5 Things I Learned at EULAR


A rheumatologist picks 5 studies he found particularly noteworthy at EULAR and gets right to the point about their potential clinical implications.

I’ve attended the recent EULAR Annual Meeting in Rome, and I've selected 5 interesting studies to report on.


#1. Do Not Fear Hydroxychloroquine Retinopathy, Unless ...


The study looks at the American Academy of Ophthalmology revised recommendations regarding screening for hydroxychloroquine (HCQ), published in 2011. “Only 0.6% of the rheumatologists and 19% of the ophthalmologists were aware of the recommended ophthalmologic assessments for baseline and follow up evaluation.” “Use of inappropriate tests to detect HCQ retinal toxicity may lead to unnecessary cessation of beneficial HCQ treatment while lack of consideration of risk factors may pose patients at risk for toxicity.”

Risk factors for retinal toxicity are:

. Therapy duration of more than 5 years

. Cumulative dose of more than 1000 g

. Daily dose of more than 400 mg

. Kidney or liver failure, and macular disease

. Advanced age


By J. Wollman, S. Shulman, S. Brikman, et al. Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. Assessment of the implementation of the revised recommendations for screening of hydroxychloroquine retinopathy in the clinical practice of opthalmologists and rheumatologists. Abstract #THU0405 DOI: 10.1136/annrheumdis-2015-eular.6050


#2. Is Erosive Hand Osteoarthritis Its Own Entity?


Ultrasound and MRI show a prevalence of synovitis in osteoarthritis, that is inflammation. This study shows that inflammation is independent of erosive hand osteoarthritis but is associated with the degree of joint damage.

The authors conclude that erosive hand osteoarthritis is a more severe form of osteoarthritis rather than a separate entity.


By A. Mathiessen1, I.K. Haugen1, PS Robinson 1,et al. 1Rheumatology, Diakonhjemmet Hospital, Oslo; 2Faculty of Medicine, University of Oslo; 3NKRR, Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. Erosive hand osteoarthritis (OA): A separate inflammatory entity or a severe form of OA? Abstract #THU0448 DOI: 10.1136/annrheumdis-2015-eular.3617


#3. Induction of Antinuclear Antibodies in Spondyloarthritis


Antinuclear antibodies (ANA) may develop in patients receiving TNF inhibitors (TNFi) like infliximab, adalimumab, and golimumab. The authors found a meaningful degree of such “seroconversion” – a rate of 45.2%, with a median time of 22 months. Therefore, the development of ANA after TNFi in patients with spondyloarthritis may “affect clinical response with worse outcomes.”

I think maybe a small dose of methotrexate may alter this path, but a prospective study has yet to come.


By R. Fonseca, R. Vieira, P. Madureira, et al. Rheumatology, Sao Joao Hospital Centre, Porto, Portugal. The induction of antinuclear antibodies in spondyloarthritis patients under anti-TNF-alpha: a new outcome predictor? Abstract #THU0225 DOI: 10.1136/annrheumdis-2015-eular.4095


#4. Substance P in Rheumatoid Arthritis


Substance P (SP) is increased in serum and synovial fluid of patients with rheumatoid arthritis. (I have been looking at substance P in terms of elevated levels in cerebrospinal fluid of fibromyalgia patients.) But this study shows a correlation between substance P serum levels in patients with rheumatoid arthritis and controls as well as in patients “in remission or with different grades of disease activity.”

The authors conclude that substance P may be a potential biomarker for the activity of rheumatoid arthritis.


By R.E. Barbosa-Cobos 1, L.T. Becerril-Mendoza 1, G. Lugo-Zamudio 1, P. Rodriguez-Henriquez 2, J.J. Flores-Estrada 3, R. Monter-Vera 4, H.I. Rocha-Gonzalez 5, R.I. Castillo-Castaneda 1, M.N. Medina-Pastor 6, J.D. Toscano-Garibay 3. 1Rheumatology, Hospital Juarez de Mexico; 2Rheumatology, Hospital General Dr. Manuel Gea Gonzalez; 3Research Division; 4Clinical laboratory, Hospital Juarez de Mexico; 5Escuela Superior de Medicina del Instituto Politecnico Nacional, Ciudad de Mexico; 6Internal medicine, Hospital General de Zona no. 58 IMSS, Estado de Mexico, Mexico. Correlation between substance P serum levels and disease activity in rheumatoid arthritis. Abstract #FRI0053 DOI: 10.1136/annrheumdis-2015-eular.6039


#5. What’s New in Fibromyalgia?


Professor Crofford gave a talk on new developments in the field of fibromyalgia. I picked up only 2 or 3 highlights. Dr Crofford looked at the refocused attention on peripheral mechanisms and the search for evidence for “involvement of cytokines, oxidative stress, and mitochondrial dysfunction.” She stressed that there is only “limited effectiveness of available pharmacologic treatments.” Using nonpharmacologic treatment modalities becomes more important.

Thank you, Dr Crofford, for the last 2 statements because we have been treating patients without drugs and with a multimodal approach at our center since the late 1990s.


L.J. Crofford. Vanderbilt University, Nashville, United States. Fibromyalgia: What is new. Abstract #SP0131 DOI: 10.1136/annrheumdis-2015-eular.6770


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