Patients with RMDs often suffer from recurrent pain, restricted function and reduction of daily activities. The current standard of intra-articular therapy is the injection of steroids, which can increase risk of infection, cartilage degenerations, and other well-known systemic side effects.

Dr Hildrun Haibel and colleagues investigated a novel approach focused on the activation of peripheral opioid receptors, using small, systemically inactive doses of morphine. Adult patients with chronic knee arthritis and a high level of pain at baseline received a single dose of either morphine, steroid, or placebo – all delivered via intra-articular injection.

The results showed that a single dose of 3 mg intra-articular morphine did not lead to significant pain improvements in comparison to placebo, and was inferior to steroid at day 7. These data do not support the use of intra-articular morphine for pain reduction in patients with chronic arthritis.

In another abstract at the Congress, Dr Joyce (Yun-Ting) Huang presents UK opioid prescribing trends in new users with one of six RMDs: rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis, systemic lupus erythematosus, osteoarthritis, or fibromyalgia.

The results show an increased in new opioid users among people with RA, PsA and fibromyalgia since 2006. However, a slight decrease in the trends of new opioid users among most RMDs after 2018 may reflect an increasing awareness of the opioid epidemic. The high proportions of long-term opioid users in RA and fibromyalgia patients highlight the importance of exploring the safety of long-term opioid use and effective pain interventions for patients with RMDs.

In 2019, low back pain was responsible for 64 million years lived with disability (YLDs). Dr Jacek Kopec shared findings from a microsimulation model looking at the impact of three strategies for reducing this burden: weight loss, ergonomic interventions, and an exercise program. The results show that a one unit reduction in body mass index (BMI) per year among overweight and obese individuals would be approximately equivalent in terms of disability reduction to an effective ergonomic intervention in 35% of at-risk workers, and an exercise intervention in 27% of eligible patients with back problems over the same period. This is the first population-based microsimulation study to compare currently available preventive strategies for low back pain in terms of YLDs averted, and to provide measures of equivalence between these strategies.

To date, there have been limited studies on joint diseases and the impact on sex. Furthermore, many lack a control group and do not explore the different areas of sexuality. Dr Carlos ValeraRibera’s group examined the impact of chronic joint diseases on the sexual sphere in a cross-sectional observational study. The aim was to describe the prevalence of sexual dysfunction in people with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) compared to the general population.

A questionnaire was used to collect information from 188 patients in four different domains: pleasure, desire, arousal, and orgasm. In total, 48% of people with RA, 30% with PsA, and 6% of the control group had scores that indicated sexual dysfunction. The scores were typically higher in men than women.

The findings demonstrate that people with RA or PA have a deteriorated sexual life when compared to a healthy population – with impact evident across all domains of the sexual sphere. As shown in previous studies, age, gender, perceived health, employment situation, and economic status are related to the risk of suffering from sexual dysfunction. The researchers suggest that these factors must be considered as a holistic part of care, and recommend that the CSFQ-14 questionnaire be used as a tool for the management of sexual health in people with RMDs.

Although it is known that systemic rheumatic diseases such as systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) may affect all aspects of life – including sexual health – no non-pharmacological treatment has been proposed to date. Barbora Heřmánková and colleagues presented an abstract on their study into the effect of an 8-week physical therapy program on sexual health in 16 female patients with SSc and IIM, as compared to a control group with no intervention.

The intervention program included pelvic floor exercise and twice-weekly supervised physiotherapy for musculoskeletal problems that were thought to subjectively limit sexual function.

Compared to the control group, there was a statistically significant improvement in both sexual function, functional status, and quality of life. The authors conclude that their pilot physiotherapy program not only prevented the natural course of progressive deterioration of functional abilities, but also led to a significant improvement in sexual function and overall quality of life in women with SSc and IIM. These findings suggest that physical therapy might be a potential therapeutic option for sexual problems in women with SSc and IIM.

Diet is unlikely to make any difference to the progression of osteoarthritis and rheumatoid arthritis, finds a review of the existing scientific evidence, published in the open access journal RMD Open.

While a healthy diet brings other health benefits, any impact on rheumatoid and musculoskeletal diseases is small and not clinically meaningful, but there just aren’t enough high quality dietary studies, the review concludes.

Diet is known to influence cardiovascular and mental health outcomes, but it’s not clear whether it might also influence the symptoms and progression of rheumatic and musculoskeletal diseases.

In a bid to find out, the European League Against Rheumatism (EULAR) convened an international taskforce in 2018 to look at the potential impact of diet, exercise, weight, alcohol, smoking and paid work on disease progression, and develop appropriate recommendations for clinicians and patients for each of these behaviours. 

For the dietary recommendations, the taskforce searched for relevant systematic reviews of randomised controlled trials or observational studies and pooled data analyses looking at the impact of dietary components/supplements on pain, joint damage, and physical function for seven common rheumatoid and musculoskeletal conditions.

