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American College of Rheumatology, Nov. 14-19

Last Updated: November 20, 2014.

The 78th Annual Meeting of the American College of Rheumatology

The annual meeting of the American College of Rheumatology was held from Nov. 14 to 19 in Boston and attracted approximately 15,000 participants from around the world, including rheumatologists, scientists, and other health care professionals. The conference featured presentations focusing on the latest advances in the diagnosis and treatment of arthritis as well as other rheumatic and musculoskeletal diseases.

In one study, Tuhina Neogi, M.D., Ph.D., of the Boston University School of Medicine, and colleagues found that synovitis and effusion may contribute to pain in knee osteoarthritis (OA), at least in part through their effects on sensitization.

"Synovitis and effusion are associated with change in pressure pain threshold and temporal summation, respectively, which are two measures of sensitization, while bone marrow lesions, representing primarily mechanical lesions, were not associated with either measure of sensitization," Neogi said. "This suggests that inflammation in knee OA contributes to pain severity at least in part through sensitization. In contrast, bone marrow lesions do not appear to affect pain sensitization, suggesting that predominantly mechanical pathways may not contribute to sensitization knee OA in humans. Therefore, the way in which bone marrow lesions contribute to pain may be through other mechanisms."

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In another study, Jeffrey Sparks, M.D., of Brigham and Women's Hospital in Boston, and colleagues found that rheumatoid arthritis (RA) increases risk of death even after controlling for traditional mortality risk factors such as obesity and smoking. In addition, the investigators found that cardiovascular disease mortality rates are significantly higher for RA patients.

"We confirmed that RA is associated with a higher risk of mortality (40 percent), independent of mortality risk factors such as smoking and obesity. We identified that women with seropositive RA have nearly three-fold risk of respiratory-related death compared to women without RA. Respiratory-related death is an underappreciated and significant contributor to RA mortality that deserves further research," Sparks said. "Clinicians should be aware of this risk and perhaps screen symptomatic RA patients with pulmonary function tests or chest imaging. It is unclear how modifiable RA mortality might be."

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Sajina Prabhakaran, M.D., of the Drexel University College of Medicine in Philadelphia, and Charles Pritchard, M.D., of the Drexel University College of Medicine in Willow Grove, Pa., found that the total number of infections, hospitalizations, and drug discontinuation rates among patients taking denosumab and a biologic disease-modifying antirheumatic drug (DMARD) is not different from patients taking a biologic DMARD alone.

"The key conclusion is that, although denosumab is a biologic agent, based on this study there does not appear to be additional risk of infections or infection-related complications in patients taking a combination of denosumab with a biologic DMARD any more than that from taking a biologic DMARD alone," Prabhakaran said. "Based on the results of this study, physicians can have less concern regarding the risk of infection when using denosumab with a biologic DMARD in patients with rheumatic disease."

One author disclosed financial ties to Genentech and AbbVie.

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Stephen Lindsey, M.D., of the Ochsner Health System in Baton Rouge, La., and colleagues found that patients with RA, psoriatic arthritis, and spondyloarthropathies on biologics can be safely given the herpes zoster vaccination.

"Herpes zoster vaccination is approved for all people over 60, but not approved in patients on biologics, as there is a concern this live virus vaccine could cause serious infection in an immunocompromised host. Recent studies have not found this risk in large cohort reviews," Lindsey said.

The investigators developed a specific protocol to address safety concerns and have been able to vaccinate 176 of 255 patients eligible. No occurrences of local or generalized shingles have been noted in the post-vaccination period (six weeks).

"I believe rheumatologists can begin to consider vaccination for shingles in select patient as per our protocol with a more secure feeling of safety," Lindsey added. "We should be able to help prevent complications of this common infection in our practices. I know future large controlled studies are being planned to address this issue as there is not enough evidence yet to change our present guidelines. I feel our study can help stimulate these considerations."

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ACR: Running Won't Raise Risk of Knee Osteoarthritis

MONDAY, Nov. 17, 2014 (HealthDay News) -- Regular running doesn't seem to increase the chances of developing knee osteoarthritis, and it may even help prevent the disease, researchers report. The new findings are being presented at the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Boston.

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ACR: Contraception Choice May Affect RA-Related Autoantibodies

MONDAY, Nov. 17, 2014 (HealthDay News) -- For women at increased risk of rheumatoid arthritis (RA), choice of contraceptive may affect serum autoantibodies to citrullinated protein antigens (ACPA) positivity, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Boston.

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ACR: Most Hospitalizations for Gout Are Preventable

MONDAY, Nov. 17, 2014 (HealthDay News) -- Most hospitalizations for a primary diagnosis of gout are preventable, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 14 to 19 in Boston.

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