Key clinical point: Increased prevalence for temporomandibular (TMD) pain is reported in individuals at risk for rheumatoid arthritis (RA). It is recommended to be alert to TMD pain disorders in such cases.

Major finding: The prevalence of TMD pain was higher in individuals at risk for RA vs. controls (P = .046). However, patients with early RA showed no difference in the prevalence of TMD pain vs. control individuals.

Study details: The data come from a cross-sectional study involving 50 individuals each with early RA, those at risk for RA, and controls.

Disclosures: The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors. The authors declared no conflicts of interest.

Source: Kroese JM et al. RMD Open. 2021 Jan 11. doi: 10.1136/rmdopen-2020-001485.

Key clinical point: Increased prevalence for temporomandibular (TMD) pain is reported in individuals at risk for rheumatoid arthritis (RA). It is recommended to be alert to TMD pain disorders in such cases.

Major finding: The prevalence of TMD pain was higher in individuals at risk for RA vs. controls (P = .046). However, patients with early RA showed no difference in the prevalence of TMD pain vs. control individuals.

Study details: The data come from a cross-sectional study involving 50 individuals each with early RA, those at risk for RA, and controls.

Disclosures: The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors. The authors declared no conflicts of interest.

Source: Kroese JM et al. RMD Open. 2021 Jan 11. doi: 10.1136/rmdopen-2020-001485.

Key clinical point: Increased prevalence for temporomandibular (TMD) pain is reported in individuals at risk for rheumatoid arthritis (RA). It is recommended to be alert to TMD pain disorders in such cases.

Major finding: The prevalence of TMD pain was higher in individuals at risk for RA vs. controls (P = .046). However, patients with early RA showed no difference in the prevalence of TMD pain vs. control individuals.

Study details: The data come from a cross-sectional study involving 50 individuals each with early RA, those at risk for RA, and controls.

Disclosures: The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors. The authors declared no conflicts of interest.

Source: Kroese JM et al. RMD Open. 2021 Jan 11. doi: 10.1136/rmdopen-2020-001485.

Emerging data support the clinical validity and use of DecisionDx-SCC as a prognostic 40-gene expression profile test for patients with high-risk squamous cell carcinoma (SCC), according to Anna A. Bar, MD.

“The incidence of SCC has been growing rapidly, and the disease-related mortality is actually more than that of melanoma,” Dr. Bar, associate professor of dermatology at Oregon Health & Science University, Portland, said during a virtual forum on cutaneous malignancies jointly presented by Postgraduate Institute for Medicine and Global Academy for Medical Education.

“Like many cancers, SCC management plans are guided by the risk of metastasis. The current staging systems, like NCCN, AJCC, or Brigham and Women’s systems, struggle to provide accurate data of the metastatic potential of an individual’s SCC,” she said. “Furthermore, the predictive accuracy of these systems in SCC is variable, and many patients who have high risk factors do not experience poor outcomes, while others initially classified as having less concerning tumors will go on to have metastatic disease. That is where new gene expression tests come into play.”

Developed by and commercially available from Castle Biosciences, DecisionDx-SCC classifies an individual SCC patient’s tumor into one of the categories: low (class 1), moderate (class 2A), or high (class 2B) biologic risk of metastasis. “We’re hoping that DecisionDx results can help make management decisions within established guidelines,” Dr. Bar said. The test is indicated for patients with high-risk features including tumor size greater than 2 cm; tumor location on the head, neck, hands, genitals, feet, or pretibial surface; immunosuppression; a rapidly growing tumor; a tumor with poorly defined borders; a tumor at the site of prior radiation or chronic inflammation; perineural invasion; poorly defined tumor grade, and a deep tumor beyond the subcutaneous fat.

One validity study and three clinical utility studies of DecisionDx-SCC have been published that include data from more than 1,100 patients (see Curr Med Res Opin. 2020 Aug;36[8]:1301-7; Curr Med Res Opin. 2020 Aug;36[8]:1295-1300, and J Drugs Dermatol. 2019 Oct 1;18[10]:980-4). “This is a work in progress,” said Dr. Bar, director of the university’s Mohs micrographic surgery and cutaneous oncology fellowship.

The test was validated in an another study, which was prospectively designed and used archival tissue from 33 independent academic and community centers, including Oregon Health & Science University. All 420 patients in the clinical validation study had one or more high-risk factors, meeting the definition of high risk by NCCN or Mohs Appropriate Use Criteria (AUC). Their mean age was 71 years, 73% were male, 99% were White, and 25% were immune deficient.

Of the 420 patients, 63 had metastasis, and 86% of metastases were located on the head and neck. About 30% of metastasized lesions had perineural involvement, 27% had invasion beyond subcutaneous fat, and metastasized lesions were about 1 cm wider compared with lesions that were not. The overall metastasis rate at 3 years was 15%, “which is similar to that seen in the medical literature for high-risk populations,” Dr. Bar said.

The median time to metastasis was 0.9 years and the 95th percentile was 2.7 years. “This means that the 3-year horizon for identifying events in this study enabled identification of most patients who eventually experienced metastatic events,” she said. In this cohort, approximately half of the metastatic events occurred around 11 months post diagnosis, which “may provide guidance about the timeline and duration of high-intensity follow-up with frequency of clinical visits and imaging for patients at highest risk within the first year.”

The positive predictive value of the DecisionDx-SCC is 52%, meaning that half of class 2B lesions will metastasize. “This compares favorably when you look at the lower positive predictive value of the other staging systems,” Dr. Bar said. “The negative predictive value is 93%, meaning there are not a lot of false negatives. This also compares favorably to the other staging systems.”

Kaplan-Meier analysis of metastasis-free survival showed strong separation between patients with class 1, class 2A, and class 2B results, Dr. Bar said. While the overall risk of metastasis in this patient cohort was 15%, the risk among those with a class 1 result was less than half of that. “Patients with a class 2A result behave similarly to those with traditional risk factors such as deep invasion and poor differentiation, having about a 20% risk of metastasis,” she said. “The class 2B result identifies the most worrisome SCCs, with a greater than 50% risk of metastasis. While the results distribution from routine clinical testing is not yet known, this large validation study of high-risk SCC revealed that approximately half of the patients were class 1, less than half were class 2A, and about 1 in 18 had a class 2B result.”

On univariate analyses with traditional risk factors and use of the Brigham and Women’s staging system, the hazard ratio (HR) for class 2A lesions was 3.2, “which is similar to deep invasion, poor differentiation, or perineural involvement,” Dr. Bar said. At the same time, the HR for class 2B lesions was 11.6, “so class 2B is the strongest predictor of metastasis. The class 2B HR remained statistically significant in the multivariate analysis and is three times higher than that of the next highest HR in this cohort. For example, a high-risk SCC with deep invasion is already two times more likely to metastasize. Adding a class 2B score would be over 14 times more likely to metastasize than a tumor with a class 1 result.”

