Easier Early Arthritis - Dr. David Liew Save

Hi. I'm David Liu, reporting here from Melbourne Australia for rheumnow.com on the July 2020 virtual conference meant to be in Frankfurt, now exists solely online. It's been quite good in Australia logging in, because it it kicks off the 10AM start, works out to be a 6PM start for us. So quickly finish off clinic, rush home from work, get a beverage and sit in front of the computer to take in a little bit of the great ULR content that's been on offer. As always, the early arthritis material at ULR is very strong and there have been two abstracts that have been talked about at this meeting, which I'd like to talk to you about.

And they regard firstly, how quickly do we need to see our patients in clinic? How soon after symptoms start? And then the second idea, second one is about for patients with clinically suspect arthralgias, so CCP positive with musculoskeletal symptoms, how quickly do we need to in those well, how can we predict who which of those patients will actually go on to develop inflammatory arthritis? So that first abstract, looking at those outcomes in terms of how quickly we need to see patients comes from combined data from the Leiden and Esquire cohorts, both two very strong early arthritis cohorts. And what they looked at is to see how much we need, to follow the ULI recommendations regarding how quickly to see patients and how that might affect outcomes that we care about like drug free remission and radiographic progression.

So, the recommendations, you may or may not be aware, ULI recommendations for early arthritis are quite strict. They suggest that patients should be seen by a rheumatologist within six weeks of the start of their symptoms, and they should have therapy started, in the first three months, so in twelve weeks, about twelve weeks. And, so I ran a poll online about this. I think a lot of people like me, definitely me included, struggle to see patients in that time frame because of access issues. We've got a workforce shortage in The United States.

We've got a workforce shortage, certainly got a workforce shortage in Australia, and it's hard to be able to get to see all these patients in the time that we would like. At the same time, does that make a difference for outcomes? Well, they looked at this at drug free remission and at radiographic progression. And what was clear from this was that, in fact, drug free remission actually was better if you could get patients in in in that early in that first six weeks. But radiographic progression, there was no difference between the people who got in the first six weeks and between six to twelve weeks.

Now once you go out past twelve weeks, when you go out past the therapeutic window of opportunity, then yes, it does have an effect on radiographic progression. Yeah, we should try and get these patients in in the first three months. But we perhaps don't need to be as strict as the Euler recommendations imply. Of course, there's a bit to work through and we'd always like more data in that space. The second abstract comes from leads, from Paul Emery's group, looking at patients with CCP positivity and and musculoskeletal symptoms and see which of those patients end up going to develop inflammatory arthritis, clinically evident inflammatory arthritis.

It's always an important question because we're not great at doing this. These are the patients we think, well, if we're gonna try and make those timelines, let's try and pick up when they start having inflammatory arthritis so we can swoop in and hit at that point. And we've always we've been trying to figure out for some time good ways of predicting what happens to these patients. And I talked last year about some of the work from the same group looking at ultrasound, and there have been lots of other things, that have been attempted in this area. Well, one thing which we haven't talked about as much, until now has been about patient reported outcomes.

What happens if we actually listen to the patient and rely on them to say when they might notice something's going off? Well, this study looked at, very global patient reported outcomes. So, including global pain and looking at HACC, and looked at these in these patients. The fact these actually went up in the weeks preceding the development of, inflammatory arthritis, which is an enticing prospect because it'd be nice to be able to say to our patients, well, if if you're not if you're feeling more pain, if if things are getting worse, then that might be a trigger for us to actually examine you and see whether you do have synovitis or not. Now, of course, an equipoise is required here.

There's a balance between seeing patients too much and being able to catch things on the basis of patient reported outcomes. But certainly, it's an enticing prospect which should and which delivers a message that we should put a bit more attention on, which is listen to our patients. I'm David Liu, and for more content, go to roomnow.com.