Secukinumab at the ACR 2015 Meeting in San Francisco

There have been more than 10 publications on secukinumab at the ACR 2015 Annual Meeting in San Francisco. I feel like watching a poker game in the end phase, an all-in-call.

Xenofon Baraliakos and colleagues looked at: “Effect of Interleukin-17A Inhibition on Spinal Radiographic Changes through 2 Years in Patients with Active Ankylosing Spondylitis: Results of a Phase 3 Study with Secukinumab”. Conclusion: “[…]No radiographic progression was observed in ~80% of the pts receiving secukinumab over 104 wks. […]”. Since the tofacitinib debacle concerning EMEA approval, we know how important radiographic data are.

Juergen Braun and colleagues presented: “Secukinumab Significantly Improves Signs and Symptoms of Active Ankylosing Spondylitis: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Loading and Maintenance Dosing”. In conclusions the authors state: “Secukinumab 150 mg s.c. provided sustained improvements over 52 weeks in the signs and symptoms of AS, reducing inflammation, and improving physical function and health-related quality of life. Secukinumab was well tolerated; safety findings were consistent with previous reports.”

The second set of studies is on psoriatic arthritis.

Arthur Kavanaugh and collegues looked at: “Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Psoriatic Arthritis in Anti-TNF-Naive Patients and Those Previously Exposed to Anti-TNF Therapy: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Dosing”. Conclusion: “Secukinumab provided sustained improvements in the signs and symptoms of PsA in both anti‒TNF-naïve and anti‒TNF-IR pts.”.

I’ll skip a few interesting studies, but will list these under references.

Alice B. Gottlieb and colleagues presented: “Secukinumab Reduces the Burden of Nail and Skin Disease in Patients with Psoriasis and Patients with Psoriatic Arthritis: Results from Two Phase 3 Studies”. Conclusion: “Secukinumab improved nail and skin symptoms in pts with psoriasis with significant nail involvement and in pts with concomitant PsA and nail involvement.” I guess, we all expected that it would be this way!

And Alice B. Gottlieb also presented: “Secukinumab Improves Skin Symptoms and Physical Functioning Compared with Ustekinumab in Patients with Moderate to Severe Psoriasis with Concomitant Psoriatic Arthritis: Subanalysis of a Randomized, Double Blind, Parallel-Group, Active Comparator-Controlled Phase 3b Trial”. Conclusion: “Secukinumab was superior to ustekinumab at improving skin symptoms in patients with moderate to severe plaque psoriasis. In the small sub-group of patients with psoriasis and concomitant PsA, secukinumab showed a trend for improving skin symptoms and physical functioning compared with ustekinumab.” I must admit that this surprised me.

Laure Gossec an colleagues looked at: “Relationship Between Improvements in Fatigue and Signs & Symptoms of Active Psoriatic Arthritis: a Sub-Analysis of a Phase 3 Study with Secukinumab”. Conclusion: “Secukinumab improved fatigue in patients with active PsA regardless of prior anti-TNF therapy. A relationship between improvement in fatigue and improvements in the signs and symptoms of PsA was only shown for ACR 20 response and not for other assessments of disease. These results suggest that fatigue in PsA is not strongly related to disease activity but was still improved by secukinumab.” I’ll have to look all over the studies if improvement of fatigue has been addressed elsewhere.

Secukinumab is already available under the name Cosentyx in Germany for the indication of moderate to severe plaque psoriasis. In the U.S. Secukinumab had been approved by the FDA even earlier. Now, we rheumatologists have to wait, until FDA and/or EMEA approve the use in psoriatic arthritis, ankylosing spondylitis, and other inflammatory rheumatic conditions. I’ll be happy to have a new tool, though we still don’t know if a certain consecutive order of biologics and the small molecule should be recommended.

PS. Since yesterday (26.11.2015) Cosentyx has been approved in Germany for the indications of psoriatic arthritis and ankylosing spondylitis. So, the waiting is over.

References.

