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Lana Dykes is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LDykes@mjhlifesciences.com.

Articles

"All forms of arthritis can make life difficult for people because of the pain, swelling, or stiffness in a joint or joints, and because of difficulties in getting about," investigators explained. 

Probability of Employment Lower in Patients With Arthritis 

Dr. Ian Flinn explains that as a Bruton's tyrosine kinase (BTK) therapy, zanubrutinib provides an option with reduced adverse events compared with chemotherapy treatments like venetoclax.

Ian Flinn, MD, PhD: Bruton's Tyrosine Kinase Therapy Offers Fewer Adverse Events for CLL, SLL

Connor Iapoce is an associate editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

New data from the AHA 2023 Statistical Update suggest more people died from cardiovascular-related causes in 2020 than in any year since 2003. 

CVD-Related Deaths Surged During First Year of COVID-19 Pandemic 

“Our primary motivation was to help develop treatments for people with osteoarthritis that would slow or prevent the disease and be more than painkillers- actually affect the disease process itself,” Virginia Kraus, MD, explains. 

Biomarker Predicts Patients at Greater Risk of Worsening Knee Osteoarthritis 

The rheumatology condition center is a comprehensive resource for clinical news and expert insights on rheumatology. Read more at HCPLive.

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clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

Clinical Topics

Rheumatology condition center page is a comprehensive resource for clinical news and insights on rheumatologic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for arthritis, gout, nr-AxSpA, and more.

A study published in the Canadian Medical Association Journal reveals that PPIs for treating acid reflux elevate the risk of osteoporosis-related fractures.

Antacid Drugs Raise Fracture Risk

The AAPS said that many physicians have decided not to use EHRs because they fear the data will be used to control what they do and how they do it.

Should the Government Be Involved with HIT Adoption?

The fetal environment potentially preprograms the brain or endocrine system to be maladapted later in life and that patients with rheumatoid arthritis are known for having a dysregulated HPA axis, which may be affected in utero. 


High Birth Weight Leads to Rheumatoid Arthritis in Adulthood

For perhaps the first time, a social networking site geared to the young medical student or resident is now just a mouse click away. DoctorsHangout is exactly as its name implies, and so much more.

DoctorsHangout May Give Sermo a Run for Its Money

According to a team of researchers, nearly three-quarters of the patients seen at the South Infirmary-Victoria University Hospital rheumatology clinic of Cork City, Ireland, (SIVUH) have a vitamin D deficiency.

Vitamin Deficiency in Rheumatic Diseases

There are no blood tests, no biomarkers to analyze a patient for relapsing polychondritis. This very rare autoimmune disease is extremely difficult to diagnose. Unfortunately, if this condition isn't identified early and treated effectively, a patient can suffer from irreversible damage and long-term complications. 

® invited Joseph Ahearn, MD, Chair, Autoimmunity Institute, 

, to focus attention on Autoimmune Disease Awareness Month by discussing relapsing polychondritis (RP).

After talking about the recent partnership of AHN and the Relapsing Polychondritis Foundation, and the impact that their initiative will have on the future of patients with RP, Ahearn is optimistic, depite the current gaps and obstacles within the field. 

"A common thread through all of what we're saying is caring for patients with rare disease, whether it's autoimmune or otherwise," he said, "it's a combination of art and science. And we don't have enough science, and we don't have enough artists. But if we can make those discoveries and come up with a scientific test, it's going to take much less artistic expertise."

"If we can, for example, do a biopsy, like a liquid biopsy, and then we say, okay, this is what you have, this is what we're going to do," he continued, "we'll get there."

In honor of Autoimmune Disease Awareness Month, expert Dr. Joe Ahearn and advocate Michael Linn discuss relapsing polychondritis. 

The Rare Disease Report Podcast: Relapsing Polychondritis

In early February, the American College of Rheumatology (ACR) 

COVID-19 Vaccine Clinical Guidance for Patients with Rheumatic and Musculoskeletal Diseases.

This update - the fifth of its kind- featured support for booster and supplemental doses in addition to recommendations regarding the timing of the injection as well as immunomodulatory medication use.

Revisions were also made regarding pre- and post-exposure prophylaxis with monoclonal antibody treatment, which are still supported by the guidance despite some limitations being issued by the US Food and Drug Administration.

