At this year’s European Alliance of Associations for Rheumatology (EULAR) Congress, held June 1 to 4 in Copenhagen, Hospital for Special Surgery (HSS) presented new research related to the treatment and management of rheumatoid arthritis (RA).

The studies focus on the tapering of treatment in patients whose disease is well controlled, real-world outcomes for targeted therapies, assessing the effects of biologic treatments on immune cells from patients with RA, and the underlying mechanisms of arthritis triggered by immune checkpoint therapies used to treat cancer.

What follows are some highlights from the meeting:

Effectiveness of Upadacitinib in the Treatment of Rheumatoid Arthritis: Analysis of 6-Month Real-World Data from the United Rheumatology Normalized Integrated Community Evidence (UR-NICETM) Database

Upadacitinib, an oral Janus kinase (JAK) inhibitor, was approved for the treatment of RA in 2019 after clinical trials suggested that it reduced symptoms and had acceptable side effects. But since that time, few real-world data have been reported on how patients respond to upadacitinib outside of clinical trials. This six-month study looked at outcomes for 140 patients receiving upadacitinib alone and 223 receiving upadacitinib plus conventional synthetic disease-modifying antirheumatic drugs (DMARDs). The investigators, led by HSS rheumatologist Allan Gibofsky MD, JD, MACR, FACP, FCLM, found that overall 46% of patients receiving upadacitinib achieved low disease activity and 14% achieved remission, with better results for patients in the combination therapy group than those who got upadacitinib alone. The effectiveness of upadacitinib was not impacted by prior therapy with a tumor necrosis factor inhibitor or tofacitinib. This study supported the use of upadacitinib in clinical practice, including in patients with prior exposure to advanced therapy.

Authors: Allan Gibofsky, MD, JD, MACR, FACP, FCLM (HSS), Mark E. Pearson, MD (West Suburban Center for Arthritis), Andrew Concoff, MD (United Rheumatology), Anna Shmagel, MD, Patrick Zueger, PhD, Yanna Song, MS, Lauren D. Smith, MD (AbbVie Inc.), Grace C. Wright, MD, PhD (Grace C. Wright MD PC, Association of Women in Rheumatology).

Can Patients with Controlled RA Receiving Any Class of Targeted Therapy with Methotrexate (MTX) Sustain Disease Control after Tapering MTX? A Systematic Review and Meta-Analysis 

People with RA frequently wish to taper the use of methotrexate therapy due to its side effects, but there are questions about the best way to do that. Guidelines that recommend tapering methotrexate before tapering biologic DMARDs are not based on direct evidence. In this study, a team of HSS investigators led by rheumatologist Charis F. Meng, MD, and Director of the Inflammatory Arthritis Center Vivian P. Bykerk, MD, FRCPC, conducted a literature search to look at whether patients who are taking the combination of methotrexate and targeted therapy (biologic therapies and JAK-inhibitors) can taper methotrexate and still be in remission from their RA, while continuing their targeted therapies. They identified 10 studies that met their inclusion criteria. These studies included a number of different targeted therapies. Based on their analysis, the team concluded that patients with controlled RA have a high probability of maintaining disease control for at least 18 months after tapering their methotrexate and continuing targeted therapies. They noted that this review may inform patients who are experiencing controlled disease while taking methotrexate in combination with any of a range of targeted therapies and who are struggling with methotrexate-related side effects. However, they concluded longer follow-up studies are needed to confirm the disease will not worsen over time and that patients should be told about this possibility.

Authors: Charis F. Meng, MD, Diviya Rajesh, Deanna Jannat-Khah, DrPH, Omar Bruce, MPH, Bridget Jivanelli, MLIS, Vivian P. Bykerk, BSc, MD, FRCPC (HSS).

Differential Pharmacodynamic Alterations After Treatment with Abatacept or Adalimumab in MTX-Inadequate Responder Patients with Early RA: Whole Blood RNA-Seq Analysis of the Early AMPLE Study

A number of novel agents for RA are now available for treatment, but tools to predict which patients are likely to respond to specific drugs are lacking. To ensure that patients are matched with the best treatment, more research is needed to determine the molecular signatures of these drugs and their mechanisms of action. In this study, part of a Phase 4 trial called Early AMPLE, investigators including HSS Physician-in-Chief and Chair of the Department of Medicine S. Louis Bridges, Jr., MD, PhD, and Director of the Inflammatory Arthritis Center Vivian P. Bykerk, MD, FRCPC, looked at pharmacodynamic changes in patients in response to treatment with either abatacept or adalimumab. The aim was to identify and differentiate the impact of each drug on modulation of immune cells at the molecular level. The investigators performed pharmacodynamic and other analyses for 14,540 protein-coding genes in 664 RNA- Seq samples, with materials collected from 79 patients with RA who were predicted to respond better to abatacept. They found that after treatment, twice as many genes and pathways were significantly altered in the adalimumab arm versus the abatacept arm and that abatacept treatment decreased immune cell cycle gene expression while adalimumab treatment increased expression of these genes. The differential gene expression was seen in genes known to correlate with RA disease activity. The investigators concluded that these findings may explain the greater clinical improvements seen with abatacept versus adalimumab. Because patients in the Early AMPLE study were predicted to respond differentially to abatacept, these findings may be relevant only to this subgroup of patients. These findings warrant further studies to investigate the potential positive correlation between RA-relevant effects and better therapeutic outcomes.

