50+ Updates on Arthritis and Rheumatic Diseases You Need to Stay Informed About Your Health

Every June, thousands of rheumatology health care providers around the world gather to share information and updates about the prevention, diagnosis, treatment, and management of rheumatic diseases at the annual medical meeting of EULAR, the newly renamed European Alliance of Associations for Rheumatology. (It used to be called the European League Against Rheumatism.)

This year’s meeting, called the European Congress of Rheumatology 2021, was not an in-person gathering, of course, because of the COVID-19 pandemic. But the second-year-in-a-row virtual format did not detract from the main goal of the meeting: educating providers about the latest rheumatology science in order to provide better care for their patients.

From our perspective, however, the meeting serves a second and equally important goal: Educating patients about the latest rheumatology science so they can learn more about their conditions and be more engaged in their care with their providers.

We hope these updates help you to ask your provider questions, improve your understanding of your rheumatic conditions, and ultimately improve your care, so you can live with less pain, fatigue, and disruption to your daily life. Our CreakyJoints team read through hundreds of studies and curated conference coverage from health care provider websites. Below is a sample of what we think you should know from the European Congress of Rheumatology 2021.

Here is a table of contents to the sections in this resource:

• COVID-19
• Axial Spondyloarthritis
• Psoriatic Arthritis
• Rheumatoid Arthritis
• Gout
• Lupus
• Osteoarthritis
• Fibromyalgia
• Mental Health
• Diet & Exercise
• Family Planning

And FYI: You can participate in research studies about arthritis by using our ArthritisPower app to join our patient-centered research registry.

COVID-19

The COVID-19 vaccine is safe for people with rheumatic diseases. In reassuring news for people with inflammatory arthritis and other rheumatic conditions, the COVID-19 vaccine has not been linked to an uptick in disease flares for the overwhelming majority of patients. Researchers collected data from 1,519 people from February 5, 2021 to April 27, 2021. They found that disease flares were reported by 5 percent of patients with inflammatory rheumatic and musculoskeletal diseases (RMDs), with just 1.2 percent classified as severe flares.

A little over 30 percent of patients reported potential vaccine side effects, most of which were typical early adverse events within a week of vaccination — such as pain at the site of injection and headache. These side effects typically occurred within seven days of vaccination.

“The safety profiles for COVID-19 vaccines in RMD patients was reassuring,” the researchers wrote. “Most adverse events were the same as in the general population, they were non-serious, and involved short term local and systemic symptoms.” Read more about the study findings.

More data reveals how immunosuppressive medications may affect the response to the COVID-19 vaccine. In addition to vaccine safety, the other major question on everyone’s minds is: Could my medication make the vaccine less effective? Israeli researchers presented data from nearly 700 patients with autoimmune and inflammatory rheumatic diseases who received the Pfizer COVID-19 vaccine. Antibody levels were measured at least two weeks after their second dose and compared to those of a control group.

The researchers found that 86 percent of patients had adequate antibody levels (compared to 100 percent of controls). However, as other research has found, antibody levels varied considerably by type of medication.

More than 97 percent of people on common biologics, including TNF inhibitors, IL-6 inhibitors, and IL-17 inhibitors had “appropriate” responses to the vaccine. Medications associated with a reduced response to the vaccine included: rituximab, abatacept, mycophenolate, and methotrexate. These are the same therapies that the American College of Rheumatology recommends temporarily pausing or timing when you get the vaccine so it occurs at a certain point during the course of your treatment — in order to help boost your response to the vaccine.

In a review of the research on RheumNow, rheumatologist David Liew, MD, called the findings an “encouraging result for autoimmune rheumatic disease patients.”

We recommend talking to your doctor if you have questions about the vaccine and your personal health condition and medications.

Among rheumatoid arthritis patients, rituximab and JAK inhibitors are linked to worse COVID outcomes than other medications. Since the start of the pandemic, one of the big concerns among rheumatic disease patients is how their immunosuppressive medications could affect their course of disease should they get infected with COVID-19. To help answer this, researchers from the Global Rheumatology Alliance analyzed medical data on the use of certain biologics and targeted therapies among people with rheumatoid arthritis (RA) at the time they got infected with COVID-19.

They found that taking rituximab was strongly associated with a higher chance of worse COVID-19 severity compared to taking a TNF biologic. In fact, 22 percent of rituximab users required hospitalization with oxygen or ventilation and 14.8 percent died — compared with 7.4 percent and 2.6 percent of TNF users, respectively. Among JAK inhibitor users, 15.3 percent were hospitalized with oxygen or ventilation and 7.1 percent died. There was no association found between abatacept or IL-6 use with worse COVID-19 outcomes when compared with TNF users.

However, it’s important to note that the researchers did not look at the effects of these medications after people were vaccinated against COVID-19, “so it’s a bit of speculation as to how it applies to patients with vaccination,” says rheumatologist Jeffrey Sparks, MD, a co-first author of the study. Read more about the findings.

Rheumatic disease patients are generally not at increased risk for contracting COVID-19, according to the latest EULAR recommendations. EULAR presented an update to its recommendations about COVID-19 in people with rheumatic, autoimmune, or musculoskeletal diseases. High-level recommendations like these are important because they consider data from many different research sources. In this case, a panel reviewed more than 6,500 data sets and articles, ultimately relying on 29 articles on COVID-19 incidence, 15 on risk factors, and five that included data for both incidence and risk factors, Healio Rheumatology reported.

Among the big takeaways: Patients do not appear to have an increased risk of contracting COVID-19 compared to the general population. And while some studies (see above as an example) do find differences in COVID-19 outcomes based on diseases or medications compared to the general population, Robert B.M. Landewé, MD, PhD, of the Department of Rheumatology and Clinical Immunology at the Amsterdam Rheumatology Center, said that when taken in aggregate, data ultimately show no worse prognosis for rheumatology populations compared to those without rheumatic diseases. Many of the same risk factors for worse COVID outcomes for the general population similarly affect rheumatic disease patients: older age and certain comorbidities, like heart disease, lung disease, diabetes, and being obese. Read more from Healio Rheumatology.

People with inflammatory arthritis have been dealing with sleep issues during the COVID-19 pandemic. Between March and September 2020, rheumatic disease patient associations in Italy asked people to complete an online survey about sleep issues, as well as pre- and post-lockdown self-reported use of medications that treat mental health issues. Researchers found that the majority of patients had issues falling asleep (65.6 percent) and staying asleep (63.5 percent). Additionally, they noticed an increase in the use of psychiatric medications post-lockdown, especially for sleep medications: 6.1 percent of patients reported using sleep medications pre-lockdown compared to 7.5 percent who reported using these medications post-lockdown. “Changes in daily life related to confinement have influenced psychological distress leading to a significant impact on sleep difficulties such as inability to fall early asleep or to maintain adequate sleep,” researchers wrote.