DecisionDx-SCC test results can inform management decisions within established guidelines. For example, for a high-risk SCC patient who has a class 1 result, or low risk of metastasis, “you may proceed with surgery and clinical nodal exam, and then follow up a couple of times a year,” Dr. Bar said. “For a high-risk patient with a 2A or moderate risk result, you might proceed with surgical treatment plus consider imaging studies such as ultrasound, CT, PET CT, and consider referral to other specialties.”

For a high-risk patient with a 2B or high risk result, she continued, “you may want to proceed with imaging studies right away in addition to surgery and consider consultation with radiation oncology or medical oncology, as well as more frequent follow-up with nodal exams, because the class 2B patients have been shown to have a greater than 50% risk of metastasis.”

Global Academy for Medical Education and this news organization are owned by the same parent company.

Dr. Bar disclosed that Oregon Health & Science University has received research funding from Castle Biosciences.

[email protected]

Emerging data support the clinical validity and use of DecisionDx-SCC as a prognostic 40-gene expression profile test for patients with high-risk squamous cell carcinoma (SCC), according to Anna A. Bar, MD.

“The incidence of SCC has been growing rapidly, and the disease-related mortality is actually more than that of melanoma,” Dr. Bar, associate professor of dermatology at Oregon Health & Science University, Portland, said during a virtual forum on cutaneous malignancies jointly presented by Postgraduate Institute for Medicine and Global Academy for Medical Education.

“Like many cancers, SCC management plans are guided by the risk of metastasis. The current staging systems, like NCCN, AJCC, or Brigham and Women’s systems, struggle to provide accurate data of the metastatic potential of an individual’s SCC,” she said. “Furthermore, the predictive accuracy of these systems in SCC is variable, and many patients who have high risk factors do not experience poor outcomes, while others initially classified as having less concerning tumors will go on to have metastatic disease. That is where new gene expression tests come into play.”

Developed by and commercially available from Castle Biosciences, DecisionDx-SCC classifies an individual SCC patient’s tumor into one of the categories: low (class 1), moderate (class 2A), or high (class 2B) biologic risk of metastasis. “We’re hoping that DecisionDx results can help make management decisions within established guidelines,” Dr. Bar said. The test is indicated for patients with high-risk features including tumor size greater than 2 cm; tumor location on the head, neck, hands, genitals, feet, or pretibial surface; immunosuppression; a rapidly growing tumor; a tumor with poorly defined borders; a tumor at the site of prior radiation or chronic inflammation; perineural invasion; poorly defined tumor grade, and a deep tumor beyond the subcutaneous fat.

One validity study and three clinical utility studies of DecisionDx-SCC have been published that include data from more than 1,100 patients (see Curr Med Res Opin. 2020 Aug;36[8]:1301-7; Curr Med Res Opin. 2020 Aug;36[8]:1295-1300, and J Drugs Dermatol. 2019 Oct 1;18[10]:980-4). “This is a work in progress,” said Dr. Bar, director of the university’s Mohs micrographic surgery and cutaneous oncology fellowship.

The test was validated in an another study, which was prospectively designed and used archival tissue from 33 independent academic and community centers, including Oregon Health & Science University. All 420 patients in the clinical validation study had one or more high-risk factors, meeting the definition of high risk by NCCN or Mohs Appropriate Use Criteria (AUC). Their mean age was 71 years, 73% were male, 99% were White, and 25% were immune deficient.

Of the 420 patients, 63 had metastasis, and 86% of metastases were located on the head and neck. About 30% of metastasized lesions had perineural involvement, 27% had invasion beyond subcutaneous fat, and metastasized lesions were about 1 cm wider compared with lesions that were not. The overall metastasis rate at 3 years was 15%, “which is similar to that seen in the medical literature for high-risk populations,” Dr. Bar said.

The median time to metastasis was 0.9 years and the 95th percentile was 2.7 years. “This means that the 3-year horizon for identifying events in this study enabled identification of most patients who eventually experienced metastatic events,” she said. In this cohort, approximately half of the metastatic events occurred around 11 months post diagnosis, which “may provide guidance about the timeline and duration of high-intensity follow-up with frequency of clinical visits and imaging for patients at highest risk within the first year.”

The positive predictive value of the DecisionDx-SCC is 52%, meaning that half of class 2B lesions will metastasize. “This compares favorably when you look at the lower positive predictive value of the other staging systems,” Dr. Bar said. “The negative predictive value is 93%, meaning there are not a lot of false negatives. This also compares favorably to the other staging systems.”

Kaplan-Meier analysis of metastasis-free survival showed strong separation between patients with class 1, class 2A, and class 2B results, Dr. Bar said. While the overall risk of metastasis in this patient cohort was 15%, the risk among those with a class 1 result was less than half of that. “Patients with a class 2A result behave similarly to those with traditional risk factors such as deep invasion and poor differentiation, having about a 20% risk of metastasis,” she said. “The class 2B result identifies the most worrisome SCCs, with a greater than 50% risk of metastasis. While the results distribution from routine clinical testing is not yet known, this large validation study of high-risk SCC revealed that approximately half of the patients were class 1, less than half were class 2A, and about 1 in 18 had a class 2B result.”

On univariate analyses with traditional risk factors and use of the Brigham and Women’s staging system, the hazard ratio (HR) for class 2A lesions was 3.2, “which is similar to deep invasion, poor differentiation, or perineural involvement,” Dr. Bar said. At the same time, the HR for class 2B lesions was 11.6, “so class 2B is the strongest predictor of metastasis. The class 2B HR remained statistically significant in the multivariate analysis and is three times higher than that of the next highest HR in this cohort. For example, a high-risk SCC with deep invasion is already two times more likely to metastasize. Adding a class 2B score would be over 14 times more likely to metastasize than a tumor with a class 1 result.”

DecisionDx-SCC test results can inform management decisions within established guidelines. For example, for a high-risk SCC patient who has a class 1 result, or low risk of metastasis, “you may proceed with surgery and clinical nodal exam, and then follow up a couple of times a year,” Dr. Bar said. “For a high-risk patient with a 2A or moderate risk result, you might proceed with surgical treatment plus consider imaging studies such as ultrasound, CT, PET CT, and consider referral to other specialties.”

For a high-risk patient with a 2B or high risk result, she continued, “you may want to proceed with imaging studies right away in addition to surgery and consider consultation with radiation oncology or medical oncology, as well as more frequent follow-up with nodal exams, because the class 2B patients have been shown to have a greater than 50% risk of metastasis.”

Global Academy for Medical Education and this news organization are owned by the same parent company.

Dr. Bar disclosed that Oregon Health & Science University has received research funding from Castle Biosciences.

[email protected]

Emerging data support the clinical validity and use of DecisionDx-SCC as a prognostic 40-gene expression profile test for patients with high-risk squamous cell carcinoma (SCC), according to Anna A. Bar, MD.

