The EULAR 2023 Hybrid Congress provided an engaging and interactive forum for the presentation and discussion of the latest advancements and trends in the field of rheumatology. Four leading rheumatologists gave us their expert opinions on the key data presented at this year’s congress.

The views of the healthcare professionals expressed in this piece are their own and do not necessarily represent those of Pfizer.

"A primer designed by patients shows how to create education tailored to patient needs"

Proactively engaging patients with rheumatoid arthritis (RA) in the management of their disease remains a critical component of delivering patient-centric care in clinical practice, whereby addressing individual needs, concerns and preferences may meaningfully impact patient outcomes.¹ Some of the strategies to actively engage patients in their care include education, shared decision-making and self-management.¹

At this year’s EULAR congress, I was therefore interested to learn about the development of an educational primer intended to not only support patient understanding of RA and its management but to transform the way in which patients embrace their role in treatment.²

Presented by Rodriguez and colleagues from Bogotá, Colombia, the patient primer was developed by an editorial committee comprising eight patients educated in RA, a rheumatologist, a coordinator of educational programs for patients with chronic disease, and a team of reviewers.² The primer was initially developed by patients based on topics considered to address the greatest educational needs, before being finalized after review by rheumatologists and the interdisciplinary team.² The final primer, due to be distributed in 2023, covers topics including: the definition of RA, signs and symptoms, diagnosis and treatment, disease impact, therapeutic adherence, myths and beliefs, and the medical team.²

In my opinion, by involving patients in the design process, the development of the primer provides a good example of how we can embrace a more patient-centric approach to delivering healthcare. Having created an educational material specifically tailored to patient needs, the primer ultimately aims to improve patient engagement, treatment adherence, and overall outcomes in RA, serving as a valuable resource for patients during their healthcare journey.²

"High intensity exercise improves fatigue in patients with established rheumatoid arthritis"

Despite advances in pharmacological treatment to control inflammation in RA, pain and fatigue continue to be persistent problems contributing to a decline in general health and function.³

At this year’s EULAR congress, I was therefore encouraged by the results of a study suggesting that high-intensity exercise could help to manage fatigue in RA.³ Presented by Bilberg and colleagues, the study randomized 73 patients to either a 12-week program of supervised cardiorespiratory high-intensity interval exercise and strength training twice weekly, plus an additional unsupervised session of the patient’s own choice, or to receive information on physical activity based on general health recommendations, with encouragement to be moderately active for ≥150 minutes weekly (control group).³

Results at 3 months showed that there was an improvement in general fatigue and physical fatigue subscales of the 20-item Multidimensional Fatigue Inventory (MFI) among patients who participated in high-intensity exercise compared with the control group.³ There were no differences between groups with respect to other MFI subscales, including mental fatigue, reduced activity and reduced motivation.³ While the use of a visual analog scale (VAS) showed no difference between high-intensity exercise and the control group with respect to pain and fatigue, there was a significant difference in general health due to RA.³

In my opinion, there are two key learnings to emerge from this study. Firstly, there is a benefit of high-intensity exercise in reducing general fatigue and physical fatigue in RA and secondly, a multidimensional scale for measuring fatigue (i.e., MFI) may be more suitable than a one-dimensional scale (i.e., VAS).³

"Fatigue is associated with disease activity in ankylosing spondylitis but not psoriatic arthritis"

Fatigue is common among patients with rheumatic disease and is consistently ranked as a top concern.^4–6 Although it remains a challenge for rheumatologists given its multifactorial etiology, a relationship with rheumatic disease activity has been acknowledged.^7,8

One of my highlights at EULAR this year, and an important contribution to this topic, were results from a cross-sectional analysis of 50 patients with ankylosing spondylitis (AS) and 55 patients with psoriatic arthritis (PsA) exploring factors associated with fatigue (measured using the Functional Assessment of Chronic Illness Therapy Fatigue Scale [FACIT-F]).⁹ Results of the study presented by Rodriguez-Muguruza et al., showed that fatigue in patients with AS and PsA correlated with subjective variables including the Hospital Anxiety and Depression Scale, Health Assessment Questionnaire and pain scores.⁹ However, no relationship could be observed between fatigue and objective variables including C-reactive protein, erythrocyte sedimentation rate and hemoglobin level.⁹ Furthermore, while fatigue could be correlated with high disease activity in AS, there was no such relationship between fatigue and disease activity in patients with PsA.⁹

In my opinion, although this is a limited study, it serves to show that the relationship between fatigue and rheumatic disease continues to be actively explored, which is important to communicate to patients given its impact on their quality of life. However, as this study shows, we need to learn more about this relationship and how to address it. I believe this will become increasingly relevant as we transition to managing our patients more holistically to achieve optimal health outcomes.

"A consensus definition of early axial spondyloarthritis has been established for the first time"

Interest in the early stages of axial spondyloarthritis (axSpA) has been growing. However, when considering our research efforts, how early is early? For the first time ever, the answer to this question was presented at this year’s EULAR congress following efforts by the Assessment of SpondyloArthritis International Society (ASAS)-SPondyloarthritis EARly definition (SPEAR) steering committee to establish a consensus definition.¹⁰ This new definition of early axSpA was the result of an extensive five-step process that included a comprehensive literature review, robust discussions within the ASAS community, a meticulous three-round Delphi survey, and the presentation of survey results before final endorsement.¹⁰

As presented by Navarro-Compán in Milan, it can now be established that early axSpA should be defined as “a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA.”¹⁰ Other axial symptoms included cervical pain and thoracic pain.¹⁰ Interestingly, the presence or absence of radiographic damage, often a key factor in the diagnosis of spondyloarthritis,^11–14 does not influence the definition of early axSpA, and while other axial symptoms such as shoulder pain and hip pain were considered during the process, they were ultimately excluded.¹⁰

With 88% of full ASAS members voting in favor, this new definition clearly represents an important step forward for the research community.¹⁰ Indeed, there is no doubt in my mind that we have reached a significant milestone that will help to advance our understanding of early axSpA and its treatment.