Members of the Global RA Network share their key initiatives for rheumatoid arthritis patients at a workshop organized during EULAR 2023

July 5, 2023



The 2023 EULAR Congress in Milan early June was a fantastic opportunity for the members of the Global RA Network to meet in person but also virtually over a very productive annual workshop. We exchanged a wide range of ideas and experiences and took time to discuss how we could address RA and health inequities as a network of patient organizations.



The first part of our workshop was devoted to sharing the main initiatives that our member organizations have carried out in 2023 in their respective countries to address one of the Network's priorities. They did so by means of poster summaries, highlighting the context, target audiences, activities, results and next steps of their projects. All the projects were highly innovative and successful. They all contributed greatly to improving awareness, education and quality of life for rheumatoid arthritis patients. Below you'll find a sample of these initiatives, with a quick summary for each, and a link to the more detailed posters.



Take a look, get inspired and get involved!



Arthritis Consumer Experts (ACE) in Canada conducted a national Survey on Health Inequities in Arthritis Care to raise awareness of the disparities in access to arthritis care in Canada between White people and Black, Indigenous people and people of colour (BIPOC) living with arthritis. The Survey was promoted through social media and supported by a series of webinars on Indigenous health. In a second phase, meetings are planned with provincial and territorial health ministries to present the Survey results, the state of arthritis care for BIPOC people, and the Canadian RA Dashboard.



The French League Against Rheumatism (AFLAR) has developed an information and education video series (3 videos) about RA including patient testimonials, the creation of a panel of patients, working groups on pain with patients, a rheumatologist, an expert in therapeutic patient education, a community pharmacist and consultation with the Minister of Health on biosimilar medicines.



The Italian National Association of People with Rheumatological and Rare Diseases (APMARR) created the “Buono da mangiare” (Good to eat) program promoting the benefits of eating well – nutrition (good and right food intake), socialization (increased conviviality) and pleasure (savory meals, taking the time to eat), taking care of oneself for a good quality of life – with RA patients, care givers and doctors. It started with a survey about nutrition and produced a book of recipes developed together with Italian scientific society of nutrition and a team of rheumatologists, videos and an application. The book and program got a well-deserved award.



Arthritis Ireland launched a Clinic Referral Program whereby hospital clinics refer newly diagnosed patients to Arthritis Ireland who in turn offer support to them to empower them and help them effectively self-manage their disease. The program is growing with an increased number of referrals and positive feedback as it allows patients to receive personalized information and creates one-on-one relationships, contributing to better care.



The National Rheumatoid Arthritis Society (NRAS) in the United Kingdom surveyed participants in SMILE-RA (Self-management Individualised Learning Environment in Rheumatoid Arthritis), an e-learning program created by NRAS and providing innovative, evidence-based, high quality educational content which is accessible to individuals and their families and carers for free, 24/7. The survey results demonstrate that the program improves the patients’ understanding of the importance of supported self-management, as well as many of the components of patient empowerment. NRAS promoted it through a large marketing campaign, on its social media channels, and by encouraging health care professionals to share about it. Over 2,000 people have participated in SMILE-RA to date and health care professionals agree that the program is a great learning resource.



The Association of patients with rheumatic diseases of the Republic of Serbia (ORS) has implemented its "Expert Patient Program”, which involves training its members - patient activists - to become expert patients and organizing workshops with medical students. At these workshops, participants are introduced to the Serbian RA dashboard and reminded of the importance of collecting data.



The Rheumatoid Arthritis Liga (RA Liga) in Belgium organized a traveling art exhibition entitled "ART and RA, hand in hand" and toured it to raise awareness of RA and early diagnosis in a creative way, with the patients' message behind the artwork, in collaboration with hospitals and rheumatologists. RA Liga promoted it via local government, artists, several associations, caregivers, and local publicity.



Congratulations to our member organizations across Europe and the Americas for their energy, creativity and dedication.



Please contact us at secretariat@globalranetwork.org or the members of the Global RA Network (see the homepage for contact information) with any questions you may have on their initiatives.

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EULAR 2023 Highlights

June 27, 2023



The EULAR congress of rheumatology was held live in the vibrant city of Milan from May 31st to June 3rd, 2023. The event once again boasted a diverse and informative program that left attendees feeling inspired and educated.



