Highlights From ACR 2007

Here we summarize abstracts that were presented by Arthritis Foundation-Funded Researchers at the 2007 American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting. Abstracts are displayed and discussed in poster sessions at the meeting, and often become the basis for full-length articles that will be submitted to scientific journals for peer review and publication.

Patients’ Knowledge of Arthritis

Karen Golan, Jamie Weiss, Lisa C. Vasanth, Stephen A. Paget, Theodore Fields, Melanie J. Harrison

Researchers from the Hospital for Special Surgery in New York, including Arthritis Foundation-funded scientists Lisa C. Vasanth, MD, and Melanie J. Harrison, MD, developed a pilot study to explore early arthritis patients’ understanding of arthritis and inflammation. They conducted in-depth phone interviews with eight people with newly diagnosed rheumatoid arthritis or undifferentiated joint inflammation to identify gaps and misunderstandings in arthritis-related knowledge.

Questions asked of the participants focused on five areas of interest: what are arthritis and inflammation; who is at risk for developing arthritis; what are its causes; what exacerbates or alleviates it; and what are the implications of arthritis for long-term outcome.

Some participants’ knowledge about arthritis was accurate. For example, they understood that certain types of arthritis are autoimmune conditions, which can involve more than just the joints. However, the majority believed arthritis was a natural part of aging and typically affected the elderly. They also underestimated the potential for disability associated with inflammatory arthritis, especially without proper or early intervention.

Overall, the participants had a very basic knowledge of signs and symptoms of arthritis and inflammation. How- ever, they possessed a limited understanding and often a misunderstanding of its treatment and long-term prognosis. The authors conclude, “Only by identifying these areas of misunderstanding can we develop effective educational tools for both patients and providers so that we can better advise patients, appropriately adjust perceptions and expectations, and communicate the seriousness of inflammatory arthritis.”

Stress and Coping in Children and Adolescents with Fibromyalgia

Christopher J. Libby, David S. Glenwick, Pamela J. Degotardi

Researchers from Fordham University in Bronx, N.Y., and Queens College in Flushing, N.Y., – including Christopher J. Libby, who received an Arthritis Foundation Summer Student Fellowship – applied a stress and coping model to juvenile fibromyalgia syndrome. Fifty-seven children diagnosed with juvenile fibromyalgia (ages 10 to 18 years) and their parents were recruited to the study and they completed several questionnaires regarding pain, stress, use of coping strategies, etc.

Significant correlations were found between daily hassles (such as homework and fear of being teased) and depression and between daily hassles and child-rated quality of life. High depression scores were related to low child-rated quality of life. High catastrophizing (persistent thoughts of “this is terrible, I can’t bear this, there’s nothing I can do to make this better, etc.”) scores were related to high ratings of current pain, worst pain in the past week and depression scores. High catastrophizing scores also were related to low child-rated quality of life. Good self-efficacy (the confidence that you are in control of yourself and of managing your disease) was associated with good child-rated quality of life. Low self-efficacy scores were associated with high depression scores, ratings of current pain and ratings of worst pain in the past week. Statistical analyses showed that stress due to daily hassles predicted the outcome measures of depression and child-rated quality of life, suggesting that stress may exacerbate health outcomes in juvenile fibromyalgia.

The results of this study suggest that catastrophic thinking and beliefs about one’s ability to overcome fibromyalgia are important targets for psychological intervention.

Rheumatoid Arthritis Health Outcomes Are More Strongly Linked with Mutuality Than with Physical Affection

Shelley Kasle, Alex J. Zautra

Mutuality, the interest in sharing thoughts and feelings in close relationships, has been linked with better health outcomes for people with rheumatoid arthritis (RA). Physical affection, measured as frequencies of hugs, has been linked with lower stress in women. Because stress reactions have been linked with disease activity in RA, researchers from University of Arizona in Tucson wanted to test the hypothesis that physical affection and mutuality would have comparable links with RA health outcomes.