Axial Spondyloarthritis

Treatment wear-off between biologic doses is common in axial spondyloarthritis. Researchers have found biologic medications to be an effective treatment for axial spondyloarthritis (axSpA). But treatment wear-off between medication doses is common — and can impact patient satisfaction and the need for additional therapies for pain relief as a bridge to their next dose. In a study of 127 axSpA patients from the ArthritisPower research registry (which is run by CreakyJoints and the Global Healthy Living Foundation), 61 percent said their biologic wears off before the next dose. Of these, more than 80 percent say they use additional treatments for symptom relief, including NSAIDs, muscle relaxers, opioids, or nerve pain medications or antidepressants, and steroids. They also reported using cannabis and alcohol.

“It would help if providers let patients know that their biologic may wear off between doses and give them guidance about what they can do if their dose does wear off and they have residual pain,” says study author W. Benjamin Nowell, PhD, Director of Patient-Centered Research at the Global Healthy Living Foundation. “Setting expectations is important, as is partnering with your doctor to make sure you’re aware of and safely using additional therapies if necessary.” Read more here about the research.

There are key differences between people who have axial spondyloarthritis and who have psoriatic arthritis with axial symptoms. Axial spondyloarthritis and psoriatic arthritis (PsA) are both in the spondyloarthritis family. These types of arthritis have many characteristics in common, can be treated with some of the same medications, and can be mistakenly diagnosed for each other. It’s important to learn more about what makes them similar and different in order to improve patient care. A study of 1,044 patients (470 had psoriatic arthritis with axial symptoms, meaning that their spine is affected, and 574 had axSpA) found that a greater proportion of axial PsA patients were female, while a greater proportion of axSpA patients were male. Uveitis (eye inflammation) and inflammatory bowel disease were more likely to occur in axSpA than in axial PsA, while dactylitis (swollen digits) and enthesitis (inflammation of tendons and ligaments) were more common in axial PsA than in axSpA. While people with axSpA had more self-reported pain and spinal pain, fewer of them had tried biologics or targeted DMARDs than those with axial PsA. Morning stiffness, fatigue, and work impairment scores were similar between the two groups.

Some stable axSpA patients may be able to space out biologic doses and maintain low disease activity. Once they’re on a biologic and have gotten to low disease activity, some patients start to wonder: Can I take less of this medication? A team of French researchers studied this in a group of 398 axSpA patients, all of whom were in low disease activity for at least six months when the study started. One group stayed on their usual biologic (all were taking various TNF inhibitors) and the other started progressively spacing out their doses. At one year, 91.5 percent of those who stayed on the medication remained in low disease activity, as did 88 percent of those who spaced out their treatment. The researchers concluded that “it is possible to increase intervals between injections while maintaining a low disease activity by adjusting treatment with quarterly monitoring of SpA activity.”

One thing to note is that imaging was not part of the trial, so researchers were not able to see whether there was any impact on radiographic progression. If you have questions about tapering your medications, talk to your doctor. You should never make changes to your medication regimen on your own.

TNF inhibitor biologics appear to slow progression in axial spondyloarthritis, but it takes time to see this effect. When patients take a biologic for a disease like axial spondyloarthritis, which can cause debilitating back pain along with other symptoms, they want to know that it will relieve pain and help them feel better, of course. But they also want to know whether such medications only relieve symptoms or also prevent the progression of the disease. When German researchers studied this in a group of axSpA patients, they found that TNF biologics appear to have a “delayed effect” on radiographic progression in the sacroiliac joints (the joints where the spine connects with the pelvis). There were no significant differences in sacroiliitis progression between people who were taking biologics for more than 12 months and those who were not taking the medication when researchers looked at only the latest two-year period. But they did observe a difference in sacroiliitis progression when they went back and looked at the previous two-year period. This suggests that the medications took at least two years to demonstrate signs of improvement. “You have to wait to see this effect,” study author Murat Torgutalp said in the Eular Congress News. Read more here about the findings.

When axial spondyloarthritis is diagnosed early, it’s likely that the diagnosis remains accurate over time. Like many rheumatic diseases, axSpA is not diagnosed from a single test or symptom but rather because many clinical symptoms and tests suggest the patient has axSpA. When doctors determine this diagnosis, it’s important to understand whether it is accurate and persists over time. A group of Dutch, Italian, and Swedish researchers studied this in a group of patients between the ages of 16 and 45 who had chronic back pain (for at least three months but less than two years) that was suggestive of spondyloarthritis. Researchers were looking to see how many were diagnosed with axSpA and how many were not, then followed them for two years and reassessed their symptoms to see if they would still be considered to have an axSpA diagnosis (or not).

Out of 295 people studied, the “diagnostic consistency rate” was 84 percent, which means that most patients who were diagnosed with axSpA initially were still considered to have it two years later, and most patients who did not get diagnosed with axSpA initially were still considered not to have it two years later. The people whose diagnosis switched over time (from having axSpA initially to not having it later, or vice versa) tended to have fewer features of spondyloarthritis when the study began than those whose diagnoses remained consistent over time. The number of patients with sacroiliitis (inflammation of the sacroiliac joints) on X-ray and MRI was much higher in the group with a consistent diagnosis of axSpA.

While the initial diagnosis remained accurate in about four out of five cases, it’s important to keep in mind that about 20 percent of the time, the diagnosis did change, which means some patients would benefit from being reassessed, particularly if symptoms have changed over time.

Fatigue may be a factor in why female axSpA patients report worse disease activity scores than males. Research shows there are differences in how axSpA presents in male and female patients. This continues to be a fascinating and important area of study, especially since females have historically been under-diagnosed with axSpA and outdated misconceptions persist that the disease predominantly affects men.

Irish researchers sought to understand why female patients tend to have worse patient-reported outcomes than male patients by looking at the results of various patient surveys in a group of 857 axSpA patients (75 percent were male). They found that females actually scored better than males when it came to spinal mobility and scored similarly in most aspects of the BASDAI, a commonly used tool to assess axSpA disease activity. But a notable area where things differed: fatigue. Females reported worse fatigue than males, which affected their overall disease activity scores. “This variation by gender should be kept in consideration when evaluating a patient with suspected active axSpA,” say authors.

To treat fatigue in axSpA, we have to understand what factors are associated with it. A team of researchers looked at data on a large number (2,846) axSpA patients from across 13 different European countries to better understand which factors are linked with fatigue. They found people who reported worse fatigue or tiredness were more likely to be younger, female, have a lower educational level, and be divorced or separated. People with worse fatigue were also likely to report a greater impact of their axSpA on their ability to work, having sleep disorders, being physically inactive, having worse morning stiffness, and having mental health conditions like anxiety and depression.

It takes longer for axial spondyloarthritis to get diagnosed than other inflammatory diseases, despite advancements made in understanding the disease. Diagnostic delay has been a significant problem when it comes to treating axial spondyloarthritis, especially when compared to other forms of inflammatory arthritis. Researchers from England and Wales looked into this further, analyzing data on 784 patients from the National Early Inflammatory Arthritis Audit (NEIAA). Researchers found that “symptom duration prior to initial rheumatology assessment was significantly longer in axSpA [patients] than rheumatoid arthritis (RA) patients.” Specifically:

• 7% of axSpA patients had symptom durations of >6 months, compared to 33.7% of RA patients.
• 6% of axSpA patients had symptom durations of >5 years, compared to 3.5% of RA patients.