Baraliakos X, Deodhar AA, Braun J, Baeten D, Dougados M, Sieper J, Emery P, Readie A, Martin R, Mpofu S, Richards H. Effect of Interleukin-17A Inhibition on Spinal Radiographic Changes through 2 Years in Patients with Active Ankylosing Spondylitis: Results of a Phase 3 Study with Secukinumab [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/effect-of-interleukin-17a-inhibition-on-spinal-radiographic-changes-through-2-years-in-patients-with-active-ankylosing-spondylitis-results-of-a-phase-3-study-with-secukinumab/. Accessed November 16, 2015.

Braun J, Deodhar AA, Sieper J, Dougados M, Porter B, Andersson M, Richards H. Secukinumab Significantly Improves Signs and Symptoms of Active Ankylosing Spondylitis: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Loading and Maintenance Dosing [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-significantly-improves-signs-and-symptoms-of-active-ankylosing-spondylitis-52-week-results-from-a-randomized-double-blind-placebo-controlled-phase-3-trial-with-subcutaneous-loading-and/. Accessed November 16, 2015.

Kavanaugh A, McInnes IB, Mease PJ, Hall S, Chinoy H, Kivitz AJ, Patekar M, Wang Z, Mpofu S. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Psoriatic Arthritis in Anti-TNF-Naive Patients and Those Previously Exposed to Anti-TNF Therapy: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Dosing [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-the-signs-and-symptoms-of-active-psoriatic-arthritis-in-anti-tnf-naive-patients-and-those-previously-exposed-to-anti-tnf-therapy-52-week-results-from-a/. Accessed November 16, 2015.

Mease PJ, McInnes IB, Kirkham B, Kavanaugh A, Rahman P, van der Heijde D, Landewé RBM, Nash P, Pricop L, Wang Z, Mpofu S. Secukinumab Provides Sustained Improvements in Psoriatic Arthritis: 2-Year Efficacy and Safety Results from a Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-psoriatic-arthritis-2-year-efficacy-and-safety-results-from-a-phase-3-randomized-double-blind-placebo-controlled-trial/. Accessed November 16, 2015.

Gottlieb AB, Reich K, Wang Z, Milutinovic M, Mpofu S. Secukinumab Reduces the Burden of Nail and Skin Disease in Patients with Psoriasis and Patients with Psoriatic Arthritis: Results from Two Phase 3 Studies [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-reduces-the-burden-of-nail-and-skin-disease-in-patients-with-psoriasis-and-patients-with-psoriatic-arthritis-results-from-two-phase-3-studies/. Accessed November 16, 2015.

Gottlieb AB, Thaci D, Blauvelt A, Milutinovic M, Mpofu S. Secukinumab Improves Skin Symptoms and Physical Functioning Compared with Ustekinumab in Patients with Moderate to Severe Psoriasis with Concomitant Psoriatic Arthritis: Subanalysis of a Randomized, Double Blind, Parallel-Group, Active Comparator-Controlled Phase 3b Trial [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-improves-skin-symptoms-and-physical-functioning-compared-with-ustekinumab-in-patients-with-moderate-to-severe-psoriasis-with-concomitant-psoriatic-arthritis-subanalysis-of-a-randomized-d/. Accessed November 16, 2015.

Betts KA, Mittal M, Joshi A, Song J, Bao Y. Relative Efficacy of Adalimumab Versus Secukinumab in Active Psoriatic Arthritis: A Matching-Adjusted Indirect Comparison [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/relative-efficacy-of-adalimumab-versus-secukinumab-in-active-psoriatic-arthritis-a-matching-adjusted-indirect-comparison/. Accessed November 16, 2015.

Gossec L, Kvien TK, Conaghan PG, Østergaard M, Cañete JD, Gaillez C, Mpofu S, Sherif B, Jugl S. Relationship Between Improvements in Fatigue and Signs & Symptoms of Active Psoriatic: Arthritis a Sub-Analysis of a Phase 3 Study with Secukinumab [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/relationship-between-improvements-in-fatigue-and-signs-symptoms-of-active-psoriatic-arthritis-a-sub-analysis-of-a-phase-3-study-with-secukinumab/. Accessed November 16, 2015.

