Eric Matteson

Boston — A molecule in the blood shows promise as a marker to predict whether individual rheumatoid arthritis patients are likely to benefit from biologic medications or other drugs should be tried, a Mayo Clinic-led study shows. The protein, analyzed in blood tests, may help avoid trial and error with medications, sparing patients treatment delays and unnecessary side effects and expense. The research is among several Mayo Clinic studies presented at the American College of Rheumatology annual meeting in Boston. Researchers tested blood samples taken before rheumatoid arthritis treatment was given. The patients then were treated with anti-inflammatory biologic drugs, tumor necrosis factor-alpha inhibitors, a new class of medications used for rheumatoid arthritis. They found that a protein made by the immune system, type 1 interferon, appears to serve as a valid marker to tell whether individual rheumatoid arthritis patients will respond to biologics, or other medications should be tried. MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu Journalists: Sound bites of Dr. Niewold are available in the downloads below.

MULTIMEDIA ALERT: Mayo Clinic study finds rheumatoid arthritis patients at higher risk of kidney disease ROCHESTER, Minn. — Rheumatoid arthritis patients are likelier than the average person to develop chronic kidney disease, and more severe inflammation in the first year of rheumatoid arthritis, corticosteroid use, high blood pressure and obesity are among the risk factors, new Mayo Clinic research shows.  Physicians should test rheumatoid arthritis patients periodically for signs of kidney problems, and patients should work to keep blood pressure under control, avoid a high-salt diet, and eliminate or scale back medications damaging to the kidneys, says senior author Eric Matteson, M.D., Mayo rheumatology chair.  The study is published in the American Journal of Kidney Diseases, the National Kidney Foundation journal . Researchers studied 813 Mayo Clinic patients with rheumatoid arthritis and 813 without it. They found that over a 20-year period, people with rheumatoid arthritis have a 1 in 4 chance of developing chronic kidney disease, compared with the general population’s 1-in-5 risk. Journalists: Sound bites with Dr. Matteson are available in the downloads.

ROCHESTER, Minn. — Patients with rheumatoid arthritis, lupus and other chronic forms of inflammatory arthritis can face life-threatening complications, and heart disease tops the list. People with such rheumatic diseases are twice as likely as the average person to develop heart problems. Catching heart disease early is critical. Mayo cardiologists and rheumatologists have joined forces to create the Mayo Clinic Cardio-Rheumatology Clinic to pioneer new diagnostic tools and break this dangerous disease connection. MULTIMEDIA ALERT: Video of Dr. Matteson is available for download from the Mayo Clinic News Network. Mayo Clinic has found that the traditional methods used to pinpoint heart disease risk, such as the Framingham Risk Score, do not work very well in rheumatic disease patients, because their heart disease may manifest itself in a different and more subtle way. To prevent, detect and treat heart problems as early as possible, the Cardio-Rheumatology Clinic examines a broader spectrum of risk factors. "We offer patients a more detailed assessment of their cardiovascular status and a more detailed examination of risk factors besides the usual conventional risk factors such as lipids, cholesterol and smoking," says Eric Matteson, M.D., Mayo Clinic rheumatology chair, who is moderating a presentation Saturday on "cardio rheumatology" during an American Heart Association scientific meeting in Dallas. "We also are taking into account the rheumatic disease burden, the disease activity and the treatment of the rheumatic disease as a factor for mitigating cardiovascular risk." In part based on Mayo Clinic research, Cardio-Rheumatology Clinic physicians are employing new ultrasound techniques to evaluate blood vessels for the earliest signs of heart disease. "By evaluating and educating our patients early on in their rheumatic disease processes, we hope to be able to understand the mechanisms and make a difference in the development and severity of their atherosclerotic complications," says Sharon Mulvagh, M.D., a cardiologist and director of the Mayo Clinic's Women's Heart Clinic, noting heart attack and stroke risk in particular. Because women are more commonly affected by autoimmune disorders, the Cardio-Rheumatology Clinic will be located within the Women's Heart Clinic. Physicians plan to publish their findings from the clinic as part of a long-standing Mayo Clinic effort to identify the factors driving heart disease in rheumatic disease patients, reduce risk and slow the progression of heart disease. There is some evidence that moderating inflammation through treatment reduces the risk of heart disease in patients with rheumatic diseases, Dr. Matteson says. But, physicians do not really know why there is this connection between heart problems and rheumatic diseases, he adds. "We think it must have to do with the inflammatory burden of the rheumatic disease; that is, the same process that leads to inflammation in the joints, for instance in rheumatoid arthritis, may also affect the lining of the blood vessels," Dr. Matteson says.

