ACR24 RA Panel Key Discussions on Rheumatoid Arthritis
Dec 3, 2024
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Rheumatologists Eric Dein from Atlantic Health, Jiha Lee from the University of Michigan, and Jeffrey Spark from Harvard Medical School dive into crucial topics surrounding rheumatoid arthritis. They discuss the importance of statin prescription amidst cardiovascular risks and the challenges of steroid use, particularly for elderly patients. Innovations in remote monitoring with smartphone technology and AI are highlighted, alongside a study aimed at improving fertility for women with RA, showcasing advancements in tailored treatment strategies.
The underutilization of statins among rheumatoid arthritis patients on tofacitinib highlights the urgent need for cardiovascular risk assessments by rheumatologists.
Long-term glucocorticoid use in rheumatoid arthritis patients significantly increases mortality risks, emphasizing the importance of careful medication management and discontinuation strategies.
Deep dives
The Importance of Optimizing Statin Use in Patients on Tofacitinib
Research presented highlighted the underutilization of statins among rheumatoid arthritis patients taking tofacitinib, particularly those with a history of cardiovascular disease. Among patients identified with pre-existing cardiovascular conditions, only half were on a statin, with a mere 14% on high-intensity therapy. Notably, the analysis showed that those patients on a statin had similar major adverse cardiovascular events (MACE) as those on adalimumab, indicating that proper management of comorbidities could mitigate risks associated with tofacitinib. This emphasizes the need for rheumatologists to prioritize cardiovascular risk assessments and therapy optimization to enhance patient safety and efficacy of treatments.
Long-Term Risks of Glucocorticoid Use
A study examining the long-term mortality risks associated with glucocorticoid use in rheumatoid arthritis patients revealed significant findings regarding cardiovascular disease and infections. It was shown that patients who had been on glucocorticoids for over two years continued to show elevated mortality risks long after stopping the medication. There was a quantifiable increase in mortality for each year of glucocorticoid use, with a gradual decline post-cessation, but risks remained significantly heightened for those with prolonged exposure. This underscores the critical need for careful management and prompt discontinuation of glucocorticoids whenever possible to reduce long-term health consequences.
The Challenge of Treating Late-Onset Rheumatoid Arthritis
A recent study explored the unique characteristics and challenges associated with late-onset rheumatoid arthritis, characterized by diagnoses in individuals aged 65 and older. Compared to younger patients, those diagnosed later typically exhibited higher disease activity and were more likely to present with erosive changes, yet they received less aggressive treatment. The data indicated that this group often experienced a diminished sex disparity, with an increased likelihood of being seronegative and less likely to receive biologics. This highlights a critical gap in care where health professionals must become more aware of the particular needs of older patients and adjust treatment approaches accordingly to ensure they are receiving optimal care.
Advancements in Remote Patient Monitoring for Rheumatology
Innovations in digital health were discussed, particularly the development of a remote patient monitoring system that assesses joint swelling through photographic analysis of finger skin folds. This technology allows patients to capture images of their fingers, which software then analyzes to determine the degree of swelling, enhancing the efficiency of monitoring between clinic visits. Such advancements address the ongoing rheumatologist shortage by facilitating better and more timely patient evaluations. This approach could transform rheumatological care by enabling remote assessments and prioritizing patient needs, potentially reducing disparities in access to care.