EULAR 2017 - Annual European Congress of Rheumatology in Madrid

The EULAR conference focuses on rheumatic diseases, also known as musculoskeletal diseases, and are defined as disorders of the connective tissues. Here are some facts: 1 There are over 200 rheumatic diseases which typically affect the joints, tendons, ligaments, bones and muscles. 2 Rheumatic diseases are primarily classified into the non-inflammatory diseases and inflammatory diseases. 3 One quarter of Europe's population (>120 million people) suffer from a rheumatic disease3. This is the burden of rheumatic diseases -

Social

• Rheumatic diseases are widely prevalent in present-day society, with substantial negative effects on health and quality of life4
• The burden of rheumatic diseases on people and society is expected to increase 4
• Rheumatic diseases are the most common cause of severe long-term pain and physical disability, and in Europe, 20 to 30% of adults are affected at any one time 4
• Rheumatic diseases can also have a profound effect on absence from work. They are the single biggest cause of both sick leave and premature retirement, causing physical disability 2
• They are also a common reason for claiming disability pensions which impacts a countries' economy5 Emotional
• Two in five people with a rheumatic disease are limited in their everyday activities5
• The pain and disability caused by a rheumatic disease can have an impact on the emotional well-being and mental health of a person
• The prevalence of clinical anxiety and clinical depression in those with a rheumatic disease is about twice that seen in the general population6
• Rheumatic diseases not only affect the people suffering from them, but also their families who bear significant burden in terms of high financial costs, time and personal commitment to ensure relatives receive the necessary care and treatment Rheumatic disease risk factors The underlying cause of most rheumatic diseases is unknown. However, several risk factors have been identified that increase the likelihood of developing the condition7,8.

The long-term consequences rheumatic diseases have been shown to be more detrimental when a person is clinically obese or overweight.9

Smoking

Smoking is a major risk factor for developing rheumatoid arthritis, it decreases the effectiveness of drugs prescribed to treat rheumatoid arthritis and can be a barrier to engaging in activities that may relieve symptoms, such as exercise.11 Smoking has been shown to be a major preventable risk factor for several rheumatic diseases12

Gender and age

The prevalence of musculoskeletal conditions is higher among women and increases markedly with age. 3 Osteoarthritis is particularly likely to increase in prevalence with an aging population13

Between 1985 and 2007, the incidence of rheumatoid arthritis (RA) rose by an increment of 9.2 per 100,000 among women, with obesity accounting for just over half of this increase10

Lack of physical activity

A physically active lifestyle is associated with a lower prevalence of musculoskeletal disorders14

Diagnosis

• Diagnosing rheumatic diseases can be difficult because there are more than 200 and they often share the same symptoms2
• However, early diagnosis and treatment is important because it has been shown to help reduce pain and also to slow and even prevent disease progression15-17
• Whilst some rheumatic diseases can be identified by a physician based on signs and symptoms, a diagnosis often needs to be confirmed in a hospital setting by performing a physical examination or ordering specific laboratory tests, and undertaking imaging investigations2 Treatment Most rheumatic diseases cannot be cured, but in many cases they can be managed so that patients can lead a full life. Both pharmacological and non-pharmacological therapies are important as part of a complete management programme Non-pharmacological
• Often the first line of treatment for most rheumatic diseases consists of lifestyle changes such as a programme of physical exercise, an appropriate diet and plenty of sleep13
• When some diseases are more severe, surgery may be necessary to provide significant pain relief and to facilitate an active lifestyle, despite not being able cure the disease Pharmacological
• DMARDs: traditional disease-modifying anti-rheumatic drugs (DMARDs) combat disease symptoms and slow down progressive joint destruction. They impact disease progression by curbing the underlying processes that cause certain forms of inflammatory arthritis including RA, ankylosing spondylitis, and psoriatic arthritis. DMARDs are often used in combination with one another, or with a biologic or non-steroid anti-inflammatory drugs (NSAIDs)18,19
• Biologics: biologics impact disease progression in inflammatory rheumatic diseases. They are genetically-engineered drugs originating from a living organism that have specific targets within the immune system20
• Glucocorticoids: glucocorticoids control the symptoms of inflammatory rheumatic diseases.21 They are anti-inflammatory hormones related to cortisol, a steroid produced naturally in the body. Despite their benefits, glucocorticoids are associated with significant side effects including diabetes, osteoporosis, hypertension, cataracts, and susceptibility to infections. As such they are often prescribed in combination and the dose is usually reduced as soon as possible19
• NSAIDs: non-steroidal anti-inflammatory drugs (NSAIDs) help control the symptoms of all rheumatic diseases by reducing pain, swelling, and inflammation in the joints. However, they do not slow down the progression of the disease22
• Biosimilars: in recent years, several biosimilar products have come to market, including the first biosimilar monoclonal antibody (mAb) CT-P13 (biosimilar infliximab), which is approved in Europe for treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), psoriasis (Ps), Crohn's disease (CD) and ulcerative colitis UC).23