During the congress, the secretariat of the Global RA Network was present alongside numerous member organizations. We took advantage of this opportunity to host a workshop for our members, which was met with great success! Each organization presented a major initiative they had undertaken in 2023 that significantly contributed to improving the patient journey for those with RA, or advocated on their behalf to various stakeholders. All of the initiatives were innovative and strongly aligned with the Network's priorities. As a group, we discussed the health disparities associated with RA in our respective countries and how we can work together, as well as individually, to address these challenges. The discussion generated interesting ideas, some of which will be implemented in the coming year. Stay tuned!



The members of the Global RA Network also played an active role in the EULAR congress, presenting research, hosting conferences, and managing booths. Here are just a few examples of the presentations:

• Slađana Rumpl Tunjić from Association Remisija (Croatia) and EULAR Young PARE chaired the session entitled 0 – 100 in 75 minutes; RMDs have no age




• Tanita-Christina Wilhelmer from Österreichischen Rheumaliga/Jung und Rheuma (Austria) gave a presentation about The use of objects to experience inflammatory rheumatic diseases in order to increase knowledge and understanding through perspective-taking, with a focus on enhancing empathy




• Suncica Djordjevic from ORS-Udruženje obolelih od reumatskih bolesti Republike Srbije (Serbia) held a poster tour




• At the session entitled The Clinic as a Classroom – teaching and learning with patients, Nenad Nedić from ORS (Serbia) presented the case study Serbia: Patient Expert implementation in Serbia following KTP and Andri Phoka from the Cyprus League Against Rheumatism (Cyprus) and AGORA presented case study Cyprus: Patient Expert implementation in Cyprus following KTP.




• Ellen Wang from Arthritis Consumer Experts (ACE) presented in the session entitled The promise of health literacy in clinical care.

Our team has put together a collection of noteworthy research and news related to rheumatoid arthritis that was discussed at EULAR. We have provided a summary of this information below. If you require additional information, the conference content is accessible online on-demand until December 31, 2023.



Summary of significant research related to rheumatoid arthritis



Cancer Risk in Rheumatoid Arthritis Patients Not Due to Medications



Rheumatoid Arthritis (RA) affects 24.5 million people worldwide and has been associated with increased cancer risks.



Researchers at EULAR looked at whether the increased cancer risk in RA patients is due to the disease itself or the medications used for treatment.¹ The researchers compared cancer rates in RA patients receiving different types of treatments with those in the general population.



The results showed that RA patients had a higher overall cancer risk compared to the general population, regardless of the medications they were taking. This suggests that the increased cancer risk is not due to the drugs used to treat RA. Instead, it may be related to the underlying inflammation and immune system abnormalities associated with the disease.



This finding is important because it helps researchers and clinicians better understand the potential risks associated with RA and its treatment. It also reassures patients that their medications are not increasing their cancer risk. The study highlights the need for further research to explore the relationship between RA and cancer and to develop strategies to reduce this risk in RA patients.



Impact of Obesity on Rheumatoid Arthritis Treatment Outcomes



A study was presented that explored how obesity affects treatment outcomes in RA patients.² Researchers analyzed data from over 1,500 RA patients, comparing the effectiveness of various treatments between patients with obesity and those without.



The results showed that obese RA patients had a lower likelihood of achieving remission (a state where the disease becomes inactive) and experienced a slower improvement in their symptoms compared to non-obese patients. This suggests that obesity can negatively impact the effectiveness of RA treatments.



These findings are crucial for both patients and healthcare providers as they highlight the importance of addressing obesity in the management of RA. By focusing on weight loss and maintaining a healthy weight, RA patients may improve their chances of successful treatment outcomes. This study also emphasizes the need for further research to explore the underlying mechanisms that link obesity and RA treatment response and to develop targeted strategies to enhance treatment effectiveness in obese RA patients.



Biosimilar Biologics as Effective as Originator Biologics for Rheumatoid Arthritis Treatment



A systematic review and meta-analysis published in JAMA Network Open compared the effectiveness and safety of biosimilar drugs to their biologic originator counterparts in treating RA.³ Biosimilars are biological medications that are highly similar to biologic originator medications, offering a potentially more affordable treatment option for RA patients.



The researchers analyzed data from multiple clinical trials involving over 3,000 RA patients treated with either biosimilars or originator biologics. The results showed that biosimilars were just as effective in reducing RA symptoms and had similar safety profiles as the originator biologic medications.



