The EULAR 2015 Report- Friday Save

These abstracts and presentations were presented 12 June at the EULAR 2015 annual meeting.

EULAR Recommendations on Cardiovascular Monitoring. Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis patients are all at an increased for CV events and mortality. A EULAR task force recommends practitioners monitor their patient for CV risk (#SP0033) by: 1) measuring and controlling inflammatory disease activity at every visit, 2) using national guidelines (or the SCORE CV risk model) to assess a patient's CV risk every five years or with major changes in therapy, 3) monitoring Lipid levels when the disease is stable; 4) managing CV risk according to national guidelines, 5) using NSAIDs with caution, 6) limiting corticosteroid use, 7) counseling patients on diet, exercise and smoking cessation, 8) carotid plaque screening may be part of a CV risk assessment, and 9) they confirmed that CV risk score models should be adapted to RA by 1.5 multiplication factor. (Editor’s note: the role of the rheumatologist in guiding these assessments or interventions needs to be clarified. RheumNow recommends rheumatologists either instruct patients to have these assessments done as part of their mandatory annual PCP evaluations or carry them out themselves.)

Predictive Value of Ultrasound. 248 RA patients in the Dutch POET study were treated with TNF inhibitor and DMARDs (#OP0181). Those achieving low disease activity were randomly assigned to continue or withdraw TNF inhibitor. Patients with ultrasound evidence of synovitis in ≥1 joint had a 77% greater risk of flare (HR 1.77).  In the Italian Starter Study, 427 RA patients underwent musculoskeletal ultrasound and followed prospectively. MKUS power doppler signal for either synovitis or tenosynovitis was most apt to predict subsequent RA flares (#OP0217).

A Replacement for Gadolinium? For several reasons (renal impairment, cost, side effects) gadolinium (Gd) may not be appropriate for many patients. Bowes et al from Manchester performed a comparative study of gadolinium versus voxel classification of fat saturated T2 images (without Gd) in 45 RA patients treated with rituximab in a clinical trial (#SAT0585). Visual assessment of 170 3D MRI images showed good agreement in all cases. Like Gd, voxel classification of T2 image will likely detect synovial tissue and fluid. This study suggests a modification in current methodology may provide an alternative to Gd contrast use in the future.

Statins in RA. Although statins have been effective in lowering CRP, several studies failed to show any clinical benefit or disease activity when statins are used in RA. Finckh and coworkers also studied this issue and showed that RA patients in the Swiss RA registry (SCQM-RA) did not have any significant adjunctive benefit on radiographic outcomes (OP0182).

Obesity and Disease Activity. Several studies at EULAR examined the negative effects of obesity. Goodman and coworkers from the Canadian CATCH cohort showed the BMI level to be inversely correlated with remission and DAS28 scores. Dalen et al studied the ESPOIR early RA cohort showed BMI >30 was associated with poorer responses measured by DAS28 and HAQ scores. Total and erosion Sharp scores were not different by weight groups, but joint space narrowing on X-ray was greater in obese patients (#FRI0034). Lastly Gigante and Ferraccioli studied 64 consecutive obese RA patients (BMI>30 Kg/m2) with DAS>1.6. These patients remained on stable conventional or biologic DMARD and underwent a scheduled diet for 6 months. They showed that after 6 months, a mean weight loss of 6.6% improved DAS28 scores by 25%. Significant reductions in SDAI, TJC, SJC, CRP, ESR, HAQ and pain were also seen and without changes in steroid dose.

Flares Do Add Up. A few reports confirmed what was expected – that flares of RA activity may have consequences beyond pain and interruption of lifestyle. 287 RA patients in LDAS were asked to recall if they had no flares, transient flares or persistent activity in the prior year (#OP0132). Patients with transient flares or persistent activity had more radiographic damage by the end of year 2.

The Utility of Hydroxychloroquine Drug Levels. Duncan and Petri presented their study of HCQ levels in SLE patients (#OP0187). Blood HCQ levels did not correlate well with disease activity and therefore may not be of value in guiding therapy. They do reveal which patients are noncompliant with HCQ therapy. Moreover, there is limited access to commercial testing for HCQ levels which must be done on whole blood samples and not on serum or plasma.

Certolizumab in Early RA. A large (n=879), 1 year, multicenter study of early, DMARD naive RA patients compared MTX to CZP+MTX. At 1 year CZP+MTX had 2.3-fold higher remissions, 2-fold higher LDAS and 40% more ACR50 responder patients. Changes in X-rays were also significantly different for MTX+CZP (+0.2 Sharp units) compared to MTX (+1.9 Sharp units) (#SAT0164).

Scleroderma Treatment with Tocilizumab. Dinesh Khanna and coworkers reported their preliminary open-label study of TCZ in patients with diffuse systemic sclerosis (#OP0054) – the faSSinate trial. Enrolled patients had modified Rodnan skin scores (mRSS) of 15-40, with less than 5 years of disease and increased ESR or CRP. They treated 87 PSS with weekly TCZ 162 s.c. or placebo. Although their primary endpoint for a significant change in mRSS was not achieved – more mRSS success was seen in TCZ patients. TCZ also had significantly less deterioration in their forced vital capacity measures.