In a statement made on the day of the announcement, Jeffrey Curtis, MD, MS, MPH, Chair of the ACR COVID-19 Vaccine Guidance Task Force, said that “There is now more nuance with supplemental and booster dose recommendations that should prompt us to ask patients not only whether they have been vaccinated, but with what, how many times, and how recently.”

 to speak of the main updates included in the newest version of the guidance and the implications of these changes for patients with 

“The main updates included in the version are quite specific to trying to establish the clarity between supplemental and booster doses, te nomenclature was incredibly confusing not just for patients, but it was confusing for clinicians too,” Curtis said. “So, we've tried to harmonize and differentiate what's a supplemental dose, what's the booster dose, and to start moving away from numbering the doses just because that led to a lot of confusion.”

In addition to doing away with the numbering of doses, a more precise scheduling of supplemental and booster doses has been put in place to ensure that patients with rheumatic and musculoskeletal diseases are reaping the benefits of multiple doses.

“Certainly one of the most important messages is that rheumatologists heretofore probably we're just asking patients, have you been vaccinated and with what and hopefully when?” Curtis said. “But now it's gotten more complicated. Now, it's what dose are you on and when were you vaccinated most recently? So, a more careful history about vaccination status is important for clinicians and from a patient's perspective, if you don't know that there might be some important timing considerations, you'll just go out and get the dose that you think you should get.”

Curtis added in some cases the possibility exists where doctors can either hold medications such as rituximab temporarily or space the vaccine throughout a medication cycle so that patients have the best chance of responding to the vaccine.

The revisions to the guidance provided by ACR also apply to patients who were infected with the COVID-19 virus, though some recommendations may vary. Regarding patients who were treated with monoclonal antibodies for their COVID-19 infection, it is recommended that they wait 3 or more months to receive a vaccine dose.

Additionally, the FDA has limited the use of certain monoclonal antibody therapies that have underperformed against Omicron, the current dominant variant.

“As rheumatologists, we need to be querying patients as to how recently they were vaccinated with what in light of their treatments and their disease and their activity,” Curtis said. “Early on, everyone was just in a hurry, get them something even if the vaccine response wasn't great. Now we have a little bit more time to be thoughtful to try to get it right to the extent we know what right looks like.”

To hear more from Dr. Curtis, listen to the full episode of DocTalk above.

Dr. Curtis speaks to how the new ACR COVID-19 vaccine guidelines further protect patients with rheumatic disease.

How Rheumatology Patients Should Be Vaccinated for COVID-19  

Last week, Janssen announced results from a network meta-analysis (NMA) that showed that the biologic therapy guselkumab ranked highest for overall level of skin clearance for psoriatic arthritis. The NMA involved 33 phase 3 randomized clinical trials and 15 different targeted therapies including risakinumab and more.

Guselkumab targets interleukin (IL)-23 inhibitors, and recent approvals in 2017 and 2020 have indicated the therapy for adults with moderate-to-severe plaque psoriasis and adults with plaque psoriasis.

Philip J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington in Seattle, Washington, spoke of how the biologic distinguished itself from other targeted therapies in the network meta-analyses, and how these kinds of analyses could aid physicians in treating patients affected by psoriasis.

“I would argue that of the biologics that we use the IL-23, I think, are showing the most pristine safety profile,” Mease said. “The serious infection risk is extremely low, we don't see any malignancy risk, we don't see any weird things getting kicked up like with the TNF inhibitors.”

He added that in the absence of expensive and occasionally difficult head-to-head clinical trials, network meta-analysis have slowly become a more acceptable statistical methodology for indirectly comparing data, and that the original request for these analyses predominantly came from agencies that were attempting to make decisions about the approval and availability of drugs.

“We can't make claims in the safety arena, because these studies aren't powered for safety endpoints, but we can at least say that there was comparability or we're not seeing greater safety issues then another drug,” Mease said. “This is really, frankly, quite helpful for the patient conversation.”

The patient conversation regarding guselkumab, Mease explained, could be informed by the biologic’s safety profile, which was proven in previous clinical trials, and it’s ability to work across a wide spectrum of issues that plaque patients with psoriasis.