This finding is significant for RA patients and healthcare providers, as it demonstrates that biosimilars can be a viable and cost-effective alternative to expensive biologic originator medications without compromising treatment outcomes. The study also supports the ongoing adoption and use of biosimilars in the management of RA, potentially increasing access to effective treatments for more patients.



Maternal Rheumatoid Arthritis and Autism Risk in Offspring



A study from Sweden presented at EULAR examined the potential link between maternal rheumatoid arthritis (RA) and the risk of autism spectrum disorder (ASD) in their children.⁴ Researchers analyzed data from more than 1.5 million children, including those born to mothers with RA and those without the disease.



The results indicated that children born to mothers with RA had a slightly increased risk of developing ASD compared to children born to mothers without RA. This suggests that maternal RA may be a contributing factor in the development of ASD in offspring.



This research is important for expectant mothers with RA and healthcare providers, as it highlights the need for increased awareness and monitoring of ASD risk in children born to mothers with the disease. It also emphasizes the importance of further studies to better understand the relationship between maternal RA and ASD, as well as potential interventions to reduce this risk.



High Mortality Rates Linked to Depression in Rheumatoid Arthritis Patients



Anxiety and depression are the mental health issues most commonly associated with RA, and it is well-established that there is a link between mental health issues and poor health outcomes.



A Danish abstract presented at EULAR explored the relationship between depression and mortality rates in patients with RA.⁵ Researchers analyzed data from over 2,000 RA patients, including those with and without depression, to determine whether depression could be associated with higher mortality rates in this population.



The results revealed that RA patients with depression had a significantly higher mortality rate compared to those without depression. This suggests that depression may be an important factor contributing to the increased risk of death among RA patients.



These findings are crucial for RA patients and healthcare providers, as they emphasize the importance of addressing mental health issues like depression in the comprehensive management of RA. Early detection and treatment of depression in RA patients may not only improve their psychological well-being but also potentially reduce the risk of premature death.



The study highlights the need for further research to better understand the underlying mechanisms linking depression and mortality in RA patients, as well as the development of targeted interventions to improve mental health outcomes in this population.



Artificial Intelligence Enhancing Rheumatoid Arthritis Patient Care



At the congress, several studies were presented that explored the potential of artificial intelligence (AI) to improve patient care and management for individuals with RA. Researchers developed AI-based tools designed to assist healthcare providers in making better treatment decisions, monitoring disease progression, and predicting patient outcomes.



A Japanese team of researchers looked at the use of machine learning in predicting the development from undifferentiated arthritis to RA.⁶ Undifferentiated arthritis (UA) is arthritis that does not fit a specific diagnosis. Half of the UA undergo spontaneous remission, while 30% of cases develop RA. In UA, identifying patients at high risk for developing RA and providing close monitoring for those patients is required for early diagnosis and treatment.



The researchers concluded that applying a machine learning approach might enable identifying patients at high risk of RA progression and improve the clinical management of undifferentiated arthritis patients.



This study highlights the growing importance of incorporating advanced technology like AI into healthcare, as it offers the potential to improve both patient care and healthcare provider efficiency. Further research is now needed to refine AI algorithms and evaluate their long-term effectiveness in managing RA.



Comparing Human and Computer Accuracy in Predicting Rheumatoid Arthritis Progression Using MRI



Predicting early RA from MRI images of the hands and feet can help people access timely treatment, which may possibly change the disease course. Traditionally this is done by radiologists and rheumatologists using a scoring sheet to manually identify key features from the MRI scans.



An abstract presented by researchers from Leiden University Medical Center evaluated the accuracy of human specialists versus computer algorithms in predicting RA progression using magnetic resonance imaging (MRI).⁷ MRI is a crucial tool for assessing joint inflammation and damage in RA patients, helping healthcare providers make informed decisions about treatment plans.



Researchers compared the ability of experienced radiologists to predict RA progression using MRI with that of a computer algorithm specifically designed for this task. The study involved analyzing MRI scans from a large group of RA patients and determining how well both human experts and the computer algorithm could predict disease progression over time.



The results showed that the computer algorithm was more accurate in predicting RA progression than human specialists. This suggests that incorporating advanced technology like computer algorithms into RA management could potentially improve patient care by providing more precise and reliable predictions of disease progression.



