Even a limited amount of low-impact exercise can significantly help patients with osteoarthritis (OA), according to one of the presenters at Saturday’s ARHP Clinical Focus Course, Clinical Advances in Rheumatologic Diseases: A Case-Based Approach.
Research shows that taking part in activities such as fitness walking and aquatic exercise for as little as 15 to 30 minutes three times a week can reduce the common OA symptoms of pain, stiffness, and swelling, said Karen Huisinga, MN, ARNP, FNP, a rheumatology nurse practitioner at the Seattle Division of the VA Puget Sound Health Care System.
In addition, coupling exercise with a good diet can result in a weight loss target of losing 10 pounds over 10 years, which research has shown decreased the odds of developing knee OA by 50 percent.
“When you have that message and can give it to your patients, that is empowering,” she said.
Huisinga called it an exciting time in the treatment of OA, which affects nearly 30 million Americans, because there finally seems to be some pharmaceutical options like the many therapeutics available for rheumatoid arthritis (RA).
Huisinga highlighted the drug duloxetine, a serotonin and norepinephrine reuptake inhibitor shown by one study to reduce pain in knee OA.
“That seems to be a tool now in our toolbox,” she said.
She also noted the increased emphasis for catching OA earlier in the disease process, including the earlier performance of MRIs instead of x-rays to get a clearer picture of early onset of the condition.
On the pediatric side, Peter Chira, MD, MS, discussed juvenile idiopathic arthritis (JIA), an arthritis of unknown etiology that begins before a child’s 16th birthday and persists for at least six weeks.
One of the more common types, oligoarticular, occurs most often in 2-year-old, blonde-haired, blue-eyed girls, said Dr. Chira, Associate Professor of Clinical Pediatrics at the University of California-San Diego Rady Children’s Hospital.
One of the biggest concerns with JIA, he said, is uveitis, which occurs in about one in five cases of oligoarticular JIA. The condition can lead to cataracts, glaucoma, or even blindness. Sometimes it is asymptomatic and picked up only by a routine eye exam, Dr. Chira said.
The U.S. Food and Drug Administration has approved a number of biologics for various types of JIA, he said, starting with etanercept in 1999 and including canakinumab two years ago.
A major emphasis in treating JIA, he said, is the establishment of multi-disciplinary teams that include nurses, social workers, and parents.
“We know that looking at the patient very holistically we get better outcomes in the long run,” Dr. Chira said.
Jessica Farrell, PharmD, Associate Professor of Pharmacy Practice at the Albany College of Pharmacy and Health Sciences, addressed some of the newest developments in RA.
She noted the advent of new tests searching for biomarkers as predictors of radiographic progression in early RA.
Dr. Farrell pointed to research on anti-carbamylated protein (anti-CarP) antibodies. A study involving 460 RA patients who were positive for anti-CarP antibodies observed the patients for seven years. It found that patients had significantly more disability over time and higher levels of disease activity than the negative anti-CarP group.
“There is a lot going on in terms of new drug development,” Dr. Farrell said when discussing emerging treatment options.
One such compound is baricitinib, a JAK inhibitor now in a Phase IIb trial. She said data on baricitinib indicated that it might be one of the best options to try if methotrexate does not work.