MDedge Rheumatology

TOPLINE:

Methotrexate (MTX) is not associated with testicular toxicity, so therapy can be safety started in men pursuing parenthood, a small study finds.

METHODOLOGY:

• Lack of evidence regarding MTX’s effect on sperm quality has resulted in inconsistent recommendations for men actively pursuing parenthood.
• Researchers enrolled 20 men aged 18 years or older with an immune-mediated inflammatory disease (IMID) who were about to begin MTX therapy and 25 healthy men as controls.
• Participants provided semen samples prior to beginning MTX therapy and 13 weeks after beginning therapy.
• Researchers tested samples in both groups for markers of testicular toxicity.
• Also evaluated whether MTX polyglutamates could be detected in sperm of seminal fluid, as a secondary outcome.

TAKEAWAY:

• Found no significant differences in conventional semen parameters, sperm DNA damage, or male reproductive endocrine axis between the MTX group and controls.
• The concentration of MTX polyglutamates is low in both sperm and seminal fluid and is particularly low in sperm.

IN PRACTICE:

“Therapy with MTX can be safely started or continued in men diagnosed with an IMID and with an active wish to become a father,” the authors write.

STUDY DETAILS:

Luis Fernando Perez-Garcia, MD, Erasmus Medical Center, Rotterdam, the Netherlands, led the research. The study was published online in Annals of the Rheumatic Diseases on June 1, 2023.

LIMITATIONS:

The small number of participants and that the study included only MTX starters and not those who have taken MTX longer term.

DISCLOSURES:

Grants from the Dutch Arthritis Foundation, The Netherlands Organization for Health Research and Development, and Consejo Nacional de Ciencia y Tecnologia funded the project. Researchers disclosed financial relationships with Galapagos NV and UCB.

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

TOPLINE:

Methotrexate (MTX) is not associated with testicular toxicity, so therapy can be safety started in men pursuing parenthood, a small study finds.

METHODOLOGY:

• Lack of evidence regarding MTX’s effect on sperm quality has resulted in inconsistent recommendations for men actively pursuing parenthood.
• Researchers enrolled 20 men aged 18 years or older with an immune-mediated inflammatory disease (IMID) who were about to begin MTX therapy and 25 healthy men as controls.
• Participants provided semen samples prior to beginning MTX therapy and 13 weeks after beginning therapy.
• Researchers tested samples in both groups for markers of testicular toxicity.
• Also evaluated whether MTX polyglutamates could be detected in sperm of seminal fluid, as a secondary outcome.

TAKEAWAY:

• Found no significant differences in conventional semen parameters, sperm DNA damage, or male reproductive endocrine axis between the MTX group and controls.
• The concentration of MTX polyglutamates is low in both sperm and seminal fluid and is particularly low in sperm.

IN PRACTICE:

“Therapy with MTX can be safely started or continued in men diagnosed with an IMID and with an active wish to become a father,” the authors write.

STUDY DETAILS:

Luis Fernando Perez-Garcia, MD, Erasmus Medical Center, Rotterdam, the Netherlands, led the research. The study was published online in Annals of the Rheumatic Diseases on June 1, 2023.

LIMITATIONS:

The small number of participants and that the study included only MTX starters and not those who have taken MTX longer term.

DISCLOSURES:

Grants from the Dutch Arthritis Foundation, The Netherlands Organization for Health Research and Development, and Consejo Nacional de Ciencia y Tecnologia funded the project. Researchers disclosed financial relationships with Galapagos NV and UCB.

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

TOPLINE:

Methotrexate (MTX) is not associated with testicular toxicity, so therapy can be safety started in men pursuing parenthood, a small study finds.

METHODOLOGY:

• Lack of evidence regarding MTX’s effect on sperm quality has resulted in inconsistent recommendations for men actively pursuing parenthood.
• Researchers enrolled 20 men aged 18 years or older with an immune-mediated inflammatory disease (IMID) who were about to begin MTX therapy and 25 healthy men as controls.
• Participants provided semen samples prior to beginning MTX therapy and 13 weeks after beginning therapy.
• Researchers tested samples in both groups for markers of testicular toxicity.
• Also evaluated whether MTX polyglutamates could be detected in sperm of seminal fluid, as a secondary outcome.

TAKEAWAY:

• Found no significant differences in conventional semen parameters, sperm DNA damage, or male reproductive endocrine axis between the MTX group and controls.
• The concentration of MTX polyglutamates is low in both sperm and seminal fluid and is particularly low in sperm.

IN PRACTICE:

“Therapy with MTX can be safely started or continued in men diagnosed with an IMID and with an active wish to become a father,” the authors write.

STUDY DETAILS:

Luis Fernando Perez-Garcia, MD, Erasmus Medical Center, Rotterdam, the Netherlands, led the research. The study was published online in Annals of the Rheumatic Diseases on June 1, 2023.

LIMITATIONS:

The small number of participants and that the study included only MTX starters and not those who have taken MTX longer term.

DISCLOSURES:

Grants from the Dutch Arthritis Foundation, The Netherlands Organization for Health Research and Development, and Consejo Nacional de Ciencia y Tecnologia funded the project. Researchers disclosed financial relationships with Galapagos NV and UCB.

