MDedge Rheumatology

Recently,  the results of a survey of consumers regarding their health care experiences were reported by Carta Healthcare. As you might expect, a top complaint about doctors was time spent waiting to see them; 23% said they waited 30 minutes or longer. I’ve written about punctuality before, but this is such a ubiquitous problem that it bears repeating. Here are some suggestions:

Start on time. That seems obvious, but I’m always amazed at the number of doctors who admit to running late who also admit that they start late. If you’re in the hole before you even start, you can seldom dig yourself out. Sometimes an on-time start is the solution to the entire problem! If you doubt me, try it.

Book realistically. Everyone works at a different pace. Determine the number of patients you can comfortably see in an hour, and book only that number. If you want to see more patients, the solution is working longer hours or hiring physicians or physician extenders (or both), not overloading your schedule.

Time-stamp each chart. Pay attention to patient arrival times if your EHR records them, and step up your pace if you start to fall behind. If your EHR does not record arrival times or you are still using paper records, buy a time clock and have your receptionist time-stamp the “encounter form” that goes to the back with the patient. One glance at the stamp will tell you exactly how long that patient has been waiting.

Schedule all surgeries. If you haven’t scheduled the time necessary for a surgical procedure, don’t do it. It’s frequently tempting to “squeeze in” an excision, often because you feel guilty that the patient has already had to wait for you. But every unscheduled surgery puts you that much further behind. And hurrying through a procedure increases the risk of mistakes. Tell the patient that surgery requires extra time and it can’t be rushed, so you will have to schedule that time.

Work-ins come last, not first. Patients with urgent problems should be seen after scheduled patients. That may seem counterintuitive; receptionists often assume it’s better to squeeze them in early, while you’re still running on time. But doing that guarantees you will run late, and it isn’t fair to patients who have appointments and expect to be seen promptly.

Work-ins, on the other hand, expect a wait because they have no appointment. We tell them, “Our schedule is full today; but if you come at the end of hours, the doctor will see you. But you may have a wait.” Far from complaining, they invariably thank us for seeing them.

Seize the list. You know the list I mean. “Number 16: My right big toe itches. Number 17: I think I feel something on my back. Number 18: This weird chartreuse thing on my arm ...” One long list can leave an entire half-day schedule in shambles.

When a list is produced, the best option is to take it and read it yourself. Identify the most important two or three problems, and address them. For the rest, I will say, “This group of problems deserves a visit of its own, and we will schedule that visit.”

Ask if you can place the list (or a photocopy) in the patient’s chart. (It is, after all, important clinical information.) All of these problems are important to the patient and should be addressed – but on your schedule, not the patient’s.

Avoid interruptions. Especially phone calls. Unless it’s an emergency or an immediate family member, my receptionists say, “I’m sorry, the doctor is with patients. May I take a message?” Everyone – even other physicians – understands. But be sure to return those calls promptly.

Pharmaceutical reps should not be allowed to interrupt you, either. Have them make an appointment, just like everybody else.

There will be times, of course, when you run late. But these should be the exception rather than the rule. By streamlining your procedures and avoiding the pitfalls mentioned, you can give nearly every patient all the time he or she deserves without keeping the next patient waiting.

Incidentally, other common patient complaints in that survey were the following:

• Couldn’t schedule an appointment within a week.
• Spent too little time with me.
• Didn’t provide test results promptly.
• Didn’t respond to my phone calls promptly.

Now would be an excellent opportunity to identify and address any of those problems as well.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Recently,  the results of a survey of consumers regarding their health care experiences were reported by Carta Healthcare. As you might expect, a top complaint about doctors was time spent waiting to see them; 23% said they waited 30 minutes or longer. I’ve written about punctuality before, but this is such a ubiquitous problem that it bears repeating. Here are some suggestions:

Start on time. That seems obvious, but I’m always amazed at the number of doctors who admit to running late who also admit that they start late. If you’re in the hole before you even start, you can seldom dig yourself out. Sometimes an on-time start is the solution to the entire problem! If you doubt me, try it.

Book realistically. Everyone works at a different pace. Determine the number of patients you can comfortably see in an hour, and book only that number. If you want to see more patients, the solution is working longer hours or hiring physicians or physician extenders (or both), not overloading your schedule.

Time-stamp each chart. Pay attention to patient arrival times if your EHR records them, and step up your pace if you start to fall behind. If your EHR does not record arrival times or you are still using paper records, buy a time clock and have your receptionist time-stamp the “encounter form” that goes to the back with the patient. One glance at the stamp will tell you exactly how long that patient has been waiting.

Schedule all surgeries. If you haven’t scheduled the time necessary for a surgical procedure, don’t do it. It’s frequently tempting to “squeeze in” an excision, often because you feel guilty that the patient has already had to wait for you. But every unscheduled surgery puts you that much further behind. And hurrying through a procedure increases the risk of mistakes. Tell the patient that surgery requires extra time and it can’t be rushed, so you will have to schedule that time.

Work-ins come last, not first. Patients with urgent problems should be seen after scheduled patients. That may seem counterintuitive; receptionists often assume it’s better to squeeze them in early, while you’re still running on time. But doing that guarantees you will run late, and it isn’t fair to patients who have appointments and expect to be seen promptly.

