Rheum Round-up: IBD Diet, Baricitinib Treatment Interruptions, and more

By Kaitlyn D’Onofrio - May 29, 2020

Here are the top stories recently covered by DocWire News in the Rheumatology section. In this edition, read about the popular diet that inflammatory bowel disease (IBD) patients may want to consider, how baricitinib treatment interruptions affect rheumatoid arthritis (RA) patients, the degree to which patients want to be involved when making orthopedic decisions, and postoperative pain levels after a patient’s first versus second surgery in scheduled staged bilateral total knee arthroplasty (TKA).

For three consecutive years, the Mediterranean diet has claimed the No. 1 spot on the U.S. News & World Report’s annual ranking of diets—and seemingly with good reason. Researchers recently examined its impact on IBD patients and found adherence to it significantly reduced malnutrition-related parameters and liver steatosis. Final analysis included 142 IBD patients. At six months, adhering to the Mediterranean diet was associated with improved body mass index and waist circumference, as well as significantly lower rates of all-grade liver steatosis. After six months, fewer patients with stable therapy had active disease and elevated inflammatory biomarkers. No associations were observed between the Mediterranean diet and serum lipid profile or liver function.

A study analyzed the effects of brief treatment interruptions on RA symptoms among patients taking baricitinib and found that this may result in minor, temporary symptom increases. In placebo-controlled studies, interruptions took place in greater proportions of patients treated with baricitinib compared to placebo in only one study. In the active comparator-controlled studies, in RA-BEGIN, the lowest rates of interruption were observed in the baricitinib monotherapy arm, compared to methotrexate monotherapy or combination therapy, while in RA-BEAM, similar outcomes were observed in patients on baricitinib and adalimumab. The most commonly cited reason for interruption was adverse events, but reoccurrence was infrequent when the drug was restarted. Interruptions tended to last for two weeks or less. Based on patients’ daily diaries, modest symptom increases were observed during interruption, but upon resumption, symptoms returned to pre-interruption levels or better. Long-term efficacy outcomes were not affected by interruptions.

As treatment options for various conditions expand, patients are sometimes given choices when it comes to how they wish to manage their conditions. Researchers recently explored just how much patients want to take part in decision making when it comes to musculoskeletal conditions and found that it depends on the choice in question. The researchers explained that patients seemed to have specific preferences regarding when they wanted to be involved in decision making and said that implementing shared decision-making would perhaps be most advantageous if focused on the specific choices important to patients. In this study, for example, patients did not want to take an active role in choosing which suture to use to close an incision, deferring to the surgeon.

Researchers recently compared early postoperative pain levels after a patient’s first versus second surgery in scheduled staged bilateral TKA. The study included 32 patients (64 knees) with osteoarthritis. Patients were assessed based on the number of requests made for analgesic agents during the first three days postoperatively, time to walking, and the Wong-Baker FACES pain assessment score (WBS). WBS and the frequency and total number of requests for analgesics did not largely differ between the first and second TKA. A moderately strong, positive correlation was identified between the total number of analgesic requests between the first and second TKA. At 24 hours after the second TKA, a moderately strong, positive correlation was identified between patients’ WBS and requests for analgesics. The median time to walking after both TKAs was one day.

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