“The incidence of SCC has been growing rapidly, and the disease-related mortality is actually more than that of melanoma,” Dr. Bar, associate professor of dermatology at Oregon Health & Science University, Portland, said during a virtual forum on cutaneous malignancies jointly presented by Postgraduate Institute for Medicine and Global Academy for Medical Education.

“Like many cancers, SCC management plans are guided by the risk of metastasis. The current staging systems, like NCCN, AJCC, or Brigham and Women’s systems, struggle to provide accurate data of the metastatic potential of an individual’s SCC,” she said. “Furthermore, the predictive accuracy of these systems in SCC is variable, and many patients who have high risk factors do not experience poor outcomes, while others initially classified as having less concerning tumors will go on to have metastatic disease. That is where new gene expression tests come into play.”

Developed by and commercially available from Castle Biosciences, DecisionDx-SCC classifies an individual SCC patient’s tumor into one of the categories: low (class 1), moderate (class 2A), or high (class 2B) biologic risk of metastasis. “We’re hoping that DecisionDx results can help make management decisions within established guidelines,” Dr. Bar said. The test is indicated for patients with high-risk features including tumor size greater than 2 cm; tumor location on the head, neck, hands, genitals, feet, or pretibial surface; immunosuppression; a rapidly growing tumor; a tumor with poorly defined borders; a tumor at the site of prior radiation or chronic inflammation; perineural invasion; poorly defined tumor grade, and a deep tumor beyond the subcutaneous fat.

One validity study and three clinical utility studies of DecisionDx-SCC have been published that include data from more than 1,100 patients (see Curr Med Res Opin. 2020 Aug;36[8]:1301-7; Curr Med Res Opin. 2020 Aug;36[8]:1295-1300, and J Drugs Dermatol. 2019 Oct 1;18[10]:980-4). “This is a work in progress,” said Dr. Bar, director of the university’s Mohs micrographic surgery and cutaneous oncology fellowship.

The test was validated in an another study, which was prospectively designed and used archival tissue from 33 independent academic and community centers, including Oregon Health & Science University. All 420 patients in the clinical validation study had one or more high-risk factors, meeting the definition of high risk by NCCN or Mohs Appropriate Use Criteria (AUC). Their mean age was 71 years, 73% were male, 99% were White, and 25% were immune deficient.

Of the 420 patients, 63 had metastasis, and 86% of metastases were located on the head and neck. About 30% of metastasized lesions had perineural involvement, 27% had invasion beyond subcutaneous fat, and metastasized lesions were about 1 cm wider compared with lesions that were not. The overall metastasis rate at 3 years was 15%, “which is similar to that seen in the medical literature for high-risk populations,” Dr. Bar said.

The median time to metastasis was 0.9 years and the 95th percentile was 2.7 years. “This means that the 3-year horizon for identifying events in this study enabled identification of most patients who eventually experienced metastatic events,” she said. In this cohort, approximately half of the metastatic events occurred around 11 months post diagnosis, which “may provide guidance about the timeline and duration of high-intensity follow-up with frequency of clinical visits and imaging for patients at highest risk within the first year.”

The positive predictive value of the DecisionDx-SCC is 52%, meaning that half of class 2B lesions will metastasize. “This compares favorably when you look at the lower positive predictive value of the other staging systems,” Dr. Bar said. “The negative predictive value is 93%, meaning there are not a lot of false negatives. This also compares favorably to the other staging systems.”

Kaplan-Meier analysis of metastasis-free survival showed strong separation between patients with class 1, class 2A, and class 2B results, Dr. Bar said. While the overall risk of metastasis in this patient cohort was 15%, the risk among those with a class 1 result was less than half of that. “Patients with a class 2A result behave similarly to those with traditional risk factors such as deep invasion and poor differentiation, having about a 20% risk of metastasis,” she said. “The class 2B result identifies the most worrisome SCCs, with a greater than 50% risk of metastasis. While the results distribution from routine clinical testing is not yet known, this large validation study of high-risk SCC revealed that approximately half of the patients were class 1, less than half were class 2A, and about 1 in 18 had a class 2B result.”

On univariate analyses with traditional risk factors and use of the Brigham and Women’s staging system, the hazard ratio (HR) for class 2A lesions was 3.2, “which is similar to deep invasion, poor differentiation, or perineural involvement,” Dr. Bar said. At the same time, the HR for class 2B lesions was 11.6, “so class 2B is the strongest predictor of metastasis. The class 2B HR remained statistically significant in the multivariate analysis and is three times higher than that of the next highest HR in this cohort. For example, a high-risk SCC with deep invasion is already two times more likely to metastasize. Adding a class 2B score would be over 14 times more likely to metastasize than a tumor with a class 1 result.”

DecisionDx-SCC test results can inform management decisions within established guidelines. For example, for a high-risk SCC patient who has a class 1 result, or low risk of metastasis, “you may proceed with surgery and clinical nodal exam, and then follow up a couple of times a year,” Dr. Bar said. “For a high-risk patient with a 2A or moderate risk result, you might proceed with surgical treatment plus consider imaging studies such as ultrasound, CT, PET CT, and consider referral to other specialties.”

For a high-risk patient with a 2B or high risk result, she continued, “you may want to proceed with imaging studies right away in addition to surgery and consider consultation with radiation oncology or medical oncology, as well as more frequent follow-up with nodal exams, because the class 2B patients have been shown to have a greater than 50% risk of metastasis.”

Global Academy for Medical Education and this news organization are owned by the same parent company.

Dr. Bar disclosed that Oregon Health & Science University has received research funding from Castle Biosciences.

[email protected]

Key clinical point: Treat-to-target strategy (T2T) was associated with higher probability of achieving the treatment target in patients with rheumatoid arthritis (RA) who could not reach treatment target within 6 months.

Major finding: RA patients following T2T had a 2.8 times higher likelihood for remission/low disease activity at 12 months than those not following the T2T strategy (P = .005).

Study details: Data from ATTRA registry were assessed. Seventy-five patients with RA following T2T were matched with 75 patients who continued initial treatment despite not reaching the treatment target within 6 months.

Disclosures: The work was supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization (Institute of

Rheumatology). The authors declared no conflicts of interest.

Source: Nekvindová L et al. Arthritis Res Ther. 2021 Jan 6. doi: 10.1186/s13075-020-02393-8.

Key clinical point: Treat-to-target strategy (T2T) was associated with higher probability of achieving the treatment target in patients with rheumatoid arthritis (RA) who could not reach treatment target within 6 months.

Major finding: RA patients following T2T had a 2.8 times higher likelihood for remission/low disease activity at 12 months than those not following the T2T strategy (P = .005).

Study details: Data from ATTRA registry were assessed. Seventy-five patients with RA following T2T were matched with 75 patients who continued initial treatment despite not reaching the treatment target within 6 months.

