New research and recommendations were presented at ACR/ARHP 2018, the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting, from October 19 to 24 in Chicago. The features below highlight key presentations from the conference.
Post-Transplant Lupus Nephritis Recurrence
Previous studies have shown a variable rate of recurrent lupus nephritis in renal transplant patients, ranging from 3% to 46%. To determine the impact of a newer posttransplant immunosuppressive regimen consisting of tacrolimus and mycophenolate mofetil instead of cyclosporine and azathioprine in addition to prednisone, researchers investigated the recurrence of lupus nephritis among patients with end-stage renal disease secondary to lupus nephritis who underwent transplantation. Among participants, 11% had biopsy-proven lupus nephritis recurrence. During a median follow-up of 1,230 days, 26% experienced graft loss or death. Patients with recurrence showed a trend for increased risk of graft loss or death.
A Treat-to-Target Approach to Optimal RA Medication
With personal experiences indicating that changing clinical practice patterns and incorporating patient-reported outcome measures (PROMs) for disease activity assessment into routine workflow is challenging, study investigators sought to integrate a treat-to-target (TTT) approach for medication optimization for patients with rheumatoid arthritis in their practice through: 1) a reliable system to collect disease activity scores (PROMs) using iPads in the waiting room, 2) a multidisciplinary learning collaborative for providers focused on TTT, and 3) incorporation of patient perspectives on shared decision making and treatment satisfaction. Rheumatologists were allocated to either an intervention or control group. Phone calls were made to patients of physicians in the intervention group following a medication change to measure treatment satisfaction using the 100-point Treatment Satisfaction Questionnaire for Medication (TSQM) and use of SDM through the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Mean TTT scores were 9% higher in the intervention group (43% vs 34%). Among phone calls completed by the intervention group, median TSQM score components were 75 for effectiveness, 92 for side effects, 100 for convenience, and 83 for global satisfaction. The median SDM-Q-9 score was 96.
Boosting Immune Response in RA Patients
Research shows that the 1.3 million people living with rheumatoid arthritis (RA) in the United States are at increased risk for severe influenza. For a study, antibody responses were assessed in adults with seropositive rheumatoid arthritis who were recruited during the 2016/17 and 2017/18 flu seasons and randomized to a high- or standard-dose flu vaccine. Upon logistic regression analysis, those in the high-dose group were 2.8, 2.0, and 2.3 times more likely to seroconvert to the H3N2, B/Brisbane, and H1N1 flu subtypes, respectively. Neither group displayed evidence of increased RA disease activity in the month following vaccination. The few serious adverse events that occurred in both groups were unrelated to the vaccine. Vaccine dose and age were the only predictors of patient response.
Sexual Dysfunction in Mew With Lupus
Although multiple studies have assessed sexual function in women with systemic lupus erythematosus (SLE), little is known regarding the impact of SLE-associated physical and psychological aspects on sexual function in men. Men aged 16 and older with SLE who were sexually active during the previous 6 months completed the International Index of Erectile Function-15 (IIEF-15) and the SF-36 (which determines generic health-related quality of life) questionnaires for a study. Positive correlations were observed between IIEF-15 and SF-36 scores. A weak correlation was found between oxidized low-density lipoprotein levels and global IIEF-15. The 50% of participants who had some degree of erectile dysfunction were older, had a lower educational level, and had a higher prevalence of type 2 diabetes when compared with those without erectile dysfunction.
Opioids for Osteoarthritis
Recommended treatment approaches for patients with osteoarthritis (OA) are inconsistent in regard to the use of opioids, and data are lacking on whether OA pain is appropriately managed with opioids in clinical practice. While opioids are not contraindicated in OA treatment, the positive risk-benefit ratio of these agents depends upon appropriate use, which has been shown to often not occur. For a study, researchers assessed the prevalence of inappropriate pain management in a real-world setting and developed criteria to identify it. They found that patients on double-barreled, long-acting opioids were at the highest risk for inappropriate paint management (83%), compared with 32% of those on intermittent daily doses of opioids. Among those using nonopioid analgesics, overuse was seen among 15%, and overuse was observed among 14% of patients using osteoarthritis-related medical services.