MDedge Rheumatology

Key clinical point: Tumor necrosis factor inhibitors (TNFi) increased the risk for septic arthritis in patients with seropositive rheumatoid arthritis (RA), with higher incidences within 1 year of initiating TNFi.

Major finding: Patients with seropositive RA treated with infliximab (adjusted hazard ratio [aHR] 2.37), etanercept (aHR 1.82), or adalimumab/golimumab (aHR 1.82; all P < .01) were prone to develop septic arthritis, with the incidence being higher within 1 year of initiating TNFi (incidence rate/1000 person-year 25.51).

Study details: This retrospective study included 145,129 patients with new-onset seropositive RA or ankylosing spondylitis, of which 1170 patients developed septic arthritis.

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

Source: Kim HW et al. Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF-inhibitor therapy. Rheumatology (Oxford). 2022 (Dec 23). Doi: 10.1093/rheumatology/keac721

Key clinical point: Tumor necrosis factor inhibitors (TNFi) increased the risk for septic arthritis in patients with seropositive rheumatoid arthritis (RA), with higher incidences within 1 year of initiating TNFi.

Major finding: Patients with seropositive RA treated with infliximab (adjusted hazard ratio [aHR] 2.37), etanercept (aHR 1.82), or adalimumab/golimumab (aHR 1.82; all P < .01) were prone to develop septic arthritis, with the incidence being higher within 1 year of initiating TNFi (incidence rate/1000 person-year 25.51).

Study details: This retrospective study included 145,129 patients with new-onset seropositive RA or ankylosing spondylitis, of which 1170 patients developed septic arthritis.

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

Source: Kim HW et al. Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF-inhibitor therapy. Rheumatology (Oxford). 2022 (Dec 23). Doi: 10.1093/rheumatology/keac721

Key clinical point: Tumor necrosis factor inhibitors (TNFi) increased the risk for septic arthritis in patients with seropositive rheumatoid arthritis (RA), with higher incidences within 1 year of initiating TNFi.

Major finding: Patients with seropositive RA treated with infliximab (adjusted hazard ratio [aHR] 2.37), etanercept (aHR 1.82), or adalimumab/golimumab (aHR 1.82; all P < .01) were prone to develop septic arthritis, with the incidence being higher within 1 year of initiating TNFi (incidence rate/1000 person-year 25.51).

Study details: This retrospective study included 145,129 patients with new-onset seropositive RA or ankylosing spondylitis, of which 1170 patients developed septic arthritis.

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

Source: Kim HW et al. Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF-inhibitor therapy. Rheumatology (Oxford). 2022 (Dec 23). Doi: 10.1093/rheumatology/keac721

Key clinical point: Cumulative local joint inflammation over time was significantly associated with radiographic joint damage progression in the same joint in patients with early rheumatoid arthritis (RA) who were treated to a target disease activity score (DAS) of ≤2.4 for 10 years.

Major finding: Cumulative joint swelling was positively associated with local joint damage progression in the same joint (β 0.14; 95% CI 0.13-0.15). Each additional visit for joint swelling increased the joint damage score by a 0.13 unit and frequency of joint swelling in same vs other joints better predicted local joint damage progression (P < .001).

Study details: This post hoc analysis of the BeSt study included 473 patients with early RA who were randomly assigned to receive sequential monotherapy, step-up combination therapy, or initial combination therapy with methotrexate with or without sulfasalazine+prednisone or infliximab, with treatment intensification every 3 months until DAS ≤2.4 was achieved.

Disclosures: The BeSt study received funding from the Dutch College of Health Insurances and others. No competing interests were declared.

Source: Heckert SL et al. Frequency of joint inflammation is associated with local joint damage progression in rheumatoid arthritis despite long-term targeted treatment. RMD Open. 2023;9(1):e002552 (Jan 6). Doi: 10.1136/rmdopen-2022-002552

Key clinical point: Cumulative local joint inflammation over time was significantly associated with radiographic joint damage progression in the same joint in patients with early rheumatoid arthritis (RA) who were treated to a target disease activity score (DAS) of ≤2.4 for 10 years.

Major finding: Cumulative joint swelling was positively associated with local joint damage progression in the same joint (β 0.14; 95% CI 0.13-0.15). Each additional visit for joint swelling increased the joint damage score by a 0.13 unit and frequency of joint swelling in same vs other joints better predicted local joint damage progression (P < .001).