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

The Food and Drug Administration has approved the anti-inflammatory drug colchicine 0.5 mg tablets (Lodoco) as the first specific anti-inflammatory drug demonstrated to reduce the risk for myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.

The drug, which targets residual inflammation as an underlying cause of atherosclerotic cardiovascular disease, has a dosage of 0.5 mg once daily, and can be used alone or in combination with cholesterol-lowering medications. 

Olivier Le Moal/Getty Images

The drug’s manufacturer, Agepha Pharma, said it anticipates that Lodoco will be available for prescription in the second half of 2023.

Colchicine has been available for many years and used at higher doses for the acute treatment of gout and pericarditis, but the current formulation is a much lower dose for long-term use in patients with atherosclerotic heart disease.

Data supporting the approval has come from two major randomized trials, LoDoCo-2 and COLCOT.

In the LoDoCo-2 trial, the anti-inflammatory drug cut the risk of cardiovascular events by one third when added to standard prevention therapies in patients with chronic coronary disease. And in the COLCOT study, use of colchicine reduced cardiovascular events by 23% compared with placebo in patients with a recent MI. 

Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston, who has been a pioneer in establishing inflammation as an underlying cause of atherosclerotic cardiovascular disease, welcomed the Lodoco approval.
 

‘A very big day for cardiology’

“This is a very big day for cardiology,” Dr. Ridker said in an interview.

“The FDA approval of colchicine for patients with atherosclerotic disease is a huge signal that physicians need to be aware of inflammation as a key player in cardiovascular disease,” he said.

Dr. Ridker was the lead author of a recent study showing that among patients receiving contemporary statins, inflammation assessed by high-sensitivity C-reactive protein (hsCRP) was a stronger predictor for risk of future cardiovascular events and death than LDL cholesterol.

He pointed out that the indication for Lodoco was very broad, simply stating that it can be used in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.

“That is virtually identical to the indication approved for statin therapy. That shows just how important the FDA thinks this is,” he commented.

But Dr. Ridker added that, while the label does not specify that Lodoco has to be used in addition to statin therapy, he believes that it will be used as additional therapy to statins in the vast majority of patients.

“This is not an alternative to statin therapy. In the randomized trials, the benefits were seen on top of statins,” he stressed.

Dr. Ridker believes that physicians will need time to feel comfortable with this new approach. 

“Initially, I think, it will be used mainly by cardiologists who know about inflammation, but I believe over time it will be widely prescribed by internists, in much the same way as statins are used today,” he commented.

Dr. Ridker said he already uses low dose colchicine in his high-risk patients who have high levels of inflammation as seen on hsCRP testing. He believes this is where the drug will mostly be used initially, as this is where it is likely to be most effective.

The prescribing information states that Lodoco is contraindicated in patients who are taking strong CYP3A4 inhibitors or P-glycoprotein inhibitors, such as ketoconazole, fluconazole, and clarithromycin, and in patients with preexisting blood dyscrasias, renal failure, and severe hepatic impairment.

Common side effects reported in published clinical studies and literature with the use of colchicine are gastrointestinal symptoms (diarrhea, vomiting, abdominal cramping) and myalgia.

More serious adverse effects are listed as blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, and aplastic anemia; and neuromuscular toxicity in the form of myotoxicity including rhabdomyolysis, which may occur, especially in combination with other drugs known to cause this effect. If these adverse effects occur, it is recommended that the drug be stopped.

The prescribing information also notes that Lodoco may rarely and transiently impair fertility in males; and that patients with renal or hepatic impairment should be monitored closely for adverse effects of colchicine.

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

The Food and Drug Administration has approved the anti-inflammatory drug colchicine 0.5 mg tablets (Lodoco) as the first specific anti-inflammatory drug demonstrated to reduce the risk for myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.

The drug, which targets residual inflammation as an underlying cause of atherosclerotic cardiovascular disease, has a dosage of 0.5 mg once daily, and can be used alone or in combination with cholesterol-lowering medications. 

Olivier Le Moal/Getty Images

The drug’s manufacturer, Agepha Pharma, said it anticipates that Lodoco will be available for prescription in the second half of 2023.

Colchicine has been available for many years and used at higher doses for the acute treatment of gout and pericarditis, but the current formulation is a much lower dose for long-term use in patients with atherosclerotic heart disease.

Data supporting the approval has come from two major randomized trials, LoDoCo-2 and COLCOT.

In the LoDoCo-2 trial, the anti-inflammatory drug cut the risk of cardiovascular events by one third when added to standard prevention therapies in patients with chronic coronary disease. And in the COLCOT study, use of colchicine reduced cardiovascular events by 23% compared with placebo in patients with a recent MI. 

Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston, who has been a pioneer in establishing inflammation as an underlying cause of atherosclerotic cardiovascular disease, welcomed the Lodoco approval.
 

‘A very big day for cardiology’

“This is a very big day for cardiology,” Dr. Ridker said in an interview.

“The FDA approval of colchicine for patients with atherosclerotic disease is a huge signal that physicians need to be aware of inflammation as a key player in cardiovascular disease,” he said.

Dr. Ridker was the lead author of a recent study showing that among patients receiving contemporary statins, inflammation assessed by high-sensitivity C-reactive protein (hsCRP) was a stronger predictor for risk of future cardiovascular events and death than LDL cholesterol.