These were: osteoarthritis; rheumatoid arthritis; systemic lupus erythematosus; axial spondyloarthritis; psoriatic arthritis; systemic sclerosis; and gout.

In all, 24 systematic reviews, published between 2013 and 2018, and 150 original research articles with no restriction on publication date, were included in the pooled data analysis 

Most of the studies concerned osteoarthritis and rheumatoid arthritis and featured a wide range of dietary compounds/supplements: animal products; experimental diets; food components; fruit and veg plus other plant-based interventions; minerals and supplements; and vitamins.

There were relatively few dietary studies for osteoarthritis, meaning that the evidence for these was graded as poor or very poor. 

The pooled data analyses showed that for dietary interventions with moderate evidence (fish oil, chondroitin, glucosamine, vitamin D, avocado and soybean), the magnitude of the impact on disease progression was generally small and not clinically meaningful.

The evidence for most dietary interventions in rheumatoid arthritis was graded as poor or very poor, primarily because of the small number of studies and participants. There was moderate quality evidence  for probiotics, vitamin D, fish oil/omega-3 but the impact was either negligible or too small to make much difference.

The evidence for fish oil/omega-3 for systemic lupus erythematosus was rated as moderate but showed no effect on outcomes. The evidence for all other studies on this condition was rated as poor or very poor, as it was for axial spondyloarthritis.

Similarly, the evidence for fish oil/omega-3 for psoriatic arthritis was rated as moderate and showed no effect on outcomes. The evidence for other dietary interventions was rated as poor. The evidence for systemic sclerosis and gout was also rated as poor.

“Therefore, based on the current evidence, there is no single dietary intervention which has substantial benefits on the outcomes of people with [osteoarthritis and rheumatoid arthritis],” conclude the authors. 

“While there have been far fewer research studies published for the other included [rheumatic and musculoskeletal diseases], again, there is no consistent evidence that any dietary exposure significantly improves outcomes in these conditions,” they add.

While diet might not make much difference to disease progression in these conditions, those who live with them should nevertheless make sure they eat healthily and don’t put on too much weight, they emphasise.

“Health professionals can advise people with [these conditions] that consuming specific dietary components is unlikely to influence the progression of their [disease], but that it is important to maintain a healthy diet and healthy weight for general health reasons,” they write.

New research from Queen Mary University of London, published in Nature Medicine, has shown that molecular profiling of the diseased joint tissue can significantly impact whether specific drug treatments will work to treat rheumatoid arthritis (RA) patients. The researchers also identified specific genes associated with resistance to most available drugs therapies, commonly referred to as refractory disease, which could provide the key to developing new, successful drugs to help these people.

While there has been much progress made over the past decades in treating arthritis, a significant number of patients (approximately 40%) do not respond to specific drug therapies, and 5-20% of people with the disease are resistant to all current forms of medication.

The researchers carried out a biopsy-based clinical trial, involving 164 arthritis patients, in which their responses to either rituximab or tocilizumab – two drugs commonly used to treat RA – were tested. The results of the original trial published in The Lancet in 2021 demonstrated that in those patients with a low synovial B-cell molecular signature only 12% responded to a medication that targets B cells (rituximab), whereas 50% responded to an alternative medication (tocilizumab). When patients had high levels of this genetic signature, the two drugs were similarly effective.

As part of the first-of-its-kind study, funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership, the Queen Mary team also looked at the cases where patients did not respond to treatment via any of the drugs and found that there were 1,277 genes that were unique to them specifically.

Building on this, the researchers applied a data analyses technique called machine learning models to develop computer algorithms which could predict drug response in individual patients. The machine learning algorithms, which included gene profiling from biopsies, performed considerably better at predicting which treatment would work best compared to a model which used only tissue pathology or clinical factors.

The study strongly supports the case for performing gene profiling of biopsies from arthritic joints before prescribing expensive so-called biologic targeted therapies. This could save the NHS and society considerable time and money and help avoid potential unwanted side-effects, joint damage, and worse outcomes which are common amongst patients. As well as influencing treatment prescription, such testing could also shed light on which people may not respond to any of the current drugs on the market, emphasising the need for developing alternative medications.

Professor Costantino Pitzalis, Versus Arthritis Professor of Rheumatology at Queen Mary University of London, said: “Incorporating molecular information prior to prescribing arthritis treatments to patients could forever change the way we treat the condition. Patients would benefit from a personalised approach that has a far greater chance of success, rather than the trial-and-error drug prescription that is currently the norm.

“These results are incredibly exciting in demonstrating the potential at our fingertips, however, the field is still in its infancy and additional confirmatory studies will be required to fully realise the promise of precision medicine in RA.

“The results are also important in finding solutions for those people who unfortunately don’t have a treatment that helps them presently. Knowing which specific molecular profiles impact this, and which pathways continue to drive disease activity in these patients, can help in developing new drugs to bring better results and much-needed relief from pain and suffering.”

The incorporation of these signatures in future diagnostic tests will be a necessary step to translate these findings into routine clinical care.