PracticeUpdate: Dermatology & Rheumatology

ACR 2016 21

Median time from symptom onset to inclusion was 2.6 (range 0–78) years. The last follow-up visit was a median of 10.5 years after symptom onset. Ninety-five percent of patients fulfilled theAmerican College of Rheumatology 1987 classification criteria for rheumatoid arthritis and 73.2% were positive for anti-citrullinated protein antibodies. Visits took place at a median interval of 6 (range 1 to 215) months. The duration of remission was defined as the time between the first visit fulfilling remission criteria and the subsequent first visit with higher disease activity, after a median 2.8 years. The estimated time to sustained remission for each year was calculated with life table analysis and compared using the log-rank test. A total of 12,193 (41.9%) patients reached sustained remission according to Disease Activity Score 28 at some time point during follow-up. Of patients with symptom onset from 1981–1990, 1991–2000, and 2001–2010, 35.0%, 43.0% and 45.6% reached sustained remission, respectively (P < 0.001 for each increment). The time period from symptom onset to sustained remission decreased every other year with only two exceptions (P < 0.001). The estimated mean time to sustained remission was 11.7 years in 1999 and 4.2 years in 2009. Dr Einarsson concluded that the prevalence of sustained remission was higher from 2001–2010 than during the previous two decades. The time from onset of rheumatoid arthritis symptoms to sustained remission decreased gradually between 1999 and 2009. The treatment strategy over the past decade improved the outcome of rheumatoid arthritis, though improvement in time to diagnosis and early effective treatment is required to reach the treatment goal of sustained remission in the majority of patients.

Statins may lower mortality of patients with ankylosing spondylitis, psoriatic arthritis by a third Patients with ankylosing spondylitis or psoriatic arthritis who take statins may be at up to 33% lower mortality risk, results of a retrospective database analysis show. A mar Oza, MD, of Massachusetts General Hospital, Boston, Massachusetts, explained that ankylosing spondylitis is arthritis of the spine that can resemble rheumatoid arthritis. It more often affects males. HLA antigen is present and rheumatoid factor absent. Psoriatic arthritis is a chronic form of arthritis that can affect the skin and joints. If not treated, psoriatic arthritis can lead to joint damage. Both ankylosing spondylitis and psoriatic arthritis are seronegative spondyloarthropathies, and both are associated with increased cardiovascular mortality risk. The goal was to determine whether initiation of statins might be associated with a lower mortality risk in this patient population. Dr Oza said, “The expanding literature on the dual role of statins to lower both inflammation and cholesterol levels has naturally led to an interest in the role of statins in inflammatory arthritis. A randomised trial found such a dual benefit among patients with rheumatoid arthritis, and a population-based study of patients with rheumatoid arthritis found a survival benefit associated with statin use as well.” He continued, “We hoped to quantify the potential impact of statins in the seronegative spondyloarthropathies, since the risk of all-cause and even cardiovascular-specific mortality has been shown to be elevated in these conditions.” Using a UK general population database, the researchers studied patient data on patients with ankylosing spondylitis or psoriatic arthritis patients from 2000 through 2014. They used 50 different variables to create propensity scores, including disease duration, socioeconomic status, body mass index, lifestyle factors, and medication use. Of 2904 patients with either ankylosing spondylitis or psoriatic arthritis who started statins, 271 died during the mean 5.3 years of follow-up. Of 2904 propensity-matched patients with ankylosing spondylitis or psoriatic arthritis who did not start statins, 376 died during the mean 5.15 years of follow-up. Baseline characteristics between the two groups were well balanced. Statin initiation was associated with a 33% reduction in all-cause mortality. The inverse association of statin initiation and mortality risk among patients with ankylosing spondylitis or psoriatic arthritis appeared larger than that observed in other population-based cohort studies of patients with rheumatoid arthritis. The dual benefits of lowering lipids and reducing inflammation, both contributors to cardiovascular disease risk, could be the reason for this significant benefit of statins. Dr Oza said, “Given the increased risk of mortality and cardiovascular disease compared to the general population, patients with seronegative spondyloarthropathies like ankylosing spondylitis and psoriatic arthritis may benefit from the dual anti- inflammatory and lipid-lowering properties of statins, perhaps even more than the general population.” He added, “This observational study raises the possibility that clinicians may have a lower threshold for starting their patients on statins to mitigate this mortality risk. The results set the groundwork for potential clinical trials that will provide high- level evidence about the impact statins exert on health of patients with seronegative spondyloarthropathies.”

DECEMBER 2016