He pointed out that the indication for Lodoco was very broad, simply stating that it can be used in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.

“That is virtually identical to the indication approved for statin therapy. That shows just how important the FDA thinks this is,” he commented.

But Dr. Ridker added that, while the label does not specify that Lodoco has to be used in addition to statin therapy, he believes that it will be used as additional therapy to statins in the vast majority of patients.

“This is not an alternative to statin therapy. In the randomized trials, the benefits were seen on top of statins,” he stressed.

Dr. Ridker believes that physicians will need time to feel comfortable with this new approach. 

“Initially, I think, it will be used mainly by cardiologists who know about inflammation, but I believe over time it will be widely prescribed by internists, in much the same way as statins are used today,” he commented.

Dr. Ridker said he already uses low dose colchicine in his high-risk patients who have high levels of inflammation as seen on hsCRP testing. He believes this is where the drug will mostly be used initially, as this is where it is likely to be most effective.

The prescribing information states that Lodoco is contraindicated in patients who are taking strong CYP3A4 inhibitors or P-glycoprotein inhibitors, such as ketoconazole, fluconazole, and clarithromycin, and in patients with preexisting blood dyscrasias, renal failure, and severe hepatic impairment.

Common side effects reported in published clinical studies and literature with the use of colchicine are gastrointestinal symptoms (diarrhea, vomiting, abdominal cramping) and myalgia.

More serious adverse effects are listed as blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, and aplastic anemia; and neuromuscular toxicity in the form of myotoxicity including rhabdomyolysis, which may occur, especially in combination with other drugs known to cause this effect. If these adverse effects occur, it is recommended that the drug be stopped.

The prescribing information also notes that Lodoco may rarely and transiently impair fertility in males; and that patients with renal or hepatic impairment should be monitored closely for adverse effects of colchicine.

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

The Food and Drug Administration has approved the anti-inflammatory drug colchicine 0.5 mg tablets (Lodoco) as the first specific anti-inflammatory drug demonstrated to reduce the risk for myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.

The drug, which targets residual inflammation as an underlying cause of atherosclerotic cardiovascular disease, has a dosage of 0.5 mg once daily, and can be used alone or in combination with cholesterol-lowering medications. 

Olivier Le Moal/Getty Images

The drug’s manufacturer, Agepha Pharma, said it anticipates that Lodoco will be available for prescription in the second half of 2023.

Colchicine has been available for many years and used at higher doses for the acute treatment of gout and pericarditis, but the current formulation is a much lower dose for long-term use in patients with atherosclerotic heart disease.

Data supporting the approval has come from two major randomized trials, LoDoCo-2 and COLCOT.

In the LoDoCo-2 trial, the anti-inflammatory drug cut the risk of cardiovascular events by one third when added to standard prevention therapies in patients with chronic coronary disease. And in the COLCOT study, use of colchicine reduced cardiovascular events by 23% compared with placebo in patients with a recent MI. 

Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston, who has been a pioneer in establishing inflammation as an underlying cause of atherosclerotic cardiovascular disease, welcomed the Lodoco approval.
 

‘A very big day for cardiology’

“This is a very big day for cardiology,” Dr. Ridker said in an interview.

“The FDA approval of colchicine for patients with atherosclerotic disease is a huge signal that physicians need to be aware of inflammation as a key player in cardiovascular disease,” he said.

Dr. Ridker was the lead author of a recent study showing that among patients receiving contemporary statins, inflammation assessed by high-sensitivity C-reactive protein (hsCRP) was a stronger predictor for risk of future cardiovascular events and death than LDL cholesterol.

He pointed out that the indication for Lodoco was very broad, simply stating that it can be used in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.

“That is virtually identical to the indication approved for statin therapy. That shows just how important the FDA thinks this is,” he commented.

But Dr. Ridker added that, while the label does not specify that Lodoco has to be used in addition to statin therapy, he believes that it will be used as additional therapy to statins in the vast majority of patients.

“This is not an alternative to statin therapy. In the randomized trials, the benefits were seen on top of statins,” he stressed.

Dr. Ridker believes that physicians will need time to feel comfortable with this new approach. 

“Initially, I think, it will be used mainly by cardiologists who know about inflammation, but I believe over time it will be widely prescribed by internists, in much the same way as statins are used today,” he commented.

Dr. Ridker said he already uses low dose colchicine in his high-risk patients who have high levels of inflammation as seen on hsCRP testing. He believes this is where the drug will mostly be used initially, as this is where it is likely to be most effective.

The prescribing information states that Lodoco is contraindicated in patients who are taking strong CYP3A4 inhibitors or P-glycoprotein inhibitors, such as ketoconazole, fluconazole, and clarithromycin, and in patients with preexisting blood dyscrasias, renal failure, and severe hepatic impairment.

Common side effects reported in published clinical studies and literature with the use of colchicine are gastrointestinal symptoms (diarrhea, vomiting, abdominal cramping) and myalgia.

More serious adverse effects are listed as blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia, and aplastic anemia; and neuromuscular toxicity in the form of myotoxicity including rhabdomyolysis, which may occur, especially in combination with other drugs known to cause this effect. If these adverse effects occur, it is recommended that the drug be stopped.

