The Genotype of JIA
A study published in Annals of the Rheumatic Diseases included about 5,000 patients with juvenile idiopathic arthritis (JIA) and 14,000 controls. Researchers conducted fine mapping of the major histocompatibility complex (MHC) and looked at subtypes of JIA and their relationship to the MHC.4
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Explore This IssueDecember 2017
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They found oligoarthritis and RF-negative and RF-positive polyarthritis all share an HLA-DRB1 variant as their primary association—similar to what is seen in adult-onset rheumatoid arthritis (RA). Enthesis-related arthritis is associated with HLA-B27. And systemic JIA has a completely distinct set of associations.
“Future JIA classification criteria may be based more on genotype, and not only clinical presentation,” Dr. Solomon proposed.
IL-1 Antagonist & CV Risk
Dr. Solomon drew attention to a study, published in the New England Journal of Medicine, that examined whether canakinumab, an IL1-beta blocker, reduces repeat cardiovascular (CV) events in patients with elevated levels of high-sensitivity C-reactive protein (hsCRP).5
Although these findings are somewhat outside the rheumatology sphere, he highlighted them, saying, “it’s very important for all of us to be aware that immunomodulators are being tested for cardiovascular disease.”
More than 10,000 patients were enrolled in the study, with the outcomes of those taking canakinumab compared with those taking placebo. All patients had a prior myocardial infarction (MI) and hsCRP of at least 2 mg/L.
Researchers found patients taking 150 mg canakinumab had a 17% reduction in MI, stroke, CV death, unstable angina with hospitalization or urgent revascularization. A subanalysis found patients with the largest hsCRP reduction benefited the most, with a 30% reduction in CV events compared with placebo-treated patients.
“Immunosuppression with an IL-1 antagonist reduces CV events, with the success based on inflammation reduction,” Dr. Solomon said.
In a double-blind, randomized controlled trial, researchers compared intra-articular triamcinolone with intra-articular saline in patients with symptomatic knee osteoarthritis with synovitis. Researchers enrolled 140 patients in the study, which was published in JAMA.6
They found both intra-articular steroids and saline are associated with reduced pain and improved function, but that intra-articular steroids may cause cartilage damage.
Bariatric Surgery & Psoriasis
In an observational study from JAMA Surgery, researchers analyzed the rates of psoriasis and psoriatic arthritis in 12,364 patients who underwent gastric bypass and 1,071 patients who underwent gastric banding.7 The capacity of the stomach is reduced in both procedures.
Using presurgery patients as their controls, researchers found gastric bypass reduced psoriasis by half and psoriatic arthritis by 70%, both statistically significant results. Gastric banding did not produce any significant reduction in risk.