“When you're an experienced clinician, you've been around the block a few times (and) you've seen patients have meaningful side effects, serious infections, other kinds of things,” Mease said. “To be able to have a drug that has the biology behind it to treat each of these particular areas, skin, joints, tendon insertion sites, each of which are comprised of different they're different biological entities, to be able to crossover I think is highly important.”

Dr. Mease discusses a recent network meta-analyses that included new phase 3 data on guselkumab.

Guselkumab Ranked Highest Overall in Skin Clearance with Philip Mease, MD

DMARDs are the most commonly used treatment for patients with rheumatoid arthritis but have been linked with pneumonia and other pulmonary infections.

Pneumonia Risk in Patients on DMARD, Glucocorticoid Therapy for Rheumatoid Arthritis 

The use of cannabis was associated with more severe levels of pain, as well as more severe disease activity.

Cannabis Use Higher in Patients With Rheumatic Diseases

General practitioners and rheumatologists were viewed as sources of information that led to positive views toward vaccinations, while internet chatrooms, social media, and mainstream media were seen as sources of information that led to negative views. 

Patients With Inflammatory Arthritis Feel Positive Toward Most Vaccinations

The syndrome, although rare, has a high mortality rate, with approximately half of patients dying within 5 years of diagnosis.

VEXAS Syndrome More Prevalent Than Previous Estimates, Certain Types Of Rheumatologic Conditions

, Virginia Byers Kraus, MD, PhD, professor in the departments of Medicine, Pathology, and Orthopedic Surgery at Duke University School of Medicine and lead investigator of the study, “

A “best-in-class” systemic biomarker predictor of clinically relevant knee osteoarthritis structural and pain progression

,” discusses the multi-biomarker blood tests that could be used to predict which individuals are at a greater risk of worsening knee osteoarthritis.

“Our primary motivation was to help develop treatments for people with osteoarthritis that would slow or prevent the disease and be more than painkillers- actually affect the disease process itself,” Kraus explains.

Through a blood test that used multiple biomarkers, investigators were able to predict, with 74% accuracy, which patients at baseline were more likely to progress within the next 2 to 4 years. However, while some of the proteins were able to positively predict those at higher risk, other proteins indicated lower risk. For example, parts of the vitamin D binding protein both predicted progression and non-progression.

“The immediate application and significance is that we could partner with companies doing trials to identify the people that are most appropriate for the trials so that we could reduce the costs and the time it takes to do the trials,” Kraus emphasized. “We could get to a treatment that's really effective faster and at a much lower cost. Therefore, it would be more likely that more companies would test things and that we would get to a positive result… Having a biomarker in your drug development program increases the chance that you're going to be successful.”

Kraus emphasizes that patients with osteoarthritis should continue to be optimistic regarding possible breakthroughs in treatment. “We've seen recent breakthroughs with Alzheimer's disease, another chronic disabling condition, so I take that all with great enthusiasm and optimism that osteoarthritis will soon follow.”

Osteoarthritis

: 2023 will bring us a variety of expanded labels, some new agents with different mechanisms of actions as well as delivery systems of mechanisms of actions. I think the focus in 2023 may also be finally coming up with therapeutic alternative payment models so that pathways can be developed to better serve our patients, but also help the overall outcomes in patient care as well as reduce costs. As much as we talk about wanting to do the best for our patients, we also need to be realistic and weigh the pros and cons of the cost burden to society, as well as the cost to patient. Then on the flip side, what a little bit more cost upfront might translate into long-term, as a huge cost savings down the road? I'm excited to see what the next 13, 14 months brings as we close out 2022 and enter into 2023.

Nehad Soloman, MD, provides final thoughts on what rheumatologists can look forward to in 2023 for rheumatic disease management.