The prescribing information also notes that Lodoco may rarely and transiently impair fertility in males; and that patients with renal or hepatic impairment should be monitored closely for adverse effects of colchicine.

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

Key clinical point: Patients with rheumatoid arthritis (RA) who were ≥65 years old had a significantly increased risk of developing sarcopenia, particularly if they were men with poor nutritional status and long-standing disease.

Major finding: Sarcopenia was diagnosed in a higher proportion of patients with RA vs control individuals without RA (15.8% vs 3.9%; P = .014). Male sex (P = .042), longer disease duration (P = .012), and poorer nutritional status (P = .042) were significant risk factors for the development of sarcopenia in older patients with RA.

Study details: Findings are from a cross-sectional study including 76 patients age ≥ 65 years with RA and 76 age- and sex-matched control individuals without RA.

Disclosures: This study was funded by Redes de Investigación Cooperativa Orientadas a Resultados en Salud, Spain, and other sources. The authors declared no conflicts of interest.

Source: Cano-García L et al. Sarcopenia and nutrition in elderly rheumatoid arthritis patients: A cross-sectional study to determine prevalence and risk factors. Nutrients. 2023;15:2440 (May 24). doi: 10.3390/nu15112440

Key clinical point: Patients with rheumatoid arthritis (RA) who were ≥65 years old had a significantly increased risk of developing sarcopenia, particularly if they were men with poor nutritional status and long-standing disease.

Major finding: Sarcopenia was diagnosed in a higher proportion of patients with RA vs control individuals without RA (15.8% vs 3.9%; P = .014). Male sex (P = .042), longer disease duration (P = .012), and poorer nutritional status (P = .042) were significant risk factors for the development of sarcopenia in older patients with RA.

Study details: Findings are from a cross-sectional study including 76 patients age ≥ 65 years with RA and 76 age- and sex-matched control individuals without RA.

Disclosures: This study was funded by Redes de Investigación Cooperativa Orientadas a Resultados en Salud, Spain, and other sources. The authors declared no conflicts of interest.

Source: Cano-García L et al. Sarcopenia and nutrition in elderly rheumatoid arthritis patients: A cross-sectional study to determine prevalence and risk factors. Nutrients. 2023;15:2440 (May 24). doi: 10.3390/nu15112440

Key clinical point: Patients with rheumatoid arthritis (RA) who were ≥65 years old had a significantly increased risk of developing sarcopenia, particularly if they were men with poor nutritional status and long-standing disease.

Major finding: Sarcopenia was diagnosed in a higher proportion of patients with RA vs control individuals without RA (15.8% vs 3.9%; P = .014). Male sex (P = .042), longer disease duration (P = .012), and poorer nutritional status (P = .042) were significant risk factors for the development of sarcopenia in older patients with RA.

Study details: Findings are from a cross-sectional study including 76 patients age ≥ 65 years with RA and 76 age- and sex-matched control individuals without RA.

Disclosures: This study was funded by Redes de Investigación Cooperativa Orientadas a Resultados en Salud, Spain, and other sources. The authors declared no conflicts of interest.

Source: Cano-García L et al. Sarcopenia and nutrition in elderly rheumatoid arthritis patients: A cross-sectional study to determine prevalence and risk factors. Nutrients. 2023;15:2440 (May 24). doi: 10.3390/nu15112440

Key clinical point: Intensive treatment more effectively suppressed joint damage progression than the current treatment in patients with rheumatoid arthritis (RA) who showed joint damage progression and had low disease activity (LDA) or were in remission.

Major finding: At 1 year of treatment, intensive vs current treatment was associated with a smaller change in the van der Heijde modified total Sharp score (ΔTSS; 0.67 vs 1.79; P < .001) and joint space narrowing scores (0.57 vs 1.41; P < .001) and a larger proportion of patients achieved a ΔTSS of ≤0.5 (66.7% vs 32.4%; P = .010).

Study details: This retrospective study included 89 patients with RA in remission or with LDA who showed joint damage progression and were assigned to either receive intensive treatment or continue the current treatment.

Disclosures: This study did not declare the funding source. T Mochizuki, K Yano, and K Ikari declared receiving lecture honoraria from various sources. The other authors declared no conflicts of interest.

Source: Mochizuki T et al. Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission. Mod Rheumatol. 2023 (Jun 2). doi: 10.1093/mr/road041

Key clinical point: Intensive treatment more effectively suppressed joint damage progression than the current treatment in patients with rheumatoid arthritis (RA) who showed joint damage progression and had low disease activity (LDA) or were in remission.

Major finding: At 1 year of treatment, intensive vs current treatment was associated with a smaller change in the van der Heijde modified total Sharp score (ΔTSS; 0.67 vs 1.79; P < .001) and joint space narrowing scores (0.57 vs 1.41; P < .001) and a larger proportion of patients achieved a ΔTSS of ≤0.5 (66.7% vs 32.4%; P = .010).

Study details: This retrospective study included 89 patients with RA in remission or with LDA who showed joint damage progression and were assigned to either receive intensive treatment or continue the current treatment.

Disclosures: This study did not declare the funding source. T Mochizuki, K Yano, and K Ikari declared receiving lecture honoraria from various sources. The other authors declared no conflicts of interest.