Mease PJ, McInnes IB, Gottlieb AB, Widmer A, Pricop L, Mpofu S. Secukinumab Safety and Tolerability in Patients with Active Psoriatic Arthritis and Psoriasis: Results from a Pooled Safety Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-safety-and-tolerability-in-patients-with-active-psoriatic-arthritis-and-psoriasis-results-from-a-pooled-safety-analysis/. Accessed November 16, 2015.

Deodhar AA, Baeten D, Sieper J, Porter B, Widmer A, Richards H. Safety and Tolerability of Secukinumab in Patients with Active Ankylosing Spondylitis: Pooled Safety Analysis of Two Phase 3, Randomized, Controlled Trials [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/safety-and-tolerability-of-secukinumab-in-patients-with-active-ankylosing-spondylitis-pooled-safety-analysis-of-two-phase-3-randomized-controlled-trials/. Accessed November 16, 2015.

Baeten D, Blanco R, Geusens P, Sieper J, Jui-Cheng T, Martin R, Porter B, Richards H. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Ankylosing Spondylitis in Anti-TNF-Naïve Patients and Those Previously Exposed to Anti-TNF Therapy: 52-Week Results from Two Randomized, Double-Blind, Placebo-Controlled Phase 3 Trials [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-the-signs-and-symptoms-of-active-ankylosing-spondylitis-in-anti-tnf-naive-patients-and-those-previously-exposed-to-anti-tnf-therapy-52-week-results-from/. Accessed November 16, 2015.

Baeten D, Braun J, Sieper J, Dougados M, Deodhar AA, Baraliakos X, Porter B, Gong Y, Richards H. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Ankylosing Spondylitis: 2-Year Efficacy and Safety Results from a Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-the-signs-and-symptoms-of-active-ankylosing-spondylitis-2-year-efficacy-and-safety-results-from-a-phase-3-randomized-double-blind-placebo-controlled/. Accessed November 16, 2015.

Carpe Diem Haiku No. 860 Cosmic Order

The hunter takes up

The mighty eagle to hunt

Beware small yeanling

Forwards and backwards

The hunters and herders move

In seasons’ circle

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-860-cosmic-order.html

Hyaluronic Acid Injections at the ACR 2015 Meeting in San Francisco

There have been two publications on hyaluronic acid injections at the ACR 2015 Annual Meeting in San Francisco.

Kevin Ong and colleagues analyzed retrospective data: “Hyaluronic Acid Injections in Knee Osteoarthritis Patients Are Associated with Delay to Knee Arthroplasty”. They concluded: “Our analysis of elderly knee OA patients showed a significantly longer delay to KA [knee arthroplasty] for those who were treated with HA [hyaluronic acid].” The authors presented a retrospective, observational study, which cannot take into account the placebo effect of an injection. It lacks a control group. Or do we have a control group?

Astrid in “Fringe” asked Dr. Walter Bishop: “What’s this?” And Walter answered: “A watermelon as a control group.”

I don’t see the two groups comparable; the second group isn't a control group. The time intervals are differently fixed: one with the treatment and the other one arbitrarily.

There may be other reasons as well: different coping attitudes (one trying to avoid arthropasty and the other wishing an arthroplasty), waiting for therapeutic effect or others.

All in all, I don’t think that this study has a good point to convince us of using hyaluronic acid in delaying the time to knee arthroplasty.

Gurjit S. Kaeley and colleagues also used retrospective data in their study: “Utilization of Viscosupplementation: 2011 – 2013”. The authors wanted to estimate and compare the prevalence and cost of Viscosupplemention utilization as recent “ American Academy of Orthopedic Surgeons (AAOS) guidelines have strongly recommended against use of hyaluronic acid because of lack of clinical improvement compared with placebo.” The authors concluded: “This study highlights the significant cost of VS [viscosupplementation ] in the Medicare population. […] In view of the negative recommendations by the AAOS [American Academy of Orthopedic Surgeons] against the use of Hyaluronic acid joint injections, the current trajectory of use of Hyaluronic acid may not represent optimal value care.”

Hyaluronic acid in knee osteoarthritis hasn’t proven efficacy like clinical improvement compared with placebo or delaying the time to knee arthroplasty. Therefore guidelines recommend against using it.

