CARE sessions combine clinical updates and interactive participation

A trio of 2021 CARE sessions offers a unique combination of live clinical updates and interactive participation from learners as each speaker presents cases and solicits your best guess for next steps. Two CARE sessions on Sunday, Nov. 7, will focus on osteoarthritis (OA) and spondyloarthritis, and a session on Tuesday, Nov. 9, will focus on scleroderma. All three sessions will remain available to registered meeting participants until March 11, 2022.

“These are interactive sessions focusing on what’s known and what has emerged recently in these three areas,” said Eli Miloslavsky, MD, Assistant Professor of Medicine, Harvard Medical School and Co-director of the Vasculitis and Glomerulonephritis Center at Massachusetts General Hospital. “The focus of these sessions is much more on the approaches that are being used today rather than what the landscape might look like in five or 10 years.”

Dr. Miloslavsky will moderate 2021 CARE: Spondyloarthritis from 4:15 – 5 p.m. ET Sunday. Alexis Ogdie, MD, Associate Professor of Medicine and Epidemiology at the University of Pennsylvania and Deputy Director of the Penn Center for Clinical Epidemiology and Biostatistics, is the session’s featured presenter.

Until recently, clinicians had many fewer options for treating spondyloarthritis beyond non-biologic disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine, methotrexate, leflunomide, and TNF inhibitors. More recently, additional biologics and small molecules have transformed both treatment and outcomes.

“Today, we have a very different landscape with multiple IL-17 agents, IL-23 inhibitors, CTLA-4 antibodies, phosphodiesterase 4 inhibitors, and agents that inhibit the Janus Kinase (JAK) pathways,” he said. “We have multiple classes and multiple agents in each class, which is great, but also comes with a host of new challenges. Which agent is right for my patient right now? How do I best track disease activity? What are the most effective strategies for treating to target?”

TNF inhibitors are generally considered the first-line biologic option, Dr. Miloslavsky added, but clinicians may be less familiar with how to choose among the more recently approved options. Comorbidities drive treatment choices for many patients.

Osteoarthritis

Osteoarthritis has its own challenges. OA has few effective choices when it comes to disease-modifying therapies.

“The interventions we make in OA are not game-changers,” said Luc Nguyen, MD, Assistant Professor of Rheumatology at the University of Texas Health Science Center, San Antonio. “But just because we don’t win easily or quickly doesn’t mean the problem goes away for the patient. Sometimes it feels like we are fighting OA with sticks and stones, but those are the tools we have right now.”

Tuhina Neogi, MD, PhD, Professor of Medicine and Chief of Rheumatology at Boston University School of Medicine/Boston Medical Center, will explore different management options during 2021 CARE: Osteoarthritis (OA) and Related Disorders from 10:30 – 11:15 a.m. ET Sunday. Dr. Neogi will also discuss factors that contribute to OA pathogenesis and symptoms and key principle of OA diagnosis and long-term management, starting with safety. Dr. Nguyen will moderate the session.

“With OA, you’re looking at treatment month after month, more likely year after year, so safety is paramount,” Dr. Nguyen said. “And a lot of patients tend to be older to begin with, with more risk factors and comorbidities. I tend to start with topical nonsteroidal anti-inflammatories to avoid the systemic side effects of oral anti-inflammatories. Or topical capsaicin. Then we can consider oral NSAIDs if there are no contraindications. In San Antonio, where I practice, we see a population enriched with the triad of diabetes, hypertension, and hyperlipidemia, and a lot of our patients also have a component of chronic kidney disease. We have to be cautious when we use oral NSAIDs.”

Nonpharmacologic alternatives can be helpful for many patients. Diet and weight loss can make a tremendous difference in OA symptoms. For patients with knee OA, bracing can also help support the leg and improve kinesthetics.

Physical therapy (PT) is another viable alternative for some patients. Like bracing, PT cannot cure OA, but it can help alleviate symptoms by strengthening muscles that support affected joints.

“There is no cure for OA, but a multi-pronged approach is more likely to help patients manage their symptoms and their lives,” Dr. Nguyen said. “This is a common problem. Your parents, your relatives, your neighbors will ask you about this. OA is something we are all going to have if we’re lucky enough to live to become old one day.”

Scleroderma

Exciting data from the past several years has led to the approval of novel therapies for scleroderma-related interstitial lung disease (ILD). Furthermore, newly studied and/or approved medications also bring promise to the targeted treatment of gastrointestinal complications in this complex disease.

“New agents for scleroderma-associated ILD, and the repurposing of existing therapies to benefit scleroderma-associated GI complications are enhancing our abilities to effectively manage these patients,” said Zsuzsanna H. McMahan, MD, MHS, Associate Professor of Rheumatology at the Johns Hopkins Scleroderma Center. “For the first time in many years, we have several newly approved medications that can impact the disease progression and quality of life for our patients.”

Dr. McMahan will discuss updates in the current armamentarium for treating GI disease and ILD during 2021 CARE: Scleroderma from 2 – 2:45 p.m. ET Tuesday. She will also focus on treatment options for patients with the more complicated Raynaud’s phenomenon, which are aimed at reducing interruptions in digital blood supply and ultimately preventing damage, loss of function, and even amputation.

One of the challenges in treating scleroderma is that patients may present with a variety of symptoms and complications. Depending on the clinical picture, risk factors, and a patient’s prior experience with other medications, the selection of an immunosuppressive agent may be impacted. As there are many treatment options now available, it is important for rheumatologists to understand how to approach the evaluation and management of this complicated patient population.

“There have been real improvements in clinical care,” Dr. McMahan said. “It’s important to recognize them to help improve our patients’ outcomes and lives.”