Source: Mochizuki T et al. Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission. Mod Rheumatol. 2023 (Jun 2). doi: 10.1093/mr/road041

Key clinical point: Intensive treatment more effectively suppressed joint damage progression than the current treatment in patients with rheumatoid arthritis (RA) who showed joint damage progression and had low disease activity (LDA) or were in remission.

Major finding: At 1 year of treatment, intensive vs current treatment was associated with a smaller change in the van der Heijde modified total Sharp score (ΔTSS; 0.67 vs 1.79; P < .001) and joint space narrowing scores (0.57 vs 1.41; P < .001) and a larger proportion of patients achieved a ΔTSS of ≤0.5 (66.7% vs 32.4%; P = .010).

Study details: This retrospective study included 89 patients with RA in remission or with LDA who showed joint damage progression and were assigned to either receive intensive treatment or continue the current treatment.

Disclosures: This study did not declare the funding source. T Mochizuki, K Yano, and K Ikari declared receiving lecture honoraria from various sources. The other authors declared no conflicts of interest.

Source: Mochizuki T et al. Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission. Mod Rheumatol. 2023 (Jun 2). doi: 10.1093/mr/road041

Key clinical point: Ultrasound detected subclinical inflammation in the wrist joints of most patients with rheumatoid arthritis (RA) in clinical remission or with lower disease activity, with the risk for subclinical inflammation being lower among those using biologic therapy.

Major finding: Overall, subclinical inflammation was detected in 57.4% of the patients in complete remission or with lower disease activity. Factors negatively associated with subclinical inflammation included the use of biologic therapy (odds ratio [OR] 0.59; P = .001), methotrexate (OR 0.83; P = .020), and glucocorticoids (OR 0.60; P = .001) and alcohol consumption (OR 0.55; P = .006).

Study details: This cross-sectional study included 1248 patients with RA who underwent gray scale and power Doppler ultrasound assessments of the dorsal radiolunate joints of both wrists.

Disclosures: This study was supported by the Kaohsiung Chang Gung Memorial Hospital, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Wang YW et al. Factors associated with subclinical inflammation of wrist joints in rheumatoid arthritis patients with low or no disease activity—A RA ultrasound registry study. BMC Musculoskelet Disord. 2023;24:438 (May 30). doi: 10.1186/s12891-023-06521-8

Key clinical point: Ultrasound detected subclinical inflammation in the wrist joints of most patients with rheumatoid arthritis (RA) in clinical remission or with lower disease activity, with the risk for subclinical inflammation being lower among those using biologic therapy.

Major finding: Overall, subclinical inflammation was detected in 57.4% of the patients in complete remission or with lower disease activity. Factors negatively associated with subclinical inflammation included the use of biologic therapy (odds ratio [OR] 0.59; P = .001), methotrexate (OR 0.83; P = .020), and glucocorticoids (OR 0.60; P = .001) and alcohol consumption (OR 0.55; P = .006).

Study details: This cross-sectional study included 1248 patients with RA who underwent gray scale and power Doppler ultrasound assessments of the dorsal radiolunate joints of both wrists.

Disclosures: This study was supported by the Kaohsiung Chang Gung Memorial Hospital, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Wang YW et al. Factors associated with subclinical inflammation of wrist joints in rheumatoid arthritis patients with low or no disease activity—A RA ultrasound registry study. BMC Musculoskelet Disord. 2023;24:438 (May 30). doi: 10.1186/s12891-023-06521-8

Key clinical point: Ultrasound detected subclinical inflammation in the wrist joints of most patients with rheumatoid arthritis (RA) in clinical remission or with lower disease activity, with the risk for subclinical inflammation being lower among those using biologic therapy.

Major finding: Overall, subclinical inflammation was detected in 57.4% of the patients in complete remission or with lower disease activity. Factors negatively associated with subclinical inflammation included the use of biologic therapy (odds ratio [OR] 0.59; P = .001), methotrexate (OR 0.83; P = .020), and glucocorticoids (OR 0.60; P = .001) and alcohol consumption (OR 0.55; P = .006).

Study details: This cross-sectional study included 1248 patients with RA who underwent gray scale and power Doppler ultrasound assessments of the dorsal radiolunate joints of both wrists.

Disclosures: This study was supported by the Kaohsiung Chang Gung Memorial Hospital, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Wang YW et al. Factors associated with subclinical inflammation of wrist joints in rheumatoid arthritis patients with low or no disease activity—A RA ultrasound registry study. BMC Musculoskelet Disord. 2023;24:438 (May 30). doi: 10.1186/s12891-023-06521-8

Key clinical point: Depression significantly predicted death in patients with incident rheumatoid arthritis (RA), but with a strength similar to that in matched comparator individuals without RA.

Major finding: The risk for all-cause mortality was >3-fold higher (adjusted hazard rate ratio [aHRR] 3.15; 95% CI 2.62-3.79) in patients with RA with vs without depression, with the risk being higher among patients age < 55 years compared with other age groups (aHRR 8.13; 95% CI 3.89-17.02). In addition, depression predicted all-cause mortality with similar strength in comparator individuals without RA (aHRR 3.77; 95% CI 3.48-4.08).

Study details: This study included 11,071 patients with incident RA and 55,355 matched comparator individuals without RA from the general population.