When it came to getting an assessment, axSpA patients once again had a longer wait time: 36 days compared to 24 days for RA patients.

Weight may impact pain and stiffness for axial spondyloarthritis patients. Researchers wanted to better understand whether and how body mass index (BMI) affects axSpA disease activity and quality of life. A group of 2,846 axSpA patients completed a survey: 18.7 percent were obese, 33.5 percent were overweight, 44 percent were at a healthy weight, and 3.8 percent were underweight. Researchers found that patients who were obese or overweight reported greater disease activity and spinal stiffness compared to patients who were at a healthy weight or underweight. A slightly greater proportion of overweight and obese axSpA patients reported functional limitations with household chores than healthy and underweight patients.

These findings suggest weight management may be an important part of axSpA treatment, as a higher BMI is associated with higher disease activity, more spinal stiffness, and high functional limitations.

Psoriatic Arthritis

Psoriatic arthritis patients want a treatment plan that improves their quality of life. Each person living with psoriatic arthritis (PsA) has their own needs and preferences when it comes to finding a treatment that works. Some people may find fatigue to be a big problem; others may be more concerned about their ability to be physically active. A study of 332 patients from the ArthritisPower research registry (which is run by CreakyJoints and the Global Healthy Living Foundation), asked psoriatic arthritis patients which PsA symptoms they find most bothersome and which aspects of their life they most wanted to see improved. The majority of patients surveyed said they most want to improve their ability to perform physical activities. This is not necessarily surprising, as the majority of patients deemed joint pain-related symptoms the most bothersome — possibly because these symptoms affect their ability to be active. Read more about the research here.

New treatment recommendations for psoriatic arthritis emphasize matching therapies with patient-specific domains. Treatment guidelines for rheumatic diseases are issued and updated over time to help physicians (and patients) utilize the latest scientific research to decide which medications and therapies to use. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), an international group of PsA and psoriasis researchers, clinicians, and patients, presented an update to the 2015 PsA treatment recommendations.

Over the last six years, there have been considerable advances in new therapies and management strategies for psoriasis and psoriatic arthritis, which are reflected in the new recommendations. A key takeaway is that the recommendations attempt to match therapies with different psoriatic disease domains, including arthritis in peripheral joints, spine (axial) disease, enthesitis, dactylitis, psoriasis, and nail psoriasis. They also account for which treatments to use in patients who have uveitis and inflammatory bowel disease, which are common co-occurring conditions. The recommendations include newer classes of medications for psoriatic disease, including IL-17 and IL-23 inhibitor biologics and JAK inhibitors.

Overall, the emphasis was on personalizing therapy: “Choice of therapy for an individual should ideally address all of the domains that impact on that patient, supporting shared decision making with the patient involved,” the recommendations state.

Can a fecal transplant help treat psoriatic arthritis? An initial study doesn’t show a benefit, but more research is needed. The microbiome — the billions of bacteria that live in the gut — is increasingly thought to play a role in many chronic diseases, and especially inflammatory rheumatic diseases. A fecal transplant, in which stool from a healthy person is transplanted into a person with chronic illness, is one way to attempt to change the makeup of someone’s microbiome, which could, in turn, improve their underlying disease.

Danish researchers sought to test this hypothesis with a “proof of concept” study in a small group of 30 people with psoriatic arthritis. The goal was to test whether fecal transplant was safe and effective when compared with a sham treatment. People received either the fecal transplant or a placebo transplant and were followed for 26 weeks. Researchers found that people who received the fecal transplant actually fared worse than those who got the placebo transplant: they reported worse scores when it came to daily function, measures of joints affected by arthritis, enthesitis, and the need to start either new biologics or receive steroid injections. The fecal transplant did appear safe, though; no serious side effects were reported.

While the small trial does call into question the role of the microbiome in PsA and other inflammatory diseases, it’s far from the final word. The researchers acknowledged that larger studies are needed, as is more research into the “composition and functional potential of the microbiota in donor and recipients.”

Psoriatic arthritis patients have a higher prevalence of many comorbidities compared with patients who have psoriasis without PsA. The inflammatory conditions psoriasis and psoriatic arthritis are closely linked, with about 30 percent of people with psoriasis ultimately also developing psoriatic arthritis. Researchers used a database of patients from Great Britain to better understand whether there are differences in the co-occurring conditions that people have, depending on whether they have only psoriasis or also psoriatic arthritis. They found a notably higher disease burden in PsA. There was a greater prevalence of obesity, diabetes, hypertension, and an inability to work in psoriatic arthritis when compared with psoriasis. Researchers concluded that their results potentially indicate a “higher inflammatory and quality-of-life burden” in people who have psoriatic arthritis, highlighting the need for adequate patient assessment and follow-up to ensure a best possible holistic patient management approach.”

Many psoriasis patients report having musculoskeletal pain, but most have not seen a rheumatologist. Identifying which psoriasis patients are likely to go on to develop psoriatic arthritis (and whether this progression can be prevented) is an active area of research. Danish researchers shed more light on this topic by studying a group of people with psoriasis to understand the prevalence and burden of musculoskeletal pain. They found that while many patients with psoriasis reported having musculoskeletal pain either presently or in the past, more than 70 percent had never seen a rheumatologist. Of course, most psoriasis patients with musculoskeletal pain likely do not have psoriatic arthritis; they could have osteoarthritis (OA), say, or an injury. But given that some psoriasis patients do go on to develop psoriatic arthritis, paying attention to such early telltale signs could be an important way to get diagnosed as soon as possible.

The biologic guselkumab (Tremfya) helped PsA patients who didn’t previously respond to a TNF biologic. As researchers and doctors learn more about newer therapies for rheumatic diseases, an ongoing area of study is what medication to prescribe to someone who has already tried and not responded to a different type of medication. This is increasingly important as more therapies become available and doctors start trying to personalize treatment for a given patient. In a new study on guselkumab, which is a biologic that targets the immune system protein interleukin (IL)-23 and is approved for psoriasis and psoriatic arthritis, researchers wanted to see how people who had already not responded to one or two biologics that target a different immune system protein called tumor necrosis factor (TNF) would do while taking it. After six months on treatment, 44 percent of people on guselkumab had a 20 percent improvement in symptoms like the number of tender and swollen joints, compared to 20 percent of people on a placebo demonstrating that same level of symptom improvement. They experienced significant improvements relative to placebo on other measures too, including skin clearance and surveys measuring quality of life and disability. The results suggest that guselkumab is an effective and safe option for people who haven’t responded well to other biologic therapies.

