EULAR 2021 news in brief: Better treatment for RA reduces dementia; Weight loss can’t prevent arthroplasty; Defining SLE lupus remission

Wednesday, 9 Jun 2021

Treatment advances in RA reduce excess risk of dementia

A significant decline in rates of dementia has been seen in patients with RA over time – coinciding with the advent of novel biologic treatments for RA, a population-based study from the US has shown.

Dr Vanessa Kronzer, from the Mayo Clinic, told EULAR 2021 that the 10-year cumulative incidence of dementia in people diagnosed with RA during the 1980s, 1990s, and 2000s was 12.7%, 7.2%, and 6.2%, respectively.

For people in the general population without RA, the 10-year cumulative incidence of dementia in the 1980s, 1990s, and 2000s was 9.3%, 5.0%, and 7.1%, respectively.

“Our findings show substantial decline in risk of dementia in patients with RA onset in the 2000s as compared to 1980s, including when compared to the general population comparators.”

“Further studies should investigate this association using manual verification rather than billing codes for dementia, and should also elucidate the role of inflammation, autoimmunity, and anti-rheumatic treatments in risk of dementia.”

Reducing load on joints with surgery doesn’t reduce arthroplasty

Bariatric surgery decreases the risk of moderate to severe hip or knee osteoarthritis but is associated with increased rates of a first hip or knee arthroplasty.

A large Swedish study presented at EULAR 2021 comprised data from 51,000 patients undergoing weight-reducing surgery and 341,000 obese patients not exposed to surgery.

Dr Theresa Burkard, a postdoctoral researcher at ETH Zurich, said that bariatric surgery patients had less diabetes (15.3% v 25.5%), hyperlipidaemia (10.3% v 23.8%), and ischaemic heart disease (1.1% v 7.7%) than obese patients, but more gastroesophageal reflux disease (48.1% v 18.0%).

After propensity matching, the hazard ratio for any arthroplasty was 1.43, 1.21 for hip arthroplasty and 1.58 for knee arthroplasty in bariatric patients compared to obese patients. Men and women had similar risk but the risk of arthroplasty increased with older age.

The highest risk of arthroplasty was seen shortly after bariatric surgery (HR 1.79) but attenuated with longer follow-up.

The hazard ratios for osteoarthritis diagnoses – 0.84 overall, 0.90 for hip OA and 0.82 for knee OA – favoured bariatric surgery to reduce the mechanical load on joints.

“Bariatric surgery likely acted as an enabler to undergo hip or knee arthroplasty,” Dr Burkard concluded.

Defining the most important target in lupus – remission

The DORIS project, working towards a common definition of remission in SLE, has added five recommendations to the existing 2016 framework.

Professor Ronald Van Vollenhoven, from the Amsterdam UMC and Amsterdam Rheumatology Centre, told EULAR 2021 that recent work including systematic reviews and individual studies has resolved a number of outstanding issues.

The DORIS Task Force found:

  • serology such as anti-DNA or complement should not be included in the definition of remission on-treatment.
  • duration should not be included in the definition of remission
  • SLEDAI-based definitions of remission have more evidence than BILAG D/E or clinical ECLAM
  • remission off-treatment is rare. Remission on-treatment should therefore be the outcome in clinical trials
  • both the LLDAS definition of low disease activity and the DORIS definition of remission are recommend as outcomes in clinical trials.

The definition of remission includes a clinical SLEDAI = 0 and a Physician Global Assessment <0.5.

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