Disclosures: This study was supported by the Danish Rheumatism Association. The authors declared no conflicts of interest.

Source: Pedersen JK et al. Mortality in patients with incident rheumatoid arthritis and depression: A Danish cohort study of 11,071 patients and 55,355 comparators. Rheumatology (Oxford). 2023 (May 30). doi: 10.1093/rheumatology/kead259

Key clinical point: Depression significantly predicted death in patients with incident rheumatoid arthritis (RA), but with a strength similar to that in matched comparator individuals without RA.

Major finding: The risk for all-cause mortality was >3-fold higher (adjusted hazard rate ratio [aHRR] 3.15; 95% CI 2.62-3.79) in patients with RA with vs without depression, with the risk being higher among patients age < 55 years compared with other age groups (aHRR 8.13; 95% CI 3.89-17.02). In addition, depression predicted all-cause mortality with similar strength in comparator individuals without RA (aHRR 3.77; 95% CI 3.48-4.08).

Study details: This study included 11,071 patients with incident RA and 55,355 matched comparator individuals without RA from the general population.

Disclosures: This study was supported by the Danish Rheumatism Association. The authors declared no conflicts of interest.

Source: Pedersen JK et al. Mortality in patients with incident rheumatoid arthritis and depression: A Danish cohort study of 11,071 patients and 55,355 comparators. Rheumatology (Oxford). 2023 (May 30). doi: 10.1093/rheumatology/kead259

Key clinical point: Depression significantly predicted death in patients with incident rheumatoid arthritis (RA), but with a strength similar to that in matched comparator individuals without RA.

Major finding: The risk for all-cause mortality was >3-fold higher (adjusted hazard rate ratio [aHRR] 3.15; 95% CI 2.62-3.79) in patients with RA with vs without depression, with the risk being higher among patients age < 55 years compared with other age groups (aHRR 8.13; 95% CI 3.89-17.02). In addition, depression predicted all-cause mortality with similar strength in comparator individuals without RA (aHRR 3.77; 95% CI 3.48-4.08).

Study details: This study included 11,071 patients with incident RA and 55,355 matched comparator individuals without RA from the general population.

Disclosures: This study was supported by the Danish Rheumatism Association. The authors declared no conflicts of interest.

Source: Pedersen JK et al. Mortality in patients with incident rheumatoid arthritis and depression: A Danish cohort study of 11,071 patients and 55,355 comparators. Rheumatology (Oxford). 2023 (May 30). doi: 10.1093/rheumatology/kead259

Key clinical point: Perioperative use of Janus kinase inhibitors (JAKi) seemed safe in patients with rheumatoid arthritis (RA) undergoing orthopedic procedures; however, the benefits of withholding JAKi to prevent postoperative complications should be balanced against the risk for a flare-up in disease activity.

Major finding: Overall, 20 patients undergoing 31 orthopedic procedures continued JAKi perioperatively, whereas 16 patients undergoing 18 procedures discontinued JAKi perioperatively by ≥1 dose for various reasons. No surgical site infections were reported during ≥90 days of follow-up. Disease flare-up was observed in 2 patients who discontinued JAKi for 3 and 14 days, respectively; however, those who discontinued JAKi for ≤1 day showed no flare-up.

Study details: This retrospective study included 32 patients with RA who had disease under control with JAKi and underwent a total of 49 orthopedic procedures.

Disclosures: This study did not receive any funding, grants, or other support. K Nishida declared receiving research grants or speaker fees from various sources.

Source: Nishida K et al. Influence of Janus kinase inhibitors on early postoperative complications in patients with rheumatoid arthritis undergoing orthopaedic surgeries. Mod Rheumatol. 2023 (Jun 3). doi: 10.1093/mr/road047

Key clinical point: Perioperative use of Janus kinase inhibitors (JAKi) seemed safe in patients with rheumatoid arthritis (RA) undergoing orthopedic procedures; however, the benefits of withholding JAKi to prevent postoperative complications should be balanced against the risk for a flare-up in disease activity.

Major finding: Overall, 20 patients undergoing 31 orthopedic procedures continued JAKi perioperatively, whereas 16 patients undergoing 18 procedures discontinued JAKi perioperatively by ≥1 dose for various reasons. No surgical site infections were reported during ≥90 days of follow-up. Disease flare-up was observed in 2 patients who discontinued JAKi for 3 and 14 days, respectively; however, those who discontinued JAKi for ≤1 day showed no flare-up.

Study details: This retrospective study included 32 patients with RA who had disease under control with JAKi and underwent a total of 49 orthopedic procedures.

Disclosures: This study did not receive any funding, grants, or other support. K Nishida declared receiving research grants or speaker fees from various sources.

Source: Nishida K et al. Influence of Janus kinase inhibitors on early postoperative complications in patients with rheumatoid arthritis undergoing orthopaedic surgeries. Mod Rheumatol. 2023 (Jun 3). doi: 10.1093/mr/road047

Key clinical point: Perioperative use of Janus kinase inhibitors (JAKi) seemed safe in patients with rheumatoid arthritis (RA) undergoing orthopedic procedures; however, the benefits of withholding JAKi to prevent postoperative complications should be balanced against the risk for a flare-up in disease activity.