Rheumatoid Arthritis

Exposure to cigarette smoke in childhood increases the risk of rheumatoid arthritis later in life. Inflammatory or autoimmune diseases like rheumatoid arthritis (RA) are thought to result from combinations of genetic and environmental factors. Previous research has linked being an active smoker to an increased risk of RA, particularly the anti-cyclic citrullinated protein (anti-CCP) positive kind. (These are antibodies your body makes that play a role in the development of RA.) French researchers sought to study the role that “passive” (or secondhand) exposure to cigarette smoke can play by analyzing data from a group of 80,000 women who were followed over time. Indeed, they found that childhood cigarette smoke exposure increased the risk of getting RA in adulthood by 24 percent, and the risk was even higher (40 percent) in women who never smoked themselves. However, the greatest increased risk of RA was seen in women who were exposed to secondhand smoke during childhood and were smokers themselves as adults.

Many patients with rheumatoid arthritis report high levels of disability despite low levels of inflammation. It’s been observed that over time, people with RA continue to report challenges with daily function despite having low levels of inflammation (as measured by blood tests like C-reactive protein, or CRP). Researchers sought to understand what such patients may have in common by analyzing data on a group of nearly 2,000 people with RA, including their scores on a questionnaire about daily activities and function (called the HAQ, or Health Assessment Questionnaire) and their disease activity (tender and swollen joint counts and CRP levels). They found that patients with high disability scores and low disability scores both had similar levels of inflammation, which decreased over time. This suggests that factors other than inflammation are contributing to disability in people with RA over the long run. Patients with high disability despite low inflammation were older, a greater proportion were women, and they had higher levels of fatigue and pain.

Elderly RA patients on biologics or JAK inhibitors do not have an increased risk of serious infections compared with those taking conventional disease-modifying treatment. The potential risk of serious infections is a concern for many people when they start a biologic or JAK inhibitor, but it’s especially concerning for older adults, whose age alone increases their risk for infections. For this reason, many elderly patients are not prescribed these advanced therapies. Now, a study on a group of 2,274 German patients over age 70 shows they may need not to worry. Researchers did not see any difference in the rates of serious infections when they compared people on biologics, JAK inhibitors, and conventional disease-modifying medications (like methotrexate). What did influence infection rates: having more comorbidities (such as diabetes and lung and kidney disease, high disease activity, and using corticosteroids).

‘Polypharmacy’ in rheumatoid arthritis is associated with being less likely to achieve remission. Polypharmacy, or taking multiple medications (usually for multiple health conditions) at the same time, is common in people with RA. French researchers divided a group of 813 patients into two groups based on the number of medications they were taking for conditions other than RA: the “polypharmacy” group was taking a higher number than the “non-polypharmacy” group. After 10 years of follow-up, the researchers found that the polypharmacy patients had a 43 percent lower chance of achieving remission compared to the non-polypharmacy group. Polypharmacy patients also had a greater risk of adverse events. Studying how people who take many different medications for conditions other than RA can be a different way of looking at the impact of co-occurring medical problems on RA management.

Seropositive RA patients had better retention on the biologic abatacept and were more likely to get to remission than seronegative patients. An ultimate goal of treatment for inflammatory rheumatic disease is personalization: providing the most effective therapy for each person based on their unique traits and needs. Some research has shown that autoantibodies for RA (rheumatoid factor and anti-CCP) can impact treatment outcomes when it comes to certain therapies. A study of 1,748 RA patients found that those who were seropositive (they have both RF and anti-CCP antibodies) and took the biologic abatacept (Orencia) had better disease activity scores than those who took the medication and were seronegative (had neither antibody). They also had better drug retention over time, which means that fewer seropositive patients stopped taking the medication than those who were seronegative. (Patients often stop therapies because they’re not working.) This was even more so the case in people who received abatacept as their first biologic than in those who already “failed” previous biologic treatment. This research seems to demonstrate the importance of using personalized medicine to find early, effective treatment for RA.

Researchers are learning more about genetic markers for interstitial lung disease (ILD) in rheumatoid arthritis. This inflammation and scarring of lung tissue is a common and serious comorbidity of RA; over time, it can cause difficulty breathing and can be life-threatening. Understanding which RA patients are more likely to develop ILD — to intervene earlier and prevent complications — is increasingly important. Researchers presented data from a national registry of patients from Finland to look for the presence of a specific genetic marker that had been previously linked to ILD in RA. Out of 5,534 RA patients, 178 (3.2 percent) developed ILD, and having the MUC5B gene was a strong predictor. The researchers determined that the MUC5B genetic variant conferred a lifetime risk of developing ILD of 14.5 percent compared to a lifetime risk of developing ILD of 5 percent in RA patients without the variant. Research like this could ultimately help doctors identify RA patients at high risk of developing ILD.

The medication nintedanib may help treat interstitial lung disease in rheumatoid arthritis. Given the prevalence and seriousness of interstitial lung disease, it’s important not only to diagnose it early, but to develop an arsenal of effective treatments. In one study, which was a new analysis of a larger trial of people with interstitial lung disease, researchers focused on a group of 89 people with ILD related to RA. They were randomized to take the medication nintedanib (Ofev), which is already approved to treat pulmonary fibrosis and was recently approved for use in lung disease in systemic sclerosis. The researchers showed that RA patients on nintedanib had slower rates of lung function decline over a year than those in a placebo group, which was consistent with the results from the larger trial on ILD. On RheumNow, rheumatologist Aurelie Najm, MD, PhD called the results part of a body of research that is providing “new therapeutic insights into a yet poorly understood and difficult to treat RA manifestation.”

Rates of cardiovascular events continue to stay high among rheumatoid arthritis patients, despite improvements in inflammation control. People with RA have an increased risk of developing cardiovascular disease, which is thought to be mainly due to effects of inflammation. While there is ample research on this link, there is not as much data on the incidence of cardiovascular events over longer periods of time. Dutch researchers have been following a group of 353 rheumatoid arthritis for more than 20 years, looking to see if they had any cardiovascular events and comparing them with another group of patients who did not have RA, but were at increased risk for heart disease because of diabetes and other risk factors. Over the 20-year period, 33 percent of the RA patients experienced at least one cardiovascular event. The incidence rate was much higher than that of the patients without RA but who had other cardiovascular risk factors.

“The incidence rate of CV events in RA patients has remained consistently high when compared with the general population, despite better control of RA inflammation in recent years,” researchers wrote. “This again confirms the need for timely [cardiovascular disease] risk screening and management.”

A treat-to-target strategy may help reduce the increased cardiovascular disease risk in RA. Cardiovascular disease is one of the most worrisome comorbidities for RA patients, as it’s been well-established that systemic inflammation raises the risk of all kinds of heart problems, including heart attack and stroke. What’s less well-understood, though, is how RA treatment that reduces inflammation may affect these risks. New research from patients in Hong Kong seems promising. Researchers looked at data on a group of 261 RA patients who were diagnosed early and were following a treat-to-target strategy (this means adjusting treatment with the aim of helping patients achieve remission or low disease activity). Researchers compared their risk of having a cardiovascular event with a control group of 783 patients without RA (who were matched so they were similar to the patients in terms of age, gender, smoking status, and comorbidities). Cardiovascular events occurred in 2.3 percent of the RA patients on the treat-to-target strategy and in 3.3 percent of the control patients, which suggests that the RA patients on treat-to-target did not have an excess heart disease risk. The longer patients were in remission, the more likely they were not to have a heart-related event.