Disclosures: The work was supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization (Institute of

Rheumatology). The authors declared no conflicts of interest.

Source: Nekvindová L et al. Arthritis Res Ther. 2021 Jan 6. doi: 10.1186/s13075-020-02393-8.

Key clinical point: Treat-to-target strategy (T2T) was associated with higher probability of achieving the treatment target in patients with rheumatoid arthritis (RA) who could not reach treatment target within 6 months.

Major finding: RA patients following T2T had a 2.8 times higher likelihood for remission/low disease activity at 12 months than those not following the T2T strategy (P = .005).

Study details: Data from ATTRA registry were assessed. Seventy-five patients with RA following T2T were matched with 75 patients who continued initial treatment despite not reaching the treatment target within 6 months.

Disclosures: The work was supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization (Institute of

Rheumatology). The authors declared no conflicts of interest.

Source: Nekvindová L et al. Arthritis Res Ther. 2021 Jan 6. doi: 10.1186/s13075-020-02393-8.

An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues.

The finding could unlock a number of COVID-19’s clinical mysteries. They include the puzzling collection of symptoms that can come with the infection; the persistence of symptoms in some people for months after they clear the virus, a phenomenon dubbed long COVID-19; and why some children and adults have a serious inflammatory syndrome, called multisystem inflammatory syndrome in children (MIS-C) or MIS in adults (MIS-A), after their infections.

“It suggests that the virus might be directly causing autoimmunity, which would be fascinating,” says lead study author Paul Utz, MD, who studies immunology and autoimmunity at Stanford (Calif.) University.

The study also deepens the question of whether other respiratory viruses might also break the body’s tolerance to itself, setting people up for autoimmune diseases like multiple sclerosis, rheumatoid arthritis, and lupus later in life.

Dr. Utz said he and his team are next going to study flu patients to see if that virus might also cause this phenomenon.

“My prediction is that it isn’t going to be specific just to SARS-CoV-2. I’m willing to bet that we will find this with other respiratory viruses,” he said.

The study comes on the heels of a handful of smaller, detailed investigations that have come to similar conclusions.

The study included data from more than 300 patients from four hospitals: two in California, one in Pennsylvania, and another in Germany.

Researchers used blood tests to study their immune responses as their infections progressed. Researchers looked for autoantibodies – weapons of the immune system that go rogue and launch an attack against the body’s own tissues. They compared these autoantibodies with those found in people who were not infected with the virus that causes COVID.

As previous studies have found, autoantibodies were more common after COVID – 50% of people hospitalized for their infections had autoantibodies, compared with less than 15% of those who were healthy and uninfected.

Some people with autoantibodies had little change in them as their infections progressed. That suggests the autoantibodies were there to begin with, possibly allowing the infection to burn out of control in the body.

“Their body is set up to get bad COVID, and it’s probably caused by the autoantibodies,” Dr. Utz said.

But in others, about 20% of people who had them, the autoantibodies became more common as the infection progressed, suggesting they were directly related to the viral infection, instead of being a preexisting condition.

Some of these were antibodies that attack key components of the immune system’s weapons against the virus, like interferon. Interferons are proteins that help infected cells call for reinforcements and can also interfere with a virus’s ability to copy itself. Taking them out is a powerful evasive tactic, and previous studies have shown that people who are born with genes that cause them to have lower interferon function, or who make autoantibodies against these proteins, appear to be at higher risk for life-threatening COVID infections.

“It seems to give the virus a powerful advantage,” said study author, John Wherry, PhD, who directs the Institute for Immunology at the University of Pennsylvania, Philadelphia. “Now your immune system, instead of having a tiny little hill to climb, is staring at Mount Everest. That really is devious.”

In addition to those that sabotage the immune system, some people in the study had autoantibodies against muscles and connective tissues that are seen in some rare disorders.

Dr. Utz said they started the study after seeing COVID patients with strange collections of symptoms that looked more like autoimmune diseases than viral infections – skin rashes, joint pain, fatigue, aching muscles, brain swelling, dry eyes, blood that clots easily, and inflamed blood vessels.

“One thing that’s very important to note is that we don’t know if these patients are going to go on to develop autoimmune disease,” Dr. Utz said. “I think we’ll be able to answer that question in the next 6-12 months as we follow the long haulers and study their samples.”

Dr. Utz said it will be important to study autoantibodies in long haulers to see if they can identify exactly which ones seem to be at work in the condition. If you can catch them early, it might be possible to treat those at risk for enduring symptoms with drugs that suppress the immune system.

What this means, he said, is that COVID will be with us for a long, long time.

“We have to realize that there’s going to be long-term damage from this virus for the survivors. Not just the long haulers, but all the people who have lung damage and heart damage and everything else. We’re going to be studying this virus and it’s badness for decades,” Dr. Utz said.

A version of this article first appeared on WebMD.com.

An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues.

The finding could unlock a number of COVID-19’s clinical mysteries. They include the puzzling collection of symptoms that can come with the infection; the persistence of symptoms in some people for months after they clear the virus, a phenomenon dubbed long COVID-19; and why some children and adults have a serious inflammatory syndrome, called multisystem inflammatory syndrome in children (MIS-C) or MIS in adults (MIS-A), after their infections.

“It suggests that the virus might be directly causing autoimmunity, which would be fascinating,” says lead study author Paul Utz, MD, who studies immunology and autoimmunity at Stanford (Calif.) University.

The study also deepens the question of whether other respiratory viruses might also break the body’s tolerance to itself, setting people up for autoimmune diseases like multiple sclerosis, rheumatoid arthritis, and lupus later in life.

Dr. Utz said he and his team are next going to study flu patients to see if that virus might also cause this phenomenon.

“My prediction is that it isn’t going to be specific just to SARS-CoV-2. I’m willing to bet that we will find this with other respiratory viruses,” he said.

The study comes on the heels of a handful of smaller, detailed investigations that have come to similar conclusions.

The study included data from more than 300 patients from four hospitals: two in California, one in Pennsylvania, and another in Germany.

Researchers used blood tests to study their immune responses as their infections progressed. Researchers looked for autoantibodies – weapons of the immune system that go rogue and launch an attack against the body’s own tissues. They compared these autoantibodies with those found in people who were not infected with the virus that causes COVID.

As previous studies have found, autoantibodies were more common after COVID – 50% of people hospitalized for their infections had autoantibodies, compared with less than 15% of those who were healthy and uninfected.

Some people with autoantibodies had little change in them as their infections progressed. That suggests the autoantibodies were there to begin with, possibly allowing the infection to burn out of control in the body.

“Their body is set up to get bad COVID, and it’s probably caused by the autoantibodies,” Dr. Utz said.

But in others, about 20% of people who had them, the autoantibodies became more common as the infection progressed, suggesting they were directly related to the viral infection, instead of being a preexisting condition.

