Rheum Round-up: What Aggravates RA?, Suicide and Non-opioid Medication, and more

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about what aggravates rheumatoid arthritis (RA), the downsides of non-opioid medications, the fracture risk associated with warfarin versus alternate direct oral anticoagulants in atrial fibrillation patients, upadacitinib versus placebo in RA, and family comorbidities that may predict RA.

People living with rheumatoid arthritis (RA) experience ups and downs with respect to their symptoms. As noted by the Arthritis Foundation: “One day, your joints feel pretty good. The next, swelling and pain ratchet up and you can barely get out of bed. These symptom episodes – called flares – can be unpredictable and debilitating. Because symptoms differ from person to person, doctors have had trouble agreeing on a standard definition to guide them in treating flares.” Here, DocWire News highlights a list of factors that may contribute to aggravating RA and increasing  the risk of flare-up episodes, including nonadherence to therapy, diet, smoking, stress, and more.

In the wake of the opioid epidemic, prescriptions for non-opioid alternatives have been on the rise. Opioids and non-opioid medications are often prescribed to patients living with chronic pain and/or following orthopedic surgery. However, a new study reported an alarming upward trend in the rates of use in suicide attempts, misuse, and toxicity associated with non-opioid alternatives gabapentin and baclofen.

A new study evaluated the risk of fracture among nonvalvular atrial fibrillation (AF) patients taking warfarin versus alternate direct oral anticoagulants. Final analysis included 167,275 AF patients. Mean (SD) follow-up was 16.9 (13.7) months, during which time 817 hip fractures, 2,013 hospitalized fractures, and 7,294 total fractures were recorded. In multivariable-adjusted analyses, new direct oral anticoagulant users, compared to new warfarin users, had a lower risk of fractures requiring hospitalization; there was not a significant association regarding hip fractures. Specifically, among the direct oral anticoagulants, the most significant correlations were observed in apixaban. Subgroup analyses revealed a greater benefit among AF patients with a concurrent osteoporosis diagnosis compared to non-osteoporosis patients.

A new study compared the impact of upadacitinib versus placebo on patient-reported outcomes (PROs) and quality of life (QOL) among RA patients who had inadequate responses to biologic disease-modifying antirheumatic drugs (bDMARD-IR). This paper highlighted 12-week data on PRO responses between between upadacitinib 15 mg or 30 mg versus placebo. Comparisons were made between Patient Global Assessment of Disease Activity (PtGA), pain, Health Assessment Questionnaire Disability Index (HAQ-DI), Short Form-36 Health Survey (SF-36), duration and severity of morning (AM) stiffness, and Insomnia Severity Index (ISI). Final analysis included 498 patients. Compared to placebo, both upadacitinib doses were associated with statistically significant improvements in baseline PtGA, pain, HAQ-DI, SF-36 Physical Component Summary (PCS), 7 of 8 SF-36 domains (15 mg), 6 of 8 SF-36 domains (30 mg), and AM stiffness duration and severity.

A study analyzed the correlation between 79 different family comorbidities and RA. The authors observed a correlation between RA and family history of several comorbidities, including rheumatologic autoimmune diseases, pulmonary fibrosis, inflammatory bowel disease, hyper/hypothyroidism, and obstructive sleep apnea. A statistically decreased risk was observed in patients with a family history of Parkinson’s disease and type 2 diabetes, although this did not achieve the pre-specified P < 0.01 significance threshold. The study authors stated in sum that “self-reported family history of several comorbidities besides RA were associated with increased risk for RA, including other rheumatologic diseases such as lupus and scleroderma, autoimmune diseases such as thyroid disease and IBD, and potentially non-autoimmune conditions such as pulmonary fibrosis, OSA, and autism. These findings can help refine tools to predict RA risk.”