The risk of heart failure and dementia in rheumatoid arthritis is declining, likely because of advances in treatment. Two new studies from the Mayo Clinic also show some encouraging news for RA patients concerned about their increased risk for long-term health problems like heart failure and dementia. The research on dementia used data on 895 RA patients who were diagnosed between 1980 and 2009 and followed until the end of December 2019 (unless they passed away earlier). The researchers determined that the chance that someone with RA would develop dementia within a 10-year period was nearly 13 percent in the 1980s but only 7 percent in the 1990s — and down to 6 percent by the 2000s.

The researchers compared these findings to the rates of dementia among the general population (people without RA) during the same time period. While dementia rates were far lower among those without RA in the 1980s (9 percent for the general population versus 13 percent for RA patients), by the 2000s the risk of developing dementia was slightly higher for those without RA (7 percent for the general population versus 6 percent for RA patients).

The researchers observed a similar trend with heart failure. During the 30-year study, the risk of developing heart failure over a 10-year period for members of the general population held steady at around 7 percent. But for those with RA, there were significant changes: In the 1990s the risk was 8.5 percent, followed by an uptick in the 1990s to 11 percent. But in the 2000s the risk had dropped to 7 percent. In other words, people with RA initially had a greater risk of heart failure compared to those without RA, but by the 2000s they had no extra risk at all.

Is the foot the best place to look for the earliest signs of RA? The sooner you can get diagnosed with RA, the sooner you can start on treatment and try to get to remission. Identifying people with “preclinical” signs of RA so they can be closely watched and diagnosed is an important area of research. A study of 524 Dutch patients who were suspected to have RA because of clinical symptoms (and, in some cases, testing positive for RA antibodies) — but who were not yet diagnosed — found that those who developed bursitis in the foot (called intermetatarsal bursitis) were at a much higher risk of going on to develop RA than those who did not have bursitis in this area of the foot. Bursitis means inflammation of the bursae, or small fluid-filled sacs that are often found near joints (they help provide cushioning).

The study authors concluded that this intermetatarsal bursitis in the foot “precedes the development of clinical arthritis, and in particular the development of ACPA-positive RA.”

The research suggests that inflammation in the area surrounding the joint, and not just within the joint, may play a role in the onset of RA.

The JAK inhibitor upadacitinib (Rinvoq) continued to show more improvement in disease activity in rheumatoid arthritis patients when compared to adalimumab (Humira) over three years. When new therapies, like upadacitinib (Rinvoq), are FDA-approved based on initial clinical trial data, researchers keep studying the medication over time to see if it remains effective and if the safety profile remains consistent. In an earlier study, which lasted 12 weeks, researchers showed that people with RA who weren’t doing well on methotrexate alone had a better response when given 15 mg once a day of upadacitinib than those who were given adalimumab. (Both medications are manufactured by AbbVie.)

Now, after researchers followed patients for three years, they found that the results still held up. By one measure, “greater proportions of participants randomized to upadacitinib demonstrated low disease activity and remission at three years compared with those randomized to receive adalimumab,” reported Healio Rheumatology.

Researchers also looked at the data a different way: by seeing whether people who were taking either medication weren’t doing well enough such that they could get “rescue” therapy by switching to the other drug. After three years, they found that 47 percent of people who were randomized to receive upadacitinib did not require rescue therapy compared to 36 percent of those receiving adalimumab.

The safety profile of upadacitinib was consistent with results from earlier trials, with higher rates of herpes zoster (shingles), lymphopenia (low levels of white blood cells), liver changes, and elevated CPK levels.

Gout

‘Immunomodulation’ with methotrexate in advanced gout therapy improves patients’ outcomes, and the results persist at one year. Gout patients whose disease is not responding to first-line uric acid-lowering therapy may benefit from a type of treatment called pegloticase (Krystexxa), which is very effective at helping the body get rid of high levels of uric acid. But one hitch is that people can build up antibodies to the treatment, which reduces its effectiveness and often leads to discontinuation. For a few years now, researchers have been studying whether giving patients on pegloticase additional medications that dampen immune system activity, like methotrexate, helps improve how they fare on their gout therapy, but the studies have been small and short-term.

An ongoing small study, which started with 14 patients, has now reported data after a year of follow-up. It was not a randomized controlled trial; rather, all patients were taking pegloticase for up to a year (they were able to stop taking it when they achieved their treatment goals) with a weekly dose of injectable methotrexate throughout the duration of receiving pegloticase therapy. Among the 10 patients who completed the study, researchers saw improvements in the number of affected joints along with various patient reported outcomes, such as disability scores and assessments about gout disease activity. Among two patients who had CT imaging done, researchers observed reductions in uric acid volume and could see improvements in bone erosion healing.

Larger, randomized trials looking at this immunomodulating approach are underway, which should add more insights into this new therapeutic approach for hard-to-treat gout.

Maintaining a healthy weight may help prevent gout — especially if you’re genetically predisposed. Studies have found that being overweight may increase a person’s risk for developing gout. So it stands to reason that maintaining a healthy weight could help reduce your gout risk, but what about those who have a high genetic risk for gout? Researchers examined the association between excess weight and self-reported gout, factoring in genetic risks, in 530 women and 983 men from two different study databases. They found that excess weight accounted for a larger proportion of new gout cases among women who had higher genetic risks scores than those with lower scores. For men, excess weight accounted for similar proportions of gout cases regardless of genetic risk.

This research seems to indicate there could be an interplay between weight and genetic risk, whereby being overweight may play an even more important role in gout onset in people who are genetically predisposed. On the other hand, this could be an impactful way to prevent gout: “In genetically predisposed individuals, addressing excess weight may prevent a large proportion of gout cases,” the researchers note.

Addressing cardiovascular risk factors early may reduce the risk of cardiac events in gout. Gout is associated with an increased risk of cardiovascular disease, but it’s still unclear whether that risk is due something about gout itself or because of underlying comorbidities, such as obesity, hypertension, and diabetes. Researchers in Sweden compared the risk of first-time acute coronary syndrome (ACS) in people with gout (more than 20,000 patients) to those in the general population (more than 84,000 patients). (ACS is an umbrella term for conditions associated with sudden, reduced blood flow to the heart, like a heart attack.)

They found that people with gout had a 43 percent increased risk of a first-time coronary event compared to the general population, but that rates of cardiac events were more similar between the groups after researchers adjusted for cardiovascular disease risk factors.

“This increased risk is largely explained by the increased occurrence of comorbidities in gout,” researchers wrote, noting that “there is still a modestly increased risk that may be due to gout related factors.” The research highlights the importance of screening patients for heart disease and “the need for appropriate management of the underlying cardiovascular risk factors in patients with gout,” say researchers.