Study details: This post hoc analysis of the BeSt study included 473 patients with early RA who were randomly assigned to receive sequential monotherapy, step-up combination therapy, or initial combination therapy with methotrexate with or without sulfasalazine+prednisone or infliximab, with treatment intensification every 3 months until DAS ≤2.4 was achieved.

Disclosures: The BeSt study received funding from the Dutch College of Health Insurances and others. No competing interests were declared.

Source: Heckert SL et al. Frequency of joint inflammation is associated with local joint damage progression in rheumatoid arthritis despite long-term targeted treatment. RMD Open. 2023;9(1):e002552 (Jan 6). Doi: 10.1136/rmdopen-2022-002552

Key clinical point: Cumulative local joint inflammation over time was significantly associated with radiographic joint damage progression in the same joint in patients with early rheumatoid arthritis (RA) who were treated to a target disease activity score (DAS) of ≤2.4 for 10 years.

Major finding: Cumulative joint swelling was positively associated with local joint damage progression in the same joint (β 0.14; 95% CI 0.13-0.15). Each additional visit for joint swelling increased the joint damage score by a 0.13 unit and frequency of joint swelling in same vs other joints better predicted local joint damage progression (P < .001).

Study details: This post hoc analysis of the BeSt study included 473 patients with early RA who were randomly assigned to receive sequential monotherapy, step-up combination therapy, or initial combination therapy with methotrexate with or without sulfasalazine+prednisone or infliximab, with treatment intensification every 3 months until DAS ≤2.4 was achieved.

Disclosures: The BeSt study received funding from the Dutch College of Health Insurances and others. No competing interests were declared.

Source: Heckert SL et al. Frequency of joint inflammation is associated with local joint damage progression in rheumatoid arthritis despite long-term targeted treatment. RMD Open. 2023;9(1):e002552 (Jan 6). Doi: 10.1136/rmdopen-2022-002552

Key clinical point: “Plants for Joints” (PFJ), a 16-week multidisciplinary lifestyle program based on whole food plant-based diet, physical activity, and stress management in addition to usual care, significantly improved disease activity compared with usual care alone in patients with rheumatoid arthritis (RA) and low-to-moderate disease activity.

Major finding: After 16 weeks, patients receiving PFJ vs usual care alone had a greater reduction in disease activity score of 28 joints (DAS28; mean difference −0.90; P < .0001) and were more likely to achieve DAS28 <2.60 (odds ratio [OR] 4.6) and European Alliance of Associations for Rheumatology Good Response (OR 4.3; both P < .001). No serious adverse events were reported.

Study details: This randomized controlled trial, “Plants for Joints,” included 77 patients with RA and low-to-moderate disease activity who were randomly assigned to receive PFJ intervention plus usual care or usual care alone.

Disclosures: The trial was funded by Reade (The Netherlands) and other sources. The authors declared no conflicts of interest.

Source: Walrabenstein W et al. A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology (Oxford). 2023 (Jan 6). Doi: 10.1093/rheumatology/keac693

Key clinical point: “Plants for Joints” (PFJ), a 16-week multidisciplinary lifestyle program based on whole food plant-based diet, physical activity, and stress management in addition to usual care, significantly improved disease activity compared with usual care alone in patients with rheumatoid arthritis (RA) and low-to-moderate disease activity.

Major finding: After 16 weeks, patients receiving PFJ vs usual care alone had a greater reduction in disease activity score of 28 joints (DAS28; mean difference −0.90; P < .0001) and were more likely to achieve DAS28 <2.60 (odds ratio [OR] 4.6) and European Alliance of Associations for Rheumatology Good Response (OR 4.3; both P < .001). No serious adverse events were reported.

Study details: This randomized controlled trial, “Plants for Joints,” included 77 patients with RA and low-to-moderate disease activity who were randomly assigned to receive PFJ intervention plus usual care or usual care alone.

Disclosures: The trial was funded by Reade (The Netherlands) and other sources. The authors declared no conflicts of interest.

Source: Walrabenstein W et al. A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology (Oxford). 2023 (Jan 6). Doi: 10.1093/rheumatology/keac693

Key clinical point: “Plants for Joints” (PFJ), a 16-week multidisciplinary lifestyle program based on whole food plant-based diet, physical activity, and stress management in addition to usual care, significantly improved disease activity compared with usual care alone in patients with rheumatoid arthritis (RA) and low-to-moderate disease activity.

