Rheumatology Rundown: Pregnancy and Lupus, Attitudes Toward Exercise, and More

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Some of the latest rheumatology news includes updates on pregnancy, exercise, and treatment for psoriatic arthritis.

Pregnant women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) would benefit from a multidisciplinary clinical pathway, according to a recent report in Rheumatology Network.

In a retrospective analysis, researchers compared pregnant patients with SLE/APS who were managed in a multidisciplinary clinical pathway, which included pre-pregnancy counseling, with patients who were not managed in a clinical pathway. The primary outcome was disease flares for patients with SLE and thromboembolic events (TEE) for patients with APS.

A total of 78 patients with 112 pregnancies were analyzed. The pathway cohort was made up of 30 patients and 41 pregnancies (12 patients with SLE and 18 patients with APS). Of those patients awaiting pregnancy, 6 patients had disease flares during the follow-up period, 2 had active disease and were told to postpone conception, and 1 patient conceived against medical advice.

In the group not managed on a pathway, 47 patients and 71 pregnancies were included (33 patients with SLE and 15 patients with APS).

Results showed that the pathway cohort had significantly fewer composite end point disease-related SLE and TEE flares (7% vs 28%) during pregnancy.

Another report from Rheumatology Network described a recent analysis examining attitudes and beliefs about exercise in patients with rheumatoid arthritis. The disease itself can be either a motivating or demotivating factor behind levels of exercise, according to the study.

Studies show that although activity can reduce symptoms and comorbidity risk, regular exercise levels remain low in these patients for many reasons; some patients cite pain and fatigue, time and cost, low motivation and poor self-regulation skills, physical limitations, and a lack of knowledge on the part of both providers and patients alike.

Researchers reviewed 15 studies, which included 233 patients with RA (177 women, 56 men, aged 21-87 years). The studies all captured patient perspectives on exercise as an agile, lifelong behavior. Seven themes emerged: considering aggravated symptoms, acknowledging the impact on health, becoming empowered and taking action, keeping informed to increase awareness, creating body awareness, dealing with social support, and feeling satisfied with circumstances and achievements

Patients with psoriatic arthritis (PsA) and minimal disease activity who continued ixekizumab had better results than those who stopped using the drug, according to a Rheumatology Network report. In addition, continuing ixekizumab after a relapse rapidly restored disease control.

The multicenter, randomized, double-blind study involved adult patients with a confirmed diagnosis of PsA for 6 or more months and inadequate response or intolerance to at least 1 conventional synthetic disease-modifying antirheumatic drug and psoriatic skin lesions or a history of plaque psoriasis.

Patients with PsA received 160 mg of ixekizumab at week 0, and then 80 mg every 2 weeks (IXE Q2W) for 36 weeks. Patients with sustained minimal disease activity for more than 3 months were then randomized 1:1 to either a blinded IXE Q2W withdrawal group and received a placebo between weeks 36-64, or continued treatment through week 104.

Investigators analyzed time to relapse, or loss of minimal disease activity, for this patient group. If a relapse occurred, they were subsequently treated with IXE Q2W for the remainder of the study. The remainder of the patients (133) did not achieve MDA and continued on IXE Q2W.

Those in the withdrawal group relapsed in a significantly shorter time (median 22.3 weeks [95% CI, 16.1-28.3]); there was also a higher proportion of patients who relapsed in that group, compared with those who continued receiving ixekizumab. In the withdrawal group, 73% patients relapsed, compared with only 34% patients who continued IXE Q2W. When patients in the withdrawal group continued treatment, they were able to return to having minimal disease activity.