The DASH diet may reduce risk of gout among women, even in those who are genetically predisposed to the disease. How much of a role does diet play in gout risk, especially if you’re genetically predisposed? In a new study, researchers compared the association between gout and two dietary patterns — the DASH diet, which emphasizes produce and whole grains and limits saturated fat, and the Western diet, which consists of a high intake of red and processed meats, refined grains, and sugar-sweetened beverages. They also examined the role genes play in this association. Researchers found that the DASH diet was associated with lower risk of developing gout while the Western diet was associated with a higher risk, regardless of whether people were genetically predisposed or not.

This suggests dietary measures may play a role in gout prevention, even in those who are predisposed to the disease.

Osteoarthritis

Krill oil worked no better than placebo for treating osteoarthritis pain. A source of omega-3 fatty acids, krill oil has anti-inflammatory properties. But studies have been mixed as to whether it can help improve knee pain or function in osteoarthritis (OA). Australian researchers randomized 262 osteoarthritis patients to receive krill oil supplements (2 grams/day) or a placebo for six months, looking to see if they reported improvements in knee pain scores or function. While knee pain improved in both groups over the course of the study, there were no differences between the people taking krill oil and those taking placebo. The researchers concluded that their findings “do not support use of krill oil for alleviating knee pain in clinical knee osteoarthritis.”

Knee osteoarthritis is linked with depression and anxiety. Studies have found that knee osteoarthritis is one of the most disabling conditions and often associated with physical limitations. For many people with knee osteoarthritis, these limitations greatly impact their quality of life which, in turn, affects their mental health. Researchers in Tunisia evaluated 66 people with knee osteoarthritis for depression and anxiety, also looking at their osteoarthritis pain scores. They found a correlation: the higher the patients’ pain scores, the higher their depression and anxiety, too. “Although knee osteoarthritis appears to be a benign pathology, its impact can be severe, including depression and anxiety, which are mainly influenced by the degree of functional disability,” researchers wrote, adding that “psychological care is sometimes necessary” when treating people with knee osteoarthritis.

Osteoarthritis may be connected to artery disease, as well as cardiovascular disease. Osteoarthritis has been associated with atherosclerosis (AT), a disease in which plaques of fatty material line the artery walls, raising the risk of heart attack. But research on the association has been conflicting, particularly when it comes to the connection between OA and cardiovascular disease. To further examine the association, researchers analyzed 23 different studies that focused on osteoarthritis, AT, and cardiovascular disease. Of those studies, 15 found a significant, positive association between OA and AT. Additionally, 13 studies found that hip and knee OA increased a person’s risk for AT and cardiovascular disease, but not cardiovascular death. Based on these findings, researchers believe a “more intensive control of traditional CV risk factors may be advised” for OA patients.

Comorbidities like high cholesterol and hypertension are linked with worse osteoarthritis (OA). There is a known association between cardiovascular risk factors and osteoarthritis (OA), but less is known about whether or how such risk factors directly affect the course of osteoarthritis and its progression. Researchers in Portugal evaluated the medical records of 304 knee OA patients, looking into the presence of cardiovascular comorbidities (hypertension, high cholesterol, and type 2 diabetes) and the severity of their knee OA. They found that patients with comorbidities had higher knee OA severity scores. They also found a link between comorbidities and faster OA disease progression, as well as a greater need for knee replacement procedures. “This study highlights the importance of acting on preventive measures for cardiovascular risk factors in osteoarthritis management,” the researchers wrote.

Osteoarthritis treatment preferences differ between Black and white patients. Data shows that Black people with osteoarthritis are less likely to have joint replacement surgery, despite having more severe arthritis symptoms. A team of researchers reviewed 31 studies that examined the connection between race and treatment preference, specifically for Black people with hip and/or knee osteoarthritis (OA). They found that Black patients were less likely to use pain relievers such as NSAIDs or opioids compared to white patients, but were more likely to utilize topical treatments, as well as spirituality and prayer. (Usage of vitamins and supplements, hot and cold therapy, and meditation was not significantly different between groups.) Additionally, Black patients were less willing than white patients to consider or undergo joint replacement procedures, even if they were recommended and deemed necessary by their health care provider. The authors called for future interventions to focus on “providing accessible information surrounding treatment options and targeting perceptions of the importance of joint health.”

Following a structured exercise and education program may help osteoarthritis patients perform physical activities. A group of Norwegian researchers set out to study the activity limitations of people with osteoarthritis, as well as what type of program could be implemented to improve these limitations. For the study, 152 OA patients identified up to three important activities they were unable to do or had difficulty doing because of their OA. They then rated their performance of the reported activities on a numeric rating scale ranging from zero (unable to perform activity) to 10 (could perform activity with no problems).

The patients were then enrolled in a 12-week program, which was implemented by general practitioners and physiotherapists. The program began with a three-hour, group-based patient education program, and was followed by eight to 12 weeks of individually tailored exercise programs, as well as two one-hour supervised group exercise sessions a week. At the end of the program, patients rated their previously identified important activities using the same numeric scale.

Researchers found that the most common activities patients struggled with involved changing body positions (26 percent), walking (23 percent) and moving around (25 percent). Following a specific exercise program — and being educated about the program — seemed to help, as patients reported significantly less difficulty performing their self-reported activities once the program ended. These findings suggest tailored exercise programs and patient education may be more beneficial to overcoming OA-related limitations than generic exercise guidance.

Lupus

Sleep apnea is common in lupus and may be linked with worse disease activity. Israeli researchers compared a group of patients with systemic lupus erythematosus with healthy controls on a number of different measures. They underwent a sleep study to see whether they had obstructive sleep apnea (periods of disrupted breathing during sleep) and took surveys about their sleep quality, fatigue, pain, depression, and more. The researchers concluded that people with lupus had an increased prevalence of sleep apnea and lower sleep quality compared with controls. Participants’ body mass index and their scores on one measure of lupus disease activity were independent predictors of sleep apnea. In other words, people with worse lupus disease activity scores were more likely to have sleep apnea. More research is needed, however, to determine whether or which underlying processes related to sleep apnea may worsen lupus disease activity.

Lupus patients with mental health conditions have longer hospital stays and more outpatient visits, and incur greater health care costs than those without mental health conditions. A multisystem autoimmune disease that can have a wide range of impacts on many different parts of the body, lupus is also associated with mental health conditions like depression and anxiety. Researchers, led by rheumatologist Michelle Petri, MD, of Johns Hopkins University, sought to explore how having a mental health condition diagnosis might affect other aspects of their medical care, including costs. After analyzing two large U.S. insurance databases, the researchers observed a few important findings. First, mental health conditions are very common in people with systemic lupus erythematosus (SLE) and with lupus nephritis. About 36 percent of SLE patients (7,760) had a mental health condition diagnosis, as did almost 29 percent of lupus nephritis patients (336). Depression and anxiety were the most common. When compared to people with lupus who did not have a mental health condition, those who did had longer hospital stays when they were hospitalized (almost three days longer for SLE patients and about even days longer for lupus nephritis patients). Lupus patients with mental health conditions also had almost twice as many outpatient doctor visits as those without. Overall health care costs per year were about double for SLE patients ($49,553 vs $26,064) and almost triple for lupus nephritis ($112,169 vs $39,529). The researchers concluded that “this study highlights not just the high prevalence of [mental health] comorbidity but its large contribution to [lupus] health care costs.”