Major finding: After 16 weeks, patients receiving PFJ vs usual care alone had a greater reduction in disease activity score of 28 joints (DAS28; mean difference −0.90; P < .0001) and were more likely to achieve DAS28 <2.60 (odds ratio [OR] 4.6) and European Alliance of Associations for Rheumatology Good Response (OR 4.3; both P < .001). No serious adverse events were reported.

Study details: This randomized controlled trial, “Plants for Joints,” included 77 patients with RA and low-to-moderate disease activity who were randomly assigned to receive PFJ intervention plus usual care or usual care alone.

Disclosures: The trial was funded by Reade (The Netherlands) and other sources. The authors declared no conflicts of interest.

Source: Walrabenstein W et al. A multidisciplinary lifestyle program for rheumatoid arthritis: The “Plants for Joints” randomized controlled trial. Rheumatology (Oxford). 2023 (Jan 6). Doi: 10.1093/rheumatology/keac693

Key clinical point: Tapering glucocorticoids to doses >2.5 mg/day was effective with no increase in the risk for flare, whereas tapering to doses ≤2.5 mg/day significantly increased the risk for flare in patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: Discontinuation of glucocorticoids (adjusted odds ratio [aOR] 1.45; 95% CI 1.13-2.24) and tapering of glucocorticoid dose to 0-2.5 mg/day (aOR 1.37; 95% CI 1.06-2.01) were significantly associated with an increased risk for flare, whereas tapering of glucocorticoid dose to >2.5 mg/day did not significantly increase the risk for flare compared with no tapering.

Study details: The data come from a case-crossover study including 508 patients with RA receiving bDMARD with or without glucocorticoids, of which 52.5% of patients reported at least one flare.

Disclosures: This study did not declare any specific funding. No conflicts of interest were declared.

Source: Adami G et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. 2023;9(1):e002792 (Jan 4). Doi: 10.1136/rmdopen-2022-002792

Key clinical point: Tapering glucocorticoids to doses >2.5 mg/day was effective with no increase in the risk for flare, whereas tapering to doses ≤2.5 mg/day significantly increased the risk for flare in patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: Discontinuation of glucocorticoids (adjusted odds ratio [aOR] 1.45; 95% CI 1.13-2.24) and tapering of glucocorticoid dose to 0-2.5 mg/day (aOR 1.37; 95% CI 1.06-2.01) were significantly associated with an increased risk for flare, whereas tapering of glucocorticoid dose to >2.5 mg/day did not significantly increase the risk for flare compared with no tapering.

Study details: The data come from a case-crossover study including 508 patients with RA receiving bDMARD with or without glucocorticoids, of which 52.5% of patients reported at least one flare.

Disclosures: This study did not declare any specific funding. No conflicts of interest were declared.

Source: Adami G et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. 2023;9(1):e002792 (Jan 4). Doi: 10.1136/rmdopen-2022-002792

Key clinical point: Tapering glucocorticoids to doses >2.5 mg/day was effective with no increase in the risk for flare, whereas tapering to doses ≤2.5 mg/day significantly increased the risk for flare in patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: Discontinuation of glucocorticoids (adjusted odds ratio [aOR] 1.45; 95% CI 1.13-2.24) and tapering of glucocorticoid dose to 0-2.5 mg/day (aOR 1.37; 95% CI 1.06-2.01) were significantly associated with an increased risk for flare, whereas tapering of glucocorticoid dose to >2.5 mg/day did not significantly increase the risk for flare compared with no tapering.

Study details: The data come from a case-crossover study including 508 patients with RA receiving bDMARD with or without glucocorticoids, of which 52.5% of patients reported at least one flare.

Disclosures: This study did not declare any specific funding. No conflicts of interest were declared.

Source: Adami G et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. 2023;9(1):e002792 (Jan 4). Doi: 10.1136/rmdopen-2022-002792

Key clinical point: Patients with rheumatoid arthritis (RA) who were males or had multiple comorbidities were less likely to achieve quality care markers, thereby highlighting the need to prioritize early treatment in the vulnerable patient population.

Major finding: Among patients with RA, males (odds ratio [OR] 0.72; 95% CI 0.72-0.73) and those with a Rheumatic Disease Comorbidity Index >2 (OR 0.88; 95% CI 0.86-0.90) were less likely to receive a rheumatologist referral, with findings being similar for annual physical examination. Additionally, the presence of diabetes was associated with reduced odds of receiving a rheumatologist referral (OR 0.77; 95% CI 0.76-0.78) or annual physical examination (OR 0.59; 95% CI 0.56-0.62).

Study details: This retrospective observational cohort study included 581,770 patients with incident RA.

