NOVEMBER 23, 2010
Optimal Drug Therapy in Rheumatoid Arthritis
A meta-analysis in the October issue of Arthritis & Rheumatism reported that disease-modifying antirheumatic drugs (DMARDs), glucocorticoids, and biologics have comparable effects on radiographic progression of rheumatoid arthritis (RA), the most critical measure of structural damage in the disease.
Niels Graudal, MD, DrMedSci, from Copenhagen University Hospital Rigshospitalet, and Gesche Jürgens, MD, PhD, from Bispebjerg University Hospital, in Denmark summarized data from 70 randomized controlled trials into 21 meta-analyses to define the differences in effects on joint destruction in RA between approved drug treatments. Participants were patients with RA diagnosed according to the criteria of the American College of Rheumatology. Four treatment groups were identified, comparing placebo with DMARDs, glucocorticoids, biologics, and combination agents. Compared with placebo, all treatments significantly reduced radiographic evidence of joint destruction at 1 year, with a relative effect of 48% to 84%.
The investigators found that a direct comparison between the combination of a biologic agent plus methotrexate (MTX) and the combination of 2 DMARDs plus initial glucocorticoids revealed no significant difference. “Our findings confirm that aggressive treatment with combination DMARDs does reduce structural joint damage as compared with less aggressive treatment with a single DMARD, and that combination DMARD treatment, especially when combined with periodic glucocorticoids, may be as effective as a biologic agent plus MTX,” the authors wrote.
Due to their expense, therefore, biologic agents should still be reserved for patients who are unresponsive to DMARDs.
Obesity Linked to Increasing Prevalence of Arthritis
According to the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report for October, 8, 2010, arthritis is on the rise, especially among obese patients. The report represents an update of previous estimates of physician-diagnosed arthritis and arthritis-attributable activity limitation.
The report found that 19.8% of obese individuals had been diagnosed with arthritis, compared with 16.9% of normal or underweight people. Rates for obese individuals doubled in comparison to normal or underweight individuals when factors such as gender (33.8% of women and 25.2% of men) and lifetime risk of knee osteoarthritis (60.5%) were analyzed. Additionally, it was found that 23.5% of physically inactive people had arthritis versus 18.7% of those who participated in recommended levels of exercise.
The report stresses that the prevalence of the disease will continue to rise unless individuals in the United States begin to control their weight. Although it is predicted that the incidence of arthritis will increase dramatically over the next 20 years, the researchers wrote that even a small weight loss could ultimately decrease the risk for arthritis and mortality by 50%.
Sleep Problems More Common in Patients with Arthritis
A study posted online in October in Arthritis Care & Research has reinforced previous findings that arthritis can considerably worsen patients’ quality of sleep, especially in cases of poorly controlled pain or comorbid depression and anxiety disorders. Using data from the 2007 National Health Interview Survey from 23,134 adults aged 18 years or older, Grant Louie, MD, MHS, of the John Hopkins University Medical School in Baltimore, Maryland, and colleagues analyzed the prevalence of insomnia, excessive daytime sleepiness, and sleep duration less than 6 hours among patients with arthritis versus those without. A total of 20% of patients had arthritis, and this group was 3 times more likely to report sleep disturbances when compared with patients without arthritis. When adjustments were made for chronic diseases such as obesity, diabetes, acid reflux, and heart disease, the association was weaker but still significant. Arthritis patients who reported experiencing depression or anxiety within the past 12 months were found to be at the highest risk for sleep disturbance.
Overall, the researchers found that the prevalence of sleep disturbances was much higher in patients with arthritis (23%) than in those without arthritis (16%). It was concluded that joint pain and limitation due to pain mediated the correlation between arthritis and sleep disturbances. The authors wrote that their findings emphasize the need to identify sleep disorders in arthritis patients, “especially those reporting pain or with depression or anxiety,” so that these patients can receive the appropriate treatment.
Fast Fact: Sleep disturbance affects more than 10 million US adults with arthritis.