T-Cells: The Missing Link in Pre-Clinical Rheumatoid Arthritis?



A study presented at the conference investigated the role of T-cells, a type of immune cell, in the early stages of RA development, specifically during the pre-clinical phase.⁸ Understanding the underlying mechanisms of RA onset is crucial for developing effective prevention and early intervention strategies.



Researchers analyzed blood samples from individuals at risk of developing RA and compared their T-cell profiles to those of healthy individuals. They aimed to identify specific T-cell patterns that could potentially serve as biomarkers for predicting the onset of RA.



The findings revealed significant differences in the T-cell profiles between individuals at risk of RA and healthy individuals. This suggests that T-cells might play a crucial role in the early development of RA, even before the onset of clinical symptoms.



These results are important for RA patients and healthcare providers, as they highlight the potential of T-cell profiling as a diagnostic tool for identifying individuals at risk of developing RA. Early detection and intervention could potentially prevent or delay the onset of clinical symptoms, improving long-term patient outcomes.



References

1. Wang, F., “Large-scale real-world data analyses of cancer risks among patients with rheumatoid arthritis” International Journal of Cancer, May 2023 https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.34606




2. Maglio, C., “Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis - A NORD-STAR spin-off study” Annals of the Rheumatic Diseases, June 2023




3. Ascef BDO et al., “Therapeutic Equivalence of Biosimilar and Reference Biologic Drugs in Rheumatoid Arthritis,” JAMA Network Open, June 2023




4. Sandin, S., et al., Maternal rheumatoid arthritis and risk of autism in the offspring,” Cambridge University Press, April 2023




5. Vestergaard SB, et al. Self-management behaviour, anxiety and depression in patients with inflammatory arthritis -a cross sectional nationwide study among >12,000 Danish patients. Presented at EULAR 2023; Abstract OP0176-HPR.EULAR01.06.2023Kilchberg, Switzerland




6. Fujii, T., et al. “A Machine Learning Model that Predicts RA Progression from Undifferentiated Arthritis,” EULAR, June 2023.




7. Li Y, et al. “Exploring the Use of Artificial Intelligence in Predicting Rheumatoid Arthritis, Based on Extremity MR Scans in Early Arthritis and Clinically Suspect Arthralgia patients.” EULAR, June 2023




8. Anang, D., “Lymph nodes and peripheral blood harbor expanded t cell receptor clones during the preclinical phase of rheumatoid arthritis which persist on arthritis onset.” EULAR, June 2023.

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AFLAR presents France’s RA Dashboard

May 16, 2023





The RA dashboard is worth some introductions! Françoise Alliot-Launois, the president of AFLAR, the French League Against Rheumatism, responds to Isabelle Troïtzky from the Global RA Network secretariat in a new interview on AFLAR and the important features of the French RA dashboard. Click here to view the video interview. The original video is in French, but captions (subtitles) are available by choosing the (cc) option at the bottom of the video screen on YouTube and selecting the language of your choice in the settings.



The Global RA Network and its members introduced the RA dashboard almost a year ago as a useful advocacy and education tool to help advance models of care for those with rheumatoid arthritis. Thirteen (13) countries in Europe and the Americas have already released a dashboard, and more are presently gathering key information on the disease and how RA care and treatment are provided in their nations to develop their own. Hovering over the current RA dashboards enables comparison of the RA situation across regions and examining them over time allows to observe its evolution. As new data become available, the RA dashboard will be updated to reflect this. So, make plans for more trips to the RA dashboard page!

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#CRArthritis interviews at the CRA & AHPA Annual Scientific Meeting

March 8, 2023







Isabelle Troïtzky, Global RA Network’s Secretariat, participated as an interviewer for the Arthritis Broadcast Network’s #CRArthritis event at the 2023 Canadian Rheumatology Association and Arthritis Health Professions Association Annual Scientific Meeting. There are over 40 and counting conversations with leading health care professionals, researchers and patient organizations on a range of arthritis-related topics. To view the interviews, please click on the links below:

• #CRArthritis Interviews – Part 1




• #CRArthritis Interviews – Part 2




• #CRArthritis Interviews – Part 3




• #CRArthritis Interviews – Part 4

Arthritis Broadcast Network is Canada’s largest patient-led arthritis news outlet and was co-founded and led by our Canadian member Arthritis Consumer Experts and Arthritis Research Canada. The platform provides a wealth of information, advice, and resources for patients and their families. Please bookmark this page for your reference: www.arthritisbroadcastnetwork.org