Work-ins, on the other hand, expect a wait because they have no appointment. We tell them, “Our schedule is full today; but if you come at the end of hours, the doctor will see you. But you may have a wait.” Far from complaining, they invariably thank us for seeing them.

Seize the list. You know the list I mean. “Number 16: My right big toe itches. Number 17: I think I feel something on my back. Number 18: This weird chartreuse thing on my arm ...” One long list can leave an entire half-day schedule in shambles.

When a list is produced, the best option is to take it and read it yourself. Identify the most important two or three problems, and address them. For the rest, I will say, “This group of problems deserves a visit of its own, and we will schedule that visit.”

Ask if you can place the list (or a photocopy) in the patient’s chart. (It is, after all, important clinical information.) All of these problems are important to the patient and should be addressed – but on your schedule, not the patient’s.

Avoid interruptions. Especially phone calls. Unless it’s an emergency or an immediate family member, my receptionists say, “I’m sorry, the doctor is with patients. May I take a message?” Everyone – even other physicians – understands. But be sure to return those calls promptly.

Pharmaceutical reps should not be allowed to interrupt you, either. Have them make an appointment, just like everybody else.

There will be times, of course, when you run late. But these should be the exception rather than the rule. By streamlining your procedures and avoiding the pitfalls mentioned, you can give nearly every patient all the time he or she deserves without keeping the next patient waiting.

Incidentally, other common patient complaints in that survey were the following:

• Couldn’t schedule an appointment within a week.
• Spent too little time with me.
• Didn’t provide test results promptly.
• Didn’t respond to my phone calls promptly.

Now would be an excellent opportunity to identify and address any of those problems as well.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Recently,  the results of a survey of consumers regarding their health care experiences were reported by Carta Healthcare. As you might expect, a top complaint about doctors was time spent waiting to see them; 23% said they waited 30 minutes or longer. I’ve written about punctuality before, but this is such a ubiquitous problem that it bears repeating. Here are some suggestions:

Start on time. That seems obvious, but I’m always amazed at the number of doctors who admit to running late who also admit that they start late. If you’re in the hole before you even start, you can seldom dig yourself out. Sometimes an on-time start is the solution to the entire problem! If you doubt me, try it.

Book realistically. Everyone works at a different pace. Determine the number of patients you can comfortably see in an hour, and book only that number. If you want to see more patients, the solution is working longer hours or hiring physicians or physician extenders (or both), not overloading your schedule.

Time-stamp each chart. Pay attention to patient arrival times if your EHR records them, and step up your pace if you start to fall behind. If your EHR does not record arrival times or you are still using paper records, buy a time clock and have your receptionist time-stamp the “encounter form” that goes to the back with the patient. One glance at the stamp will tell you exactly how long that patient has been waiting.

Schedule all surgeries. If you haven’t scheduled the time necessary for a surgical procedure, don’t do it. It’s frequently tempting to “squeeze in” an excision, often because you feel guilty that the patient has already had to wait for you. But every unscheduled surgery puts you that much further behind. And hurrying through a procedure increases the risk of mistakes. Tell the patient that surgery requires extra time and it can’t be rushed, so you will have to schedule that time.

Work-ins come last, not first. Patients with urgent problems should be seen after scheduled patients. That may seem counterintuitive; receptionists often assume it’s better to squeeze them in early, while you’re still running on time. But doing that guarantees you will run late, and it isn’t fair to patients who have appointments and expect to be seen promptly.

Work-ins, on the other hand, expect a wait because they have no appointment. We tell them, “Our schedule is full today; but if you come at the end of hours, the doctor will see you. But you may have a wait.” Far from complaining, they invariably thank us for seeing them.

Seize the list. You know the list I mean. “Number 16: My right big toe itches. Number 17: I think I feel something on my back. Number 18: This weird chartreuse thing on my arm ...” One long list can leave an entire half-day schedule in shambles.

When a list is produced, the best option is to take it and read it yourself. Identify the most important two or three problems, and address them. For the rest, I will say, “This group of problems deserves a visit of its own, and we will schedule that visit.”

Ask if you can place the list (or a photocopy) in the patient’s chart. (It is, after all, important clinical information.) All of these problems are important to the patient and should be addressed – but on your schedule, not the patient’s.

Avoid interruptions. Especially phone calls. Unless it’s an emergency or an immediate family member, my receptionists say, “I’m sorry, the doctor is with patients. May I take a message?” Everyone – even other physicians – understands. But be sure to return those calls promptly.

Pharmaceutical reps should not be allowed to interrupt you, either. Have them make an appointment, just like everybody else.

There will be times, of course, when you run late. But these should be the exception rather than the rule. By streamlining your procedures and avoiding the pitfalls mentioned, you can give nearly every patient all the time he or she deserves without keeping the next patient waiting.

Incidentally, other common patient complaints in that survey were the following:

• Couldn’t schedule an appointment within a week.
• Spent too little time with me.
• Didn’t provide test results promptly.
• Didn’t respond to my phone calls promptly.

Now would be an excellent opportunity to identify and address any of those problems as well.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a longtime monthly columnist for Dermatology News. Write to him at [email protected].

Key clinical point: Six biomarkers, including fine-specificity anti-citrullinated protein antibodies (ACPA) and anti-native protein antibodies, demonstrated a significant association with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and improved prediction sensitivity.