In Germany hyaluronic acid injections aren’t covered by the compulsory health insurance system, so patients have to pay for injection and medication.

I would not use hyaluronic acid in knee osteoarthritis.

References:

Ong K, Anderson A, Lau E, Niazi F, Fierlinger A, Kurtz S, Altman R. Hyaluronic Acid Injections in Knee Osteoarthritis Patients Are Associated with Delay to Knee Arthroplasty [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/hyaluronic-acid-injections-in-knee-osteoarthritis-patients-are-associated-with-delay-to-knee-arthroplasty/. Accessed November 16, 2015.

Kaeley GS, Thway M, Dodani S. Utilization of Viscosupplementation: 2011 – 2013 [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/utilization-of-viscosupplementation-2011-2013/. Accessed November 16, 2015.

Carpe Diem Haiku Extra No. 40 Shaman Haiku

In the dark storehouse

The shaman keeps drumming on

Then hunters don skis

The hunters on skis

Follow the reindeer through snow

But wind grows heavy

A lake full of fish

But the long boat is struggling

As wind god rages

Back at the cult place

As the spirit of death struck

Shaman starts drumming

It is a story of the magic drum.

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-extra-40-shaman-haiku.html 

Smoking and the ACR 2015 Meeting in San Francisco

I cannot discuss all the 25 studies on smoking in detail, which were presented at the ACR 2015 Annual Meeting in San Francisco, but I have selected a few and will summarize the others. Effects on pain are seen with and without concomitant inflammation. So we see worsening in inflammatory rheumatic diseases as well as in fibromyalgia.

Adam Schiffenbauer and colleagues looked at smoking and the development of mysitis antibodies. Conclusion: “These data suggest that in Caucasians smoking is a risk factor for developing ILD, as well as anti-Jo-1 Abs and ASA, but is protective for anti-TIF-1, -Mi-2, and -MJ Abs.”Interestingly they didn’t find this impact in African Americans.

Jasvinder A. Singh and colleagues presented a study on “Perioperative Interventions for Smoking Cessation in Hip and Knee Arthroplasty for Osteoarthritis and Other Non-Traumatic Diseases”. They’ve concluded: “With an overall high grade of evidence, Perioperative smoking cessation therapy is significantly more efficacious than placebo in preventing incidence of complications after knee or hip replacement.”

Karin Magnusson and colleagues’ study: “Smoking and Alcohol Use Are Associated with Structural and Inflammatory Hand Osteoarthritis Features in a Population Based Study”. The authors come to a rather irritating conclusion: “Our results suggest a protective effect of smoking on radiographic hand OA whereas alcohol consumption may increase the risk of joint inflammation in hand OA.”

Axel Finckh1and colleagues  Inform us on: “The Impact of Tobacco Smoking on the Effectiveness of Abatacept in Rheumatoid Arthritis: […]”.Conclusion: “Data from this Pan-European registry analysis suggest that smoking is associated with a decreased effectiveness of ABA, with higher discontinuation rates and lower response rates, as has previously been reported for methotrexate and anti-TNF agents.”

Daniel Wendling and colleagues presented this study: “ASDAS-Based Remission Was Less Frequent Than Basdai-Based Remission, and Both Were Related to CRP and Smoking in Early Axial Spondyloarthritis”. Conclusion: “[…] smoking appears as a major marker of disease activity and remission in early AxSpA.”

Kristina SCHREIBER and colleagues concluded from their study: “Current and past smocking is associated with an increased disease activity (BASDAI and ASDAS-CRP respectively) and functional impairment. Pathogenesis remains to be determined. Smoking cessation should be encouraged in axSpA although these results suggest that it may not impact disease prognosis.”

Jeffrey A. Sparks and colleagues: “Smoking Behavior Changes after Rheumatoid Arthritis Diagnosis and Risk of Mortality during 36 Years of Prospective Follow-up”. They concluded: “Despite the known harmful effects of smoking in chronic diseases, only 16% of smokers quit after diagnosis with RA and maintained smoking cessation during follow-up. Smoking >5 pack-years after RA diagnosis was associated with increased mortality, independent of smoking before RA diagnosis. Interventions promoting cessation of smoking for patients newly diagnosed with RA may diminish the excess mortality of RA.”

