The Annual Congress of the European League Against Rheumatism, EULAR 2010, took place June 16 to 19 in Rome, and attracted more than 15,000 participants from around the world. The conference focused on advances in the management of patients with rheumatic diseases, with presentations addressing targeted approaches and the move toward individualized medicine.
Key highlights included studies exploring the risk of cancer in juvenile idiopathic arthritis (JIA) patients, the impact of smoking on rheumatoid arthritis (RA), predictors of cardiovascular disease risk in RA patients, and the prevalence of vitamin D deficiency in patients with osteoarthritis, RA, and myalgia of unknown cause.
"The overall theme at the conference was focused on defining disease states to make personalized medicine possible," said Taunton R. Southwood, M.D., of the University of Birmingham in the United Kingdom. "Presentations focused on new approaches to use targeted therapies effectively and safely in susceptible individuals."
In an effort to assess the risk of cancer in pediatric patients with JIA, Southwood and colleagues identified 1,641 pediatric patients with JIA from three prospective JIA registries in the United States, the United Kingdom, and Germany, all of whom received their first dose of etanercept before 18 years of age. All cancer cases diagnosed before 22 years of age were included.
The researchers identified three cases of cancer, but excluded one case that occurred in an adult JIA patient who received the first dose of etanercept after age 18. A case that was diagnosed within 90 days of starting etanercept was excluded from sensitivity analysis. The observed frequency of cancer was higher than expected compared to the general population, but the result was not statistically significant.
Two authors are employees of Pfizer and another three authors disclosed financial ties to Pfizer and/or Wyeth.
"Two additional studies were presented at the meeting, and both showed that the frequency of cancer in the JIA population who had not received etanercept was increased compared with the normal population of children and young people who did not have JIA," Southwood said. "Therefore, it appears that any increased cancer risk in the JIA population is more likely to be linked to the chronic inflammatory disease state rather than etanercept treatment."
In a population-based Swedish cohort study led by Julia F. Simard, M.D., of the Karolinska Institute in Stockholm, Sweden, researchers found that the incidence of cancer among pediatric patients with JIA was comparable to that seen in the general population (0.5 versus 0.4 cases per 1,000 person-years). While patients with JIA first identified before 1987 were not at increased cancer risk, those identified in 1987 or later were at a significantly higher risk of cancers overall, likely due to a rise in incident lymphoproliferative cancers.
"The results of our study indicate that evaluations of cancer risks with biologics in pediatric populations need to factor in differences in incidence of cancer between these patients and the general population," Simard said in a statement. "From a clinical point of view, it should be remembered that although we noted an increased risk in relative terms, the excess risks remain low in absolute terms."
Two authors disclosed financial ties to the pharmaceutical industry.
In a comparative study of vitamin D levels in outpatients with a wide range of rheumatic diseases, Clive Kelly, M.D., of Queen Elizabeth Hospital in Gateshead, U.K., and colleagues evaluated 30 patients with osteoporosis, 30 patients with RA, and 30 patients with unexplained muscle pain, as well as a control group of 90 patients with chronic pain.
The researchers found that the overall median level of vitamin D was 38 nmol/L among all patients combined, with 58 percent of patients having vitamin D values below the normal range. In the control group, the median values were 51 nmol/L, but levels were significantly reduced in all three patient groups. The levels of vitamin D found in the unexplained muscle pain group were as low as those in the osteoporosis group, at 31 nmol/L. Median levels in RA patients were 36 nmol/L.
"In patients with myalgia without a cause, with vitamin D levels less than 20 nmol/L, we found that vitamin D supplementation improved muscle pain and tenderness based on clinical assessment and visual analog scale findings. Therefore, identifying and correcting low vitamin D levels may be an effective approach to treating symptoms," Kelly said.
In another study, Luca Idolazzi, M.D., of the University of Verona in Italy, and colleagues evaluated 1,191 RA patients to determine the association of vitamin D deficiency with disease activity and disability. The researchers found that vitamin D levels were lower than healthy levels (<50 nmol/L) in 85 percent of the patients not undergoing vitamin D supplementation, and in 60 percent of those taking 800 IU or more of vitamin D daily. In addition, vitamin D levels were associated with three measures of disease activity, including the Health Assessment Questionnaire Disability Index, the Mobility Activities of Daily Living Score, and the Number of Swollen Joints Count in patients not taking vitamin D supplements.
"We have seen in studies that vitamin D deficiency is common in patients with a range of rheumatic diseases, and our results have confirmed this using several clinically accepted measures of disease activity," Idolazzi said in a statement.
In a study presented at the meeting by Stella Provan, M.D., of Diakonhjemmet Hospital in Oslo, Norway, researchers studied whether early markers of RA inflammatory disease activity could predict arterial stiffness, as measured by pulse wave velocity (PWV) and augmentation index (AIx). After adjusting for age, sex, and mean arterial pressure, the researchers found that patients with elevated baseline C-reactive protein (CRP) had significantly higher Alx and PWV after 15 years. After adjusting for potential confounders, baseline elevated CRP remained a significant predictor of increased AIx and PWV.
"From this research, we can now say that certain inflammatory markers seem to be independent, longitudinal predictors of cardiovascular risk in RA patients," Provan said in a statement. "Treatment options that help manage early inflammation in patients with RA may ensure that the long-term cardiovascular risk associated with RA is managed appropriately."
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