Major finding: Six fine-specificity antibody biomarkers, including immunoglobin G, to citrullinated (adjusted odds ratio [aOR] 3.47; 95% CI 1.71-7.01) and native (aOR 2.53; 95% CI 1.47-4.34) cyclic filaggrin 48-65 were associated with an increased risk for RA-ILD. Risk scores combining antibodies with clinical features with vs without biomarkers (score 5.9 vs 2.6) demonstrated higher sensitivity (67% vs 25%) and high specificity (≥93%) for developing RA-ILD at a threshold of 50% predicted probability.

Study details: This nested case-control study within an ongoing prospective registry included adult patients with incident RA-ILD (n = 84) and matched patients with RA without ILD (n = 233).

Disclosures: This study was supported by the US National Institute of Arthritis and Musculoskeletal and Skin Diseases. Several authors reported ties with various sources unrelated to this study.

Source: Kronzer VL et al. Autoantibodies against citrullinated and native proteins and prediction of rheumatoid arthritis-associated interstitial lung disease: A nested case–control study. Lancet Rheumatol. 2023;5(2):E77-E87 (Feb). Doi: 10.1016/S2665-9913(22)00380-0

Key clinical point: Six biomarkers, including fine-specificity anti-citrullinated protein antibodies (ACPA) and anti-native protein antibodies, demonstrated a significant association with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and improved prediction sensitivity.

Major finding: Six fine-specificity antibody biomarkers, including immunoglobin G, to citrullinated (adjusted odds ratio [aOR] 3.47; 95% CI 1.71-7.01) and native (aOR 2.53; 95% CI 1.47-4.34) cyclic filaggrin 48-65 were associated with an increased risk for RA-ILD. Risk scores combining antibodies with clinical features with vs without biomarkers (score 5.9 vs 2.6) demonstrated higher sensitivity (67% vs 25%) and high specificity (≥93%) for developing RA-ILD at a threshold of 50% predicted probability.

Study details: This nested case-control study within an ongoing prospective registry included adult patients with incident RA-ILD (n = 84) and matched patients with RA without ILD (n = 233).

Disclosures: This study was supported by the US National Institute of Arthritis and Musculoskeletal and Skin Diseases. Several authors reported ties with various sources unrelated to this study.

Source: Kronzer VL et al. Autoantibodies against citrullinated and native proteins and prediction of rheumatoid arthritis-associated interstitial lung disease: A nested case–control study. Lancet Rheumatol. 2023;5(2):E77-E87 (Feb). Doi: 10.1016/S2665-9913(22)00380-0

Key clinical point: Six biomarkers, including fine-specificity anti-citrullinated protein antibodies (ACPA) and anti-native protein antibodies, demonstrated a significant association with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and improved prediction sensitivity.

Major finding: Six fine-specificity antibody biomarkers, including immunoglobin G, to citrullinated (adjusted odds ratio [aOR] 3.47; 95% CI 1.71-7.01) and native (aOR 2.53; 95% CI 1.47-4.34) cyclic filaggrin 48-65 were associated with an increased risk for RA-ILD. Risk scores combining antibodies with clinical features with vs without biomarkers (score 5.9 vs 2.6) demonstrated higher sensitivity (67% vs 25%) and high specificity (≥93%) for developing RA-ILD at a threshold of 50% predicted probability.

Study details: This nested case-control study within an ongoing prospective registry included adult patients with incident RA-ILD (n = 84) and matched patients with RA without ILD (n = 233).

Disclosures: This study was supported by the US National Institute of Arthritis and Musculoskeletal and Skin Diseases. Several authors reported ties with various sources unrelated to this study.

Source: Kronzer VL et al. Autoantibodies against citrullinated and native proteins and prediction of rheumatoid arthritis-associated interstitial lung disease: A nested case–control study. Lancet Rheumatol. 2023;5(2):E77-E87 (Feb). Doi: 10.1016/S2665-9913(22)00380-0

Key clinical point: The incidence of herpes zoster in the United States is nearly twice as high in patients with rheumatoid arthritis (RA) compared with those without RA, with the relative risk being higher among younger patients with RA than their older non-RA counterparts.

Major finding: The incidence of herpes zoster was significantly higher in patients with vs without RA (adjusted incidence rate ratio [aIRR] 1.93; P < .001) and younger patients (<50 years) with RA vs older individuals (≥50 years) without RA (aIRR 1.34; P < .001).

Study details: This retrospective, longitudinal cohort study included patients with (n = 67,650) and without RA (n = 11,401,743) without a prior diagnosis or vaccination for herpes zoster.

Disclosures: This study was funded by GlaxoSmithKline (GSK) Biologicals SA. Seven authors declared being employees of or shareholders in the GSK group of companies or a company funded by GSK. Two authors declared receiving grant support from the GSK group of companies or being a member of the American College of Rheumatology Vaccine Guideline Committee.

Source: Singer D et al. Incidence of Herpes Zoster in patients with rheumatoid arthritis in the United States: A retrospective cohort study. J Rheumatol. 2023 (Feb 1). Doi: 10.3899/jrheum.220986

Key clinical point: The incidence of herpes zoster in the United States is nearly twice as high in patients with rheumatoid arthritis (RA) compared with those without RA, with the relative risk being higher among younger patients with RA than their older non-RA counterparts.

