What will 2022 hold for rheumatology clinicians and patients? New therapeutics, more real-world evidence studies and, of course, more covid.
If you think 2022 feels a bit like Groundhog Day, you’re not alone. This time last year all eyes were on the covid vaccine rollout, and a promised return to pre-pandemic freedoms once double-dose vax rates climbed to 80%.
Fast forward 12 months and thanks to the arrival of at least two new covid variants, Delta and the more contagious Omicron, Aussies are now rolling up their sleeves for a third vaccine dose.
Dr Mona Marabani, a rheumatologist at Canterbury Hospital in Sydney, said she expects covid to continue to throw down challenges in 2022.
“Covid … will continue to challenge us to devise innovative ways to deliver safe care to our rheumatology patients,” she said.
“In outpatient clinics, telehealth will play an ongoing role. It is not appropriate for every patient or at every point in their journey. The challenge is in appropriately triaging patients for face-to-face care.”
Dr Marabani believes 2022 will bring ongoing growth in covid therapeutics and the challenges and opportunities they pose for patients with rheumatic diseases.
“Away from covid, the areas which I think are very interesting are osteoporosis, still underdiagnosed and undertreated – with the newish availability of romosozumab providing another anabolic option for patients with severe disease,” she said.
Seth Ginsberg, founder of CreakyJoints Australia, says rheumatic disease care will be driven by covid trends, safety and vaccine availability this year.
“Patients who are immunosuppressed continue to follow strict safety precautions and experience mental health effects from the pandemic,” he told Rheumatology Republic. “Their specialty and chronic disease care will continue to take a back seat to protecting themselves from covid. Patients are struggling to follow healthy lifestyle habits while they isolate as much as possible. The mental health toll of covid on immunosuppressed patients cannot be overstated.”
Dr Tegan Smith, CEO, and Dr Catherine O’Sullivan, DOO at OPAL Rheumatology, predict that real-world evidence will continue to be a prominent feature in rheumatology in 2022.
“Technology capturing the experiences of real people with rheumatic diseases is advancing at an incredible pace and there is widespread interest in observing the trajectory of real patients treated by clinicians within the boundaries of the healthcare systems in Australia and globally,” said Dr Smith.
Dr O’Sullivan said on the global stage, data on new therapies for SLE and novel therapies involving TYK2 inhibition; the real-world effectiveness of JAKis and IL-23 in SpA, and of course a greater understanding of the safety profile of JAKis following the recent postmarking surveillance study on tofacitinib “will all be eagerly watched”.
Rheumatology registrars will be hoping for some relief from the pressures of covid, with many of them finding themselves seconded to work in hospital covid wards, says Dr Julian Segan, chair of the ARA Early Career Group.
“There’s a lot of burn-out around and I think people are really struggling,” he said.
The issue of rheumatology nurses is also likely to hit the agenda. Brisbane-based rheumatology nurse practitioner Linda Bradbury hopes their value will become more prominent.
“Although I would like to see the end of covid, I don’t think this will happen. I would like to see us be able to live safely with the virus,” she said. “I hope that the PBS will consider changes to allow nurse practitioners to prescribe the medications that we use every day in rheumatology, such as methotrexate.”
Stephen Hall, Monash University Adjunct Clinical Professor of Medicine at the Alfred Hospital, believes this will be a year for consolidation. He also believes the next 12-24 months will see the development of new mRNA-based vaccinations for a range of chronic diseases including coeliac disease, rheumatoid arthritis and other connective tissue diseases.
“I see it for diseases where we can find antibodies,” he said.
In New Zealand, Rebecca Grainger, rheumatologist and professor at the University of Otago’s Department of Medicine, expects disruptions to rheumatology care.
“Let’s hope that is just a move to telemedicine when Omicron is circulating, and that it only lasts for three months,” she said. “Longer is possible and would impact care further. Worst-case scenario is redeployment of rheumatologists in public practice and complete cessation of care – fingers crossed that we avoid this.”
Patients will make the first move to biosimilars, with introduction of adalimumab biosimilar as a funded agent in March and Humira to be phased out by October.
“It might be a bit rocky as the timing may well coincide with the Omicron peak predicted for March,” she said. “Most patients will be fine but it’s another change to cope with at a time of great uncertainty.”
Conferences
ARA ASM 18-21 May, hybrid event for local attendees with streaming and speakers based in satellite hubs in Sydney, Melbourne, Brisbane, Adelaide, Perth, Hobart and Auckland.
EULAR 1-4 June, Copenhagen and online
APLAR 6-9 December, Hong Kong
ACR – dates not yet announced