Authors: Chun Wu (Bristol Myers Squibb), Yicong Li (Parexel International), Neelanjana Ray, Michael A. Maldonado, Peter Schafer (Bristol Myers Squibb), S. Louis Bridges, Jr., MD, PhD (HSS), William Rigby (Dartmouth-Hitchcock Medical Center), Vivian P. Bykerk, MD, FRCPC (HSS), Jane Buckner (Benaroya Research Institute at Virginia Mason), Jinqi Liu (Bristol Myers Squibb).

The Probability of Sustaining Rheumatoid Arthritis Remission in Patients Tapering Targeted Therapy Used as Monotherapy: a Systematic Review and Meta-Analysis 

A second study led by HSS rheumatologist Charis F. Meng, MD, and Director of the Inflammatory Arthritis Center Vivian P. Bykerk, MD, FRCPC, also used a literature review to look at the effects of tapering drugs for RA in people whose disease is well controlled. This study focused on patients receiving either biologic DMARDs or JAK inhibitors being used alone. A search resulted in five studies that compared tapering of targeted monotherapy (TNF-i, tocilizumab, abatacept, or baricitinib) with continuing therapy or other tapering regimens. A meta-analysis including data from 800 patients found a trend for lower odds of disease remission with targeted therapies versus comparator treatment regimens, but these data were not conclusive. The investigators noted that the lack of trials designed to compare tapering targeted monotherapy to continuing it led to a significant gap in knowledge in an area of research that is increasingly relevant for patients. Their review suggests that stopping targeted monotherapy is unlikely to maintain disease control, but that more gradual tapering schemes, dose reduction, and early treatment of disease may be associated with more successful tapering. More studies are needed to better inform patients, and it is not recommended to stop targeted monotherapy in RA based on this analysis.

Authors: Charis F. Meng, MD, Diviya Rajesh, Deanna Jannat-Khah, DrPH, Omar Bruce, MPH, Bridget Jivanelli, MLIS, Vivian P. Bykerk, MD, FRCPC (HSS).

Less ACPA Epitope Expansion Is Found in ACPA-Positive Immune Checkpoint Inhibitor Arthritis Patients Compared to ACPA-Positive Rheumatoid Arthritis Patients

Immune checkpoint inhibitors (ICI) have improved the treatment of many advanced cancers. However, they can lead to immune-related adverse events, including treatment-induced arthritis. This form of arthritis is similar to RA. About 9% of people with this condition test positive for the anti-citrullinated peptide antibody (ACPA). In RA, the increase in ACPA occurs over the years prior to onset of clinical disease. In this study, led by HSS rheumatologist Nilasha Ghosh, MD, MS, investigators examined the degree of ACPA epitope expansion in patients receiving ICI to determine whether treatment-induced arthritis is similar to early RA, or more suggestive of the pre-clinical phase of disease. The analysis employed clinical data and serum samples from 12 patients with ICI arthritis (ICI-A) as well as from 39 ACPA-positive RA patients. There were a number of differences between the patients in the two groups, including age and smoking history. The investigators reported that, overall, people with ICI-A had lower ACPA titers and targeted fewer ACPA epitopes than people with early RA, suggesting that ICI-A may represent an accelerated model of RA pathogenesis with ICI triggering an early transition from pre-clinical to clinical disease. They noted that sequential sampling and analysis are warranted to further determine how the pathogenesis of ICI-A relates to that of RA.

Authors: Diviya Rajesh, Nilasha Ghosh, MD, MS (HSS), Jessica Kirschmann (Stanford University), Karmela Kim Chan, MD, Deanna Jannat-Khah, Susan M. Goodman, MD, Vivian P. Bykerk, BSc, MD, FRCPC (HSS), William Robinson, MD, PhD (Stanford University), Anne R. Bass, MD (HSS).

With the summer months just around the corner, it is time to get into shape if you want to look and feel good on holiday. In particular, those headed to exotic locations in warmer climates will probably want to work on their beach body immediately. Luckily, there are a few ways that can help you elevate your look in time for your flight.