Major finding: The incidence of herpes zoster was significantly higher in patients with vs without RA (adjusted incidence rate ratio [aIRR] 1.93; P < .001) and younger patients (<50 years) with RA vs older individuals (≥50 years) without RA (aIRR 1.34; P < .001).

Study details: This retrospective, longitudinal cohort study included patients with (n = 67,650) and without RA (n = 11,401,743) without a prior diagnosis or vaccination for herpes zoster.

Disclosures: This study was funded by GlaxoSmithKline (GSK) Biologicals SA. Seven authors declared being employees of or shareholders in the GSK group of companies or a company funded by GSK. Two authors declared receiving grant support from the GSK group of companies or being a member of the American College of Rheumatology Vaccine Guideline Committee.

Source: Singer D et al. Incidence of Herpes Zoster in patients with rheumatoid arthritis in the United States: A retrospective cohort study. J Rheumatol. 2023 (Feb 1). Doi: 10.3899/jrheum.220986

Key clinical point: The incidence of herpes zoster in the United States is nearly twice as high in patients with rheumatoid arthritis (RA) compared with those without RA, with the relative risk being higher among younger patients with RA than their older non-RA counterparts.

Major finding: The incidence of herpes zoster was significantly higher in patients with vs without RA (adjusted incidence rate ratio [aIRR] 1.93; P < .001) and younger patients (<50 years) with RA vs older individuals (≥50 years) without RA (aIRR 1.34; P < .001).

Study details: This retrospective, longitudinal cohort study included patients with (n = 67,650) and without RA (n = 11,401,743) without a prior diagnosis or vaccination for herpes zoster.

Disclosures: This study was funded by GlaxoSmithKline (GSK) Biologicals SA. Seven authors declared being employees of or shareholders in the GSK group of companies or a company funded by GSK. Two authors declared receiving grant support from the GSK group of companies or being a member of the American College of Rheumatology Vaccine Guideline Committee.

Source: Singer D et al. Incidence of Herpes Zoster in patients with rheumatoid arthritis in the United States: A retrospective cohort study. J Rheumatol. 2023 (Feb 1). Doi: 10.3899/jrheum.220986

Key clinical point: Smokers with a family history of rheumatoid arthritis (RA) may be considered a high-risk group who should be informed about increased smoking-associated RA risk and advised smoking cessation.

Major finding: Risk for RA was higher in individuals with vs without first-degree relatives affected with RA (adjusted hazard ratio [aHR] 4.49; 95% CI 3.96-5.10) and in current vs non-smokers (aHR 1.37; 95% CI 1.24-1.51), with the risk being markedly higher among smokers with a positive family history of RA (HR 6.44; 95% CI 4.61-9.00).

Study details: Findings are from a population-based cohort study that evaluated lifestyle factors and family relationships of 5,524,403 individuals with (n = 76,065) and without (n = 5,448,338) first-degree relatives affected with RA, of which 47,942 individuals developed RA.

Disclosures: This study was supported by the Chungbuk National University Korea National University Development Project. The authors declared no conflicts of interest.

Source: Kim HJ et al. Familial risk of seropositive rheumatoid arthritis and interaction with smoking: a population-based cohort study. Rheumatology (Oxford). 2023 (Jan 24). Doi: 10.1093/rheumatology/kead048

Key clinical point: Smokers with a family history of rheumatoid arthritis (RA) may be considered a high-risk group who should be informed about increased smoking-associated RA risk and advised smoking cessation.

Major finding: Risk for RA was higher in individuals with vs without first-degree relatives affected with RA (adjusted hazard ratio [aHR] 4.49; 95% CI 3.96-5.10) and in current vs non-smokers (aHR 1.37; 95% CI 1.24-1.51), with the risk being markedly higher among smokers with a positive family history of RA (HR 6.44; 95% CI 4.61-9.00).

Study details: Findings are from a population-based cohort study that evaluated lifestyle factors and family relationships of 5,524,403 individuals with (n = 76,065) and without (n = 5,448,338) first-degree relatives affected with RA, of which 47,942 individuals developed RA.

Disclosures: This study was supported by the Chungbuk National University Korea National University Development Project. The authors declared no conflicts of interest.

Source: Kim HJ et al. Familial risk of seropositive rheumatoid arthritis and interaction with smoking: a population-based cohort study. Rheumatology (Oxford). 2023 (Jan 24). Doi: 10.1093/rheumatology/kead048

Key clinical point: Smokers with a family history of rheumatoid arthritis (RA) may be considered a high-risk group who should be informed about increased smoking-associated RA risk and advised smoking cessation.

Major finding: Risk for RA was higher in individuals with vs without first-degree relatives affected with RA (adjusted hazard ratio [aHR] 4.49; 95% CI 3.96-5.10) and in current vs non-smokers (aHR 1.37; 95% CI 1.24-1.51), with the risk being markedly higher among smokers with a positive family history of RA (HR 6.44; 95% CI 4.61-9.00).

Study details: Findings are from a population-based cohort study that evaluated lifestyle factors and family relationships of 5,524,403 individuals with (n = 76,065) and without (n = 5,448,338) first-degree relatives affected with RA, of which 47,942 individuals developed RA.

