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American College of Rheumatology, Nov. 10-14, 2012

Last Updated: November 19, 2012.

The 76th Annual Meeting of the American College of Rheumatology

The annual meeting of the American College of Rheumatology was held from Nov. 10 to 14 in Washington, D.C., and attracted approximately 15,000 participants from around the world, including rheumatology specialists, physicians, scientists, and other health care professionals. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of lupus, rheumatoid arthritis (RA), osteoarthritis (OA), and gout.

In one study, Diane Lacaille, M.D., of the University of British Columbia in Vancouver, Canada, and colleagues evaluated whether treatment with biologic agents affected mortality in RA.

"We assembled a population-based cohort of RA cases using administrative health data, which means that we had data on everyone who sees a doctor for their RA in the province of British Columbia, Canada, and we looked at everyone who received a biologic agent," Lacaille said. "We carefully matched these patients with RA patients who were similar in terms of prior treatment, age, gender, markers of disease severity, and other medical conditions that could affect risk of death. We evaluated the association between receiving a biologic and the risk of dying."

The investigators found that patients who received a biologic agent were much less likely to die than those who did not receive the medication. The risk of death was one-quarter of that found in patients who did not receive a biologic agent.

"The impact of these findings is that this is important information for people with RA who are contemplating taking these medications and who are hesitant because they are afraid of the side effects," Lacaille added. "These results should reassure patients that biologic agents are not likely to increase their risk of death and may even reduce their risk of death."

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In another study, Elena Losina, Ph.D., of Brigham and Women's Hospital in Boston, and colleagues assembled data from several large population-based data sources, including the National Health Interview Survey and published findings from the Osteoarthritis Policy Model, a validated computer simulation model of knee OA. The investigators used these data to estimate the risk of knee OA in populations defined by sex and race/ethnicity.

"We estimated that, by age 50, three out of every 100 women will be diagnosed with painful knee OA, compared to two out of 100 men, indicating 50 percent increased rates for women compared to men. By age 65, 11 out of every 100 African-American women will likely be diagnosed with painful knee OA, compared to eight out of every 100 men," Losina said. "Our estimates showed that, over the lifetime, the risk of being diagnosed with painful knee OA ranged from 10 percent in Hispanic men and 14 percent in Hispanic women to 17 percent in African-American women."

The investigators also found that a greater risk of developing painful knee OA leads to greater need for total knee replacement. The estimated need for total knee replacement ranged from less than 4 percent in Hispanic men and 5 percent in white men to a high of greater than 7 percent in African-American women.

"By equipping physicians and public health officials with estimates of risks of developing knee OA and need for total knee replacement for specific demographic groups, our research will enable them to convey to patients and the public the rationale for disease awareness and the need for behavior change to prevent occurrence of painful knee OA," Losina added.

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Jinoos Yazdany, M.D., M.P.H., of the University of California in San Francisco, and colleagues found that the complex way biologic drugs are currently reimbursed and subsidized in the Medicare program may be inadvertently influencing treatment decisions for patients with RA.

"On average, patients with RA paid over $4,000 in out-of-pocket costs for biologic drugs covered through Part D in 2009, unless they had a low-income subsidy, in which case, they paid about $27," Yazdany said. "Whether or not individuals received a low-income subsidy, which covers out-of-pocket costs for drugs, was strongly related to whether they used the biologic drugs covered through the Medicare Part D pharmacy benefit for their RA. Patients with subsidies were more likely to use self-injectable biologics through Part D. In contrast, those without subsidies who faced high cost-sharing under Part D were more likely to receive intravenous biologics available through their standard medical benefit."

Ideally, according to Yazdany, the biologic a patient uses should be based on factors like their preference for mode of administration and the unique safety profile of each drug, together with their physician's clinical recommendation on which drug is likely to work best for their disease. Instead, it seems that the presence or absence of a subsidy through the Part D program is driving which biologic drugs patients and providers are choosing.

"The current system appears to be neither containing costs, since we found that costs may be shifting from the Part D pharmacy benefit to the medical benefit side, nor is it serving patients, since those who have high cost-sharing may face barriers to accessing needed drugs through Part D," Yazdany added. "Moreover, the policy may be limiting treatment options for some patients who have high drug costs. The results of our study suggest that a more coherent and organized approach for coverage of biologic drugs for patients with RA is needed.

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ACR: Depression Linked to Increased Mortality in RA

MONDAY, Nov. 12 (HealthDay News) -- Depression and increased depressive symptoms correlate with increased mortality among patients with rheumatoid arthritis (RA), particularly men, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 10 to 14 in Washington, D.C.

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ACR: Overweight, Obesity Tied to Increased RA Risk in Women

MONDAY, Nov. 12 (HealthDay News) -- Being overweight or obese increases the risk of developing rheumatoid arthritis (RA), according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 10 to 14 in Washington, D.C.

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ACR: Strontium Ranelate Cuts Progression of Knee OA

MONDAY, Nov. 12 (HealthDay News) -- The osteoporosis therapeutic strontium ranelate (SrRan) reduces radiographic and radiological progression of knee osteoarthritis, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 10 to 14 in Washington, D.C.

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