The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / The ACR’s State-of-the-Art Clinical Symposium: Rheumatologists Weigh in on Tough-to-Treat Cases, Paget’s Disease, Imaging

The ACR’s State-of-the-Art Clinical Symposium: Rheumatologists Weigh in on Tough-to-Treat Cases, Paget’s Disease, Imaging

July 14, 2015 • By Thomas R. Collins

  • Tweet
  • Email
Print-Friendly Version / Save PDF
X-ray showing the pelvis of a person with Paget’s disease or osteitis deformans. The pelvic bones have a mottled appearance due to their increased porosity.

X-ray showing the pelvis of a person with Paget’s disease or osteitis deformans. The pelvic bones have a mottled appearance due to their increased porosity.
Image Credit: SPL /Science Source

CHICAGO—A 49-year-old woman has had RA for eight years. She has a rheumatoid factor reading of 35, an aCCP reading of 160, erythrocyte sedimentation rate of 42, plus erosions. She has been on methotrexate. She tried etanercept for six months, but then it stopped working. She was on 40 mg of adalimumab weekly, but it gave her a rash. Golimumab was ineffective; abatacept didn’t seem to work; rituximab gave her sinusitis twice; and tocilizumab seemed to be effective, but caused her liver function test readings to rise.

You Might Also Like
  • The ACR’s State-of-the-Art Clinical Symposium: Rheumatic, Malignant Disease Mimics Call for Diligence from Rheumatologists
  • The ACR’s State-of-the-Art Clinical Symposium: Stem Cell Therapy in Autoimmune Disease Evolution, Insights
  • The ACR’s State-of-the-Art Clinical Symposium: Patients with Scleroderma, Lung Disease May Benefit from Aggressive Therapy
Explore This Issue
July 2015
Also By This Author
  • Anti-TNF Treatment Trial Encouraging for High-Risk APS Pregnancies

“Nothing seemed to work,” said Daniel Furst, MD, director of the Rheumatology Clinical Research Center at the University of California Los Angeles, who presented the case at the American College of Rheumatology’s 2015 State-of-the-Art Clinical Symposium in May, in a talk designed to get clinicians to think “outside the box.”

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

In other talks in an a la carte session, speakers covered the latest on Paget’s disease of bone and how to make decisions on imaging.

Combination Therapy

For the patient for whom nothing seems to work, Dr. Furst suggested an approach: a concept he calls “the principle of non-overlap.” It’s based on the idea that combination therapies that don’t overlap in mechanism of action and toxicity stand a better chance of being effective.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

“This isn’t infallible, but it’s a reasonable way to approach it,” he said. Plus, when it comes to toxicities not overlapping, “if you’re going to get a side effect, at least you’ll know which drug it’s due to.”

Methotrexate and cyclosporine, for example, overlap on their IL-2 effect, but not much else, and data show that they work well together.

For patients like his difficult-to-treat 49-year-old patient, he suggested restarting abatacept, and using cyclosporine because it has a different mechanism of action. If that’s not helpful enough, add tofacitinib.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

In another case, a woman kept getting UTIs and wanted a therapy without infections. The research, Dr. Furst said, shows that etanercept has the lowest infection rates among TNF inhibitors, but that non-TNF inhibitors should be considered as well.

He used another case to draw attention to the importance of screening for hepatitis B and C: A 28-year-old man returned from Taiwan. He has had RA for three years, with a slightly elevated RF level and no erosions, but he has an ESR of 60, is fatigued and has tender hands and a few swollen joints.

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Meeting Reports Tagged With: combination therapy, drug, imaging, outcome, Paget’s disease, patient care, Rheumatic Disease, rheumatologist, toxicityIssue: July 2015

You Might Also Like:
  • The ACR’s State-of-the-Art Clinical Symposium: Rheumatic, Malignant Disease Mimics Call for Diligence from Rheumatologists
  • The ACR’s State-of-the-Art Clinical Symposium: Stem Cell Therapy in Autoimmune Disease Evolution, Insights
  • The ACR’s State-of-the-Art Clinical Symposium: Patients with Scleroderma, Lung Disease May Benefit from Aggressive Therapy
  • Paget’s Disease of Bone

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)