Disclosures: This study was supported by the Chungbuk National University Korea National University Development Project. The authors declared no conflicts of interest.

Source: Kim HJ et al. Familial risk of seropositive rheumatoid arthritis and interaction with smoking: a population-based cohort study. Rheumatology (Oxford). 2023 (Jan 24). Doi: 10.1093/rheumatology/kead048

Key clinical point: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) remains rare; treatment strategies have diversified over years, but high demand for analgesics and opioids suggests unmet needs in pain management.

Major finding: Between 2007 and 2020, the prevalence and incidence of ILD among patients with RA were 1.6%-2.2% and 0.13%-0.21% per year, respectively, and biologic disease-modifying antirheumatic drug (DMARD) use increased from 16% to 24%, whereas glucocorticoid, conventional synthetic DMARD, and nonsteroidal anti-inflammatory drug use declined from 84% to 68%, 83% to 55%, and 62% to 38%, respectively. However, analgesic use increased and ≈30% of patients received opioids.

Study details: This study analyzed insurance claims data of 98,435 and 142,657 patients diagnosed with RA, 257 and 1484 with prevalent ILD, and 18 and 90 with incident ILD in 2007 and 2020, respectively.

Disclosures: This study was supported by the German Federal Ministry of Education and Research within the Targeted Risk Management in Musculoskeletal Diseases network (TARISMA). Two authors declared receiving speaker fees from various sources outside this study.

Source: Albrecht K et al. Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020. RMD Open. 2023;9:e002777 (Jan 20). Doi: 10.1136/rmdopen-2022-002777

Key clinical point: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) remains rare; treatment strategies have diversified over years, but high demand for analgesics and opioids suggests unmet needs in pain management.

Major finding: Between 2007 and 2020, the prevalence and incidence of ILD among patients with RA were 1.6%-2.2% and 0.13%-0.21% per year, respectively, and biologic disease-modifying antirheumatic drug (DMARD) use increased from 16% to 24%, whereas glucocorticoid, conventional synthetic DMARD, and nonsteroidal anti-inflammatory drug use declined from 84% to 68%, 83% to 55%, and 62% to 38%, respectively. However, analgesic use increased and ≈30% of patients received opioids.

Study details: This study analyzed insurance claims data of 98,435 and 142,657 patients diagnosed with RA, 257 and 1484 with prevalent ILD, and 18 and 90 with incident ILD in 2007 and 2020, respectively.

Disclosures: This study was supported by the German Federal Ministry of Education and Research within the Targeted Risk Management in Musculoskeletal Diseases network (TARISMA). Two authors declared receiving speaker fees from various sources outside this study.

Source: Albrecht K et al. Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020. RMD Open. 2023;9:e002777 (Jan 20). Doi: 10.1136/rmdopen-2022-002777

Key clinical point: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) remains rare; treatment strategies have diversified over years, but high demand for analgesics and opioids suggests unmet needs in pain management.

Major finding: Between 2007 and 2020, the prevalence and incidence of ILD among patients with RA were 1.6%-2.2% and 0.13%-0.21% per year, respectively, and biologic disease-modifying antirheumatic drug (DMARD) use increased from 16% to 24%, whereas glucocorticoid, conventional synthetic DMARD, and nonsteroidal anti-inflammatory drug use declined from 84% to 68%, 83% to 55%, and 62% to 38%, respectively. However, analgesic use increased and ≈30% of patients received opioids.

Study details: This study analyzed insurance claims data of 98,435 and 142,657 patients diagnosed with RA, 257 and 1484 with prevalent ILD, and 18 and 90 with incident ILD in 2007 and 2020, respectively.

Disclosures: This study was supported by the German Federal Ministry of Education and Research within the Targeted Risk Management in Musculoskeletal Diseases network (TARISMA). Two authors declared receiving speaker fees from various sources outside this study.

Source: Albrecht K et al. Interstitial lung disease in rheumatoid arthritis: incidence, prevalence and related drug prescriptions between 2007 and 2020. RMD Open. 2023;9:e002777 (Jan 20). Doi: 10.1136/rmdopen-2022-002777

Key clinical point: A strict approach toward treat-to-target (T2T) management did not reduce radiographic progression in a daily practice cohort of patients with active rheumatoid arthritis (RA) compared with a relatively lenient approach toward T2T.

Major finding: A T2T approach in a 3-month interval failed to reduce radiographic progression in the same 6-month period with 2 vs 0 visits (change in Sharp-van der Heijde score [Δ] 0.15 units; 95% CI −0.04 to 0.33) and 1 vs 0 visits (Δ 0.08 units; 95% CI −0.06 to 0.22) after T2T.

Study details: This longitudinal analysis of a 2-year prospective observational study cohort included 521 patients with active RA who started or changed conventional synthetic or biologic disease-modifying antirheumatic drugs and underwent treatment intensification according to the T2T approach.

Disclosures: The BIODAM study was supported by an unrestricted grant from AbbVie. Several authors reported receiving research grants, consulting fees, honoraria, or an unrestricted educational grant from various sources, including AbbVie.