Looking Forward: Rheumatology Management in 2023

: The rheumatology workforce is a problem and has been a problem for some time. It will continue to be a problem, and by 2030, we're going to have a large problem on our hands. However, through the efforts of the American College of Rheumatology and other subcommittees, workforce committees, they are finding various solutions. Some of those solutions may include expansion of existing rheumatology fellowships. However, rheumatology fellowships in underserved demand areas are critical. Expansion in the southwest, for example, or parts of the Midwest or the mountain West, are severely underserved. We know most folks will train and then continue to practice where they train. Expanding a fellowship in a major city, a metropolis where there's tons of rheumatologists doesn't necessarily help the workforce shortage situation. The other aspect or the short-term solution is to help identify ways in which rheumatologists can increase their time practicing and decreasing the burnout and the burden if you will. Part of that is the introduction of advanced practice providers. Our group has been the forerunners, if you will, of utilization of advanced practice providers in rheumatology. We've got 37 of them at this point in our practice. They outnumber our physicians. We have nearly 20 rheumatologists practicing. Our ratio is almost a 2:1 ratio where each rheumatologist will have 2 advanced practice clinicians working under them or with them. We like to look at them as colleagues. We spend time training them, educating them, and giving them the tools to be successful while continuing to support them through practice. As these models continue to expand, my hope is an increasing number of fellowships for both PAs and nurse practitioners will arise so that they get a lot of that training before they go out into the workforce and can help struggling rheumatologists who may not necessarily have the time to train a PA or an NP. The idea isn't just to expand the workforce, but also provide quality workforce and so it's very important not to just throw an advanced practice provider into the fire, if you will, but rather give them the tools to be successful. Then the last aspect includes better education of the primary care physicians and which referrals they decide to send us, rather than just sending anybody with any ache and pain or any abnormal lab test, helping them to understand what the first steps in identification of rheumatic disease may be. That starts again, back in residency with better education and exposure to rheumatology, medical school with better education and exposure to rheumatology, increase the interest in both adult and pediatric rheumatology so that we can drive more folks to come in whether it's at the MD level, the DO level, the PA, or NP level. All those factors play a role. It is my firm hope that within the next 5 years, we'll start to impact change by implementing all these modalities.

An expert in rheumatology highlights challenges faced in the rheumatology workforce and how to optimize addressing these issues going forward.

Challenges in Rheumatology Workforce

: As we continue on in the future, in 2023 we know that Medicare amongst others are asking for alternative payment models. They're asking for us to be more defined. This is an opportunity for us as rheumatologists to pave the path forward as opposed to having somebody else tell us what to do. Some of the challenges, of course, that we face in rheumatology is that we don't have structured pathways that have been defined. For years, it's been, let's try and see what happens. We've had guidance from American College of Rheumatology in terms of guidelines, and some folks will use that to develop pathway programs. I think the challenges when dealing with payers is how do you develop a pathway program that is primarily good for patients, secondarily, a cost savings to society. Because the way it is structured, alternative payment pathways are based on a cost savings. It's based on better outcomes. It's based on precision medicine. If you can eliminate much of the trial and error approach and be more specific and exact with the outcomes of your therapy selection, then you will have success long-term in terms of cost to society, hospitalizations, comorbid conditions, comorbidities, deaths, and all of those things that add further cost to the cost burden to society.

It is my expectation that moving into 2023 and beyond that alternative payment models will include precision medicine-type testing such as the Prism RA test. Possibly methotrexate PG levels. Any type of tool that will help guide our hand in therapy, help inform us and inform our treatment decision-making to provide better outcomes for patients. Rather than just escalating methotrexate dose in the dark, polyglutamate level may help us decide whether that's necessary or not. Whether it's choosing the first biologic and which the Prism RA test, it continues to evolve, may help us make better-informed decisions for our patients. I'm hopeful that incorporation of these scientific tests and specific to the patient tests will drive payment pathways forward.

Dr Nehad Solman reviews the role of clinical pathways and alternative payment models in rheumatology as well as anticipated changes for 2023.