Nourish Your Body with a Well-Balanced Diet

Many people decide to go on last minute crash diets to achieve their fitness goals. Although you might yield favorable results in the short term, these diets are not long-lasting solutions. Besides feeling grumpy and hungry after depriving yourself of necessary nutrients, crash diets can also cause dehydration, stress, heart palpitations, and can even weaken your immune system. Rather than causing your body unnecessary stress, adopt a balanced diet with healthy, wholesome foods instead. Try to incorporate more whole grains, proteins, fruits and vegetables into your meals.

Contour Your Body

No matter how hard you try, some people simply cannot shift unwanted fat from certain parts of their body. Coolsculpting is a non-invasive treatment that can help to contour your body. This FDA approved treatment uses a fat freezing device that targets and eliminates pockets of fatty tissue. Studies show that this treatment can reduce fat permanently by around 30 percent. Coolsculpting can provide results in just 2 months, so it is a good idea to book a consultation as soon as possible if you want to look bikini ready in time for your summer holiday. Professional aesthetics consultants like at riveraesthetics.com will employ a team of body sculpting professionals who can advise and guide you regarding the Coolsculpting procedure.

Be More Active

An active lifestyle goes hand in hand with a balanced diet, and regular physical exercise can help you maintain an optimal body weight while reducing your risk of disease too. Besides hitting the gym more or taking up a new sport, you can also boost your activity levels by making healthier choices. For example, try parking further away from work or choose to cycle to the office instead.

Zap Away Unwanted Hair

One of the most annoying things about going away is getting rid of unwanted body hair. Many people waste time before, and during, a vacation removing hair by waxing, shaving and applying depilatory creams. Those who need to maintain their fuzz on vacation will also need to factor in precious suitcase space. Instead of going through all of that hassle time and again, why not opt for a more permanent solution? Laser hair removal is the perfect solution for those who don’t want to waste time and money on traditional hair removal methods. Using a pulsed light system, you can get rid of unwanted hair in minutes. For excellent results, many people will need six consecutive treatments. You will then only need one or two top up treatments per year to keep the hair off.

Gum disease is not only four times as common among patients with the autoimmune disease rheumatoid arthritis as it is among their healthy peers, but it also tends to be more severe, indicates a small study published online in the Annals of the Rheumatic Diseases.

The researchers base their findings on 91 adults with confirmed rheumatoid arthritis (RA) and a comparison group of 93 healthy people, matched for age and sex.

All participants were non-smokers, as smoking is a known risk factor for rheumatoid arthritis. And it is strongly associated with the production of antibodies, indicative of a systemic reaction to a person’s own proteins (ACPAs), and which often predates the development of rheumatoid arthritis by several years.

And none had been treated with arthritis drugs known as disease modifying drugs, or DMARD, for short.

Disease activity was quantified using a specific score and by measuring levels of inflammatory markers. And the extent of gum disease was assessed by quizzing participants on their symptoms.

These included swollen and bleeding gums, sensitive teeth, loose teeth, and a history of tooth loss caused by gum disease. How far the gum had receded from the surface of the tooth, known as pocketing, was also measured using a probe.

Almost two thirds of patients (just under 65%) with rheumatoid arthritis had evidence of gum disease, compared with just over one in four (28%) of their healthy peers.

Overall, patients with rheumatoid arthritis were four times as likely to have gum disease. And their gum disease also tended to be more severe.

The depth of pocketing was also significantly greater among those with rheumatoid arthritis and especially among those who tested positive for ACPA, compared with those in the healthy comparison group.

Those who tested positive for ACPA had had their rheumatoid arthritis for longer, had higher levels of disease activity, and higher levels of inflammatory markers than those who tested negative.

Porphyromonas gingivalis is one of the main bacteria behind gum disease, and it is also the only organism known to produce an enzyme capable of generating ACPA in gum tissue.

Even those with rheumatoid arthritis, but without serious gum disease, as measured by pocketing, had symptoms, such as bleeding and swollen gums and sensitive teeth, but tooth loss was seen only in those with serious gum disease.

But mild gum disease in patients with rheumatoid arthritis may become more serious, and include testing positive for ACPA, suggest the authors. Published research indicates that ACPA antibody levels increase the longer a person has had rheumatoid arthritis.

“[Gum disease] is more common and severe in rheumatoid arthritis patients than in healthy controls…and could be a potential environmental trigger in the [development] and also in the maintenance of systemic inflammation in [the disease],” they conclude.

It is universally understood that health is wealth. However, unfortunately for some of our favourite celebrities, health is only a worrisome topic that seems to raise concerns amongst fans and followers. So today we are discussing 17 Celebrities who are bravely battling serious illnesses.