New research was presented at EULAR 2018, the Annual European Congress of Rheumatology of the European League Against Rheumatism, from June 13-16 in Amsterdam. The features below highlight some of the studies that emerged from the conference.
NSAIDs & Cardiovascular Risk in Osteoarthritis
While previous research indicates that osteoarthritis (OA) is an independent risk factor for cardiovascular disease, the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in this association is not well understood. For a study, Canadian researchers compared the records of nearly 7,800 patients with OA with those of more than 23,000 age- and sex-matched controls without OA. Cardiovascular disease risk was estimated to be 23% higher in those with OA, as were risk for congestive heart failure (42% higher risk), ischemic heart disease (17% higher), and stroke (14% higher). Current NSAID use was found to be associated with almost 68% for the total effect of OA on cardiovascular disease. With NSAID use, risk for congestive heart failure, ischemic heart disease, and stroke increased nearly 45%, almost 95%, and more than 93%, respectively. The study authors note that these numbers only account for prescription NSAIDs and not over-the-counter NSAIDs.
Risk for Self-Harm in Ankylosing Spondylitis
Recently published study results suggest that risk for depression is elevated in patients with psoriasis, psoriatic arthritis, and ankylosing spondylitis. However, the risks of mental health outcomes in this patient population is not well known. Researchers assess the records of more than 53,000 patients with rheumatoid arthritis (RA), nearly 14,000 with ankylosing spondylitis, and a comparator cohort from the general population to evaluate risk for self-harm. While patients with RA were at increased risk for self-harm compared with the comparator cohort before covariate adjustment, the association did not exist after adjustment. In contrast, patients with ankylosing spondylitis were almost twice as likely to harm themselves as the matched group. Poisoning and self-mutilation were the most frequent methods of self-harm in both RA and ankylosing spondylitis patients.
Inhibitors or Rheumatoid Arthritis Remission
Few studies have assessed the reasons behind some patients with rheumatoid arthritis (RA) remain in active disease despite steadily increasing rates of remission following the formulation of treatment guidelines. To identify predictors of persistent disease, study investigators analyzed data from RA patients who mostly had moderate or high disease activity and were on conventional disease-modifying antirheumatic drugs. For women, the strongest factor for failing to achieve remission was obesity (odds ratio [OR], 2.06), followed by minority race (OR, 1.46), lower education (OR, 1.41), having comorbidities (OR, 1.12), and fatigue (OR, 1.05). For men, the strongest factor associated with persistent disease was current smoking (OR, 3.45), followed by increased aged (OR, 1.48), symptom duration (OR, 1.15), and pain (OR, 1.11).
Depression & Knee Osteoarthritis
While prior research has shown that the progression of knee osteoarthritis (OA) and symptom worsening over time may increase the risk of depression, what components of disease severity contribute to that risk in this population remains unclear. For a study, researchers analyzed data on patients with OA who did not have depression at enrollment. Compared with patients in the lowest quintile, patients in the highest quintile of disease structural severity had an odds ratio (OR) for depressive symptoms of 2.25. For functional limitations, those in the highest quintile had an OR for depression of 2.08. For pain, those in the highest quintile had an OR for depression of 1.60.
Choosing the Right Exercise for Knee & Hip Osteoarthritis
Whether one exercise type is better than another for the treatment of osteoarthritis (OA), and for which outcome, has not been well defined, despite all OA guidelines recommending exercise as a core treatment. To determine the relative efficacy of difference exercises for pain and self-reported function at (or nearest to) 8 weeks, researchers analyzed 89 randomized controlled trials for pain outcome and 87 for function. Mind-body exercise was the most effective for pain relief, closely followed by aerobic exercise. Whereas mind-body remained the best for improving function, strength and flexibility/skills exercise were better than aerobic exercise. Single exercises were consistently better than mixed exercise.