The newly approved lupus nephritis medication voclosporin (Lupkynis) continues to effectively improve kidney function after two years. The medication voclosporin was approved for lupus nephritis earlier this year based on clinical trial data that showed it improved aspects of kidney function relative to standard treatment (mycophenolate mofetil and low-dose steroids). When researchers looked at longer-term data to see how patients fared, they found that those who received voclosporin maintained “meaningful reductions” of protein in the urine (a sign of deteriorating kidney function) with stable estimated glomerular filtration rates (a measure of kidney function) at two years. No new adverse events were reported during the extension of the original study. “These data are significant as they reinforce the clinical value and safety of voclosporin for up to two years,” study author Amit Saxena, MD, of New York University Langone Health, told Healio Rheumatology.

A combination of the biologics rituximab (Rituxan) and belimumab (Benlysta) looks promising for hard-to-treat lupus. An ongoing area of research for people with refractory (difficult to treat) systemic lupus erythematosus (SLE) is whether the biologic rituximab can effectively help; so far, previous trials have been mixed. One reason, according to rheumatologist Eric Dein, MD, on RheumNow, might be that levels of a certain protein called B-cell activating factor (BAFF) “can increase after rituximab, which can lead to disease flares.” Now, new data from a preliminary study suggests that one solution might be to combine rituximab with the biologic belimumab, which decreases levels of those antibodies. In the study, 52 patients with SLE were treated with two doses of rituximab, then half were randomized to receive belimumab (every four to eight weeks, starting after their first rituximab dose) for one year while the other half got a placebo. While only 32 people completed the study, those who received belimumab had a significant reduction in levels of a certain antibody (anti-dsDNA) associated with lupus disease activity and had fewer flares than those on placebo. More research and larger trials will be needed to learn more about this treatment approach.

Fibromyalgia

Virtual reality may be a viable tool for chronic pain management in fibromyalgia. Noting that there is “an urgent need to develop widely adoptable, innovative treatment options” for people in chronic pain, British researchers conducted a small pilot study to see how fibromyalgia patients liked using virtual reality headsets/programming (such as Oculus) and whether this could be a feasible pain management tool to study further. They studied 13 patients, most of whom had never used VR before and reported severe disease with moderate pain. They each did a single session of virtual reality and then filled out various surveys about their experience. All of the participants said they would be open to using VR for future pain management and would use it regularly at home. They reported high levels of enjoyment and comfort and low levels of side effects, such as motion sickness. Previous research has demonstrated the effectiveness of VR for acute pain, but more research is needed to see how it can help treat chronic pain conditions like fibromyalgia.

Fibromyalgia stigma may affect patients’ mental and physical health. Because many chronic illnesses don’t have visible symptoms, other people often regard them as imaginary illnesses or caused by psychological problems. Not only does this take a mental toll on chronic illness patients, but research finds it may take a physical toll as well. In a German study of 162 fibromyalgia patients, reachers issued a questionnaire to evaluate the effect that stigma has on patients. As part of the questionnaire, patients were asked to rate the perceived stigma of their disease using the Chronic Pain Stigma Scale. Patients were also asked to rank disease-related variables (such as pain, stress, depression, and anxiety), and other health-related factors (such as quality of life and disease impact.)

Researchers found that perceived stigma had a great impact on patients’ mental health, physical function, and ability to cope with pain. Though perceived stigma from the general public had the greatest impact on patients’ well-being, stigma from physicians and family members also affected patients. Based on these findings, researchers believe, “assessing and addressing multi-source perceived stigmatization in routine clinical care may improve the management and well-being of patients with fibromyalgia.”

Fibromyalgia treatment should address mental and social health, as well as physical. When caring for people with chronic pain, it’s usually necessary to address not only how they feel physically, but also their emotions and ability to cope with pain. Indeed, it’s often these aspects of holistic care that strongly influence how satisfied people are with their treatment. The same group of German researchers issued a survey to fibromyalgia patients, asking patients to rank various disease variables, such as pain and general health, and psychological variables, such as depression, anxiety, and stress, on a scale of one (very unsatisfied) to 10 (very satisfied). These variables were put into four treatment categories — physio, physical, mental, and social — in order to assess satisfaction of care. Researchers found that patients surveyed were only moderately satisfied with their care in all four categories. They also found a strong association with care satisfaction and mental health outcomes. This, according to researchers, suggests that “care for chronic pain patients should also include [mental health] aspects” as well as physical aspects.

Post-workout pain and fear of fatigue are some of the things that keep fibromyalgia patients from exercising. Although fibromyalgia treatment guidelines recommend exercise as a form of pain management, sticking to a workout routine has been reported as a challenge for many patients. A group of U.K. researchers conducted in-depth telephone interviews with fibromyalgia patients to get a better idea of what factors keep them from exercising. Most patients said they experience intense pain after vigorous physical activity and, as a result, will take extra time off to recover. Another post-workout problem: fear of fatigue. Patients also noted that a lack of disease understanding from employers, loved ones, and society negatively impacts their physical activity, though the reason was not explained by the authors. Researchers believe that, “incorporating patient education with behavioral components is essential to increase adherence to and engagement with exercise and physical activity” among fibromyalgia patients. Additionally, they note that raising awareness about fibromyalgia could “increase social and workplace support,” which could also improve exercise adherence.

Mental Health

Following a mindfulness training program once a week may help patients with rheumatic diseases decrease their anxiety and stress levels. Mindfulness has been shown to help rheumatic disease patients manage the mental and emotional distress that comes with their diseases. But the perceived time commitment may turn people off. A study of 70 patients from the ArthritisPower research registry (which is run by CreakyJoints and the Global Healthy Living Foundation) evaluated and compared the effectiveness of two different-length mindfulness therapy programs — an eight-week program and a three-week program — for improving mental well-being among people with rheumatic diseases. Both programs required patients to attend one 30- to 45-minute session per week where they would learn various aspects of mindfulness, such as breathing exercises, being mindful of feelings, and combatting difficulties when practicing mindfulness. Researchers found similar reductions in anxiety and stress levels among patients in the three-week program and patients in the eight-week program. This, according to study co-author W. Benjamin Nowell, PhD, Director of Patient-Centered Research at the Global Healthy Living Foundation, suggests that “people don’t have to invest a lot of time in learning how to practice mindfulness in order to reap the benefits of it.” Read more about the research here.

Depression may have a major impact on disease activity in rheumatoid arthritis patients. Up to half of rheumatoid arthritis (RA) patients may have depression, which has been associated with high disease activity scores in past studies. To explore this further, researchers evaluated the disease activity scores of 258 rheumatoid arthritis patients with varying levels of depression. They found that RA patients who were categorized as having major depression (33.7 percent) had more tender and swollen joint counts, as well as more pain and higher disease activity scores than RA patients who had less severe depression. These findings further drive home the importance of treating mental health as part of an overall rheumatoid arthritis treatment plan.