Some of these were antibodies that attack key components of the immune system’s weapons against the virus, like interferon. Interferons are proteins that help infected cells call for reinforcements and can also interfere with a virus’s ability to copy itself. Taking them out is a powerful evasive tactic, and previous studies have shown that people who are born with genes that cause them to have lower interferon function, or who make autoantibodies against these proteins, appear to be at higher risk for life-threatening COVID infections.

“It seems to give the virus a powerful advantage,” said study author, John Wherry, PhD, who directs the Institute for Immunology at the University of Pennsylvania, Philadelphia. “Now your immune system, instead of having a tiny little hill to climb, is staring at Mount Everest. That really is devious.”

In addition to those that sabotage the immune system, some people in the study had autoantibodies against muscles and connective tissues that are seen in some rare disorders.

Dr. Utz said they started the study after seeing COVID patients with strange collections of symptoms that looked more like autoimmune diseases than viral infections – skin rashes, joint pain, fatigue, aching muscles, brain swelling, dry eyes, blood that clots easily, and inflamed blood vessels.

“One thing that’s very important to note is that we don’t know if these patients are going to go on to develop autoimmune disease,” Dr. Utz said. “I think we’ll be able to answer that question in the next 6-12 months as we follow the long haulers and study their samples.”

Dr. Utz said it will be important to study autoantibodies in long haulers to see if they can identify exactly which ones seem to be at work in the condition. If you can catch them early, it might be possible to treat those at risk for enduring symptoms with drugs that suppress the immune system.

What this means, he said, is that COVID will be with us for a long, long time.

“We have to realize that there’s going to be long-term damage from this virus for the survivors. Not just the long haulers, but all the people who have lung damage and heart damage and everything else. We’re going to be studying this virus and it’s badness for decades,” Dr. Utz said.

A version of this article first appeared on WebMD.com.

An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues.

The finding could unlock a number of COVID-19’s clinical mysteries. They include the puzzling collection of symptoms that can come with the infection; the persistence of symptoms in some people for months after they clear the virus, a phenomenon dubbed long COVID-19; and why some children and adults have a serious inflammatory syndrome, called multisystem inflammatory syndrome in children (MIS-C) or MIS in adults (MIS-A), after their infections.

“It suggests that the virus might be directly causing autoimmunity, which would be fascinating,” says lead study author Paul Utz, MD, who studies immunology and autoimmunity at Stanford (Calif.) University.

The study also deepens the question of whether other respiratory viruses might also break the body’s tolerance to itself, setting people up for autoimmune diseases like multiple sclerosis, rheumatoid arthritis, and lupus later in life.

Dr. Utz said he and his team are next going to study flu patients to see if that virus might also cause this phenomenon.

“My prediction is that it isn’t going to be specific just to SARS-CoV-2. I’m willing to bet that we will find this with other respiratory viruses,” he said.

The study comes on the heels of a handful of smaller, detailed investigations that have come to similar conclusions.

The study included data from more than 300 patients from four hospitals: two in California, one in Pennsylvania, and another in Germany.

Researchers used blood tests to study their immune responses as their infections progressed. Researchers looked for autoantibodies – weapons of the immune system that go rogue and launch an attack against the body’s own tissues. They compared these autoantibodies with those found in people who were not infected with the virus that causes COVID.

As previous studies have found, autoantibodies were more common after COVID – 50% of people hospitalized for their infections had autoantibodies, compared with less than 15% of those who were healthy and uninfected.

Some people with autoantibodies had little change in them as their infections progressed. That suggests the autoantibodies were there to begin with, possibly allowing the infection to burn out of control in the body.

“Their body is set up to get bad COVID, and it’s probably caused by the autoantibodies,” Dr. Utz said.

But in others, about 20% of people who had them, the autoantibodies became more common as the infection progressed, suggesting they were directly related to the viral infection, instead of being a preexisting condition.

Some of these were antibodies that attack key components of the immune system’s weapons against the virus, like interferon. Interferons are proteins that help infected cells call for reinforcements and can also interfere with a virus’s ability to copy itself. Taking them out is a powerful evasive tactic, and previous studies have shown that people who are born with genes that cause them to have lower interferon function, or who make autoantibodies against these proteins, appear to be at higher risk for life-threatening COVID infections.

“It seems to give the virus a powerful advantage,” said study author, John Wherry, PhD, who directs the Institute for Immunology at the University of Pennsylvania, Philadelphia. “Now your immune system, instead of having a tiny little hill to climb, is staring at Mount Everest. That really is devious.”

In addition to those that sabotage the immune system, some people in the study had autoantibodies against muscles and connective tissues that are seen in some rare disorders.

Dr. Utz said they started the study after seeing COVID patients with strange collections of symptoms that looked more like autoimmune diseases than viral infections – skin rashes, joint pain, fatigue, aching muscles, brain swelling, dry eyes, blood that clots easily, and inflamed blood vessels.

“One thing that’s very important to note is that we don’t know if these patients are going to go on to develop autoimmune disease,” Dr. Utz said. “I think we’ll be able to answer that question in the next 6-12 months as we follow the long haulers and study their samples.”

Dr. Utz said it will be important to study autoantibodies in long haulers to see if they can identify exactly which ones seem to be at work in the condition. If you can catch them early, it might be possible to treat those at risk for enduring symptoms with drugs that suppress the immune system.

What this means, he said, is that COVID will be with us for a long, long time.

“We have to realize that there’s going to be long-term damage from this virus for the survivors. Not just the long haulers, but all the people who have lung damage and heart damage and everything else. We’re going to be studying this virus and it’s badness for decades,” Dr. Utz said.

A version of this article first appeared on WebMD.com.

Key clinical point: In patients with rheumatoid arthritis (RA), baseline magnetic resonance imaging (MRI) osteitis and tenosynovitis independently predicted 2-year MRI damage. Following the MRI-targeted treatment strategy was a positive predictor for stringent remission.

Major finding: Baseline osteitis independently predicted MRI erosion (odds ratio [OR], 1.13), joint space narrowing (OR, 1.15), and combined damage progression (OR, 1.23; P less than .001 for all). Tenosynovitis independently predicted MRI erosion progression (OR, 1.13; P = .01). MRI-targeted treatment strategy predicted Clinical Disease Activity Index remission (OR, 2.94; P = .01), Simplified Disease Activity Index remission (OR, 2.50; P = .047), and Boolean remission (OR, 5.47; P less than .001).

Study details: The data come from the IMAGINE-RA study, a 2-year, investigator-initiated, randomized clinical Danish multicenter trial on 200 RA patients.

Disclosures: The work was supported by AbbVie, who supported the IMAGINE-RA primary study. Some authors received grants/personal fees/nonfinancial support from various research organizations and/or pharmaceutical companies, including AbbVie.

