Highlights from the last day of the American College of Rheumatology (ACR) annual meeting included topics related to vaccine updates for COVID-19, information related to the influence of the microbiome on arthritis and how resilience can have an impact on managing arthritis. Continue reading ACR 2020 Highlights: COVID-19 Vaccine Updates, Microbiome News, RA Guidelines, Mental Health in JIA and Patient Education
The American College of Rheumatology (ACR) has selected James Witter, MD, PhD, who serves on the Arthritis Foundation’s Medical and Scientific Advisory Committee, to be designated as an ACR Master, one of ACR’s highest honors. He will receive this recognition along with 17 others during the ACR’s annual meeting in November. Continue reading ACR Honors Arthritis Foundation Advisor
The highlights from day four of the American College of Rheumatology (ACR) annual meeting included topics related to bone health, managing and treating lupus, new treatment guidelines for juvenile idiopathic arthritis (JIA) and evidence-based research for osteoarthritis. Continue reading ACR 2020 Highlights: What to Eat, Bone & Joint Health, Lupus and New JIA Guidelines
Day three of the American College of Rheumatology’s annual meeting Saturday continued with sessions on biologics, osteoarthritis treatments, osteoporosis and more, a highlight was a lecture on COVID-19 by Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), and a top advisor on COVID-19.
Racial and ethnic disparities in health care and telemedicine was a focus of several presentations at the American College of Rheumatology’s annual meeting Friday, the second of the five-day virtual conference. Continue reading ACR 2020 Highlights: Racial Disparities, COVID-19, Empowering Patients and Pregnancy Among Friday Topics
Two new studies presented at the 2019 American College of Rheumatology Annual Meeting examine the role of opioid medications in treating rheumatic conditions. The first study found hospitalizations for opioid use disorder in people with osteoarthritis and other musculoskeletal disorders have surged over the past two decades. The second found that these drugs have only a small benefit for pain and function and do not significantly improve people’s quality of life. While these are just two of many studies on the topic, they highlight how complicated the treatment of chronic pain is.
The Centers for Disease Control and Prevention (CDC) has declared the opioid problem in this country an “epidemic.” Nearly 400,000 people died from opioid overdose between 1999 and 2017. Still, doctors continue to prescribe these drugs for patients who are in chronic pain.
Chronic musculoskeletal diseases, like arthritis, are among the top causes of chronic pain, so people with arthritis are at particularly high risk of receiving opioids and potentially developing an opioid use disorder (OUD), says lead study author Jasvinder Singh, MD, professor of medicine and epidemiology at the University of Alabama at Birmingham.
To understand the magnitude of the problem, Dr. Singh and his colleagues analyzed rates of OUD hospitalizations from 1998 to 2016 for five conditions: gout, osteoarthritis (OA), fibromyalgia, rheumatoid arthritis (RA) and low back pain.
Over that 19-year period, OUD-associated hospitalizations surged 24-fold for gout, nine-fold for OA and six-fold for RA. Eventually the rates of OUD leveled out for people with gout and low back pain, but continued to rise for those with OA or RA. “For some conditions, like gout and fibromyalgia and to some extent rheumatoid arthritis, we weren’t aware of how extensive the problem was,” Dr. Singh says.
Given the increasing awareness of the risks linked to opioid use, a drop in those numbers may occur as more recent data becomes available, Dr. Singh says. But until better solutions for chronic pain are available, opioids will likely remain an integral part of arthritis treatment. “We’re talking about diseases that outstrip cancer and heart disease in terms of numbers by several million in the United States. But the progress we’ve made in adequately treating pain in these conditions is somewhat limited,” he adds.
The other research presented at the conference included results from 23 studies on the efficacy of opioids in more than 11,000 people with knee and/or hip OA. The authors analyzed participants’ pain and function after two, four, eight and 12 weeks of opioid use. Although the drugs offered small improvements in pain and function after two to 12 weeks of treatment, they did not improve quality of life or depression.
“Additionally, we found that the magnitude of these effects [on pain and function] remains small and continues to decrease over time,” says lead author Raveendhara R. Bannaru, MD, PhD, director of the Center for Treatment Comparison and Integrative Analysis at Tufts Medical Center in Boston. “In light of dependency concerns and the discomfort that many patients feel while taking the drugs, it would appear that there is no optimal therapeutic window for the use of oral opioids in OA.”
Perhaps surprisingly, the authors found that strong opioids had consistently smaller effect on pain than weak opioids did. Dr. Bannaru says it’s possible that many participants who received strong opioids couldn’t reach a dose high enough to relieve their pain because they couldn’t tolerate the side effects. “Participants receiving strong opioids were twice as likely as participants receiving weak/intermediate opioids to discontinue the study due to adverse events,” he says.
Given the risk of dependency and side effects with opioids, the results of these studies should make people and their doctors more wary of these drugs. “I think that patients need to be fully informed with regard to benefits and risks,” Dr. Singh says. Having more information about opioid risks and their effects on quality of life from future studies should make it easier for patients and their doctors to choose the most appropriate pain reliever.
Author: Stephanie Watson for the Arthritis Foundation.
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Anti-TNF drugs have improved the lives of countless people with inflammatory forms of arthritis, like rheumatoid arthritis (RA). But when one of these medicines quits working, or you simply don’t respond to an anti-TNF drug, which drug might your doctor prescribe next? Physicians who have puzzled over these questions received some clues about how to treat the disease from the results of a new clinical trial presented at the 2015 American College of Rheumatology (ACR) Annual Meeting.
Anti-TNF drugs, which belong to a class of medicines known as biologics, block the action of tumor necrosis factor (TNF), a protein that promotes inflammation. Five anti-TNFs are currently on the market: adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi, Simponi Aria) and infliximab (Remicade). Since the first anti-TNF medicines became available in the late 1990s, newer biologics have been developed that don’t target TNF, but instead block the action of other inflammation-causing proteins.