Earlier, aggressive therapy prompts 'good news' for RA outcomes
SAN DIEGO — Early recognition and targeted, aggressive treatment have led to improved outcomes and fewer hospitalizations in rheumatoid arthritis, according to a presentation at the 2019 Congress of Clinical Rheumatology West.
Jeffrey A. Sparks, MD, assistant professor of medicine in the division of rheumatology, immunology and allergy at Brigham and Women’s Hospital, opened his talk with a snapshot of the life of a patient with RA, from birth, to onset of symptoms, undifferentiated arthritis, and then RA. “We are trying to understand things at each of these phases, and see if we can stop progression,” he said.
He also covered biomarkers, outcomes and practice considerations, and included some rare bits of good news for rheumatologists to celebrate.
The impact of CCP levels on progression to RA is an important potential target for research and treatment. “If the patient is mild positive for CCP, these people are unlikely to progress to rheumatoid arthritis,” Sparks said. “Those with high positive levels of CCP are at a sixfold risk for RA.”
Looking at other potential markers of RA onset, Sparks said that 3 to 6 years prior to diagnosis, ACPA antibodies, anti-carbamylated antigen antibodies, rheumatoid factor and cytokines also increase. “They are all increasing in concert,” he said. “This information could be used clinically to help diagnose patients.”
Sparks then pointed out the importance of smoking and BMI in RA risk. Namely, although smoking has declined, BMI in the U.S. population is increasing. “Some things are getting better and some things are getting worse,” he said. “It is important for your patients and their family members to know that it is not all luck, that there are modifiable factors in preventing RA.”
Regarding outcomes, Sparks believes there is “a lot of good news in RA,” including less joint progression and less disability.
“The thing that sticks out, however, is that RA-associated interstitial lung disease seems to be increasing,” he said. Researchers have targeted malondialdehyde-acetaldehyde as a potential biomarker for RA-associated interstitial lung disease, but the science is not quite ready for prime time.
More aggressive treatment approaches may also be having a positive impact on outcomes, according to Sparks. “Increased recognition may lead to lower mortality and increased remission,” he said. “We have been successful at not only treating patients with RA, but probably finding them earlier.”
In addition, hospitalizations for RA have also decreased. “Circulatory, respiratory and musculoskeletal outcomes are all getting better,” he said.
Turning his attention to practice considerations, Sparks suggested that treating to target and documenting disease activity could lead to improved outcomes. However, he warned that using MRI to guide treatment may be a thing of the past. “We have seen that MRI did not help reach outcomes,” he said. “There is pretty good evidence that we do not need to use MRI to reach target goals.” – by Rob Volansky
Sparks J. Update on RA. Presented at: Clinical Congress of Rheumatology West. September 26-29, 2019; San Diego.
Disclosure: Sparks reports receiving research support to Brigham and Women’s Hospital from Amgen, Bristol-Myers Squibb, the NIH and the Rheumatology Research Foundation; and consulting for Gilead, Janssen and Optum.