Major finding: Overall, 20 patients undergoing 31 orthopedic procedures continued JAKi perioperatively, whereas 16 patients undergoing 18 procedures discontinued JAKi perioperatively by ≥1 dose for various reasons. No surgical site infections were reported during ≥90 days of follow-up. Disease flare-up was observed in 2 patients who discontinued JAKi for 3 and 14 days, respectively; however, those who discontinued JAKi for ≤1 day showed no flare-up.

Study details: This retrospective study included 32 patients with RA who had disease under control with JAKi and underwent a total of 49 orthopedic procedures.

Disclosures: This study did not receive any funding, grants, or other support. K Nishida declared receiving research grants or speaker fees from various sources.

Source: Nishida K et al. Influence of Janus kinase inhibitors on early postoperative complications in patients with rheumatoid arthritis undergoing orthopaedic surgeries. Mod Rheumatol. 2023 (Jun 3). doi: 10.1093/mr/road047

Key clinical point: Hydroxychloroquine treatment conferred survival benefits in a dose-dependent manner in patients with elderly-onset rheumatoid arthritis (RA), with patients receiving a monthly cumulative dose of 1374.5-5778.5 mg or more showing better survival than those receiving <1374.5 mg.

Major finding: Hydroxychloroquine treatment was a protective factor against mortality in patients with elderly-onset RA (hazard ratio 0.30; P = .002), with a cumulative dose of <1374.5 mg vs 1374.5-5,778.5 mg or more leading to the lowest survival rate (P < .001).

Study details: Findings are from a retrospective observational study including 980 patients with elderly-onset RA (disease onset after 60 years of age) who had received conventional synthetic, biologic, or targeted synthetic disease-modifying antirheumatic drugs.

Disclosures: This study was supported by the National Science and Technology Council, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Lin CT et al. Association of hydroxychloroquine use with a dose-dependent decrease in mortality risk in patients with elderly-onset rheumatoid arthritis. Rheumatol Ther. 2023 (May 12). Doi: 10.1007/s40744-023-00561-1

Key clinical point: Hydroxychloroquine treatment conferred survival benefits in a dose-dependent manner in patients with elderly-onset rheumatoid arthritis (RA), with patients receiving a monthly cumulative dose of 1374.5-5778.5 mg or more showing better survival than those receiving <1374.5 mg.

Major finding: Hydroxychloroquine treatment was a protective factor against mortality in patients with elderly-onset RA (hazard ratio 0.30; P = .002), with a cumulative dose of <1374.5 mg vs 1374.5-5,778.5 mg or more leading to the lowest survival rate (P < .001).

Study details: Findings are from a retrospective observational study including 980 patients with elderly-onset RA (disease onset after 60 years of age) who had received conventional synthetic, biologic, or targeted synthetic disease-modifying antirheumatic drugs.

Disclosures: This study was supported by the National Science and Technology Council, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Lin CT et al. Association of hydroxychloroquine use with a dose-dependent decrease in mortality risk in patients with elderly-onset rheumatoid arthritis. Rheumatol Ther. 2023 (May 12). Doi: 10.1007/s40744-023-00561-1

Key clinical point: Hydroxychloroquine treatment conferred survival benefits in a dose-dependent manner in patients with elderly-onset rheumatoid arthritis (RA), with patients receiving a monthly cumulative dose of 1374.5-5778.5 mg or more showing better survival than those receiving <1374.5 mg.

Major finding: Hydroxychloroquine treatment was a protective factor against mortality in patients with elderly-onset RA (hazard ratio 0.30; P = .002), with a cumulative dose of <1374.5 mg vs 1374.5-5,778.5 mg or more leading to the lowest survival rate (P < .001).

Study details: Findings are from a retrospective observational study including 980 patients with elderly-onset RA (disease onset after 60 years of age) who had received conventional synthetic, biologic, or targeted synthetic disease-modifying antirheumatic drugs.

Disclosures: This study was supported by the National Science and Technology Council, Taiwan, and other sources. The authors declared no conflicts of interest.

Source: Lin CT et al. Association of hydroxychloroquine use with a dose-dependent decrease in mortality risk in patients with elderly-onset rheumatoid arthritis. Rheumatol Ther. 2023 (May 12). Doi: 10.1007/s40744-023-00561-1

Key clinical point: Tofacitinib use increased the risk for herpes zoster (HZ) in patients with rheumatoid arthritis (RA) compared with tumor necrosis factor inhibitor (TNFi); however, the rate of serious HZ or tofacitinib discontinuation due to HZ was low.

Major finding: The incidence of HZ was significantly higher among patients receiving tofacitinib vs TNFi (incidence rate ratio 8.33; P < .001). However, the incidence of serious HZ was not significantly different between the groups (P = .452), with HZ leading to only one case of permanent tofacitinib discontinuation.

Study details: This study included 912 patients with RA from two single-center prospective cohorts (tofacitinib cohort n = 200 and TNFi cohort n = 712).

Disclosures: This study was supported by the Ministry of Health and Welfare, Republic of Korea, and Pfizer. Two authors declared being employees and shareholders of Pfizer Inc. YK Sung declared receiving research grants from Pfizer and other sources. The other authors declared no conflicts of interest.

