Rheum Round-up: Most RA Patients Are Dissatisfied, NSAIDs Increase Hypertension Risk, And More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read about how most rheumatoid arthritis (RA) patients are unhappy with their treatment regimens, the association between the use of nonsteroidal anti‐inflammatory drugs (NSAIDs) and hypertension, whether exercise protects from vertebral fracture, bone mineral density (BMD) reduction in cancer survivors, and the long-lasting rheumatic effects of immunotherapy.

Three out of four rheumatoid arthritis (RA) patients say they are not happy with their current treatment plan, a new study has discovered. DocWire News spoke with study author W. Benjamin Nowell, PhD, director, Patient-Centered Research, CreakyJoints and principal investigator of ArthritisPower about the findings. “Despite the variety of available medications, including [biologic disease-modifying antirheumatic drugs], the study found that 74% of respondents with RA (n=258) expressed dissatisfaction with their treatment. Even while on treatment, respondents reported experiencing bothersome symptoms such as fatigue (82%), pain (76%) and physical limitations (75%), which negatively impacted their quality of life,” said Dr. Nowell. “One of the primary goals with a treat-to-target strategy is to reduce inflammation and pain, yet this study found that despite active treatment most respondents with RA still had either moderate disease activity (37%) or high disease activity (33%). Few respondents reported achieving remission (16%) or low disease activity (13%) with their current treatment.”

Continuous use of nonsteroidal anti‐inflammatory drugs (NSAIDs) in patients with ankylosing spondylitis (AS) may result in hypertension, a new study suggests. Of 628 AS patients (72% were male) without baseline hypertension, 129 patients received a new hypertension diagnosis during a median seven-year follow-up period. Of the hypertension patients, 40% were on continuous NSAIDs, 47% were on TNF inhibitor (TNFi), and 16% were on both. “After adjustment for study site, age, sex, race, [body mass index, TNFi use, and disease activity by ASDAS, continuous NSAID use was associated with an increased risk of incident hypertension, compared with non-continuous or no NSAID use (HR 1.12, 95%CI 1.04-1.20),” the researchers observed.

A recent study found no correlation between physical activity and vertebral fracture prevention. Compared to sedentary women, there were no observed associations between physical activity levels and vertebral fractures in moderately active women or highly active women. Among the men, compared to those who were sedentary, the odds ratios (ORs) for vertebral fracture were 1.74 for moderately active men and 1.64 for highly active men. In the prospective analyses, compared to women with sedentary unchanged physical activity, the OR for vertebral fracture in women with reduced physical activity was 0.81; for women with increased physical activity, 1.24; and for women with active unchanged physical activity, 1.54. Among the men, compared to those with sedentary unchanged physical activity, the ORs were 2.05, 2.23, and 1.81, respectively. Subanalyses by age ≥ 50 years yielded comparable outcomes.

Cancer patients who develop immune checkpoint inhibitor (ICI)-induced inflammatory arthritis (IA) may sustain long-term consequences even after cessation of ICI, a new study suggests. Patients with ICI-related IA were recruited between June 2015 and December 2018. Baseline data were collected and patients attended follow-up visits at varying intervals for up to two years after terminating ICI. Final analysis included 60 patients, who were followed for a median of nine months after ICI cessation. At their final follow-up, more than half (53.3%) of patients had active IA. Patients who used ICI for a longer period of time were more likely to have persistent IA, as were patients receiving combination ICI therapy and with more than one additional immune-related adverse events. Immunosuppression did not affect tumor response. There was a not statistically significant association between persistent IA and better tumor complete or partial response.

A new cross-sectional study examined factors associated with reduced bone mineral density (BMD) and the risk of fracture in long-term survivors of childhood leukemia and lymphoma. Final analysis included 542 patients (mean age [range], 15.5 [4.4-52.2] years; 51.5% were female) who were six (range, 2.0-35.1) years post-therapy. Of the total cohort, 116 sustained a post-therapy fracture. Low BMD and very low BMD in the lumbar spine was present in 17.2% and 3.5%, respectively, of survivors. However, subgroup analyses yielded significant between-group differences: in the cohort of survivors aged between 15 and 19 years, 10.8% had very low BMD. Multivariable analyses found the following factors to be significantly associated with low BMD: older age at diagnosis, white race, and being underweight. Survivors with low BMD were more likely to sustain nondigit fractures (odds ratio, 2.2; 95% CI, 1.3‐3.7) and specifically long‐bone fractures (odds ratio, 2.7; 95% CI, 1.5‐4.7).