Source: Ramiro S et al. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford). 2023 (Jan 16). Doi:10.1093/rheumatology/kead021

Key clinical point: A strict approach toward treat-to-target (T2T) management did not reduce radiographic progression in a daily practice cohort of patients with active rheumatoid arthritis (RA) compared with a relatively lenient approach toward T2T.

Major finding: A T2T approach in a 3-month interval failed to reduce radiographic progression in the same 6-month period with 2 vs 0 visits (change in Sharp-van der Heijde score [Δ] 0.15 units; 95% CI −0.04 to 0.33) and 1 vs 0 visits (Δ 0.08 units; 95% CI −0.06 to 0.22) after T2T.

Study details: This longitudinal analysis of a 2-year prospective observational study cohort included 521 patients with active RA who started or changed conventional synthetic or biologic disease-modifying antirheumatic drugs and underwent treatment intensification according to the T2T approach.

Disclosures: The BIODAM study was supported by an unrestricted grant from AbbVie. Several authors reported receiving research grants, consulting fees, honoraria, or an unrestricted educational grant from various sources, including AbbVie.

Source: Ramiro S et al. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford). 2023 (Jan 16). Doi:10.1093/rheumatology/kead021

Key clinical point: A strict approach toward treat-to-target (T2T) management did not reduce radiographic progression in a daily practice cohort of patients with active rheumatoid arthritis (RA) compared with a relatively lenient approach toward T2T.

Major finding: A T2T approach in a 3-month interval failed to reduce radiographic progression in the same 6-month period with 2 vs 0 visits (change in Sharp-van der Heijde score [Δ] 0.15 units; 95% CI −0.04 to 0.33) and 1 vs 0 visits (Δ 0.08 units; 95% CI −0.06 to 0.22) after T2T.

Study details: This longitudinal analysis of a 2-year prospective observational study cohort included 521 patients with active RA who started or changed conventional synthetic or biologic disease-modifying antirheumatic drugs and underwent treatment intensification according to the T2T approach.

Disclosures: The BIODAM study was supported by an unrestricted grant from AbbVie. Several authors reported receiving research grants, consulting fees, honoraria, or an unrestricted educational grant from various sources, including AbbVie.

Source: Ramiro S et al. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford). 2023 (Jan 16). Doi:10.1093/rheumatology/kead021

Key clinical point: Rheumatoid arthritis (RA) is associated with a high risk for end-stage renal disease, with the risk being prominent among relatively young and comorbidity-free individuals and those who consume alcohol.

Major finding: Patients with RA were at a significantly higher risk for end-stage renal disease compared with those without RA (adjusted hazard ratio 2.153; 95% CI 1.948-2.379), particularly among patients who were relatively young (P_interaction < .001), those without comorbidities (P_interaction < .001), and those who consumed alcohol (P_interaction  =  .021).

Study details: This retrospective population-based study included 154,997 patients with RA and 774,985 age- and sex-matched individuals without RA.

Disclosures: This study was supported by grants from the Chonnam National University Hospital Biomedical Research Institute and National Research Foundation of Korea, funded by the Korea Government. The authors declared no conflicts of interest.

Source: Suh SH et al. Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study. Front Med (Lausanne). 2023;10:1116489 (Feb 2). Doi: 10.3389/fmed.2023.1116489

Key clinical point: Rheumatoid arthritis (RA) is associated with a high risk for end-stage renal disease, with the risk being prominent among relatively young and comorbidity-free individuals and those who consume alcohol.

Major finding: Patients with RA were at a significantly higher risk for end-stage renal disease compared with those without RA (adjusted hazard ratio 2.153; 95% CI 1.948-2.379), particularly among patients who were relatively young (P_interaction < .001), those without comorbidities (P_interaction < .001), and those who consumed alcohol (P_interaction  =  .021).

Study details: This retrospective population-based study included 154,997 patients with RA and 774,985 age- and sex-matched individuals without RA.

Disclosures: This study was supported by grants from the Chonnam National University Hospital Biomedical Research Institute and National Research Foundation of Korea, funded by the Korea Government. The authors declared no conflicts of interest.

Source: Suh SH et al. Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study. Front Med (Lausanne). 2023;10:1116489 (Feb 2). Doi: 10.3389/fmed.2023.1116489

Key clinical point: Rheumatoid arthritis (RA) is associated with a high risk for end-stage renal disease, with the risk being prominent among relatively young and comorbidity-free individuals and those who consume alcohol.

Major finding: Patients with RA were at a significantly higher risk for end-stage renal disease compared with those without RA (adjusted hazard ratio 2.153; 95% CI 1.948-2.379), particularly among patients who were relatively young (P_interaction < .001), those without comorbidities (P_interaction < .001), and those who consumed alcohol (P_interaction  =  .021).

Study details: This retrospective population-based study included 154,997 patients with RA and 774,985 age- and sex-matched individuals without RA.

Disclosures: This study was supported by grants from the Chonnam National University Hospital Biomedical Research Institute and National Research Foundation of Korea, funded by the Korea Government. The authors declared no conflicts of interest.

Source: Suh SH et al. Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study. Front Med (Lausanne). 2023;10:1116489 (Feb 2). Doi: 10.3389/fmed.2023.1116489

Key clinical point: Pregnant women with vs without rheumatoid arthritis (RA) and their infants should be closely monitored prenatally and during the year after delivery as they are at a higher risk for rehospitalization within 2 years and more likely to require intensive prenatal or neonatal care.

