8 July 2021

Some DMARDs may lower CVD risk in RA patients

Anti JAKS ARA DMARDS gastro Rheumatoid Arthritis Rural

Also: How to set up a rural rheumatology clinic – webinar / tofacitinib PBS-listed for ulcerative colitis.

Anti-TNFs and hydroxychloroquine may reduce heart and stroke risk in RA patients

Research evaluating drugs commonly used by rheumatoid arthritis patients suggests two drugs – anti-TNFs and hydroxychloroquine – could protect the endothelium in rheumatoid arthritis and potentially reduce the risk of heart attack and strokes.

The Italian-Australian study was led by Professor Gian Luca Erre of the University of Sassari, Italy, and has been published in Frontiers in Cardiovascular Medicine, with the full paper to come.

“Rheumatoid arthritis patients have an increased risk of atherosclerosis and cardiovascular disease when compared to the general population, probably due to an excess of inflammation in patients with this condition,” said Professor Erre, national coordinator of the Evaluation for Coronary Heart Disease Risk Estimation in Rheumatoid Arthritis (EDRA) study.

The study used a relatively new statistical technique called latent class analysis, conducted by clinical pharmacology professor Arduino Mangoni and biostatistics and epidemiology professor Richard Woodman, both of Flinders University in Adelaide. The idea was to investigate whether specific groups of DMARDs, rather than single agents, have different effects on the endothelium.

Five different types of DMARD usage groups were evaluated in 868 RA patients in Italy. Endothelial function was “relatively preserved”, as measured by reactive hyperaemia index, in two groups: those on anti-TNFs and those on hydroxychloroquine.

“Prospective studies are now required to test whether such regimens are also able to curb the risk of heart attack and stroke in these patients,” said Professor Mangoni.

Front. Cardiovasc. Med. 2021 22 June (online)

Webinar: How to set up a rural rheumatology clinic

The ARA & NZRA are running a webinar, The benefits of rural rheumatology and practical hints on how to start up your own country clinic, as part of the RACP Specialty Society Lecture Series.

The webinar is chaired by Dr Louise Ward and features rheumatologists who live and work outside the capital cities, or are based in the capitals and run outreach clinics in rural and regional centres. We’ll hear about their experiences and get practical tips for setting up a practice, including funding options.

ARA Vice-President Dr Claire Barrett runs a clinic in Longreach, Queensland, for two days every three months and is one of the webinar panelists.

“Younger rheumatologists might quite like to do a rural or regional clinic, but it can be seen as a bit challenging, or too hard,” she said.

“The idea of the webinar was to say it’s actually not too hard. This is why you should do it. This is when you should do it. And this is how you should do it.

“Nor is it only for younger rheumatologists at the beginning of their career – some people do it toward the end of their career. It can be anytime really.”

Other speakers include Melbourne-based Dr Sabina Ciciriello, who runs a clinic in Mildura, Dubbo-based Dr Joel Riley and Adelaide-based Dr Simon Burnet who has outreach clinics in rural South Australia.

Register via the RACP Events website.

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Tofacitinib PBS listed for ulcerative colitis

Tofacitinib (Xeljanz – Pfizer) has been PBS listed for adults with moderate-to-severe ulcerative colitis from July 2021. The JAK inhibitor is already listed for rheumatoid arthritis and psoriatic arthritis, conditions that are sometimes linked with ulcerative colitis.

To be eligible patients must have had an inadequate response, lost response or intolerance to conventional therapy or biologics, of which adalimumab, infliximab, vedolizumab and golimumab are currently PBS listed for ulcerative colitis.

It’s available in a 5mg and 10mg dose to be taken twice daily. Patients on the higher dose may be at greater risk of side effects including serious infections, herpes zoster, non-melanoma skin cancers and blood clots.