Source: Møller-Bisgaard S et al. Rheumatology (Oxford). 2021 Jan 5. doi: 10.1093/rheumatology/keaa496.

Key clinical point: In patients with rheumatoid arthritis (RA), baseline magnetic resonance imaging (MRI) osteitis and tenosynovitis independently predicted 2-year MRI damage. Following the MRI-targeted treatment strategy was a positive predictor for stringent remission.

Major finding: Baseline osteitis independently predicted MRI erosion (odds ratio [OR], 1.13), joint space narrowing (OR, 1.15), and combined damage progression (OR, 1.23; P less than .001 for all). Tenosynovitis independently predicted MRI erosion progression (OR, 1.13; P = .01). MRI-targeted treatment strategy predicted Clinical Disease Activity Index remission (OR, 2.94; P = .01), Simplified Disease Activity Index remission (OR, 2.50; P = .047), and Boolean remission (OR, 5.47; P less than .001).

Study details: The data come from the IMAGINE-RA study, a 2-year, investigator-initiated, randomized clinical Danish multicenter trial on 200 RA patients.

Disclosures: The work was supported by AbbVie, who supported the IMAGINE-RA primary study. Some authors received grants/personal fees/nonfinancial support from various research organizations and/or pharmaceutical companies, including AbbVie.

Source: Møller-Bisgaard S et al. Rheumatology (Oxford). 2021 Jan 5. doi: 10.1093/rheumatology/keaa496.

Key clinical point: In patients with rheumatoid arthritis (RA), baseline magnetic resonance imaging (MRI) osteitis and tenosynovitis independently predicted 2-year MRI damage. Following the MRI-targeted treatment strategy was a positive predictor for stringent remission.

Major finding: Baseline osteitis independently predicted MRI erosion (odds ratio [OR], 1.13), joint space narrowing (OR, 1.15), and combined damage progression (OR, 1.23; P less than .001 for all). Tenosynovitis independently predicted MRI erosion progression (OR, 1.13; P = .01). MRI-targeted treatment strategy predicted Clinical Disease Activity Index remission (OR, 2.94; P = .01), Simplified Disease Activity Index remission (OR, 2.50; P = .047), and Boolean remission (OR, 5.47; P less than .001).

Study details: The data come from the IMAGINE-RA study, a 2-year, investigator-initiated, randomized clinical Danish multicenter trial on 200 RA patients.

Disclosures: The work was supported by AbbVie, who supported the IMAGINE-RA primary study. Some authors received grants/personal fees/nonfinancial support from various research organizations and/or pharmaceutical companies, including AbbVie.

Source: Møller-Bisgaard S et al. Rheumatology (Oxford). 2021 Jan 5. doi: 10.1093/rheumatology/keaa496.

Key clinical point: Patients with incident rheumatoid arthritis (RA) have increased risks for venous thromboembolism (VTE), pulmonary embolism (PE), and deep vein thrombosis (DVT) than the general population.

Major finding: RA patients showed higher overall risks for VTE (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.20-1.36), PE (aHR, 1.25; 95% CI, 1.13-1.39), and DVT (aHR, 1.30; 95% CI, 1.21-1.40) after adjusting for VTE risk factors.

Study details: The data come from a population-based study involving 39,142 patients with incident RA and 78,078 matched non-RA controls.

Disclosures: The study was supported by the Canadian Institutes of Health Research. The authors declared no conflicts of interest.

Source: Li L et al. Rheumatology (Oxford). 2021 Jan 5. doi: 10.1093/rheumatology/keaa262.

Key clinical point: Patients with incident rheumatoid arthritis (RA) have increased risks for venous thromboembolism (VTE), pulmonary embolism (PE), and deep vein thrombosis (DVT) than the general population.

Major finding: RA patients showed higher overall risks for VTE (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.20-1.36), PE (aHR, 1.25; 95% CI, 1.13-1.39), and DVT (aHR, 1.30; 95% CI, 1.21-1.40) after adjusting for VTE risk factors.

Study details: The data come from a population-based study involving 39,142 patients with incident RA and 78,078 matched non-RA controls.

Disclosures: The study was supported by the Canadian Institutes of Health Research. The authors declared no conflicts of interest.

Source: Li L et al. Rheumatology (Oxford). 2021 Jan 5. doi: 10.1093/rheumatology/keaa262.

Key clinical point: Patients with incident rheumatoid arthritis (RA) have increased risks for venous thromboembolism (VTE), pulmonary embolism (PE), and deep vein thrombosis (DVT) than the general population.

Major finding: RA patients showed higher overall risks for VTE (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.20-1.36), PE (aHR, 1.25; 95% CI, 1.13-1.39), and DVT (aHR, 1.30; 95% CI, 1.21-1.40) after adjusting for VTE risk factors.

Study details: The data come from a population-based study involving 39,142 patients with incident RA and 78,078 matched non-RA controls.

Disclosures: The study was supported by the Canadian Institutes of Health Research. The authors declared no conflicts of interest.

Source: Li L et al. Rheumatology (Oxford). 2021 Jan 5. doi: 10.1093/rheumatology/keaa262.

Key clinical point: Hydroxychloroquine for the treatment of rheumatoid arthritis (RA) does not increase the risks for depression, suicidality, or psychosis compared with sulfasalazine.

Major finding: Hydroxychloroquine use was not associated with risks for depression, acute psychosis, or suicidality compared with sulfasalazine. The hazard ratios [HRs] for short-term risks for depression, acute psychosis, and suicidality were 0.96 (95% confidence interval [CI], 0.79-1.16), 1.03 (95% CI, 0.66-1.60), and 0.94 (95% CI, 0.49-1.77), respectively. The corresponding HRs for long-term risks were 0.94 (95% CI, 0.71-1.26), 0.99 (95% CI, 0.72-1.35), and 0.77 (95% CI, 0.56-1.07), respectively.

Study details: Findings from a multinational network cohort study of RA patients using hydroxychloroquine (n=918,144) and sulfasalazine (n=290,383).

Disclosures: This study was supported by the National Institute for Health Research Oxford Biomedical Research Centre, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research & Development, IQVIA, the Korea Health Technology, and the Korea Health Industry Development Institute. Some of the authors reported personal funding/support from pharmaceutical companies and/or research organizations.

Source: Lane JCE et al. Rheumatology (Oxford). 2020 Dec 25. doi: 10.1093/rheumatology/keaa771.

Key clinical point: Hydroxychloroquine for the treatment of rheumatoid arthritis (RA) does not increase the risks for depression, suicidality, or psychosis compared with sulfasalazine.

Major finding: Hydroxychloroquine use was not associated with risks for depression, acute psychosis, or suicidality compared with sulfasalazine. The hazard ratios [HRs] for short-term risks for depression, acute psychosis, and suicidality were 0.96 (95% confidence interval [CI], 0.79-1.16), 1.03 (95% CI, 0.66-1.60), and 0.94 (95% CI, 0.49-1.77), respectively. The corresponding HRs for long-term risks were 0.94 (95% CI, 0.71-1.26), 0.99 (95% CI, 0.72-1.35), and 0.77 (95% CI, 0.56-1.07), respectively.