Patricia P. Katz and colleagues on: “Impact of Smoking on Patient-Reported Disease Status and Symptoms Among Women with Lupus”. Conclusion: “While current smoking was not common, it was associated with significantly worse patient assessments of lupus status and worse symptoms. […].”

These and other studies underline the importance to actively promote the cessation of smoking in all of patients, who are treated in rheumatology.

References:

Schiffenbauer A, Smith N, Rider LG, Miller FW. Tobacco Smoking in Different Racial Groups Is Differentially Associated with the Development of Myositis Autoantibodies and Interstitial Lung Disease in the Idiopathic Inflammatory Myopathies [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/tobacco-smoking-in-different-racial-groups-is-differentially-associated-with-the-development-of-myositis-autoantibodies-and-interstitial-lung-disease-in-the-idiopathic-inflammatory-myopathies/. Accessed November 15, 2015.

Bharat A, Singh JA. Perioperative Interventions for Smoking Cessation in Hip and Knee Arthroplasty for Osteoarthritis and Other Non-Traumatic Diseases [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/perioperative-interventions-for-smoking-cessation-in-hip-and-knee-arthroplasty-for-osteoarthritis-and-other-non-traumatic-diseases/. Accessed November 15, 2015.

Magnusson K, Mathiessen A, Hammer HB, Natvig B, Hagen KB, Østerås N, Haugen IK. Smoking and Alcohol Use Are Associated with Structural and Inflammatory Hand Osteoarthritis Features in a Population Based Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/smoking-and-alcohol-use-are-associated-with-structural-and-inflammatory-hand-osteoarthritis-features-in-a-population-based-study/. Accessed November 15, 2015.

Finckh A, Gottenberg J, Hernández MV, Iannone F, Lie E, Canhao H, Pavelka K, Turesson C, Lund Hetland M, Mariette X. The Impact of Tobacco Smoking on the Effectiveness of Abatacept in Rheumatoid Arthritis: Data from a Paneuropean Analysis of RA Registries [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/the-impact-of-tobacco-smoking-on-the-effectiveness-of-abatacept-in-rheumatoid-arthritis-data-from-a-paneuropean-analysis-of-ra-registries/. Accessed November 15, 2015.

Wendling D, Guillot X, Gossec L, Prati C, Saraux A, Dougados M. ASDAS-Based Remission Was Less Frequent Than Basdai-Based Remission, and Both Were Related to CRP and Smoking in Early Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/asdas-based-remission-was-less-frequent-than-basdai-based-remission-and-both-were-related-to-crp-and-smoking-in-early-axial-spondyloarthritis/. Accessed November 15, 2015.

SCHREIBER K, Barnetche T, Combe B, Morel J, Daien CI. Current and Past Smoking Are Associated with Functional Impairement and Increased Disease Activity in Axial Spondyloarthritis: Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/current-and-past-smoking-are-associated-with-functional-impairement-and-increased-disease-activity-in-axial-spondyloarthritis-systematic-review-and-meta-analysis/. Accessed November 15, 2015.

Sparks JA, Nguyen USDT, Chang SC, Zhang Y, Choi H, Karlson EW. Smoking Behavior Changes after Rheumatoid Arthritis Diagnosis and Risk of Mortality during 36 Years of Prospective Follow-up [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/smoking-behavior-changes-after-rheumatoid-arthritis-diagnosis-and-risk-of-mortality-during-36-years-of-prospective-follow-up/. Accessed November 15, 2015.

Katz PP, Chakravarty E, Katz RS, Michaud K. Impact of Smoking on Patient-Reported Disease Status and Symptoms Among Women with Lupus [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/impact-of-smoking-on-patient-reported-disease-status-and-symptoms-among-women-with-lupus/. Accessed November 15, 2015.

Fibromyalgia at the ACR 2015 Meeting in San Francisco / Miscellanea

As I cannot discuss all studies presented at the ACR 2015 Annual Meeting in San Francisco, I have selected a few more without a context – miscellanea.

