News in brief: Test for TNFi non-responders; Trials needed for non-drug treatments of OA flares; National strategic action plan launched for pain management

Thursday, 17 Jun 2021

Trials needed for non-drug management of OA flares

There is a serious gap in evidence for non-drug approaches to the management of osteoarthritis flares, an Australian scoping review has found.

In a literature search researchers from the Kolling Institute, Sydney University were unable to find any large, well-powered clinical trials of behavioural, lifestyle or other adjunctive treatment strategies to manage OA flares.

The few studies that could be found in this area were for physical activity or therapeutic exercise, and none examined the often-recommended treatments such as non-weight bearing activities (e.g. swimming, hydrotherapy), heat/cold therapy, joint bracing/sleeves, assistive devices, or use of electrotherapeutic devices such as TENS. There was also a paucity of evidence relating to the hip or other joints and an absence of studies examining flare outcomes beyond pain.

“There is an urgent need for more consistent, high-quality randomised and cohort trials, including those investigating trajectories of symptom improvement at timeframes more relevant to flare presentation, and by joint affected,” the researchers concluded in Seminars in Arthritis and Rheumatism

Test may help identify TNFi non-responders

A novel test may help predict patients with RA who are unlikely to show a response to TNFi therapies, according to clinicians in the Netherlands.

The molecular signature response classifier (MSRC) test was trialled in a validation study in 68 RA patients who started adalimumab or etanercept TNFi as their first biologic.

According to results presented the researchers at the recent EULAR virtual meeting, more than half the patients (54.4%) failed to achieve a EULAR good response at six months. And patients with the molecular signature of non-response at baseline testing were four times more likely to have a poor response to TNFi at six months compared to patients without the signature on testing.

“Identifying those patients who will not respond to TNFi therapy in advance, before treatment begins, has the potential to reduce time spent on trial-and-error approaches and could result in improved outcomes and decreased patient burden,” said Dr Johanna Withers (PhD) study co-author and Principal Scientist at Scipher Medicine, makers of the PrismRA test.

The researchers also presented results at EULAR on the ability of PrismRA to predict inadequate response to TNF inhibitor therapies in seronegative RA patients as well as on efforts to define high-confidence treatment response outcomes using a Monte Carlo simulation approach to evaluate the true impact of therapeutic efficacy and response.

National pain strategy launched with focus on arthritis and MSK conditions

A National Strategic Action Plan for Pain Management has been launched with eight key goals and priorities aimed at preventing and reducing the burden of chronic pain for millions of Australians.

The plan released by Pain Australia includes partners such as Arthritis Australia and the Australian Rheumatology Association.

It notes that the number of cases of arthritis and other musculoskeletal conditions in Australia is predicted to increase by 43% to 8.7 million in 2032 and affect over 30% of the population.

Among its recommendations, the plan calls for all health practitioners and carers to be trained in pain management to improve conceptualisation of pain and underpin care plans and practices.

Other objectives include the establishment of patient-centred interdisciplinary assessment and pain care and support services that take into the account the health and wellbeing of the whole person is offered in all locations and made available through delivery and funding models at the primary care level wherever possible. It also calls for technology to be harnessed to expand access to multiple services including primary care services and pain specialists.

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