What’s in store for rheumatology in 2018?

The limbic asked three rheumatologists where they see the challenges and promise in 2018. Exercise and weight management was a common theme and the hope for a completely new approach to rheumatoid arthritis.

Osteoarthritis: no more ‘one size fits all’

Professor Flavia Cicuttini, head of rheumatology at the Alfred Hospital, tells the limbic a larger workforce will be needed to deal with the burden of osteoarthritis.

However there are opportunities to share the load including through better education of primary care doctors on the management of osteoarthritis and encouraging more self-management in the community.

“Better education of the community re: osteoarthritis is necessary so we can have realistic patient expectations and better understanding of what can be achieved with therapies. This then leads to the importance of healthy lifestyle: exercise and weight management. We must get the message of ‘exercise is medicine’ across to the community.”

She says the lack of disease modifying drugs for osteoarthritis is an ongoing clinical challenge, as is the need to reduce opioid use across all musculoskeletal diseases.

Better allocation of joint replacements is also necessary especially in knee osteoarthritis, where dissatisfaction rates are high.

However there is some optimism regarding the results of clinical trials in play.

“The new approach of targeting different patient phenotype in osteoarthritis offers potential new treatments. A ‘one size fits all’ approach will not work. Each joint group is different. Within a joint such as the knee, there are different pathological drivers that offer targets for treatment.”

Gout: still suffering from stigma

Dr Philip Robinson from the University of Queensland tells the limbic that gout will remain a challenging condition to treat in 2018 and beyond.

“This is for a number of reasons including the ongoing community stigma about it being a self-inflicted disease, the under-recognition that gout is a damaging and problematic health issue, and the more practical issues associated with treating gout like doctors understanding the treat to target paradigm.”

He says new data on the increased cardiovascular risk associated with febuxostat, which triggered an FDA alert, further complicates the management of gout.

“In a patient group that already has a high prevalence of cardiovascular risk factors it is now even more challenging to treat.”

“Obesity continues to increase which drives up serum urate levels and consequently gout ,so attention both to gouty arthritis and to general health is important for the prevention and treatment of this widespread and common disease.”

Rheumatoid arthritis: hope for dendritic cell therapy

Griffith University’s Professor Julien de Jager tells the limbic that even with the plethora of new therapies that have come onto the market over recent years, there is still a cohort of rheumatoid arthritis patients whose response to treatment is not ideal.

“We’ve been using treat-to-target for at least a decade now and we still fall short in about 10% of patients. They are certainly not in full remission.”

“They are probably on multiple therapies, for example, three drugs plus a biologic, and that means the chances for toxicity are considerably higher and you have to watch them very carefully.”

“To my knowledge I don’t think there are any new therapies awaiting introduction this year.”

However he says there is the promise of a new approach.

“There are things like Ranjeny Thomas’s work on dendritic cell therapy currently in trials now and that would be really exciting because it potentially could offer cure.”

“If you can take something that changes the underlying immune process then it’s quite different to everything else we have got at the moment.”

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