Robert S. Katz and colleagues presented an observational study: “Patients Who Take Many Medications for Their Fibromyalgia Symptoms at the Initial Office Visit Tend to Have a Worse Clinical Course”. Conclusion: “Those patients taking more prescription for their fibromyalgia symptoms at their initial office visit tended to have a worse clinical course, evidenced by higher HAQ scores, poor general health, and more pain and fatigue.” I guess all rheumatologists treating fibromyalgia can agree to these findings. Now, we’d like to know, what’s behind this observation. My guess is: a different way of coping, patients in this group might be classified as being passive, avoiding, externalizing, alexithymic.

Thomas Romano presented a study (?): “Correlation of Magnesium Levels and IGF-! Levels in Fibromyalgia Patients”. Background/Purpose: “To determine if there is a correlation between RBC Mg levels and IGF-! levels in Fibromyalgia (FM) patients”. “All [patients] fulfilled ACR 1990 Criteria for FM.” Conclusion: “There was a statistically significant positive correlation between IGF-1 levels and RBC Mg levels in the 60 FM patients studied. This has implications for treatment and further diagnostic testing.” Maybe there is a correlation, so what? And maybe it’s time to use the new ACR criteria. For sure it’s a bold statement that this correlation of (unnecessary?) lab tests of selected patients should have implications for treatment and further diagnostic testing.

Low IGF-1 levels in fibromyalgia patients have already been shown in 1992; please refer to the study by RM Bennett and colleagues; somatomedin C has been renamed IGF-1. So, again I must say: nothing new under the sun.

Daniel Kim and colleagues addressed weather in their study: “Evaluating Weather’s Effect on Fibromyalgia Patients Using the Revised Fibromyalgia Impact Questionnaire and the Brief Pain Inventory”. They used a broad set of parameters, but the authors “did not find any statistically significant effect of weather on fibromyalgia symptoms”. It’s like a pendulum. We know from our patients that weather changes and rainy, humid, cold weather conditions are attributed with increased pain and other symptoms of fibromyalgia (as well as inflammatory rheumatic diseases!), but as strange as it may seem, stressable scientific proof is yet to come. I hope that research on this topic will go on.

Lin Ge and colleagues looked at: “Association of Smoking and Cognitive Function in Patients with Fibromyalgia”. Conclusion: “The results of this study indicate that smokers with FM report worse cognitive function. Although the cause-effect relationship between smoking and cognition is unclear, clinicians who care for patients with FM should be aware of this association.” I think, I’ll take this study and others to look more closely at the diseases we treat and the effects of smoking. Some studies are congruent with these findings, others are not. I guess we all agree that smoking isn’t healthy and may worsen symptoms and make treatment less effective. Concerning cognitive function there seems to be a link to Alzheimer’s and dementia per se.

References:

Katz RS, Katz Small A, Leavitt H. Patients Who Take Many Medications for Their Fibromyalgia Symptoms at the Initial Office Visit Tend to Have a Worse Clinical Course [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/patients-who-take-many-medications-for-their-fibromyalgia-symptoms-at-the-initial-office-visit-tend-to-have-a-worse-clinical-course/. Accessed November 12, 2015.

Romano T. Correlation of Magnesium Levels and IGF-! Levels in Fibromyalgia Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/correlation-of-magnesium-levels-and-igf-levels-in-fibromyalgia-patients/. Accessed November 12, 2015.

Bennett RM, Clark SR, Campbell SM, Burckhardt CS: Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Arthritis Rheum. 1992 Oct;35(10):1113-6. PMID: 1418002. http://www.ncbi.nlm.nih.gov/pubmed/1418002.

Kim D, Chan R, Plans M, Hackshaw K. Evaluating Weather’s Effect on Fibromyalgia Patients Using the Revised Fibromyalgia Impact Questionnaire and the Brief Pain Inventory [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/evaluating-weathers-effect-on-fibromyalgia-patients-using-the-revised-fibromyalgia-impact-questionnaire-and-the-brief-pain-inventory/. Accessed November 12, 2015.

