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ACR News 2 – October 22, 2018

newspaper in mail slotACE is attending this week’s American College of Rheumatology/Association of Rheumatology Health Professionals 2018 Annual Meeting, the largest international gathering of arthritis researchers, clinicians, academics, patient advocates and arthritis health professionals. Here are some of today’s highlights:

Improving osteoarthritis management

There are currently more than 4.4 million Canadians living with osteoarthritis (OA). Within a generation (in 30 years), more than 10 million (or one in four) Canadians are expected to have OA. A 2017 study, “Productivity costs of work loss associated with osteoarthritis in Canada from 2010 to 2013,” found the rising rates of OA will cost the Canadian economy an estimated $17.5 billion a year in lost productivity by 2031 as the disease forces greater numbers of people to stop working or work less.

ACE and other members of the Arthritis Alliance of Canada have helped raise awareness with health care policy makers that OA is the leading cause of disability in older adults. One of Canada’s leading osteoarthritis researchers, Dr. Gillian Hawker, Sir John and Lady Eaton Professor and Chair of Medicine, Faculty of Medicine, University of Toronto has stated: “the highest rates of OA are increasing fastest among young people (20-59 years), due largely to childhood obesity and knee injury. While effective therapies exist, the high prevalence of comorbidity in people with OA makes management challenging (as many of 90% of people with OA have at least one additional chronic condition – most often diabetes, heart disease and high blood pressure).”

At a symposium at the ACR meeting, researchers reviewed the most current and effective OA management strategies for patients. According to Dr. Stephen Messier, Director of the J.B. Snow Biomechanics Laboratory at Wake Forest University, because there is no cure for OA, what has become most important is what’s best for the patient: “That is generally a decrease in pain, improvement in function, and quality of life. With no cure in sight, research has focused on symptom-management.”

What that means for patients is having conversations with their doctors about approaches to managing OA. Dr. Messier told symposium attendees: “Pharmacologic management works for some patients. Half of the patients using non-steroidal anti-inflammatory agents (e.g. aspirin, ibuprofen, celecoxib) can expect approximately a 30 per cent reduction in pain. Non-pharmacologic approaches, specifically weight loss plus moderate exercise, can reduce pain by 30 to 50 per cent.”

Studies Dr. Messier has completed show a direct relationship between weight loss plus exercise and reduction in pain from OA. In fact, a ten per cent weight loss, plus moderate exercise, provided a 50 per cent reduction in pain as reported by patients.

“Ten percent weight loss gave us statistically and clinically significant improvements in outcomes,” Dr. Messier said. “We think it was the combination of reduced inflammation and reduced join loading that was instrumental in pain reduction. If patients want to continue losing weight safely after they reach that 10 percent goal, they will see additional benefits, People almost everywhere are living longer, and our goal is to improve their quality of life during these later years.”

Advances in treatment for axial spondyloarthritis

Recent advances in understanding axial spondyloarthritis (axSpa) and the role played by the new bone formation are transforming patient therapy, as has the development of the first interleukin-17 inhibitor for the treatment of axSpa and development of new treatment recommendations. At the symposium, researchers also shared news that a third class of therapies for axSpa, JAK inhibitors, are moving into clinical trials.

The draft of the updated Guidelines for the Management of Axial Spondyloarthritis from the ACR was introduced at a symposium at the annual meeting. The update was spurred in part by the approval of secukinumab for axSpa and includes recommendations on whether or not to use treat-to-target strategy, MRI to track disease progression and synthetic DMARDs with TNF inhibitors. A principal investigator of the update project, Dr. Michael Ward, MD, MPH, Chief of the Clinical Trials and Outcomes Branch of the National Institutes of Health, Bethesda, MD, told his audience: “The guidelines are very practical and are designed to help rheumatologists respond to patient questions like: What should be the next treatment of choice or should the patient be treated to target with the current therapy.

Arthritis Consumer Experts is reporting from the ACR meeting and encourages you, our members and subscribers, to send us your science questions. Follow #AskACE on Facebook at Arthritis Consumer Experts and Twitter at @ACEJointHealth to keep up with the conversation.

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