Rheum Round-up: ACR Issues OA Management Guideline, RA Disease Perceptions and Goals, and more

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read the American College of Rheumatology’s guideline for managing osteoarthritis, disease perceptions and goals for rheumatoid arthritis patients, hand and knee icing in total knee arthroplasty patients, and canagliflozin’s effect on gout flares in diabetes patients.

The American College of Rheumatology (ACR), in conjunction with the Arthritis Foundation, published an updated evidence-based guideline for the comprehensive management of osteoarthritis (OA) of the hand, hip, and knee. Physical, psychosocial, and mind-body approaches the team strongly recommended for hand, knee, and hip OA were exercise and self-efficacy and self-management programs. Certain exercises were more favorable for different joints; for instance, tai chi is strongly recommended in the treatment of hip and knee OA, while yoga is conditionally recommended for knee OA patients. Strong recommendations were made for weight loss and the use of a cane for hip and knee OA patients. Conditional recommendations for all three joints were made for heat and therapeutic healing, cognitive behavioral therapy, and acupuncture.

A new study evaluated what factors patients with rheumatoid arthritis (RA) think affect their provider’s treatment decisions. Final analysis included completed surveys from 249 patients. High Routine Assessment of Patient Index Data 3 (RAPID3) disease activity was observed in most patients (n = 175/249 [70%]; median score, 18). When asked why they did not change their treatment, most patients attributed this to their physician’s recommendation. Among high RAPID3 disease patients, 66 received an offer to change treatment, of whom 19 rejected the change. Among patients who chose to intensify their treatment, most did so due to nonchanging or more severe disease symptoms, while 16 said they were still looking to achieve a specific treatment goal. Overall, 202 patients stated their disease activity was none/low or medium; however, the majority of these patients still had high RAPID3 disease activity. Unlike RAPID3, Patient-Reported Outcomes Measurement Information System scores tended to agree with patient-reported health status.

A new study observed the pain reduction benefits associated with a “pleasant sensation” resulting from icing the knee and palm of the hand in total knee arthroplasty (TKA) patients. Overall, 64.8% of patients (n = 24) felt a pleasant sensation during knee icing, and 70.2% (n = 26) during hand icing. Just under a third (n = 11, 29.7%) of patients felt a pleasant sensation during knee icing but not hand icing, 35.1% (n = 13) did during hand icing but not knee icing, and 35.1% (n = 13) also felt a pleasant sensation during both knee and hand icing. Pain intensity before knee icing was 61.3 mm, compared to 46.4 after knee icing, for a 14.9 mm difference; for hand icing, the before and after scores were 63.7 mm and 48.9 mm, for a 14.7 mm difference. Upon two-way analysis of variation, the authors observed “significance only in the main effect of a pleasant sensation but not in the icing site and interaction.”

According to a study, canagliflozin was superior to placebo in reducing serum urate concentration in type 2 diabetes (T2D) patients with a history of gout. Patients who received canagliflozin had a mean serum urate concentration level −23·3 μmol/L (95% CI, –25.4 to –21.3 μmol/L) lower compared to placebo patients—a 6.7% serum urate reduction (percentage difference, –6.7%; 95% CI, –7.3% to –6.1%). Gout flare occurred in 80 patients during follow-up, and 147 initiated a drug for gout. The canagliflozin patients were less likely to experience a gout flare or require gout treatment compared to the placebo group (HR=0.53; 95% CI, 0.40–0.71; P<0.0001).