We recently attended the European Congress of Rheumatology in Madrid. Here, President Elizabeth Price talks about her highlights from EULAR 2019.
"One of the highlights of EULAR for me was the Epidemiology Abstract session chaired by Kimme Hyrich, who leads the BSR RA Biologics register in Manchester. She had collated a group of abstracts, many using registry data, which all had relevance for everyday clinical practice.
"Lene Dreyer from Denmark presented data which used the Danish and Swedish registries linked with Hospital registers to investigate the risk of neurological adverse events including demyelination and inflammatory neuropathies in rheumatic disease patients treated with TNF inhibitors. Reassuringly no association was found between treatment with anti-TNF and neurological events for RA. However, a 2 – 5 fold increased risk of demyelination and inflammatory polyneuropathies, was picked up for AS and PsA patients, although these were still very uncommon events.
"Mohammad Derakhshan presented data on Extra-articular manifestations of Axial Spondylarthritis using data from the BSRBR AS register. They confirmed the prevalence of acute anterior uveitis to be 23.5% & psoriasis to be 10.9% in line with other studies but found a somewhat higher prevalence of IBD at 10.9%. In multivariate analysis B27 positivity had a positive relationship with AAU but a negative association with psoriasis and IBD.
We are all becoming increasingly concerned about Hydroxychloroquine retinal toxicity. An American study has found that in the US 40% of patients are being prescribed doses over the recommended 5mg/kg and 10% are exceeding 6.5mg/kg – with predominantly females, those with a lower BMI and Asians being prescribed the higher doses and at increased risk of retinal toxicity.
A Leeds based study of patients presenting with new MSK symptoms in primary care found that 3% were anti-CCP +ve at presentation. Of the CCP+ve cohort, 45% progress to RA or inflammatory arthritis and 91% do so within 12 months. High titres of CCP and pain in hands and feet at presentation predicts progress.
Another UK-based study looked at frailty and disability in OA and RA using data from the UK biobank cohort of 500,000 patients. At baseline, 8% self-reported OA and 1% RA. Participants with OA were four times as likely to be frail and RA patients 10x as likely to be frail, and OA patients 4x as likely to be disabled and RA 7x as likely compared to the normal cohort.
The Danish registry data has confirmed a four-times increase in infections requiring hospitalisation in rheumatic disease patients within 12 months of starting a new biologic compared to matched controls.
Finally, reassuringly a UK based study has shown no association between Flu vaccination and disease flares in AIRDs on immunosuppression.