Ge L, Oh TH, Vincent A, Mohabbat A, Jiang L, Whipple M, McAllister S, Wang Z, Qu W. Association of Smoking and Cognitive Function in Patients with Fibromyalgia [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/association-of-smoking-and-cognitive-function-in-patients-with-fibromyalgia/. Accessed November 12, 2015.

Fibromyalgia and smoking: http://rheumatologe.blogspot.de/2011/11/fibromyalgia-and-smoking.html

Fibromyalgia at the ACR 2015 Meeting in San Francisco / Multidisciplinary Programs

 

There were two studies on multidisciplinary programs at the ACR 2015 Annual Meeting in San Francisco. I would have like to see more studies, but still …

Amrita Kaur Bath and colleagues presented this study: “Immediate Benefits of a Multidisciplinary Educational Program for Fibromyalgia on Patients’ Pain Related Self-Efficacy and Health Locus of Control”. They looked at 77 female patients, who met the ACR 2010 preliminary criteria for fibromyalgia, and took part in participated in an 3.5 hour educational program. “The program was rated very or extremely helpful by 79.7% of patients, with 78.6% reporting getting answers to most or all their questions. Results showed significant increases in PSEQ [Pain Related Self Efficacy Questionnaire] (p < 0.0001), and decreases in external locus of control MHLC [Multidimensional Health Locus of Control Scale] “chance” (p < 0.0001). Conclusion: “These results show that a brief multidisciplinary educational program in FM [Fibromyalgia] can significantly enhance self efficacy related to pain and external attributions in patients with severe FM and moderate depression. Our study supports the utility of short education programs on positive coping for FM patients.”

Though I like this study, I must utter a word or two of caution. Knowing “about clinical, pathophysiologic, and therapeutic aspects of FM; exercise instruction, orientation on the cognitive behavioral model of pain and stress, review of psychosocial contributors to chronic pain, family education, and introduction to relaxation techniques“ in 3.5 hours doesn’t mean that everything has been understood or that anything will change. One needs to looks at long term effects. Could these patients change anything in daily life? I think education is the first and right step on a way to behavioral changes.

The second study by N. Halliday and colleagues is a systematic review: “Effectiveness of Multidisciplinary Pain Rehabilitation Programs for Patients with Fibromyalgia Syndrome: A Systematic Review”. “After screening 11,280 abstracts, nine RCT’s (1216 patients) met the inclusion criteria.” “Comparison groups included waiting list control with exercise, pharmacological treatment, less intensive MPRP’s [multidisciplinary pain rehabilitation program], and no intervention.” “A meta-analysis revealed that MPRP’s are effective in the long term at reducing to pain levels (…) and disease impact (…). The narrative synthesis revealed moderate to low quality evidence in support of MPRP’s FMS.” Conclusion: “These findings suggest that MPRP have a positive impact on long-term pain levels and disease impact in people with FMS. (…)”

I work in a setting, where multimodal/multidisciplinary pain intervention is the rule for fibromyalgia patients as current health policy and insurance conditions don’t allow other treatments. Therefore I have a great interest in these studies. These studies support our own efforts in multidisciplinary pain programs, which include education, physical/sport therapy, behavioural therapy. Thanks for that!

References:

Bath AK, Gota CE, Morales Cavolo A, Davin S. Immediate Benefits of a Multidisciplinary Educational Program for Fibromyalgia on Patients’ Pain Related Self-Efficacy and Health Locus of Control [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/immediate-benefits-of-a-multidisciplinary-educational-program-for-fibromyalgia-on-patients-pain-related-self-efficacy-and-health-locus-of-control/. Accessed November 12, 2015.

Halliday N, Treanor C, Galvin R, Brooks J. Effectiveness of Multidisciplinary Pain Rehabilitation Programs for Patients with Fibromyalgia Syndrome: A Systematic Review [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/effectiveness-of-multidisciplinary-pain-rehabilitation-programs-for-patients-with-fibromyalgia-syndrome-a-systematic-review/. Accessed November 12, 2015.

Fibromyalgia: Multimodal Therapy at the Rheinische Rheuma Zentrum

http://rheumatologe.blogspot.de/2010/11/fibromyalgia-multimodal-therapy-at.html