Major finding: Women with vs without RA required more intensive prenatal care (adjusted relative risk [aRR] 1.46; 95% CI 1.33-1.60) and had a higher risk for postpartum non-pregnancy rehospitalization <2 years after delivery (aRR 1.33; 95% CI 1.13-1.56). Infants of women with vs without RA had a higher risk for neonatal intensive care unit admission (aRR 1.89; 95% CI 1.56-2.30) and rehospitalization <2 years after birth (aRR 1.22; 95% CI 1.01-1.46).

Study details: This population-based retrospective cohort study included pregnant women with (n = 1223) and without (n = 12,293) RA and those with (n = 1354) and without (n = 13,751) systemic lupus erythematosus.

Disclosures: This study was funded by Eunice Kennedy Shriver National Institute of Child Health & Human Development, US National Institutes of Health. The authors did not report conflicts of interest.

Source: Singh N et al. Birth outcomes and re-hospitalizations among pregnant women with rheumatoid arthritis and systemic lupus erythematosus and their offspring. Arthritis Care Res (Hoboken). 2023 (Jan 10). Doi: 10.1002/acr.25087

Key clinical point: Pregnant women with vs without rheumatoid arthritis (RA) and their infants should be closely monitored prenatally and during the year after delivery as they are at a higher risk for rehospitalization within 2 years and more likely to require intensive prenatal or neonatal care.

Major finding: Women with vs without RA required more intensive prenatal care (adjusted relative risk [aRR] 1.46; 95% CI 1.33-1.60) and had a higher risk for postpartum non-pregnancy rehospitalization <2 years after delivery (aRR 1.33; 95% CI 1.13-1.56). Infants of women with vs without RA had a higher risk for neonatal intensive care unit admission (aRR 1.89; 95% CI 1.56-2.30) and rehospitalization <2 years after birth (aRR 1.22; 95% CI 1.01-1.46).

Study details: This population-based retrospective cohort study included pregnant women with (n = 1223) and without (n = 12,293) RA and those with (n = 1354) and without (n = 13,751) systemic lupus erythematosus.

Disclosures: This study was funded by Eunice Kennedy Shriver National Institute of Child Health & Human Development, US National Institutes of Health. The authors did not report conflicts of interest.

Source: Singh N et al. Birth outcomes and re-hospitalizations among pregnant women with rheumatoid arthritis and systemic lupus erythematosus and their offspring. Arthritis Care Res (Hoboken). 2023 (Jan 10). Doi: 10.1002/acr.25087

Key clinical point: Pregnant women with vs without rheumatoid arthritis (RA) and their infants should be closely monitored prenatally and during the year after delivery as they are at a higher risk for rehospitalization within 2 years and more likely to require intensive prenatal or neonatal care.

Major finding: Women with vs without RA required more intensive prenatal care (adjusted relative risk [aRR] 1.46; 95% CI 1.33-1.60) and had a higher risk for postpartum non-pregnancy rehospitalization <2 years after delivery (aRR 1.33; 95% CI 1.13-1.56). Infants of women with vs without RA had a higher risk for neonatal intensive care unit admission (aRR 1.89; 95% CI 1.56-2.30) and rehospitalization <2 years after birth (aRR 1.22; 95% CI 1.01-1.46).

Study details: This population-based retrospective cohort study included pregnant women with (n = 1223) and without (n = 12,293) RA and those with (n = 1354) and without (n = 13,751) systemic lupus erythematosus.

Disclosures: This study was funded by Eunice Kennedy Shriver National Institute of Child Health & Human Development, US National Institutes of Health. The authors did not report conflicts of interest.

Source: Singh N et al. Birth outcomes and re-hospitalizations among pregnant women with rheumatoid arthritis and systemic lupus erythematosus and their offspring. Arthritis Care Res (Hoboken). 2023 (Jan 10). Doi: 10.1002/acr.25087

Key clinical point: Patients with early rheumatoid arthritis (ERA) receiving treat-to-target management did not have an excess 5-year risk for cardiovascular events (CVE) compared with risk factor-matched non-RA control individuals.

Major finding: Over 5 years, the risk for incident CVE was comparable among patients with ERA and matched non-RA control individuals (hazard ratio [HR] 0.53; P  =  .3), but significantly higher among patients with historical RA (HRA) receiving routine care vs matched non-RA control individuals (HR 1.95; P  =  .009).

Study details: The data come from an observational case-control study including patients with ERA (n = 261) receiving treat-to-target management and patients with HRA (n = 268) receiving routine care, each of whom were cardiovascular risk factor-matched to 3 non-RA control individuals.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lam TO et al. Five-year cardiovascular event risk in early rheumatoid arthritis patients who received treat-to-target management: A case-control study. Rheumatology (Oxford). 2023 (Jan 27). Doi: 10.1093/rheumatology/kead039

Key clinical point: Patients with early rheumatoid arthritis (ERA) receiving treat-to-target management did not have an excess 5-year risk for cardiovascular events (CVE) compared with risk factor-matched non-RA control individuals.

Major finding: Over 5 years, the risk for incident CVE was comparable among patients with ERA and matched non-RA control individuals (hazard ratio [HR] 0.53; P  =  .3), but significantly higher among patients with historical RA (HRA) receiving routine care vs matched non-RA control individuals (HR 1.95; P  =  .009).