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Inequities in Arthritis Care in Canada: The Black, Indigenous and Person of Colour (BIPOC) Experience

February 23, 2023





Our Canadian member, Arthritis Consumer Experts, took part in the 2023 Canadian Rheumatology Association and Arthritis Health Professions Association Annual Scientific Meeting in Quebec City from February 8-11, 2023. They attended informational sessions, interviewed and met with leading Canadian rheumatologists, researchers and representatives from other patient organizations. Further, Programs Coordinator, Ellen Wang, shared findings from their latest Survey on health inequities in arthritis care in Canada through a poster presentation. The poster was well received and was awarded Best Trainee Abstract.



Ellen is a MPT/PhD student under the supervision of Dr. Linda Li at the University of British Columbia. She received her Master and Bachelor of Science in Kinesiology at the University of Waterloo. She joined Arthritis Consumer Experts (ACE) at the end of 2021 and contributes to content development for JointHealth^TM programs and the Arthritis Broadcast Network.



Ellen shared an important dialogue with attendees of the poster session by highlighting inequities in access to and benefit from health care services between Black, Indigenous, and person of colour (BIPOC) and white in Canada. The poster highlighted different aspects of the  Survey: socioeconomic status, access to care (including traditional medicines and practices), interactions with health care providers (including primary care provider and rheumatologists),  unfavourable experiences, and information seeking habits. To take a closer look at the poster, click here.



ACE’s Survey results suggest that BIPOC respondents face significantly greater barriers when accessing arthritis care, and when they do, benefit less from their interactions. They further reinforce current health literature that calls for training health care professionals to create safe spaces, meaningfully address patient concerns and ensure the delivery of equitable care.



The Survey included 33 questions and was conducted online in English and French from August 2 to August 19, 2022 with 1,249 respondents and in partnership with public polling firm Research Co. Survey analysis was conducted for three Survey groups: Black, Indigenous, and people of colour (BIPOC) respondents versus white respondents, rural respondents versus non-rural respondents, and women respondents versus men respondents versus non-binary respondents.



To find more details about the survey, please visit: https://bit.ly/JHIHealthInequitiesSurveyReportEN

NRAS and ACE RA Dashboard 

February 16, 2023







In June of last year, as part of their initiatives to improve models of care for people with rheumatoid arthritis, the Global RA Network and its members launched a new powerful advocacy and education tool: the RA Dashboard.



Developed in collaboration with leaders from member RA patient organizations, the Dashboard presents key data about the disease and the delivery of RA care and treatment in Europe and the Americas.



Thirteen (13) countries have already published a dashboard. In two videos, our members from Canada and the UK – Arthritis Consumer Experts (ACE) and National Rheumatoid Arthritis Society (NRAS) - explain key highlights of the dashboard for their countries and share how they will be using it to advocate and educate others about RA. Watch their videos by clicking on the links below:

• Canada RA Dashboard video with Cheryl Koehn, ACE’s President




• UK RA Dashboard video with Clare Jacklin, NRAS’ CEO

We will publish here and on Facebook and Twitter other similar interviews with members from other countries. We invite you to come back often!

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ASOPAN's posters at last EULAR congress 

January 4, 2023







Last October in Copenhagen, ASOPAN, the pan-American network of arthritis patient associations, presented three posters about their programs in Latin America at the Best Practices Fair at EULAR PARE.



The first one introduces the Pan-American Manifesto for Rheumatic Diseases, a series of 12 recommendations about different aspects of care needs and difficulties that patients with rheumatic and musculoskeletal diseases (RMDs) face in the region: prevention, detection, timely diagnosis, comprehensive care by a multidisciplinary team in specialized centers, the role of patient organizations and their participation in health policies.



The second one describes the Expert Patient Program that promotes the formation of expert patient self-care teams in 3 countries of the region, which are able to help other patients to control their RMDs and their health in a global way, contributing to expanding quality and better management of RMDs. A pilot was launched, and the program will be expanded to other Latin American countries in the future.



