A huge barrier to obtaining remission in rheumatoid arthritis… pun intended
Obesity Halves Chance for RA Remission, Study Suggests
Janis Kelly writing in Medscape reported rheumatoid arthritis (RA) remission rates were significantly lower among patients who were obese compared with nonobese patients, according to a systematic review and meta-analysis reported in an article in Arthritis Care & Research. The authors also found that disease activity scores were significantly higher and call for studies to determine whether interventions to reduce body mass index (BMI) might also improve outcomes in RA.
Coauthor Gilaad G. Kaplan, MD, MPH, told Medscape Medical News, “Obesity is a growing problem for society. Our work adds another negative stigma to the obesity epidemic…[O]bese patients who are diagnosed with [RA] are more likely to fare worse than nonobese individuals with [RA]. Because obesity is a modifiable risk factor, future studies are needed to determine whether adding weight loss to a treatment plan will improve outcomes for these patients.”
Comment: Obesity is a growing epidemic. We need to inform patients with rheumatoid arthritis that they need to lose weight.
A workhorse drug for rheumatoid arthritis causing an excessive number of deaths in Australia
Eight Deaths Linked to Methotrexate in Australia
Dr. Jack Cush writing in Rheumnow reported methotrexate (MTX), a cornerstone drug used to treat rheumatoid arthritis (RA), has led to 90 hospitalizations and 8 deaths according to a recent report from the Medical Journal of Australia.
Many of these events were the result of inappropriate higher or more frequent doses than that prescribed. Such practices led to gastrointestinal tract ulceration, liver toxicity, bone marrow suppression, septicemia, and death.
In a nationwide search of MTX-related death rates, three datasets discovered that over 90 dosing error cases were reported from 2004 to 2015.
Twenty-two died from taking MTX, but only 7 deaths were directly attributed to overdosing. The United States Food and Drug Administration has noted 25 MTX deaths over a four-year timeframe.
The authors recommended changes in packaging and tablet appearance to reduce the incidence of these events.
Comment: Methotrexate is still the disease modifying drug of choice for rheumatoid arthritis. It has to be monitored though.
Most Patients Do Not Store Their Biologic Drugs Within the Recommended Temperature Range
Dr. Kevin Deane writing in Medscape reported on a Dutch study which evaluated the temperatures at which patients with rheumatic diseases stored their biologic disease-modifying antirheumatic drugs (DMARDs). They did this by providing patients with an electronic temperature logger.
Of the 293 study participants given a temperature logger, 255 (87.0%) returned their logger to the pharmacy. Of these 255 participants, only 17 (6.7%) had stored their medication within the recommended temperature range. Of those who did not, 24.3% stored their medication for more than 2 hours outside of the recommended range.
The authors did not evaluate the effect of these storage conditions on the biologic activity of the medication but speculated that storing these medications outside of the recommended temperature range may adversely affect their efficacy.
Comment: It’s important to know what the temperature restrictions are for your medication.
For years, patients taking methotrexate have been told by rheumatologists to avoid alcohol altogether. Maybe these rheumatologists were wrong… next
Moderate Alcohol Intake While on Methotrexate Appears Prudent
Research presented at the annual British Society for Rheumatology conference revealed that rheumatoid arthritis (RA) patients who drink moderately while taking methotrexate (MTX) appear to be at no greater risk for liver damage than nondrinkers. They found the risk of increased liver function tests were not different between drinkers and nondrinkers. In the UK, it is advised that patients keep their alcoholic intake under 14 units per week. Similar to practitioners in the United States, UK rheumatologists tend to restrict alcohol consumption by their patients, as they believe alcohol to be hepatotoxic. But the evidence supporting a presumed adverse interaction is scant.
Dr. Jenny Humphreys of the Arthritis Research U.K. Centre for Epidemiology at the University of Manchesterl presented findings from a database of more than 8,000 RA patients who started MTX between 1987 and 2011. They correlated alcohol intake with routinely collected serum alanine or aspartate aminotransferase (ALT/AST) levels.
With 38,000 person-years of follow-up, they found 241 patients with abnormal LFTs (ALT/AST levels more than three times the upper limit of normal). The incidence rates of abnormal LFTs per 1,000 person-years was 5.58 in nondrinkers, 5.57 in those who drank 1-7 units of alcohol per week, 5.99 in those who drank 8-14 units, 7.58 in those who drank 15-21 units, 8.61 in those who drank 22-28 units, and 9.05 in those who drank more than 28 units.
They concluded that alcohol consumption does not significantly increase your risk of abnormal LFTs, especially if you drink less than 14 units a week. Hence, moderation appears to be prudent.
Comment: Good news. By the way, a drink contains anywhere from 1-3 units depending on the alcohol content.
Expert advice about shingles vaccine in rheumatoid arthritis
Bruca Jancin writing in Rheumatology News reported on a lecture given by Dr. John Cush at the Winter Rheumatology Symposium. While the recommendation is against giving zoster vaccine to patients on biologics, Dr. Cush did a survey of more than 200 patients inadvertently given the vaccine while on biologics. Not one case of shingles occurred. A study conducted in Alabama of 633 patients on biologics given inadvertent zoster vaccine also failed to show an increase in shingles risk and actually showed a 39% reduction in shingles risk.
Comment: Reassuring news that shingles vaccine, even though it is live, is not the end of the world if given to patients on biologic therapy. That being said, I still think that a 4 week waiting period before vaccination while holding a biologic is prudent.