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Specialty Pharmacy Times
April 2012
Specialty Pharmacy Times:   April 2012

Rheumatoid Arthritis

Michael C. Wisotsky, PharmD, RPh
Published Online: Monday, April 9, 2012
RA Patients at Risk for Atrial Fibrillation
In a study published in the British Medical Journal on March 8, 2012, Danish researchers concluded that patients with rheumatoid arthritis (RA) seem to have a higher propensity for developing atrial fibrillation later in life, a condition that puts patients at higher risk for stroke and thromboembolism.

The longitudinal study examined the entire Danish population over the age of 15 years and rates of atrial fibrillation and stroke were recorded. Of the 4,182,335 participants included in the cohort, 18,247 were identified as having RA during follow-up. A total of 156,484 people, including 774 with RA, were diagnosed with atrial fibrillation, with an adjusted incidence rate ratio of 1.41 (95% confidence interval 1.31-1.51). In addition, 165,343 people, including 718 with RA, had a stroke, with a resultant rate ratio of 1.32 (1.22-1.42).

The researchers found that the rates of both atrial fibrillation and stroke were higher in patients with RA than in patients without RA. They concluded that RA is associated with an increased risk of atrial fibrillation and stroke, a novel finding, the researchers write. “[This association] suggests that arrhythmia is relevant in cardiovascular risk assessment” in RA patients.

Prednisone with Methotrexate Best Option for Early RA Patients
In a study published in the March 6, 2012, issue of the Annals of Internal Medicine, researchers from the University Medical Center in Utrecht, the Netherlands, found that starting treatment of early rheumatoid arthritis with methotrexate plus low-dose prednisone is more effective than methotrexate alone.

The study enrolled 236 patients from 7 hospitals in the Netherlands, all of whom had RA duration of less than 1 year. The study was a randomized, doubleblind, placebo-controlled study in which patients received either methotrexate and prednisone or methotrexate and placebo. Outcomes included tender joint count, visual analog scales of general well-being, and erythrocyte sedimentation rate at monthly visits. All patients were switched to other therapies if they did not reach remission after 5 weeks of a maximum tolerable dosage of subcutaneous methotrexate.

The researchers found that erosive joint damage, although limited in both groups, was on average 0.87 unit lower in the methotrexate/prednisone group compared with the methotrexate/placebo group (P = .001). In addition, patients who received methotrexate plus prednisone reached remission on average 5 months sooner than patients who received only methotrexate.

Finally, the researchers also found that patients who received early prednisone therapy were less likely to require additional treatment such as cyclosporine or monoclonal antibodies, demonstrating that adding prednisone was more effective at reducing disease activity. This study, the researchers argue, confirms that the use of prednisone as a disease-modifying antirheumatic drug should be encouraged, particularly in patients newly diagnosed with RA.

Fewer Children for Women with RA
Women with autoimmune disorders such as RA generally have fewer children than they would like to have, according to a survey that appeared recently in Arthritis Care and Research.

In the study, researchers analyzed questionnaire responses from 114 women with lupus and 578 with RA who were enrolled in the National Data Bank for Rheumatic Diseases. Respondents were separated into 3 groups: women who had fewer children than planned, those with the number of children they desired, and those who no longer wished to have more children.

“On the surface, the two patient populations share primary vulnerabilities, as both diseases are characterized by systemic inflammation, affect women during their reproductive years, and require similar medications,” the researchers wrote.

Among women with RA, those who had fewer children than they had planned reported rates of infertility 1.5 times higher than the other 2 groups. Researchers also noted that factors other than infertility, such as fear they could not care for children (53%) or the concern that they would pass their disease to their offspring (17%), affected their number of pregnancies. SPT

Fast Fact: Smoking cigarettes can increase the risk for developing rheumatoid arthritis.
About the Author
Michael C. Wisotsky, PharmD, RPh, practices in Shrewsbury, New Jersey.

Further Reading
In an interview with Specialty Pharmacy Times, James E. Smeeding, executive director of the National Association of Specialty Pharmacy, discusses the organization’s future and issues in the specialty marketplace.
Michael R. Page earned his PharmD from the Ernest Mario School of Pharmacy at Rutgers University. He has worked as a community pharmacist at CVS Pharmacy and is currently clinical editor in clinical and scientific affairs at Pharmacy Times.
Apremilast (Otezla) is the first oral therapy FDA approved to improve signs and symptoms, including physical functioning for patients with this condition.
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