Arthritis Foundation-funded researcher Shelley Kasle, PhD, and previous award recipient Alex J. Zautra, PhD, recruited for their study a total of 105 people with RA who were in committed relationships. They completed measures of mutuality, physical affection, and health outcomes: depressive symptoms, anxiety symptoms, physical disability and arthritis impact. Researchers analyzed the data looking for correlations among mutuality, physical affection and health outcomes.

Participants with higher levels of mutuality in their relationships reported better health. Correlations between health outcomes and physical affection were not significant.

One might suspect that a couple’s verbal and physical relationships would have similar associations with health outcomes in RA, but this study finds otherwise. The association between health outcome and mutuality was generally stronger than the association between health outcome and physical affection. With additional data, these findings could be interpreted as suggesting a potentially larger benefit from enhancing couples’ verbal relational behaviors than their physical ones.

Fatigue, Discomfort, and Burden of Illness Among Sjögren’s Syndrome (SS) Patients in the United States

S. J. Bowman, B. M. Segal, P. C. Fox, F. B. Vivino, N. Murukutla, T. V. Kamath, M. Yin, L. McLean

A multicenter team of scientists, including Arthritis Foun-dation-funded researcher Barbara M. Segal, MD, of the University of Minnesota in Minneapolis, conducted the first, large, comprehensive study of burden of illness among people with Sjögren’s syndrome (SS) in the United States. Sjögren’s syndrome is a disorder characterized by dry eyes and mouth; when it occurs alone it is called primary SS, but it commonly accompanies a rheumatic disease and is called secondary SS.

Surveys were mailed to 8,694 members of the Sjögren’s Syndrome Foundation. Half the SS patients were asked to give a similar survey to a friend of the same sex and age without SS. This cohort of friends formed the control group.

In total, 1,225 surveys from people with primary SS, 1,278 surveys from people with secondary SS, and surveys from 606 controls were returned. All SS patients reported significantly poorer health and functioning, greater fatigue and dryness, and higher scores on the pain, depression and impaired thinking scales than controls.

In conclusion, the authors found the comparison to the control group suggests patients’ experiences of significant disability and burden of illness are related to the disease and not merely attributable to the natural processes of aging.

Costs and Benefits of Strategies for Treating New Onset Rheumatoid Arthritis within 12 Weeks

A. Finckh, N. Bansback, C. Marra, A. H. Anis, K. Michaud, S. Lubin, M. White, V. Gall, M. H. Liang

Information from recent studies suggests that if rheumatoid arthritis (RA) is treated early, remission may be possible. A multicenter team of scientists, using a gift from an anonymous donor and a grant from the Arthritis Foundation, conducted an economic analysis of three strategies for treating early RA.

The model the team used estimates the lifetime costs and benefits of treatments expressed as quality-adjusted life years (QALYs). Three management strategies were compared for people with RA of less than 12 weeks’ duration: A pyramid approach with a disease-modifying antirheumatic drug (DMARD) beginning at one year; early intervention with conventional DMARDs; and early biologics and methotrexate. The benefits of each treatment were calculated by estimating how each strategy impacted radiological progression, patient function, drug-related toxicities and life years.

Preliminary results suggested a strategy including early biologics gives the greatest lifetime benefit (11.2 QALYs) compared to conventional DMARDs (10.9 QALYs) and pyramid strategy (10.6 QALYs). Early biologic treatment is the most expensive strategy ($83,000/lifetime) followed by early DMARD treatment ($60,000/lifetime). However, the research team found that the additional costs of early treatment strategies are mostly offset by avoiding future hospitalizations and delaying hip replacements.

Using the most objective measures of RA progression (joint erosions and function), the researchers found that early initiation of DMARDs and biologics can prevent future disability and reduce long-term costs. The conclusions drawn by the research team are heavily dependent on the costs of the therapeutic interventions. The authors conclude, “Reducing the costs of biologics would improve the cost-effectiveness of this strategy.”