Alternative Payment Models in Rheumatology

: For many years, we've had no real insight as to how to treat our rheumatic disease, specifically rheumatoid arthritis. It's been a vast trial-and-error approach. We've had toxic agents such as gold and various alkylating agents used in the 60s and 70s. Then in the 80s, the immersion of methotrexate use gave many people pause since they didn't have cancer and why are we using a low-dose cancer drug? Effectively for a while, we floundered. For a good 20 years or so, we floundered until the advent of biologic agents. Biologic agents gave our patients a newfound hope. It gave rheumatologists a little bit more excitement in their life, something more that they can do to prevent disease progression. As a result of modern technology and within the last 2 decades, a relative explosion of new targeted therapies, whether it's targeted synthetic therapies such as JAK inhibitors or drugs that target B-cells or drugs that target interleukin 6 or T-cell molecules. We have choices, and yet we still are a bit in the dark as to therapy selection. And when we talk about things like precision medicine and individualized or personal patient medicine, we need therapies that can be revealed to us through testing. When we talk about precision medicine, we're talking about a test that can help us based on a patient's biology, their genetics, their individual characteristics as to which therapy selection would be appropriate. As it stands right now, we do have a molecular signature test that helps give insight to potential non-response. If there's a gene signature for non-response for TNF, we tend to sway away with about 80%, 90% confidence. That swaying away from the TNF drug will result in improvements in patients. Whereas if we don't follow or heed the advice of the test, then the likelihood of response would be 10% or less. As precision medicine continues to evolve and the holy grail, if you will, becomes viable to us, we'll be able to not only decide which therapies to stay away from, but hopefully, these tests will help us predict or model for us a path forward for our patients that are individualized and not mandated by payers or formulary restrictions.

Nehad Soloman, MD, comments on the use of precision medicine and its advantages in the field of rheumatology.

Precision Medicine in Rheumatology

: Gout is yet another condition that has been rather frustrating to treat, partially because of the lack of effective treatments, partially because of the nature of our understanding and treatment of disease, and partially because of the compliance factor of patients with gout. But as we start to change our minds about this being a more chronic systemic disease as opposed to an episodic disease, and start to implement therapies that are chronic, advise patients to come in regularly, we're going to start to see improved management of disease, improved outcomes of disease. It's exciting to see mechanisms of actions of old come back and be utilized in more aggressive fashion, especially in those patients who are tophaceous or who have erosive disease. It's also exciting to see newer mechanisms of action in development targeting URAT1 or at the level of the renal tubules to give us an option alternative to probenecid and can be used either in combination or alone with other xanthine oxidase inhibitors. That's kind of on the horizon now and we're rather excited.

Recently there has been an expansion in the label according to the FDA based on new scientific evidence in both ankylosing spondylitis as well as non-radiographic axSpA. This gives us even more tools in our belt, if you will, to help against the fight. Non-radiographic axSpA which has been a disease that has been better defined since about 2009, clearly differentiating itself from ankylosing spondylitis, requiring more aggressive therapies because of the real burden of disease for our patients. Traditionally just the TNF initially, and then ultimately a couple of IL17s with an approval within the past couple of years and now expanded label for JAK inhibitors. It's very exciting for us to have yet another tool especially when one of the most common diseases within rheumatology is osteoarthritis. In fact, it affects the greatest number of patients in the world within our panel of patients, osteoarthritis of the hands, osteoarthritis of the knees, the CMC joints. Aside from nonsteroidal anti-inflammatories, we've not had any effective options. We've got some topical over-the-counter therapies, and we dabble in a variety of different remedies. However, stem cell research now is starting to emerge specifically for osteoarthritis of the knees. We've been talking about stem cells and their ability to regenerate. We're excited. We have a couple of trials now looking specifically at stem cell injections into the knees. My expectation is as the data emerges and hopefully, the trial is successful, that within the next year or so as these trials end and submission to the FDA happens that we could within the next2 to 3 years, have a viable therapeutic option for osteoarthritis of the knees that doesn't require surgical intervention. That's where we are with osteoarthritis.

An expert in rheumatology shares updates in clinical research that may shape rheumatic disease care in the future.

Updates in Clinical and Stem Cell Research in Rheumatic Diseases

: Recently there have been new developments and expansion of label in upadacitinib for treatment of ankylosing spondylitis as well as nr-axSpA. Additionally, there have been updated label changes in gout products, for example, Krystexxa® with the co-administration of immunomodulation to help mitigate risks of infusion reactions as well as improve longevity on drug. There are new drugs that have been approved for the treatment of lupus as well as lupus nephritis. It's an exciting time in rheumatology now where some of these diseases that have been long ignored or have not had a good armamentarium of treatments now are increasing in interest in research as well as coming to market.