Early menopause is risk factor, research presented at American College of Rheumatology meeting shows SAN DIEGO — Oct. 26, 2013 — People with rheumatoid arthritis and other chronic inflammatory conditions are at higher risk of heart disease. Who is in the most danger, why and how best to prevent and detect cardiovascular complications are important questions for physicians and researchers. Mayo Clinic studies presented at the American College of Rheumatology annual meeting shed new light on this connection, in part by revealing factors that seem to put some rheumatoid arthritis patients in greater jeopardy of heart problems: early menopause, more severe rheumatoid arthritis and immunity to a common virus, cytomegalovirus, among others. MULTIMEDIA ALERT: Video of Dr. Matteson is available for download from the Mayo Clinic News Network. In one study, Mayo researchers discovered that patients whose rheumatoid arthritis is more severe are likelier to have heart problems. That becomes true soon after rheumatoid arthritis strikes, making early treatment of rheumatoid arthritis important, says co-author Eric Matteson, M.D., chair of rheumatology at Mayo Clinic in Rochester, Minn.

WASHINGTON — Refuting a belief long held by many physicians, a Mayo Clinic study found that rheumatoid arthritis patients also can get gout. The research is among several studies Mayo Clinic is presenting at the American College of Rheumatology annual meeting in Washington. Researchers also found that gut bacteria has potential to treat autoimmune disorders, rheumatoid arthritis patients are at higher risk for cancer, broken bones put rheumatoid arthritis patients in greater danger of heart disease and death, and corticosteroids are a mainstay of rheumatoid arthritis treatment even as new drugs emerge.

VIDEO ALERT: For an interview with Dr. Matteson and Mayo Clinic News Network membership, visit the Mayo Clinic News Network.

The gout study shows that, contrary to conventional wisdom, rheumatoid arthritis patients aren't immune to the nation's obesity-fueled gout epidemic, says lead author Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic in Rochester, Minn. The two are distinct conditions, treated differently. Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks tissues, inflaming joints. In gout, the body produces too much uric acid or has problems flushing it out, and urate crystals build up in joints, causing inflammation and intense pain. The reason it was thought that rheumatoid arthritis patients didn't get gout likely had to do with the way rheumatoid arthritis used to be treated, Dr. Matteson says. Such patients used to be given aspirin in high doses, and that coincidentally helped their kidneys expel uric acid. Aspirin is no longer used much for rheumatoid arthritis, and that, combined with a rise in obesity, is likely fueling gout in rheumatoid arthritis patients, he says. "It is probably true that flares of rheumatoid arthritis in some cases might have actually been flares of gout, and that the gout wasn't diagnosed; it wasn't realized that it was a coexistent problem," Dr. Matteson says. "Awareness that gout does exist in patients with rheumatoid arthritis hopefully will lead to better management of gout in those patients." Researchers studied 813 patients diagnosed with rheumatoid arthritis between 1980 and 2007 and followed them as long as they were alive and in the county, until last April. The study used the Rochester Epidemiology Project, a National Institutes of Health-supported pool of Olmsted County, Minn., patient medical records from Mayo and other health care providers. Twenty-two patients developed gout over the study period, most often in the big toe. Gout was more common in patients diagnosed with rheumatoid arthritis from 1995 on. The risk factors for gout were the same as in the general population: being overweight, being older and being male. Other Mayo studies being presented at the rheumatology conference found that: *Gut bacteria, specifically Prevotella histicola, have anti-inflammatory benefits that could help treat autoimmune disorders such as lupus, rheumatoid arthritis and ankylosing spondylitis. Researchers examined the possibility using mice, and more studies are planned. "This is a hot area of research now," says Dr. Matteson, who wasn't part of the study team. *Corticosteroids, whose discovery at Mayo Clinic earned the Nobel Prize in 1950, are still a common treatment for rheumatoid arthritis even as newer drugs with fewer side effects emerge. The proportion of patients on the drugs at any given point in their rheumatoid arthritis is actually higher than it used to be, the study found. "Not only do we think that they're helpful in controlling symptoms of disease, especially in the first year, but we also are realizing that they have some effect in modifying the disease course," says Dr. Matteson, the lead author. "We try to use the minimum amount possible for the shortest time necessary."