Major psychological trauma or stress can also contribute to poor disease activity. Many rheumatic disease patients know firsthand that there’s a strong connection between significant life stress and control of their disease, but it’s validating to see scientific data that supports this. Researchers looked at survey data from 507 rheumatoid arthritis patients in Pakistan and found that 36 percent reported experiencing a major psychological stress during the preceding year, which was linked to having higher RA disease activity. (Psychological stresses were defined as major personal injury or illness; death/major illness of a close relative; marital separation/divorce; loss of job; major financial loss; or mass casualty incident loss.) “Therapies that focus on stress management may be important adjuncts to traditional pharmacotherapy in the treatment of inflammatory rheumatic diseases,” the researchers noted.

Starting biologic treatment is linked with high levels of anxiety in psoriatic arthritis patients. It’s estimated that 20 percent of psoriatic arthritis (PsA) patients deal with anxiety, though the number is likely larger due to under-reporting. But how does someone’s treatment plan affect their anxiety levels? Researchers from Turkey took a closer look at this question, evaluating anxiety levels of 520 PsA patients before they started biologic treatment, as well as anxiety levels during treatment. They found that, of the patients who had anxiety, their anxiety scores decreased between the time they started treatment and at a follow-up six months later. “Anxiety is a more frequent problem at the time of biologic initiation compared to rates observed in general PsA population, which could be related to the high disease activity,” the researchers wrote. They also noted that even though anxiety rates were still high at follow-up, they showed a trend toward decreasing that was parallel to treatment response.

Diet & Exercise

Vitamin D: Is it an inexpensive ‘disease-modifying’ drug? That’s the question rheumatologist Janet Pope, MD, posed in a RheumNow video about research on the role that vitamin D may play rheumatoid arthritis management. Vitamin D is increasingly thought to have “immunomodulatory effects,” which means it could affect the way the immune system functions. Portuguese researchers looked at a group of 236 rheumatoid arthritis patients who were about to start a biologic (most had high disease activity and had already used conventional DMARDs or glucocorticoids). They sought to study which patients would respond well to the biologic and go into remission, and whether their vitamin D levels could play a role in this. The researchers found that the proportion of patients who were good responders to a biologic was much lower in patients who had low vitamin D levels than in those whose levels were normal. Indeed, patients with normal vitamin D levels were significantly more likely to be in remission after taking a biologic than those with low vitamin D levels.

Vitamin D is inexpensive and most patients are likely to have low levels of it, especially during and right after the winter months, said Dr. Pope, who noted there’s also an association between low vitamin D and worse COVID-19 outcomes. She said that she would start asking patients about their D intake and likely start recommending supplements to most patients. Those with kidney and liver disease may need to have their vitamin D levels tested before taking supplements.

Adapting Mediterranean Diet habits may reduce disease activity and damage in people with lupus. Some studies have found that following a Mediterranean diet may help prevent or improve various inflammatory diseases. This makes sense, given the anti-inflammatory components of the Mediterranean Diet — fruits, vegetables, whole grains, and omega-3s, to name a few. To gain more insight into this, researchers surveyed 253 women with lupus to determine if there was an association between following a Mediterranean-style diet and disease activity, damage accrual and lupus-related clinical markers. Researchers assigned patients Mediterranean diet adherence scores (the higher the score, the more closely you followed the diet), as well as disease activity and damage scores. They found that the odds for having active lupus or lupus-related damage was lower among women whose diet adherence scores were higher. “[Lupus] patients would benefit from nutritional counseling and education. . . to help adapt their lifestyles toward the Mediterranean diet pattern,” researchers wrote, adding that this may “help slow the progression of lupus and the damage it causes.”

Even a little walking could reduce fatigue in people with rheumatoid arthritis. Doctors often emphasize the importance of physical exercise in managing fatigue in rheumatoid arthritis (as well as other inflammatory chronic diseases). The problem is sometimes fatigue is so powerful, it’s hard to fathom being able to exercise. But a little activity may go a long way in managing fatigue, according to a new study that evaluated the effectiveness of walking to manage fatigue in rheumatoid arthritis (RA) patients. For the study, 111 women with RA participated in a 21-day rehabilitation program that required them to walk 30 to 60 minutes a day, as well as stretch and utilize an anti-gravity treadmill. Researchers found an association between patients’ walking time and fatigue: the more they walked, the less severe their fatigue.

Family Planning

The pregnancies of partners of men with inflammatory arthritis may have a higher rate of miscarriage. While there is ample and increasing research on how having inflammatory arthritis affects pregnancy outcomes in women, less is known about the pregnancy outcomes of women whose male partners have inflammatory arthritis. Dutch researchers studied this by surveying a group of 628 men. The researchers found that pregnancies that were conceived after the male partner was diagnosed with arthritis had a slightly higher rate of miscarriage than those conceived before the arthritis diagnosis. More research is needed to see if these findings hold up in other patient populations, and what factors could be playing a role. For example, it could be that there’s something about the underlying disease process or the medications used to treat it. Or it could be that both or either the male and female partners are likely to be older once a male patient has an arthritis diagnosis, which could in turn influence miscarriage risk.

Men diagnosed with inflammatory arthritis before age 40 may have a lower fertility rate than those diagnosed later. The same research team asked the same group of male inflammatory arthritis patients a different set of questions to understand whether their age at disease diagnosis could impact their fertility rate, including their age, age at disease diagnosis, and the number of children they had. They found that men diagnosed with arthritis at younger ages had fewer children than men who were diagnosed at an older age. However, it’s unclear whether this is because something biological (such as the underlying disease or medications used to treat it) is affecting fertility, or because of non-medical factors. For example, it stands to reason that older men will generally have more children than younger men (simply because they’ve had more time to have them). Or maybe men who are diagnosed with arthritis at a younger age choose to have fewer children because of concerns about their health.

Low-dose aspirin may prevent adverse pregnancy outcomes in people with inflammatory arthritis. Past research has found that having inflammatory arthritis may increase the risk of adverse pregnancy outcomes, such as preterm birth, low birth weight, and stillbirth. Italian researchers recently looked into whether low-dose aspirin could prevent these complications in inflammatory arthritis patients, and the findings are promising. For the small study, 13 inflammatory arthritis patients received low-dose aspirin during their pregnancy while the other 32 did not. The patients treated with low-dose aspirin had a live-birth rate of 100 percent, whereas patients who were not treated had a live birth rate of 84.4 percent (27 live-birth pregnancies, three early miscarriages, one fetal loss and 1 stillbirth observed). Though further studies need to be done on the topic, the initial findings suggest low-dose aspirin may help improve pregnancy outcomes in people with inflammatory arthritis. Always talk to your doctor about which medications are safe for you to take during pregnancy.

Be Part of Research with ArthritisPower

Join CreakyJoints’ patient-centered research registry and participate in voluntary studies about managing arthritis. Learn more and sign up here.