It's very exciting. On the horizon in 2023, there's an expectation of multiple submissions to the FDA currently engaged in quite a few clinical trials. One of which is for lupus nephritis and an exciting product that targets interferon in the treatment of lupus nephritis. Additionally, there's an IL17 AF that is going to be submitted for approval as well as an IL17 infusible. As the landscape starts to change, there will be more available options for our patients, both Medicare-aged as well as younger. In addition to help treat our patients who are going to have more options as well. As I mentioned earlier, these long-ignored diseases, have now new hope and new light for us. As we continue on in the 21st century, the pipeline of biologics continues to emerge and newer mechanisms of action continue to emerge as well.

As we know, lupus nephritis is one of the more dangerous and life-threatening components of systemic lupus erythematosus. It is exciting to know that since the end of 2020, we've had a couple of more options as add-on therapies available to us for folks with class 3, class 4, class 5 lupus nephritis with rather favorable outcomes in terms of tapering of steroids rapidly thereby mitigating complications of long-term steroid use in addition improvement in proteinuria as well as improvement in hematuria and renal function. It continues to be exciting for us in the rheumatology space to be able to have yet another agent available to us in this fight against lupus nephritis.

Dr Nehad Soloman provides insight on recent approvals and upcoming FDA submissions in biosimilars, including for lupus nephritis, and how they may change the course of rheumatic disease management moving forward.

Recent Approvals and Upcoming FDA Submissions in Rheumatic Diseases

: With the advent of Humira® biosimilars coming out in 2023, there will be a great impact in the management of rheumatoid arthritis. We already have a lot of experience with biosimilars with the originator molecule being Remicade. And experientially we've seen payers push towards use of biosimilars. We've seen mandates of non-medical switching. I expect nothing different in the upcoming year, as multiple Humira® biosimilars are going to be launched simultaneously. And with the new efforts of the current administration looking to cut costs and help with inflationary increases, my guess would be a bigger push towards increased utilization of Humira® biosimilars.

As increased utilization of biosimilars has occurred already in the last several years and the expectation of more biosimilars to come out in 2023 biosimilar for Humira®, several of them now, it is my firm belief that we're going to disrupt the market in many ways. I know right now that there's some uncertainty amongst rheumatologists about non-medical switching. Certainly, for first-line use, it makes sense if they're biologic-naive but if they're stable on the originator molecule, it is my firm belief that they should stay on what's working for them because as the name states, they're biosimilar, not bioexact. Experientially, for some of our patients that have switched over from drugs like Remicade® and gone on to the biosimilar products, or even from one biosimilar to another, some have had infusion reactions, some have had untoward effects, and some have had a loss or a lack of benefit. That speaks to the fact that not all these drugs are equal. Although cost-cutting and being economically sensitive is important in our field, it's also paramount that we put patient care first and patient safety first.

Nehad Soloman, MD, discusses the impact of new biosimilars to become available in the U.S. in 2023 on rheumatic disease management.

Biosimilars in Rheumatology in 2023

Tarun Sharma, MD, a rheumatologist with the Allegheny Health Network who helped author the American College of Rheumatology's most recent gout guidelines, sits down to provide perspective on the latest updates in gout from 2022, including new trial data, regulatory news and updates, and a glimpse into what he is most excited for in 2023.

Gout

Clinical Updates in Gout Management, with Tarun Sharma, MD

Philip Mease, MD, explains the results of his recent American College of Rheumatology Convergence 2022 presentation, “Efficacy of Guselkumab in Three Cohorts of Biologic-Naïve PsA Patients with Axial Involvement Defined Based on Imaging and Machine-Learning Criteria: Pooled Analysis of 2 Phase 3 Studies,” in which patients treated with guselkumab reported significant and clinically meaningful improvements across a variety of domains as early as week 8. Mease is a rheumatologist and Director of Rheumatology Research at the Swedish Medical Center/Providence-St Joseph Health.

“About 40%, more or less, of patients with psoriatic arthritis (PsA) have evidence of inflammatory spine disease,” Mease stated. “When you look at the back and the sacroiliac joints, it's very similar to patients with ankylosing spondylitis.”

In the post-hoc analysis, efficacy was assessed using a variety of measures, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), spinal pain, morning stiffness, and the Ankylosing Spondylitis Disease Activity Score (ASDAS).