ROCHESTER, Minn. — September 5, 2012.  Rheumatoid arthritis alone is painful and disabling, but it also puts patients at higher risk of death. The greater susceptibility to infections that accompanies the autoimmune disorder is one reason. Assessing the danger of infection a particular patient faces so it can be addressed can prove challenging for physicians. A Mayo Clinic study finds that a risk score can be developed to predict a patient's chances of having serious infections. The score uses information about how rheumatoid arthritis is affecting a patient, plus factors including age, corticosteroid use and the presence of other illnesses. The findings are published online in the American College of Rheumatology journal Arthritis & Rheumatism. Using the National Institutes of Health-funded Rochester Epidemiology Project, researchers studied medical records of 584 rheumatoid arthritis patients diagnosed between 1955 and 1994 and followed up on until January 2000. Of those, 252, or nearly half, had more than one serious infection requiring hospitalization and/or intravenous antibiotic; those 252 collectively racked up 646 infections. The Mayo team developed an infection risk score based on those and other rheumatoid arthritis patients they studied. Factors in the calculation include age; previous serious infections; corticosteroid use; a low white blood cell count; elevated results in a blood test used to detect signs of inflammation, called an erythrocyte sedimentation rate; signs of rheumatoid arthritis outside joints; and the presence of other serious conditions such as heart disease, heart failure, diabetes, lung disease, vascular disease and alcoholism. They confirmed the usefulness of the risk score in a second group of patients with rheumatoid arthritis from the same population. "Using a risk score in this way can alert physicians that their patient is at high risk for infection and needs more frequent follow-ups, measures for infection prevention and possible changes in treatments," says senior author Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic. "Rheumatoid arthritis patients are at higher risk of infection, and that risk is clearly not just because of the arthritis drugs." More research is needed to determine the level of infection risk at which patients get the most benefit from medications to prevent infection and how infection risk might affect use of a category of rheumatoid arthritis drugs called disease-modifying antirheumatic drugs, or DMARDs, such as biologics, the study says.

ROCHESTER, Minn. — June 26, 2012.  In the realm of deadly and disabling diseases, conditions such as cancer and Alzheimer's seem to attract the most media attention. But there are others that take a similarly high toll, and rheumatoid arthritis is one of them, Mayo Clinic researchers say. It is a common cause of disability: 1 of every 5 rheumatoid arthritis patients is unable to work two years after diagnosis, and within five years, that rises to one-third. Life expectancy drops by up to five years, they write in the July issue of Mayo Clinic Proceedings in an article taking stock of current diagnosis and treatment approaches. Rheumatoid arthritis patients also have a 50 percent higher risk of heart attack and twice the danger of heart failure, Mayo researchers say. Much progress has been made in recognizing the importance of early diagnosis and prompt and aggressive treatment, but gaps in understanding of the disease remain, say the authors, Mayo Clinic rheumatologists John Davis III, M.D., and Eric Matteson, M.D. "There are many drug therapies available now for management of rheumatoid arthritis, but the challenge for patients and their physicians is to decide on the best approach for initial management and then subsequent treatment modification based on the response," Dr. Davis says. "In our article, we reveal our approach including algorithms for managing the disease that we believe will enhance the probability that patients will achieve remission, improved physical function, and optimal quality of life." In rheumatoid arthritis, the immune system assaults tissue, causing swollen and tender joints and sometimes involving other organs. The top goal of treatment is to achieve remission, controlling the underlying inflammation, easing pain, improving quality of life and preserving patients' independence and ability to work and enjoy other pursuits. Long-term goals include preventing joint destruction and other complications such as heart disease and osteoporosis. Dr. Davis and Dr. Matteson offer several tips and observations: "It is very important to have rheumatoid arthritis properly diagnosed, and treatment started early on. Getting the disease under control leads to better outcomes for the patient, ability to continue working and taking care of one's self, less need for joint replacement surgery, and reduced risk of heart disease," Dr. Matteson says.

