Canadian Rheumatology Today

Shifting Paradigms in the Treatment of Systemic Lupus Erythematosus

Ann E. Clarke — 2024-09-17

For many years, therapeutic options for patients with systemic lupus erythematosus (SLE) have been extremely limited. However, over the past decade, with the approval of new drugs and several promising phase II trials, treatment paradigms are gradually shifting toward multi‑targeted therapies for lupus nephritis (LN) and earlier usage of biologics in extra-renal lupus. Below, we will present three patient cases that illustrate how, through a multidisciplinary clinic environment, we have incorporated these shifting treatment paradigms into our delivery of care. Finally, we will conclude with a discussion of emerging therapies, which have the potential to further shift, and ultimately transform, treatment paradigms.

Exploring Newer Topical Therapies for Inflammatory Skin Diseases: A Guide for Rheumatologists

Melinda Gooderham — 2024-09-17

Understanding the pathogenesis of many inflammatory skin diseases and their associated signalling pathways has revealed multiple promising therapeutic targets. Given the chronic nature of many of these conditions, products with long-term safety and efficacy are desired. While topical corticosteroids have been the mainstay of topical therapies for years, they are burdened by concerns over long-term safety (i.e., atrophy, striae, telangiectasias), risk of absorption with systemic glucocorticoid side effects, and patient apprehension regarding steroid use. Similarly, topical calcipotriol and retinoids may be ineffective and can cause irritation. Although topical calcineurin inhibitors (i.e., pimecrolimus, tacrolimus) have been approved for atopic dermatitis, their off-label use for many inflammatory conditions may be limited by tolerability issues such as stinging and burning, and lack of effectiveness. The emergence of newer targeted small molecules for topical application, including topical phosphodiesterase-4 inhibitors (PDE4i), topical Janus kinase inhibitors (JAKi), and a therapeutic aryl hydrocarbon modulating agent (TAMA), offer promising new options and will be reviewed here and summarized in Table 1.

Osteoporosis in 2024: Frequency, Monitoring and Treatment

Matthew Wong-Pack — 2024-09-17

Osteoporosis is a chronic condition characterized by decreased bone mineral density (BMD) and deterioration of bone architecture, leading to an increased risk of fractures. It is the most common metabolic bone disease globally. It is estimated that more than two million Canadians aged 40 years and older have osteoporosis. Approximately 80% of Canadians who have sustained a fracture due to osteoporosis do not receive appropriate care, leaving them at an elevated risk for subsequent fractures, deconditioning, and premature death.¹ Many clinical practice guidelines exist on the management of osteoporosis and fracture prevention. Several of them have separate definitions for patients deemed very high and high risk for fracture and, as such, have specific criteria for the use of anabolic and antiresorptive treatments.

Screening and Management of Atherosclerotic Cardiovascular Disease in Inflammatory Arthritis: A Comprehensive Approach for the Rheumatologist

Shadi Akhtari — 2024-09-17

Inflammatory arthritis (IA) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) and contributes to significant morbidity and mortality. Early identification and treatment of conventional cardiovascular disease (CVD) risk factors are pivotal in mitigating ASCVD risk among the IA population. Equally crucial is the proactive management of inflammatory disease, necessitating a thorough discussion of the risks and benefits, particularly regarding the use of some advanced therapeutic agents indicated for IA, which may carry an increased risk of CVD in high‑risk subgroups.

This article reviews the current evidence for optimal CVD screening in IA. We underscore the importance of a holistic approach that incorporates conventional risk assessment tools, biomarkers, imaging techniques, and interdisciplinary cooperation.

Axial Spondyloarthritis Treatment Recommendations in 2024: Where Are We Now?

Sherry Rohekar — 2024-09-17

As 2024 continues to evolve, so do treatment recommendations for the management of spondyloarthritis (SpA), including ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). From a Canadian perspective, we eagerly await the publication of the Canadian Rheumatology Association (CRA)/Spondyloarthritis Research Consortium of Canada (SPARCC) Living Treatment Recommendations for the Management of Axial Spondyloarthritis (axSpA), currently in press. Until these recommendations for axSpA treatment with a Canadian perspective arrive – where are we now?