to meet its primary endpoint of inducing clinically inactive disease in six months (abstract 721).