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Spotlight on rheumatology

Gout is in the news this week, with a new study from the BMJ demonstrating that eating well can downgrade your risk of developing this inflammatory condition.

The so-called DASH diet, designed to reduce blood pressure, is also good for lowering uric acid levels, US and Canadian study involving 44,000 people has found. The diet is rich in fruit, vegetables, nuts and whole grains, and low in salt, sugary drinks, red and processed meats.

Gout is also the subject of an ongoing battle in the rheumatology community, reports Health Professional Radio. New guidelines from the American College of Physicians advise doctors against urate-lowering therapy in most patients, in stark contrast to both EULAR and ACR recommendations. It’s angered many gout specialists who have set up two new professional bodies to advocate use of urate-lowering drugs.

New fibromyalgia guidelines have also come under fire. The EULAR recommendations, write two Maltese rheumatologists, underplay the importance of severe anxiety and depression in the debilitating condition.

Meanwhile, biosimilars are making news at the Digestive Disease Week held in Chicago this month. The question of whether they are interchangeable with biologics has been troubling many Australian rheumatologists since the recent PBS listing of the etanercept biosimilar Brenzys for a number of rheumatology conditions.

Three new studies (here, here and here) suggest Inflectra, an infliximab biosimilar that was PBS-listed last year, can be switched with its originator Remicade without any effect on safety or efficacy.

And in other biologics news, abatacept has been found in a phase 3 study to be effective in psoriatic arthritis. In the study of over 400 patients, around 40% of those randomised to the biologic showed improvement compared with 22% in the placebo group.

How common is hand arthritis? A large study from the US crunches the numbers: it finds that one in two women will develop the condition at some stage in their life, while only one in four men will do so.

Hand arthritis affects Caucasians more than African-Americans and is more prevalent among obese people.

But people with any kind of arthritis should go easy on some kinds of painkillers, Canadian researchers say. The BMJ study involving 450,000 people found that taking any dose of an NSAID even for only a week significantly increases the risk of myocardial infarction.

And finally, a US study has found that squeaky knees are a better predictor of osteoarthritis than knee pain.

The study looked at 3500 people at high risk of developing OA and found that 75% had radiographic evidence of the disease despite the absence of pain.

Among those not experiencing pain, crepitus was more common in those who developed OA within a year.


Need some fast facts on osteoarthritis? Buy our OA handbook at the Doctorportal bookshop. This comprehensive resource includes:

  • a clear and concise description of the normal joint;
  • a detailed overview of the pathology of osteoarthritis;
  • expert guidance on well-established diagnostic criteria and investigations;
  • up-to-date, practical information on drug therapy, non-pharmacological treatments and surgical options;
  • joint-specific treatments for the hand, hip and knee, including intra-articular corticosteroid injections.