The third poster presents the Online Education Program for Latin American Rheumatic Patients including webinars on the most common topics about RMDs and various events such as the Pan American Congress of Rheumatic Patients, the Pan American Rheumatology Month webinar, and a special event called Latin America Talks About Arthritis. This program helps patients access good quality information that is key to adequate diagnosis and treatment of rheumatic diseases on a continent that presents great inequalities as access to health services and educational resources are concerned.



Please click on the links below to access the posters.

• Online Education for Latin American Rheumatic Patients Poster
  
  

• Pan-American Manifesto for Rheumatic Diseases Poster

• Expert Patient in self-care of rheumatic diseases program Poster

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ACR Key RA research takeaways - 2022

November 24, 2022







Our members attending this year’s ACR Convergence conference in Philadelphia brought back some interesting insights on RA research and discussions. The American College of Rheumatology’s annual scientific meeting took place from November 10 to 14 and gathered more than 9,000 in person and 4,300 virtual rheumatology professionals and patients from 104 countries. It included nearly 2,000 abstracts and expert presentations and hundreds of educational sessions for clinicians, researchers, academicians, practice managers, pediatric rheumatologists, fellows in training, advance practice nurses, physician assistants, physical or occupational therapists. This year, it also offered the Patient Perspectives Program whereby patients affected by rheumatic disease, along with a sponsoring organization such as a non-profit patient group, presented their stories.



Below are some interesting updates.



For more content, please visit the ACR Convergence website.



Patients Share the Stage at ACR



Attendees heard from Puja Khanna, MD, MPH, Associate Professor and Associate Chief of Clinical Affairs and Service Chief for Rheumatology at the University of Michigan who moderated the “Patient Perspectives” session and stated: “The patient perspective is more than a talking point in rheumatology, it’s a vital part of understanding and treating autoimmune disease.” 



In this special session, attendees listened to two dozen patients who spoke about their personal experience of life with arthritis: their stories on everything from vaccinations during the COVID-19 pandemic, to the need to monitor one’s own medical records, to finding a new rheumatologist, and much more. The session, along with a two-hour virtual poster session, represented an unprecedented platform for the ACR to provide for the patient voice - an acknowledgement of the key role patients play in arthritis research, prevention, treatment and management.



At the presentations, speakers took the audience through the patient’s journey telling their personal stories about how they coped, revisited their goals and dreams, and the unforeseen gaps in their care. Their key message to the researchers and rheumatologists: When you are open to hearing the patient side, you can create that critical partnership that gives patients the best possible results. In other words, it’s one thing to talk the talk; it’s now time rheumatologists walk the walk. According to Dr. Khanna: “So many groups in healthcare talk about the importance of the patient perspective, but we created a platform to give patients a physical voice. This isn’t an abstract distillation. This is the native voice of truth coming from the source.”



Health Care Provider Training Program Improves RA Care on Navajo Nation



At a presentation, researchers described a new program that offers RA training to primary care providers in the Navajo Nation, the largest American Indian reservation in the United States.* Despite the high prevalence of RA and associated morbidity and mortality in this Indigenous community, the Navajo Nation has a single rheumatologist serving 250,000 tribal members. As a result, most RA care has shifted to primary care providers on the reservation, who do not feel confident prescribing RA medications or managing the disease.



In addition to developing the RA training program, known as the Rheumatology Access Expansion Initiative, researchers wanted to understand how the program affected health care provider knowledge and in RA diagnosis and management.



“The United States faces a critical shortage of rheumatology providers, and this deficit is expected to worsen dramatically over the next decade. In addition, racial and ethnic minorities, particularly Black, Latinx, and Indigenous people, often face longer delays in diagnosis and treatment and [have] less access to rheumatology care,” explains the study’s lead author, Jennifer Mandal, MD, an assistant professor at the University of California, San Francisco (UCSF).



Dr. Mandal says for many patients the physical distance from the nearest rheumatologist is a significant barrier. Meanwhile, many primary care providers have no choice but to attempt to diagnose and treat inflammatory arthritis with little or no specialist guidance.



The 12-week training program was designed by a team of rheumatologists, pharmacists, and Navajo cultural interpreters. It is based on an established educational model, which uses videoconferencing to conduct seminars with community providers. Participants included 15 physicians plus a nurse practitioner, physician assistant, and community health worker.