Study details: The data come from an observational case-control study including patients with ERA (n = 261) receiving treat-to-target management and patients with HRA (n = 268) receiving routine care, each of whom were cardiovascular risk factor-matched to 3 non-RA control individuals.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lam TO et al. Five-year cardiovascular event risk in early rheumatoid arthritis patients who received treat-to-target management: A case-control study. Rheumatology (Oxford). 2023 (Jan 27). Doi: 10.1093/rheumatology/kead039

Key clinical point: Patients with early rheumatoid arthritis (ERA) receiving treat-to-target management did not have an excess 5-year risk for cardiovascular events (CVE) compared with risk factor-matched non-RA control individuals.

Major finding: Over 5 years, the risk for incident CVE was comparable among patients with ERA and matched non-RA control individuals (hazard ratio [HR] 0.53; P  =  .3), but significantly higher among patients with historical RA (HRA) receiving routine care vs matched non-RA control individuals (HR 1.95; P  =  .009).

Study details: The data come from an observational case-control study including patients with ERA (n = 261) receiving treat-to-target management and patients with HRA (n = 268) receiving routine care, each of whom were cardiovascular risk factor-matched to 3 non-RA control individuals.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lam TO et al. Five-year cardiovascular event risk in early rheumatoid arthritis patients who received treat-to-target management: A case-control study. Rheumatology (Oxford). 2023 (Jan 27). Doi: 10.1093/rheumatology/kead039

Key clinical point: The risk for bacterial infections significantly increased with concomitant use of methotrexate and glucocorticoids in patients with rheumatoid arthritis (RA) who were receiving biologic disease-modifying antirheumatic drugs (bDMARD), especially when the doses of concomitant methotrexate and glucocorticoids were ≥8 mg/week and ≥5 mg/day, respectively.

Major finding: Overall, the incidence of bacterial infections was 16.8%, with the highest incidence (25.5%) observed in patients receiving combination therapy with methotrexate (≥8 mg/week) and glucocorticoids (≥5 mg/day). Co-prescription of ≥5 mg/day glucocorticoids with an increasing methotrexate dose (P  =  .013) and ≥8 mg/week methotrexate with an increasing glucocorticoid dose (P  =  .009) significantly increased the risk for bacterial infections.

Study details: This retrospective cohort study included 2837 patients with RA who initiated bDMARD with concomitant conventional synthetic DMARD, methotrexate, or oral glucocorticoids.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Ota R et al. Risk of infection from glucocorticoid and methotrexate interaction in patients with rheumatoid arthritis using biologics: A retrospective cohort study. Br J Clin Pharmacol. 2023 (Feb 8). Doi: 10.1111/bcp.15687

Key clinical point: The risk for bacterial infections significantly increased with concomitant use of methotrexate and glucocorticoids in patients with rheumatoid arthritis (RA) who were receiving biologic disease-modifying antirheumatic drugs (bDMARD), especially when the doses of concomitant methotrexate and glucocorticoids were ≥8 mg/week and ≥5 mg/day, respectively.

Major finding: Overall, the incidence of bacterial infections was 16.8%, with the highest incidence (25.5%) observed in patients receiving combination therapy with methotrexate (≥8 mg/week) and glucocorticoids (≥5 mg/day). Co-prescription of ≥5 mg/day glucocorticoids with an increasing methotrexate dose (P  =  .013) and ≥8 mg/week methotrexate with an increasing glucocorticoid dose (P  =  .009) significantly increased the risk for bacterial infections.

Study details: This retrospective cohort study included 2837 patients with RA who initiated bDMARD with concomitant conventional synthetic DMARD, methotrexate, or oral glucocorticoids.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Ota R et al. Risk of infection from glucocorticoid and methotrexate interaction in patients with rheumatoid arthritis using biologics: A retrospective cohort study. Br J Clin Pharmacol. 2023 (Feb 8). Doi: 10.1111/bcp.15687

Key clinical point: The risk for bacterial infections significantly increased with concomitant use of methotrexate and glucocorticoids in patients with rheumatoid arthritis (RA) who were receiving biologic disease-modifying antirheumatic drugs (bDMARD), especially when the doses of concomitant methotrexate and glucocorticoids were ≥8 mg/week and ≥5 mg/day, respectively.

Major finding: Overall, the incidence of bacterial infections was 16.8%, with the highest incidence (25.5%) observed in patients receiving combination therapy with methotrexate (≥8 mg/week) and glucocorticoids (≥5 mg/day). Co-prescription of ≥5 mg/day glucocorticoids with an increasing methotrexate dose (P  =  .013) and ≥8 mg/week methotrexate with an increasing glucocorticoid dose (P  =  .009) significantly increased the risk for bacterial infections.

Study details: This retrospective cohort study included 2837 patients with RA who initiated bDMARD with concomitant conventional synthetic DMARD, methotrexate, or oral glucocorticoids.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Ota R et al. Risk of infection from glucocorticoid and methotrexate interaction in patients with rheumatoid arthritis using biologics: A retrospective cohort study. Br J Clin Pharmacol. 2023 (Feb 8). Doi: 10.1111/bcp.15687