Both presenters at the ACR: Year in Review agreed on Sunday that 2019 was a year where the field of rheumatology exploded both in clinical updates and basic science research as more people enter the field and technology helps harness “big data.”
Susan Manzi, MD, MPH, Chair of the Medicine Institute and Director of the Lupus Center of Excellence Autoimmunity Institute at the Allegheny Health Network in Pittsburgh, PA, reviewed the clinical rheumatology highlights of 2019.
It was certainly the year for psoriatic arthritis, she noted, with many successful trials.
“There is evidence we need to be more aggressive with biologic therapy first line,” she said. “And IL-23 and IL-17 are key pathway targets. They have been proven to be superior to some of the TNFs. They (drugs) have sustained effects, they are good for skin, joints, and enthesitis.”
A few changing paradigms in rheumatoid arthritis made news in 2019. JAK inhibitors continue to show promise, and the concept of monotherapy — more is not always better — continues to garner more interest as some studies show getting rid of background drugs and focusing on one is better, and often cheaper, for patients.
In osteoporosis, a Women’s Health Initiative study found that physical activity is associated with lower total and hip fracture.
“The thing that was really interesting about this study … is that it didn’t have to be rigorous physical activity,” Dr. Manzi said. “Mild activity, such as walking, and they even mention golfing, actually had a reduced risk of hip fractures.”
There was a huge win for systemic sclerosis interstitial lung disease treatment this year, she noted. The U.S. FDA approved nintedanib for the rare, but sometimes deadly, form of interstitial lung disease that’s caused by systemic sclerosis.
The FDA also approved apremilast for Behcet’s disease-associated ulcers in July.
The microbiome also drew a lot of attention this year, including the idea of leaking gut bacteria inducing inflammation, and DNA from E. gallinarium can be found in the livers of patients with lupus.
“It’s not just that it may be triggering lupus; it may be paralleling disease activity, and so the idea of what’s going on in the gut may parallel what’s going on in the kidneys is sort of the new frontier,” Dr. Manzi said.
Dr. Manzi also addressed updates in immune checkpoint inhibitors and noted they’re not going anywhere because they are being used to cure cancer. She ended on a “high note,” addressing the uptick of cannabidiol (CBD) use.
A U.S. social media survey found that 60 percent of people reported using CBD to treat medical conditions. The top three uses were for chronic pain, arthritis, and anxiety.
“The bottom line is (CBD) is here,” Dr. Manzi said. “They’re ordering it on Amazon, and we as a community are going to have to have a better understanding of the impact of medical cannabis.”
In the second half of the session, David S. Pisetsky, MD, PhD, at Duke University Medical Center in Durham, NC, presented the basic science rheumatology year in review, noting that 2019 offered more data than the past 50 years combined. He reviewed new technologies, including single cell RNA sequences (scRNAseq) and mass spectrometry, which are providing an unprecedented picture of disease pathogenesis at the level of single cells in the tissue.
The new analytic approaches and advances in informatics are transforming “big data” into valuable biomarkers and providing new targets in terms of therapies, he said. He highlighted the Accelerating Medicines Partnership, a public-private partnership between the NIH, FDA, private companies, and non-profit organizations helping to transform approaches to drug development.
“We’re learning a lot more about the number of different immune cell populations that are there and how they signal,” Dr. Pisetsky said.
Dr. Pisetsky also addressed DNA sensing, noting that DNA sensors in the cytoplasm can respond to DNA introduced during viral or bacterial infection.