Rheumatology Month in Review: May 2023

Article

The rheumatology month in review highlights a program developed by Janssen to support health equity in patients with psoriatic disease, the increased risks pregnant women with rheumatic diseases face, and trends in fibromyalgia management.

The Latest Fibromyalgia Data

Fibromyalgia impacts patients in a variety of ways, including an increased risk of comorbidities, such as celiac disease and irritable bowel syndrome (IBS), as well as an increased likelihood of developing anxiety and depression. Results of a recent study showed patients with fibromyalgia tended to have lower physical activity levels when compared with healthy controls, in part due to pain. However, programs, such as the telerehabilitation intervention highlighted below, have been proven to improve quality of life in this patient population.

Fibromyalgia Significantly Linked to Benign Gastrointestinal Disorders

Investigators performed a study using data from the largest health maintenance organization in Israel. The link between fibromyalgia and benign gastrointestinal disorders, including IBS, peptic ulcer disease (PUD), celiac disease, gastroesophageal reflux disease (GERD), ulcerative colitis, and Crohn’s disease, as well as gastrointestinal malignancies such as stomach, liver, pancreatic, colorectal, and bile duct cancers, was evaluated.

A fibromyalgia diagnosis was significantly associated with GERD, PUD, IBS, Crohn’s disease, ulcerative colitis, and celiac disease. Compared with controls, patients with fibromyalgia had a higher prevalence of IBS (4.8% vs 1.1%, respectively), celiac disease (.7 vs .4%, respectively), Crohn’s disease (.8% vs .4%, respectively), and ulcerative colitis (.6% vs .4%, respectively).

However, no significant differences were observed regarding gastrointestinal malignancies between patients with fibromyalgia compared with the controls.

Reduced Physical Activity Levels Observed in Patients With Fibromyalgia

While exercise has been deemed beneficial in the management of fibromyalgia, the symptoms of the condition can create barriers that discourage exercise, including the belief that exercise may intensify symptoms. Other anecdotal data also showed that most patients with fibromyalgia lead a sedentary lifestyle.

The case-control study included 70 patients with fibromyalgia and 50 age- and gender-matched controls. Patients with fibromyalgia reported significantly less recreational, transportation-related, and total physical activity levels when compared with controls., They also reported significantly less time spent walking and in vigorous activities when compared with healthy individuals.

Telerehabilitation Improves Quality of Life in Patients With Fibromyalgia

Pooled results of a systematic review of randomized controlled trials proved that telerehabilitation improved the Fibromyalgia Impact Questionnaire (FIQ) score and quality of life in patients with fibromyalgia when compared with controls. The intervention also improved depression levels, pain intensity, and pain catastrophizing in this patient population.

“Telerehabilitation can provide accessible and continuous rehabilitation medical services for patients with fibromyalgia who cannot attend traditional face-to-face services or are geographically remote, and it could enable patients to manage their disease at any time and place in a timely and appropriate manner,” wrote Mao-Yuan Wang, PhD, Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, China, and colleagues.

Healthy Equity in Rheumatic Disease

Janssen Develops Programs to Support Health Equity in Psoriatic Disease

Soumya Chakravarty, MD, PhD, FACP, FACR, Senior Director, Strategic Lead, Janssen Rheumatology, and Daphne Chan, PhD, Head of Dermatology Medical Affairs, Janssen, highlighted Janssen’s recent programs designed to reduce health inequity in patients living with psoriatic disease.

The team developed 2 potential solutions collaboratively with the community. The first is a patient navigation program and the second is a concept called "Beyond the Textbook," which provides healthcare providers with culturally inclusive resources to navigate conversations around psoriatic disease in patients of color.

Chan and Chakravarty discovered a lack of information and representation regarding simple images of psoriatic disease, including plaques and psoriatic arthritis in patients of color.

Pregnancy Outcomes in Women With Rheumatic Disease

Pregnant women with rheumatic disease are at an increased risk of a multitude of adverse events, including preeclampsia and placental disorders. These risks may also extend to the fetus and child, including new research that maternal rheumatoid arthritis is linked to an increased risk of Autism Spectrum Disorder (ASD).

However, recent data demonstrated that monitoring 25-hydropxy vitamin D levels can lower the risk of miscarriage and premature delivery in pregnant women with lupus.

CCR East: Study Offers Overview of Pregnancy Outcomes in Takayasu Arteritis

Described by the American College of Rheumatology as a rare form of vasculitis disease characterized by inflammation of the aorta and main branches, Takayasu arteritis poses a significant threat to quality of life for patients.

Raksadawan and Sabahat Usmani, MD, of Louis A. Weiss Memorial Hospital, launched the current study with the intent of exploring the effect of Takayasu arteritis on delivery outcomes as a follow-up to a previous research examining effects on other outcomes.

“While [Takayasu arteritis] patients had a significantly higher rate of comorbidities: gestational hypertension, thyroid disorders, and increased incidence of genitourinary infections, [the condition] does not seem to cause adverse outcomes during the delivery period,” wrote investigators.

Vitamin D Levels Can Influence Risk of Miscarriage, Premature Delivery in Women with Lupus

Results of a study presented by at the Congress of Clinical Rheumatology (CCR) East 2023 annual meeting, which examined the role of 25-hydroxy vitamin D insufficiency and BMI on adverse pregnancy outcomes in systemic lupus erythematosus (SLE), describe the presence of a U-shaped curve association between maternal serum 25-hydropxy vitamin D level and adverse pregnancy outcomes. The lowest prevalence of adverse pregnancy outcomes observed among those with a maternal vitamin D level of 40-59 ng/dL.

Further analysis suggested the same trend was present when miscarriage and premature deliveries were examined separately but this P value failed to reach statistical significance, which investigators attribute to smaller numbers.

Maternal RA Linked to Increased Risk of Autism Spectrum Disorder in Children

In a cohort of Swedish mothers, a rheumatoid arthritis (RA) diagnosis before delivery was linked to an increased risk of offspring ASD. The association between maternal arthralgia and ASD indicated other pathways of risk than autoimmunity and inflammation, acting jointly or independently of RA.

The prospective, population-based cohort study included all children born alive in Sweden between 1995 and 2015, with a follow-up period through 2017. Of the 3629 children born to mothers with an RA diagnosis, 1.94% (n = 70) were ultimately diagnoses with ASD, compared with 1.92% (n = 28,892) of 1,503,908 children born to mothers without RA.

A maternal RA diagnosis before delivery was linked to an increased risk of offspring with ASD (HR = 1.43, 95% CI 1.11–1.84), particularly for those with seronegative RA (HR = 1.61, 95% CI 1.12–2.30).

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