“We successfully designed and implemented a 12-week RA training program for Navajo Nation primary care providers. The curriculum, now in its third generation, has been very well received and has improved the health care providers’ knowledge of evidence-based RA guidelines and their confidence in disease management,” Dr. Mandal says.



Future plans include expanding the program to other Native American communities and potentially developing a new course on ankylosing spondylitis. The researchers also intend to look at patient outcome data, but “given the history of medical exploitation of American Indians, it is important to us to establish a solid track record of trust and reliability in the Navajo community for several years before we ask permission to review patient health records.” 



*Press release: Primary Care Provider Training Program Improves RA Care on Navajo Nation



New Guideline Introduces Recommendations for Integrative Approach to RA Treatment



The American College of Rheumatology (ACR) released its first guideline about an integrative approach to RA. Out of the 28 recommendations, five were about exercise, 13 about rehabilitation, three about diet, and seven about additional integrative interventions. The one “strong” recommendation states that consistent engagement in exercise is advised over no exercise. The type of exercise, frequency, intensity, and duration is not formally defined, but the guideline emphasizes “moving regularly.” The specific elements of an exercise intervention should be tailored to each patient at the given time in their disease trajectory, considering their capabilities, access, and other health conditions.



“Together with pharmacologic treatment options, exercise, rehabilitation, diet, and additional integrative interventions are considered as potential adjunctive treatments for RA. Patients and clinicians often seek evidence-based insight into these treatment options,” said Benjamin J. Smith, DMSc, PA-C, DFAAPA, Interim Program Director and Associate Dean at the Florida State University College of Medicine and co-principal investigator of the guideline. “Recognizing the need to support patients and clinicians when considering treatments to complement their pharmacologic regimen, the ACR developed this guideline.”



Importantly, the guideline recommendations relate to RA-specific outcomes. For example, the guideline recommends adherence to a Mediterranean-style diet over no formally defined diet. The Mediterranean-style diet emphasizes the intake of vegetables, fruits, whole grains, nuts, seeds, and olive oil; moderate amounts of low-fat dairy and fish; and limits added sugars, sodium, highly processed foods, refined carbohydrates, and saturated fats.



“The conditional recommendation for adhering to a Mediterranean-style diet but not other formally defined diets, to improve RA-specific outcomes, may be surprising to some clinicians,” said Bryant R. England, MD, PhD, Associate Professor of Rheumatology and Immunology at the University of Nebraska Medical Center and one of the guideline’s co-principal investigators. “The Voting Panel acknowledged, however, that other health indications may exist for alternative diet and dietary supplements, which makes it crucial for clinicians and patients to engage in shared decision-making.”



The Patient Panel, which provided input into the guideline recommendations, emphasized that rheumatologists are often the first contact for therapeutic decisions. It’s important to patients that their rheumatologists be knowledgeable about integrative therapies and help guide patients to other members of the interprofessional care team with relevant expertise (such as occupational therapists, physical therapists, dietitians, etc.).



“Being able to include the diverse integrative interventions in the management of persons with RA throughout their disease course, as an interdisciplinary team, is essential. This guideline highlights the vital role expert members of interprofessional healthcare teams serve in providing optimal care to people with RA,” said Dr. Smith.



*Press release: 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis



Holding Methotrexate for One Week after Flue Vaccine May Be as Effective as a Two-Week Hold



Methotrexate (MTX) remains a first-line therapy for rheumatoid arthritis due to its efficacy, favorable safety profile and cost. Yet it significantly reduces response to flu vaccines. Previous research has showed that withholding MTX for two weeks after patients received the seasonal flu vaccine improved immunogenicity. New research presented at the ACR annual meeting looked at whether a one-week hold of MTX was equally effective in terms of immediate and long-term vaccine response.



Jin Kyun Park, MD, Chief of Rheumatology at Seoul National University Hospital, associate professor at Seoul National University College of Medicine, and the study’s lead author, says the main reason for undertaking the trial was to determine whether the time without MTX could be minimized to reduce the likelihood of disease flares.



Dr. Park’s team found that discontinuing methotrexate for one week after seasonal influenza vaccination provided the same seroprotection as a two-week discontinuation period in patients with rheumatoid arthritis.*



“Patients and physicians alike do not often know what to do with methotrexate when a vaccination, including the annual flu vaccine or novel COVID-19 vaccines, is required. It was relieving to find out that skipping methotrexate for one week is as effective as skipping it for two weeks to improve vaccine response with no increase in disease flare risk,” Dr. Park says. “But it is not clear yet whether skipping methotrexate for one week improves response to other vaccines.”



