ACR Convergence 2021: Highlights from Days 6 & 7

The 2021 American College of Rheumatology (ACR) Convergence concluded its annual conference with a wide variety of educational sessions and clinical developments. Below are some of the highlights from the final two days of ACR’s 2021 Convergence.

Evaluation of SARS-CoV-2 Vaccine Response in a Multi-Racial/Ethnic Cohort of Patients with Systemic Lupus Erythematosus

Researchers are identifying efficacy trends of the COVID-19 vaccine response in unique patient populations, specifically multi-racial/ethnic patients who use immunosuppressants or immune-modifying drugs. Exploring the effects of the vaccines on systemic lupus erythematosus (SLE) patients is crucial as immunosuppressed patients were excluded from the Phase 3 clinical studies of the vaccines.

To study the efficacy of the vaccine on SLE patients, 90 patients from the NYU Lupus cohort were evaluated along with 20 control subjects. Both groups were given a complete COVID-19 vaccine treatment and IgG seroactivity was measured in each subject post-vaccine.

Compared to the control group, 29 percent of SLE patients had lower post-vaccine antibodies. Factors such as the use of prednisone with a combination of immunosuppressants contributed to the low response, though the use of antimalarial medication increased the response level. 11 percent of the SLE patients had a disease flare up post-vaccine, and only 1 percent had a severe flare up.

Due to the lower response level, the study recommends vaccine booster protocols be explored for multi-racial/ethnic SLE patients.

Reduction of Cardiovascular Disease and Mortality versus Risk of New Onset Diabetes with Statin Use in Patients with Rheumatoid Arthritis

While statin use reduces the risk of cardiovascular disease (CVD) and mortality in the general population, it also increases the risk of type 2 diabetes mellitus (T2DM), a critical concern for rheumatoid arthritis (RA) patients. A recent study examined the risks and benefits of RA patients using statins for CVD.

To study CVD outcomes in RA patients, 1,768 statin initiators were compared with 3,528 non-users. Of this group, 63 statin initiators developed CVD compared to 340 non-users, while death occurred in 62 initiators and 525 non-users. To evaluate T2DM risks in RA patients, 3,608 statin initiators were compared to 7,208 non-users. Of this group, 128 statin initiators developed T2DM compared to 518 non-users.

The study found statin initiation reduced CVD risk in RA patients by 32 percent and reduced all-cause mortality by 54 percent. Statins did increase the risk of T2DM in RA patients by 33 percent. The number needed to treat (NNT) to prevent CVD and mortality in one year was 102 and 42, respectively. While the number needed to harm (NNH) for new T2DM was 127.

Based on these findings, the study suggests the benefits of statins used to reduce CVD outweigh the risk of statins causing T2DM in RA patients.

Improving Health Outcomes and Social Connectedness Through Virtual Exercise Programs in Community Members with Musculoskeletal Conditions

Inactivity can cause stiffness, pain, muscle weakness, and serious medical challenges in even the healthiest individuals. These challenges are amplified for those with musculoskeletal conditions who depend on physical activity to stay healthy. But the need for physical activity coupled with the restraints of the COVID-19 pandemic created a difficult situation for those with musculoskeletal conditions forced to remain at home. One potential solution came in the form of virtual exercise programs.

A recent study analyzed the effectiveness of virtual exercise programs organized by the Hospital of Special Surgery (HSS) in New York, NY. In March 2020, HSS offered 60-minute virtual exercise classes. 5,030 community members could safely follow along as online instructors demonstrated low-intensity exercises including T’ai Chi, Yoga, and Pilates.

The effectiveness of the program was measured via online participant surveys conducted before and after the classes. Along with socio-demographic data, metrics such as pain intensity, pain interference with aspects of daily living, stiffness, fatigue, and physical activity were evaluated and a longitudinal analysis was conducted using regression models.

According to the collected data, 98 percent of the subjects were women, 83 percent of the subjects were ≥60 years, and 88 percent were Caucasian. Participants with self-reported musculoskeletal conditions who took the online exercise class twice a week reported an 18 percent decrease in pain intensity and a 13 percent decrease in stiffness. After every session, the subjects also reported at least a 14 percent decrease in pain interference with six aspects of daily living: general activity, mood, walking ability, normal work, sleep, and enjoyment of life.

The study suggests virtual exercise programs can provide beneficial physical activity for those who suffer from musculoskeletal conditions. The guided physical activity and virtual social interaction provided a safe and effective option for maintaining healthy habits during the COVID-19 pandemic.

Assessing Trends in Hospitalizations for Serious Infections for Psoriatic Arthritis Patients

Biologic therapy use has grown throughout the years, especially for patients with psoriatic arthritis (PsA). And while that growth has helped many of them, it can also lead to an increase in serious infections. So to better understand this risk, a recent report sought to investigate U.S. national trends in serious infections within the PsA patient population from the years 2012-2017.

Using a national inpatient sample, researchers gathered a 20percent stratified sample of all discharges from U.S. community hospitals and identified any discharge diagnosis for PsA with a principal or secondary diagnosis of pneumonia, sepsis, urinary tract infection (UTI), and/or skin and soft tissue infections (SSTIs) using ICD-9 & ICD 10 codes.

Of the data collected for the year 2012, the mean age of discharged patients was 59.5 + 14.3 years, 56percent of patients were women, and 88.5percent of them were Caucasian. And the mean (SD) length of stay was 4.7 + 4.7 days. For the year 2017, the mean age for discharged patients was 60.8 + 14.1, 57.7percent of patients were women, and 88.4percent were Caucasian. The mean (SD) length of stay was 4.9 + 5.8 days.

Below are some of the primary results:

• For the year 2012, there were 50,700 discharge diagnoses of PsA, of which: 125 patients were admitted for pneumonia, 230 for sepsis, 312 for an SSTI, and 174 for a UTI
• For the year 2017, there were 179,400 discharge diagnoses of PsA, of which: 344 patients were admitted for pneumonia, 374 for sepsis, 681 for an SSTI, and 348 for a UTI.

These results demonstrate a significant decrease in sepsis, SSTIs, and UTIs despite the increased use of biologics in PsA patients, demonstrating that biologic use may not be playing as much of a role in these serious infectious as we had previously thought.