• More than medication is needed to best manage rheumatoid arthritis. Educating patients about how to protect their joints and the importance of rest and offering them orthotics, splints and other helpful devices can substantially reduce pain and improve their ability to function. Cognitive behavioral therapy can make patients feel less helpless. Exercise programs that include aerobic exercise and strength training help achieve a leaner body; even modest weight loss can significantly reduce the burden on joints.
• No treatment approach or guidelines can ever take into account every possibility; when a patient describes joint tenderness, fatigue and disease activity worse than the physician thinks they are, the physician should investigate the causes of symptoms. Non-inflammatory causes of pain such as osteoarthritis or regional musculoskeletal pain syndromes may be to blame.
• Unanswered questions in rheumatoid arthritis include the relative benefits and harms of emphasizing initial treatment with prednisone; the effects of treatment on the risk of developing cardiovascular disease and other potentially deadly complications; and how to better predict how well treatments will work for specific patients and what the side effects will be.

ROCHESTER, Minn. — June 11, 2012.  The billions of bugs in our guts have a newfound role: regulating the immune system and related autoimmune diseases such as rheumatoid arthritis, according to researchers at Mayo Clinic and the University of Illinois at Urbana-Champaign. Larger-than-normal populations of specific gut bacteria may trigger the development of diseases like rheumatoid arthritis and possibly fuel disease progression in people genetically predisposed to this crippling and confounding condition, say the researchers, who are participating in the Mayo Illinois Alliance for Technology Based Healthcare. The study is published in the April 2012 issue of PloS ONE. "A lot of people suspected that gut flora played a role in rheumatoid arthritis, but no one had been able to prove it because they couldn't say which came first — the bacteria or the genes," says senior author Veena Taneja, Ph.D., a Mayo Clinic immunologist. "Using genomic sequencing technologies, we have been able to show the gut microbiome may be used as a biomarker for predisposition." The roughly 10 trillion cells that make up the human body have neighbors: mostly bacteria that often help, training the immune system and aiding in digestion, for example. The bacteria in the intestines, in addition to a relatively small number of other microorganisms (the gut microbiome), outnumber human cells 10-to-1. Researchers found that hormones and changes related to aging may further modulate the gut immune system and exacerbate inflammatory conditions in genetically susceptible individuals. Nearly 1 percent of the world's population has rheumatoid arthritis, a disease in which the immune system attacks tissues, inflaming joints and sometimes leading to deadly complications such as heart disease. Other diseases with suspected gut bacterial ties include type I diabetes and multiple sclerosis. Researchers with the Mayo Illinois Alliance for Technology Based Healthcare say that identifying new biomarkers in intestinal microbial populations and maintaining a balance in gut bacteria could help physicians stop rheumatoid arthritis before it starts. "This study is an important advance in our understanding of the immune system disturbances associated with rheumatoid arthritis. While we do not yet know what the causes of this disease are, this study provides important insights into the immune system and its relationship to bacteria of the gut, and how these factors may affect people with genetic susceptibilities to disease," says Eric Matteson, M.D., chairman of rheumatology at Mayo Clinic, who was not a study author.