Study details: Findings from a multinational network cohort study of RA patients using hydroxychloroquine (n=918,144) and sulfasalazine (n=290,383).

Disclosures: This study was supported by the National Institute for Health Research Oxford Biomedical Research Centre, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research & Development, IQVIA, the Korea Health Technology, and the Korea Health Industry Development Institute. Some of the authors reported personal funding/support from pharmaceutical companies and/or research organizations.

Source: Lane JCE et al. Rheumatology (Oxford). 2020 Dec 25. doi: 10.1093/rheumatology/keaa771.

Key clinical point: Hydroxychloroquine for the treatment of rheumatoid arthritis (RA) does not increase the risks for depression, suicidality, or psychosis compared with sulfasalazine.

Major finding: Hydroxychloroquine use was not associated with risks for depression, acute psychosis, or suicidality compared with sulfasalazine. The hazard ratios [HRs] for short-term risks for depression, acute psychosis, and suicidality were 0.96 (95% confidence interval [CI], 0.79-1.16), 1.03 (95% CI, 0.66-1.60), and 0.94 (95% CI, 0.49-1.77), respectively. The corresponding HRs for long-term risks were 0.94 (95% CI, 0.71-1.26), 0.99 (95% CI, 0.72-1.35), and 0.77 (95% CI, 0.56-1.07), respectively.

Study details: Findings from a multinational network cohort study of RA patients using hydroxychloroquine (n=918,144) and sulfasalazine (n=290,383).

Disclosures: This study was supported by the National Institute for Health Research Oxford Biomedical Research Centre, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research & Development, IQVIA, the Korea Health Technology, and the Korea Health Industry Development Institute. Some of the authors reported personal funding/support from pharmaceutical companies and/or research organizations.

Source: Lane JCE et al. Rheumatology (Oxford). 2020 Dec 25. doi: 10.1093/rheumatology/keaa771.

Key clinical point: Patients with endometriosis are at a significantly higher risk of developing rheumatoid arthritis (RA).

Major finding: The risk of RA was significantly higher in patients with endometriosis (adjusted hazard ratio [aHR], 1.75; 95% confidence interval [CI], 1.27-2.41), those aged 45 years or older (aHR, 1.50; 95% CI, 1.06-2.13), and those with autoimmune disease (aHR, 6.99; 95% CI, 2.84-17.21).

Study details: This 13-year Taiwanese population-based study included 14,463 women with and 14,463 women without endometriosis who were propensity score-matched by age, comorbidities, corticosteroids, nonsteroidal anti-inflammatory drugs, and hormonal medications.

Disclosures: The study was supported by the Chung Shan Medical University’s DryLab Team and grants awarded to Chung Shan Medical University. The authors declared no conflicts of interest.

Source: Xue YH et al. Rheumatology (Oxford). 2020 Dec 17. doi: 10.1093/rheumatology/keaa784.

Key clinical point: Patients with endometriosis are at a significantly higher risk of developing rheumatoid arthritis (RA).

Major finding: The risk of RA was significantly higher in patients with endometriosis (adjusted hazard ratio [aHR], 1.75; 95% confidence interval [CI], 1.27-2.41), those aged 45 years or older (aHR, 1.50; 95% CI, 1.06-2.13), and those with autoimmune disease (aHR, 6.99; 95% CI, 2.84-17.21).

Study details: This 13-year Taiwanese population-based study included 14,463 women with and 14,463 women without endometriosis who were propensity score-matched by age, comorbidities, corticosteroids, nonsteroidal anti-inflammatory drugs, and hormonal medications.

Disclosures: The study was supported by the Chung Shan Medical University’s DryLab Team and grants awarded to Chung Shan Medical University. The authors declared no conflicts of interest.

Source: Xue YH et al. Rheumatology (Oxford). 2020 Dec 17. doi: 10.1093/rheumatology/keaa784.

Key clinical point: Patients with endometriosis are at a significantly higher risk of developing rheumatoid arthritis (RA).

Major finding: The risk of RA was significantly higher in patients with endometriosis (adjusted hazard ratio [aHR], 1.75; 95% confidence interval [CI], 1.27-2.41), those aged 45 years or older (aHR, 1.50; 95% CI, 1.06-2.13), and those with autoimmune disease (aHR, 6.99; 95% CI, 2.84-17.21).

Study details: This 13-year Taiwanese population-based study included 14,463 women with and 14,463 women without endometriosis who were propensity score-matched by age, comorbidities, corticosteroids, nonsteroidal anti-inflammatory drugs, and hormonal medications.

Disclosures: The study was supported by the Chung Shan Medical University’s DryLab Team and grants awarded to Chung Shan Medical University. The authors declared no conflicts of interest.

Source: Xue YH et al. Rheumatology (Oxford). 2020 Dec 17. doi: 10.1093/rheumatology/keaa784.

Key clinical point: In patients with active rheumatoid arthritis (RA) who had limited or no prior methotrexate (MTX) exposure, filgotinib (FIL) with MTX reduced signs and symptoms of RA and improved physical function with an acceptable safety profile up to 52 weeks.

Major finding: At week 24, significantly higher proportions of patients receiving FIL200 + MTX (81%; P less than .001) and FIL100 + MTX (80%; P = .017) achieved 20% improvement in American College of Rheumatology criteria (ACR20) vs. MTX (71%). Significant improvements in Health Assessment Questionnaire-Disability Index and 28-joint Disease Activity Score with C-reactive protein less than 2.6 were seen at week 24. Adverse event rates through week 52 were comparable between all treatments.

Study details: In this 52-week phase 3 FINCH 3 trial, 1,252 patients with RA were randomly assigned in a 2:1:1:2 ratio to receive filgotinib 200 mg with MTX (FIL200 + MTX), filgotinib 100 mg with MTX (FIL100+MTX), filgotinib 200 mg monotherapy (FIL200), or MTX.

Disclosures: The study was funded by Gilead Sciences, Inc. The lead author reported receiving grant/research support from and serving as a consultant for Celltrion, Galapagos, and Gilead Sciences.

Source: Westhovens R et al. Ann Rheum Dis. 2021 Jan 15. doi: 10.1136/annrheumdis-2020-219213.

Key clinical point: In patients with active rheumatoid arthritis (RA) who had limited or no prior methotrexate (MTX) exposure, filgotinib (FIL) with MTX reduced signs and symptoms of RA and improved physical function with an acceptable safety profile up to 52 weeks.