Source: Song YJ et al. Increased risk of herpes zoster with tofacitinib treatment in Korean patients with rheumatoid arthritis: A single‑center prospective study. Sci Rep. 2023;13:7877 (May 15). doi: 10.1038/s41598-023-33718-7

Key clinical point: Tofacitinib use increased the risk for herpes zoster (HZ) in patients with rheumatoid arthritis (RA) compared with tumor necrosis factor inhibitor (TNFi); however, the rate of serious HZ or tofacitinib discontinuation due to HZ was low.

Major finding: The incidence of HZ was significantly higher among patients receiving tofacitinib vs TNFi (incidence rate ratio 8.33; P < .001). However, the incidence of serious HZ was not significantly different between the groups (P = .452), with HZ leading to only one case of permanent tofacitinib discontinuation.

Study details: This study included 912 patients with RA from two single-center prospective cohorts (tofacitinib cohort n = 200 and TNFi cohort n = 712).

Disclosures: This study was supported by the Ministry of Health and Welfare, Republic of Korea, and Pfizer. Two authors declared being employees and shareholders of Pfizer Inc. YK Sung declared receiving research grants from Pfizer and other sources. The other authors declared no conflicts of interest.

Source: Song YJ et al. Increased risk of herpes zoster with tofacitinib treatment in Korean patients with rheumatoid arthritis: A single‑center prospective study. Sci Rep. 2023;13:7877 (May 15). doi: 10.1038/s41598-023-33718-7

Key clinical point: Tofacitinib use increased the risk for herpes zoster (HZ) in patients with rheumatoid arthritis (RA) compared with tumor necrosis factor inhibitor (TNFi); however, the rate of serious HZ or tofacitinib discontinuation due to HZ was low.

Major finding: The incidence of HZ was significantly higher among patients receiving tofacitinib vs TNFi (incidence rate ratio 8.33; P < .001). However, the incidence of serious HZ was not significantly different between the groups (P = .452), with HZ leading to only one case of permanent tofacitinib discontinuation.

Study details: This study included 912 patients with RA from two single-center prospective cohorts (tofacitinib cohort n = 200 and TNFi cohort n = 712).

Disclosures: This study was supported by the Ministry of Health and Welfare, Republic of Korea, and Pfizer. Two authors declared being employees and shareholders of Pfizer Inc. YK Sung declared receiving research grants from Pfizer and other sources. The other authors declared no conflicts of interest.

Source: Song YJ et al. Increased risk of herpes zoster with tofacitinib treatment in Korean patients with rheumatoid arthritis: A single‑center prospective study. Sci Rep. 2023;13:7877 (May 15). doi: 10.1038/s41598-023-33718-7

Key clinical point: Frailty is a significant contributing factor leading to methotrexate discontinuation due to adverse events in long-term pretreated patients with rheumatoid arthritis (RA).

Major finding: Overall, 7.4% of the patients discontinued methotrexate due to adverse events during 2 years of follow-up, with methotrexate retention being significantly lower among patients with vs without frailty (P < .05) and frailty being a significant factor contributing to methotrexate discontinuation (adjusted hazard ratio 2.34; 95% CI 1.02-5.37).

Study details: This retrospective longitudinal study included 323 patients with RA who used methotrexate at baseline.

Disclosures: This study did not declare the funding source. The authors did not report conflicts of interest.

Source: Sobue Y et al. Relationship between frailty and methotrexate discontinuation due to adverse events in rheumatoid arthritis patients. Clin Rheumatol. 2023 (May 22). doi: 10.1007/s10067-023-06639-z

Key clinical point: Frailty is a significant contributing factor leading to methotrexate discontinuation due to adverse events in long-term pretreated patients with rheumatoid arthritis (RA).

Major finding: Overall, 7.4% of the patients discontinued methotrexate due to adverse events during 2 years of follow-up, with methotrexate retention being significantly lower among patients with vs without frailty (P < .05) and frailty being a significant factor contributing to methotrexate discontinuation (adjusted hazard ratio 2.34; 95% CI 1.02-5.37).

Study details: This retrospective longitudinal study included 323 patients with RA who used methotrexate at baseline.

Disclosures: This study did not declare the funding source. The authors did not report conflicts of interest.

Source: Sobue Y et al. Relationship between frailty and methotrexate discontinuation due to adverse events in rheumatoid arthritis patients. Clin Rheumatol. 2023 (May 22). doi: 10.1007/s10067-023-06639-z

Key clinical point: Frailty is a significant contributing factor leading to methotrexate discontinuation due to adverse events in long-term pretreated patients with rheumatoid arthritis (RA).

Major finding: Overall, 7.4% of the patients discontinued methotrexate due to adverse events during 2 years of follow-up, with methotrexate retention being significantly lower among patients with vs without frailty (P < .05) and frailty being a significant factor contributing to methotrexate discontinuation (adjusted hazard ratio 2.34; 95% CI 1.02-5.37).

Study details: This retrospective longitudinal study included 323 patients with RA who used methotrexate at baseline.

Disclosures: This study did not declare the funding source. The authors did not report conflicts of interest.

Source: Sobue Y et al. Relationship between frailty and methotrexate discontinuation due to adverse events in rheumatoid arthritis patients. Clin Rheumatol. 2023 (May 22). doi: 10.1007/s10067-023-06639-z