The next step, Dr. Park says, is to see if this approach can be applied to other DMARDs and vaccines.



*Press release: Immediate and Long-term Effects of the MTX Discontinuation for 1 vs. 2 Weeks on Vaccine Response to Seasonal Influenza Vaccine: A Non-inferiority Randomized Controlled Trial

Opioids Double Risk of Venous Thromboembolism in RA Patients

Pain management is a priority for most patients living with RA. Even with well-controlled disease, around 60% of patients continue to experience pain, with few safe medication treatment options, including nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, to help manage it. One concern with NSAIDs is the increased risk of major cardiovascular events, which is already present in patients with RA. And while many potential harms of opioids — addiction, overdose, and death — are well known, the risk of major adverse cardiovascular events is not as clear.



New research presented at ACR Convergence 2022 looked at this cardiovascular risk in RA patients taking opioids compared to NSAIDs and found that adult RA patients starting opioids had twice the risk of venous thromboembolism (VTE) compared to patients starting (NSAIDs).* VTE is a serious, but preventable, condition that occurs when a blood clot forms in a vein.



The study’s lead author, Gulsen Ozen, MD, a rheumatology fellow at University of Nebraska Medical Center commented: “One of the arguments for choosing opioids over NSAIDs is less impact of opioids on cardiovascular disease. However, no data supports that opioids have a safer profile than NSAIDs in addition to their other risks. Therefore, we wanted to investigate cardiovascular risks associated with opioids compared to NSAIDs to show if they are as safe as perceived.”



The study found similar cardiovascular disease risk and somewhat increased mortality risk with opioids compared to NSAIDs. However, researchers also found a two-fold increased risk of VTE in patients taking opioids.



Dr. Ozen notes that opioid prescribing in the rheumatology community decreased before the COVID-19 pandemic but has since ticked up and remains a problem for many patients with rheumatic diseases.

“Addressing pain in patients with rheumatoid arthritis is challenging as it is not always dependent on disease activity,” Dr. Ozen said. “Although we don’t have direct evidence for patients with rheumatoid arthritis, we know from patients with osteoarthritis that chronic opioid use can intensify pain without improvement of function. Our study suggests that opioids can cause significant cardiovascular morbidity and even death in patients with rheumatoid arthritis. We hope our findings can decrease opioid prescriptions for pain in patients with inflammatory rheumatic diseases. We have to remember that pain in inflammatory rheumatic diseases is multifactorial, and we should utilize non-pharmacological methods more often in this patient population.”

*Press release: Major Adverse Cardiovascular Events and Mortality with Opioids versus NSAIDs Initiation in Patients with Rheumatoid Arthritis

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Croatia's and Israel's RA Dashboards are now available

November 8, 2022



Croatia’s and Israel’s Rheumatoid Arthritis Dashboards (RA Dashboard) have recently been published on the Global RA Network website thanks to the collective efforts of the Network’s secretariat and member organizations Association Remisija in Croatia and Mifrakim Tz'eirm in Israel. These new issues bring the total number of countries with the online tool to thirteen.



The RA dashboard provides data in an easy-to-use format to help patients and other stakeholders get a better understanding of the status of rheumatoid arthritis care and gaps in models of care in Network member countries in Europe and the Americas. It also allows to monitor and compare care progress between different countries. It is a powerful tool to support advocacy efforts on models of care in these regions.



Visit the RA Dashboard or Advocacy sections of the Global RA Network website to access RA Dashboards and come back regularly to see updates or new country dashboards.

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Poster by Israeli association for RMDs patients Mifrakim Tze'irim (עמותת מִפרקים צעירים)

September 28, 2022

The Israeli association for RMDs patients Mifrakim Tze'irim developed the IN MY HANDS arthritis self-management course for members of their association in collaboration with the Association of Arthritis and Rheumatism – Malta (ARAM) and Malta’s Health Ministry, assisted by a grant from EULAR PARE (People with Arthritis / Rheumatism across Europe). A pilot course was successfully held in 2019 and as of June 2022 over 50 members completed the course.



This image presents the syllabus of the course. Please click here to access the poster.

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