References

1 Rheumatoid Arthritis Health Center. An Overview of Rheumatic Diseases.
2 European League Against Rheumatism. 10 things you should know about rheumatic diseases.
3 European League Against Rheumatism. Questions and answers on rheumatic diseases.
4 Hagen K , Exercise therapy for bone and muscle health: an overview of systematic reviews, Hagen et al. BMC Medicine 2012, 10:167
5 Woolf AD. Economic Burden of Rheumatic Diseases, Chapter 29, In G. S. Firestein,ed. Kelley's Textbook of Rheumatology, Eighth Edition 2009
6 Geenan at al. Psychological interventions for patients with rheumatic diseases and anxiety or depression. Best Practice & Research Clinical Rheumatology. 2012; 26(3):305–319
7 Lahiri M, Morgan C, Symmons DP. Modifiable risk factors for RA: prevention, better than cure? Rheumatology. (Oxford) 2012; 51:499–512
8 Costenbader KH, Feskanich D, Mandl L. Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. Am J Med. 2006; 119:503–9
9 Hannan, MT. Introduction to special theme section: Obesity and the rheumatic diseases. Arthritis Care & Research. January 2013, 65(1):4
10 Crowson, CS, Matteson, EL, Davis JM and Gabriel, SE, Contribution of obesity to the rise in incidence of rheumatoid arthritis. Arthritis Care & Research. 2013, 65(1):71–77
11 Smoking and rheumatoid arthritis: What's the risk? Does smoking increase my risk of rheumatoid arthritis?
12 Källberg, H. Smoking is a major preventable risk factor for rheumatoid arthritis: estimations of risks after various exposures to cigarette smoke. Annals of the Rheumatic Diseases. 2010
13 Cunningham, NR. and Kashickar-Zuck, S. Nonpharmacologic Treatment of Pain in Rheumatic Diseases and Other Musculoskeletal Pain Conditions. Current Rheumatology Reports. 2013, 15(2):306
14 Morken, T., Mageroy, N. and Moen, BE, Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study. BMC Musculoskelet Disorders. 2007, 8(56).
15 Lard RL et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. The American Journal of Medicine. 2001;111(6):446–451 16 Panjwani S. Early Diagnosis and Treatment of Discoid Lupus Erythematosus. Journal of the American Board of Family Medicine. 2009, 22(2):206-213
17 Tosteson ANA, Early discontinuation of treatment for osteoporosis. The American Journal of Medicine. 2003;115(3):209-216
18 Smolen J, Landewe R, Dougados M et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69(6):964-75 19 EULAR 2013 Rheumatoid Arthritis Management Recommendations, 2013
20 Rheumatoid Arthritis Health Center. Biologics for Rheumatoid Arthritis Treatment.
21 Montecucco, C. et al. Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early rheumatoid arthritis: results of a 12-month open-label randomised study. Arthritis Research &
Therapy. 2012, 14(3):R112
22 American College of Rheumatology; NSAIDs: Nonsteroidal Anti-inflammatory Drugs.
23 T Dörner et al. The changing landscape of biosimilars in rheumatology. Ann Rheum Dis 2016;0:1–9.