Each year the NDB presents the results of our research at the annual scientific meetings of the European League Against Rheumatism and the American College of Rheumatology. Here are some of the important findings we’re reporting this year.
Biologics don’t increase breast cancer rates
Good news for women with RA! We found no evidence to date that rheumatoid arthritis therapy, particularly the newest medications, increases the risk of breast cancer. These new medications include Remicade (infliximab), Enbrel (etanercept) and Humira (adalimumab), and are known as biologic response modifiers, or biologics. They were of special interest because many older treatments do increase the risk of some cancers in rheumatoid arthritis (RA) patients. A previous NDB study found an association between the biologics and non-melanoma skin cancer. However, because the drugs have only been on the market for a few years, patient exposure to the therapy may be too short for a firm conclusion and further study will be necessary. We also found no significant relationship between breast cancer and any RA treatments, including biologics and the more common methotrexate and corticosteroid treatments. The only measure that predicts breast cancer among RA patients is age, with the highest rates occurring between the ages of 55 and 70.
RA does not increase lung cancer risk
One benefit of having such a large group of participants is the ability to compare our results with those of other studies from around the world. We recently did this and found that RA does not increase the risk of lung cancer. A previous European study showed an increased risk but could not assign the blame to RA because of lack of data.
We found that the increased risk is associated with smoking, age, low levels of education and dyspnea (breathing discomfort or significant breathlessness), but not with the disease itself.
RA and preventative aspirin
Remember the question about aspirin? Here’s something we did with your answers. Researchers already know that inflammatory diseases are associated with a higher risk of heart disease, and low-dose aspirin is recommended for adults with an increased risk of having a heart attack. We wanted to know if RA patients were taking preventative aspirin. It turns out that about six percent fewer RA patients take it compared to non-RA patients. We couldn’t find any explanation for the difference in the data. However, several possibilities exist. Doctors may feel that complicated RA treatments weigh against additional therapies. In addition, package inserts and pharmacists recommend against using aspirin with methotrexate or NSAIDs. Finally, rheumatologists, as sub-specialists, might not address primary prevention issues. Although further studies are needed to understand this discrepancy, we think that rheumatologists should be aware that RA patients, on average, receive less than the recommended care for prevention and treatment of heart disorders.
Fibromyalgia causes and risks in RA patients
Everyone wonders "What is it about me that made me get this disease?" When looking at a group of FMS patients at one point in time it can be almost impossible to separate the symptoms of the disease from the signs that say someone may get it. They are often the same. However, by looking at people over time, specifically people with RA, we are able to draw some conclusions about who will meet FMS diagnosis criteria. Unfortunately, we can’t answer the question for any individual in particular. Using recently published criteria for diagnosing FMS we found that disease in about 17 percent of RA patients. Interestingly, patients may meet the criteria at times and fail to meet them at other times. The following characteristics may predict FMS: lower levels of education, being black or Hispanic (as compared to white), being divorced or separated, having FMS symptoms, poverty, low function in daily activities, pain, sleep disturbance, a lack of general well-being and having other medical problems. FMS is more likely to occur in women. Again, we studied RA patients to get these results, and they may not apply to the general population.
A new measure of Fibromyalgia symptoms?
If you have Fibromyalgia (FMS), you might find it hard to imagine that there’s a measurement of the syndrome that can say you either have it or you don’t. Yet that’s how researchers classify FMS patients. In reality, we think FMS is better judged on a continuous scale that can show varying levels of severity. We developed a scale of Fibromyalgia Intensity (FI) using existing pain and fatigue scales, and found that it works pretty well in identifying key FMS symptoms such as mood, memory, depression and headaches. We think the new FI scale will be useful for doctors and researchers in measuring the intensity of FMS symptoms no matter what the diagnosis.