Major finding: At week 24, significantly higher proportions of patients receiving FIL200 + MTX (81%; P less than .001) and FIL100 + MTX (80%; P = .017) achieved 20% improvement in American College of Rheumatology criteria (ACR20) vs. MTX (71%). Significant improvements in Health Assessment Questionnaire-Disability Index and 28-joint Disease Activity Score with C-reactive protein less than 2.6 were seen at week 24. Adverse event rates through week 52 were comparable between all treatments.

Study details: In this 52-week phase 3 FINCH 3 trial, 1,252 patients with RA were randomly assigned in a 2:1:1:2 ratio to receive filgotinib 200 mg with MTX (FIL200 + MTX), filgotinib 100 mg with MTX (FIL100+MTX), filgotinib 200 mg monotherapy (FIL200), or MTX.

Disclosures: The study was funded by Gilead Sciences, Inc. The lead author reported receiving grant/research support from and serving as a consultant for Celltrion, Galapagos, and Gilead Sciences.

Source: Westhovens R et al. Ann Rheum Dis. 2021 Jan 15. doi: 10.1136/annrheumdis-2020-219213.

Key clinical point: In patients with active rheumatoid arthritis (RA) who had limited or no prior methotrexate (MTX) exposure, filgotinib (FIL) with MTX reduced signs and symptoms of RA and improved physical function with an acceptable safety profile up to 52 weeks.

Major finding: At week 24, significantly higher proportions of patients receiving FIL200 + MTX (81%; P less than .001) and FIL100 + MTX (80%; P = .017) achieved 20% improvement in American College of Rheumatology criteria (ACR20) vs. MTX (71%). Significant improvements in Health Assessment Questionnaire-Disability Index and 28-joint Disease Activity Score with C-reactive protein less than 2.6 were seen at week 24. Adverse event rates through week 52 were comparable between all treatments.

Study details: In this 52-week phase 3 FINCH 3 trial, 1,252 patients with RA were randomly assigned in a 2:1:1:2 ratio to receive filgotinib 200 mg with MTX (FIL200 + MTX), filgotinib 100 mg with MTX (FIL100+MTX), filgotinib 200 mg monotherapy (FIL200), or MTX.

Disclosures: The study was funded by Gilead Sciences, Inc. The lead author reported receiving grant/research support from and serving as a consultant for Celltrion, Galapagos, and Gilead Sciences.

Source: Westhovens R et al. Ann Rheum Dis. 2021 Jan 15. doi: 10.1136/annrheumdis-2020-219213.

Key clinical point: Cardiovascular (CV) disease (CVD) and CV risk factors were risk factors for incident dementia among rheumatoid arthritis (RA) patients between 65 and 74 years of age; however, this risk attenuated with increasing age.

Major finding: Patients with CVD and CV risk factors between 65 and 74 years of age had an increased risk for dementia vs. those without CVD and CV risk factors (adjusted hazard Ratio [aHR], 1.18; 95% confidence interval [CI], 1.04-1.33; aHR, 1.03; 95% CI, 1.00-1.11, respectively). For patients between 75 and 84 years of age, a trend toward an increased risk of dementia was observed with CVD but was not statistically significant (aHR, 1.03; 95% CI, 0.92-1.14). These associations were not observed among patients aged 85 years and older.

Study details: Longitudinal analysis of 56,567 patients with RA using Center for Medicare & Medicaid claims (CMS) data from 2006 to 2014; 11,789 (20.1%) incident cases of dementia were included in the analysis.

Disclosures: The study was supported by I Navarro-Millan’s IPCI award from Weill Cornell Medicine Division of General Internal Medicine. JR Curtis received research support and consulting fees from AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB. SB Lieber reported spousal ownership interests in Cigna, Intuitive Surgical, Inc., Merck, and Pfizer. I Navarro-Millán received consulting fees from Sobi. The remaining authors declared no conflicts of interest.

Source: Sattui SE et al. Semin Arthritis Rheum. 2021 Jan 5. doi: 10.1016/j.semarthrit.2020.09.022.

Key clinical point: Cardiovascular (CV) disease (CVD) and CV risk factors were risk factors for incident dementia among rheumatoid arthritis (RA) patients between 65 and 74 years of age; however, this risk attenuated with increasing age.

Major finding: Patients with CVD and CV risk factors between 65 and 74 years of age had an increased risk for dementia vs. those without CVD and CV risk factors (adjusted hazard Ratio [aHR], 1.18; 95% confidence interval [CI], 1.04-1.33; aHR, 1.03; 95% CI, 1.00-1.11, respectively). For patients between 75 and 84 years of age, a trend toward an increased risk of dementia was observed with CVD but was not statistically significant (aHR, 1.03; 95% CI, 0.92-1.14). These associations were not observed among patients aged 85 years and older.

Study details: Longitudinal analysis of 56,567 patients with RA using Center for Medicare & Medicaid claims (CMS) data from 2006 to 2014; 11,789 (20.1%) incident cases of dementia were included in the analysis.

Disclosures: The study was supported by I Navarro-Millan’s IPCI award from Weill Cornell Medicine Division of General Internal Medicine. JR Curtis received research support and consulting fees from AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB. SB Lieber reported spousal ownership interests in Cigna, Intuitive Surgical, Inc., Merck, and Pfizer. I Navarro-Millán received consulting fees from Sobi. The remaining authors declared no conflicts of interest.

Source: Sattui SE et al. Semin Arthritis Rheum. 2021 Jan 5. doi: 10.1016/j.semarthrit.2020.09.022.

Key clinical point: Cardiovascular (CV) disease (CVD) and CV risk factors were risk factors for incident dementia among rheumatoid arthritis (RA) patients between 65 and 74 years of age; however, this risk attenuated with increasing age.

Major finding: Patients with CVD and CV risk factors between 65 and 74 years of age had an increased risk for dementia vs. those without CVD and CV risk factors (adjusted hazard Ratio [aHR], 1.18; 95% confidence interval [CI], 1.04-1.33; aHR, 1.03; 95% CI, 1.00-1.11, respectively). For patients between 75 and 84 years of age, a trend toward an increased risk of dementia was observed with CVD but was not statistically significant (aHR, 1.03; 95% CI, 0.92-1.14). These associations were not observed among patients aged 85 years and older.

Study details: Longitudinal analysis of 56,567 patients with RA using Center for Medicare & Medicaid claims (CMS) data from 2006 to 2014; 11,789 (20.1%) incident cases of dementia were included in the analysis.

Disclosures: The study was supported by I Navarro-Millan’s IPCI award from Weill Cornell Medicine Division of General Internal Medicine. JR Curtis received research support and consulting fees from AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB. SB Lieber reported spousal ownership interests in Cigna, Intuitive Surgical, Inc., Merck, and Pfizer. I Navarro-Millán received consulting fees from Sobi. The remaining authors declared no conflicts of interest.

Source: Sattui SE et al. Semin Arthritis Rheum. 2021 Jan 5. doi: 10.1016/j.semarthrit.2020.09.022.