“They also, interestingly, had another group in which they applied machine learning technology, artificial intelligence technology, to the phase 3 datasets,” Mease noted. “In that, they found a cluster of patients who all had back pain, who had back involvement, or spine involvement and other characteristics.”

Both groups reported nearly identical improvements in BASDAI, ASDAS, spine pain, and spine involvement.

“The purpose of this abstract was simply to show that by 2 different methods of identifying patients with axPsA, including this artificial intelligence approach, they came out with basically the same outcomes with positive improvement of symptoms of axPsA,” Mease emphasized.

Two methods of identifying patients with axPsA, including an artificial intelligence approach, reported nearly identical outcomes with positive improvement of symptoms of axPsA. 

Psoriatic Arthritis

Conference

Philip Mease, MD: Guselkumab Effectively Treats Biologic-Naïve Patients with PsA and Axial Involvement 

It’s important for us to understand that we treat the whole patient, and we treat the whole patient in the circumstances that surround us. And the circumstance that surrounds us now is COVID-19. Sometimes, it brings families closer together because they’re sheltering in place, and that helps with their support group. But sometimes, it’s the opposite. Sometimes, an older parent can’t be around their kids because their kids are sick, or their kids have little kids who are sick. And they don’t have the support. It’s good to keep all those factors in mind when we’re prescribing things. Sometimes an infusion is better, and sometimes a self-injection, for instance, like a repository corticotropin injection, might be easier than coming in to get an infusion. And in some ways, it may be more effective. We have to take into account all the factors with our patients, their support systems, their ability to come in and get treatment, their ability to get the monitoring that they need. All those are important things. Any comments you want to make on that?

 I totally agree. I tell my patients if you want black and white, then this is not the specialty for you. We are many shades of gray, and our decisions are individualized and based on our best opinion.

: I like to say, that absence of evidence is not evidence of absence. Just because you’re paranoid, doesn’t mean that people are out to get you. My professor used to say, “I don’t know what he’s got, but he’s got something.” And sometimes what we have to do is use the information available and go with it. I had a patient who had a bad inflammatory myopathy, early in the pandemic. I wanted to get a muscle biopsy on her, and there were no elective procedures, so I couldn’t do it. I had to go ahead and treat her. And now, doing the muscle biopsy isn’t going to be that helpful because we’re pretty far along. I’m having some trouble tapering her off of her oral prednisone. And I’ve found that repository corticotropin is a good way to help taper because of its effect on melanocortin type 2 receptors in the adrenal cortex. It’s sort of helping the adrenal cortex to work, and to wake up and do its job, so you can give fewer oral steroids.

 It has both, like you mentioned, direct and indirect properties. The percentage of engagement with the adrenal cortex is minimal. That’s the other special sauce, as you might want to call it.

: Yes. Well, we’ve covered a lot of ground today about treatment options for systemic lupus erythematosus and idiopathic inflammatory myopathies. What advice would you have for community physicians treating rare systemic autoimmune rheumatic diseases?

 Don’t be afraid to say, “I don’t know.” These are rare conditions, and even we’re not seeing them every day. But a good physical history, there are some serologies that are available, that anyone can order, and try to connect the dots with other subspecialties. If it doesn’t make sense, and if they’re having multiple organs involved, and you can’t quite tie a diagnosis, rheumatologists might be the missing link.

: I like that, the rheumatologist might be the missing link. That sounds great. I say exactly the same thing, that we’re here to help. Please use us as a resource. And we want to work with you and help you to work with things that are rare. I completely agree that common things are common, and not much of what we do is. And certainly, since we don’t have necessarily a light switch that says on and off for our diseases, it takes a lot of clinical judgment, and it takes a lot of working with the patient, following the patient. And sometimes it evolves over time. We might think it’s one thing, and it turns out that it’s something else. I completely agree with everything you have to say. And I think that’s great advice for community physicians. Do you have any final comments before I make closing remarks?

 I look forward to the good old days, where we can all get together in person, and not have to socially distance ourselves and not worry about unvaccinated individuals. And I wish everyone health and the very best.

Well, this has been delightful, and I’ve really enjoyed talking with you. I hope we get to do this again sometime. I want to thank all those out there who are watching this 

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Closing out their discussion, experts highlight practical advice for caring for patients with SARDs in the current treatment landscape. 

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