Year in Review: Expert Covers 2017’s Key Clinical Findings

SAN DIEGO—Daniel Solomon, MD, MPH, professor of Medicine at Brigham and Women’s Hospital and Harvard Medical School, Boston, captured the high points of the past year’s clinical research on rheumatic diseases—touching on medical therapy, genetics, the effects of bariatric surgery and diet—in a Year in Review session at the 2017 ACR/ARHP Annual Meeting.

Based on input from experts on the literature published from October 2016 to November 2017, Dr. Solomon highlighted the following studies:

Secukinumab & Ankylosing Spondylitis

In the double-blind, randomized, controlled trial, MEASURE 1, researchers compared the IL-17A inhibitor, secukinumab, with placebo in 371 patients with ankylosing spondylitis. It was a 24-month trial with a 36-month extension.¹ The results were published in Arthritis & Rheumatology.

Researchers found significantly greater improvements on three patient-reported outcome scales—the BASDAI, SF36 and ASQoL—with the levels of minimal clinically important difference reached.

“These [results] appear to be sustained and suggest benefits patients will appreciate,” Dr. Solomon said.

Diet & Serum Urate

In a study published in Arthritis & Rheumatology, researchers compared the uric acid levels of patients on the Dietary Approaches to Stopping Hypertension (DASH) diet to patients not on the DASH diet, which comprises fruits, vegetables, grains and other foods deemed healthy.²

“How much can dietary manipulation change serum uric acid?” he asked. “This is an age-old question that we all wonder about when we’re seeing patients with gout.”

Patients received a low-, medium- and high-sodium diet in successive months. Researchers found patients in the DASH diet, low-sodium group had no change in uric acid levels compared with baseline. But during their months on medium- or high-sodium intake, a significant lowering in uric acid levels occurred. Patients not on the DASH diet had statistically significant increases in serum urate (SUA) when on the low-sodium diet, but experienced no change during their medium- and high-sodium months.

They also found that those in the DASH group with a baseline SUA of 6–7 mg/dL had a reduction of 0.8 mg/dL, and those with a baseline of 7 mg/dL or higher had a reduction of 1.3 mg/dL.

“This is proof of the concept that in specific subgroups, diet can effectively lower serum urate,” Dr. Solomon said.

Systemic Sclerosis & Mortality Risk

An observational study, published in Arthritis & Rheumatology, involved cohorts similar in makeup from Australia, Canada and Spain, including 1,070 patients with incident systemic sclerosis (SSc) and 3,218 patients with prevalent SSc.³

Researchers found the risk of mortality was a three- to fourfold increase in risk of death for these patients, with about 11–25 years of life lost in these groups. Cardiac, lung, gut and renal complications were the most common causes of death.