Disclosures: This study was funded by joint grants from Chang Gung Memorial Hospital-University of Michigan Medical Center to two authors. KC Chung reported receiving funding, research grant, and book royalties from various sources.

Source: Seyferth AV et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. 2022;5(12):e2246299 (Dec 12). Doi: 10.1001/jamanetworkopen.2022.46299.

Key clinical point: Patients with rheumatoid arthritis (RA) who were males or had multiple comorbidities were less likely to achieve quality care markers, thereby highlighting the need to prioritize early treatment in the vulnerable patient population.

Major finding: Among patients with RA, males (odds ratio [OR] 0.72; 95% CI 0.72-0.73) and those with a Rheumatic Disease Comorbidity Index >2 (OR 0.88; 95% CI 0.86-0.90) were less likely to receive a rheumatologist referral, with findings being similar for annual physical examination. Additionally, the presence of diabetes was associated with reduced odds of receiving a rheumatologist referral (OR 0.77; 95% CI 0.76-0.78) or annual physical examination (OR 0.59; 95% CI 0.56-0.62).

Study details: This retrospective observational cohort study included 581,770 patients with incident RA.

Disclosures: This study was funded by joint grants from Chang Gung Memorial Hospital-University of Michigan Medical Center to two authors. KC Chung reported receiving funding, research grant, and book royalties from various sources.

Source: Seyferth AV et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. 2022;5(12):e2246299 (Dec 12). Doi: 10.1001/jamanetworkopen.2022.46299.

Key clinical point: Patients with rheumatoid arthritis (RA) who were males or had multiple comorbidities were less likely to achieve quality care markers, thereby highlighting the need to prioritize early treatment in the vulnerable patient population.

Major finding: Among patients with RA, males (odds ratio [OR] 0.72; 95% CI 0.72-0.73) and those with a Rheumatic Disease Comorbidity Index >2 (OR 0.88; 95% CI 0.86-0.90) were less likely to receive a rheumatologist referral, with findings being similar for annual physical examination. Additionally, the presence of diabetes was associated with reduced odds of receiving a rheumatologist referral (OR 0.77; 95% CI 0.76-0.78) or annual physical examination (OR 0.59; 95% CI 0.56-0.62).

Study details: This retrospective observational cohort study included 581,770 patients with incident RA.

Disclosures: This study was funded by joint grants from Chang Gung Memorial Hospital-University of Michigan Medical Center to two authors. KC Chung reported receiving funding, research grant, and book royalties from various sources.

Source: Seyferth AV et al. Factors associated with quality care among adults with rheumatoid arthritis. JAMA Netw Open. 2022;5(12):e2246299 (Dec 12). Doi: 10.1001/jamanetworkopen.2022.46299.

Key clinical point: Current use of oral glucocorticoids significantly increased the risk for Staphylococcus aureus bacteremia (SAB) in a dose-dependent manner in patients with rheumatoid arthritis (RA), but the absolute risk was low with biological disease-modifying antirheumatic drug (bDMARD) use.

Major finding: Relative risk for SAB was 2.2-fold (adjusted odds ratio [aOR] 2.2; 95% CI 1.3-4.0) and 9.5-fold (aOR 9.5; 95% CI 3.9-22.7) higher with current use of ≤7.5 and >7.5 mg/day prednisolone-equivalent oral glucocorticoids, respectively. The number needed to harm was approximately 10 times higher with the current use of bDMARD vs >7.5 mg/day oral glucocorticoids (1172 vs 110).

Study details: This nested case-control study included 180 patients with first-time SAB who received glucocorticoids or bDMARD and 720 age- and sex-matched control individuals from a cohort of 30,479 patients with RA.

Disclosures: This study was supported by The Danish Rheumatism Association (TDRA) and Beckett-Fonden. Several authors reported ties with various sources, including TDRA and Beckett-Fonden.

Source: Dieperink SS et al. Antirheumatic treatment, disease activity and risk of Staphylococcus aureus bacteraemia in rheumatoid arthritis: A nationwide nested case-control study. RMD Open. 2022;8(2):e002636 (Dec 14). Doi: 10.1136/rmdopen-2022-002636

Key clinical point: Current use of oral glucocorticoids significantly increased the risk for Staphylococcus aureus bacteremia (SAB) in a dose-dependent manner in patients with rheumatoid arthritis (RA), but the absolute risk was low with biological disease-modifying antirheumatic drug (bDMARD) use.

Major finding: Relative risk for SAB was 2.2-fold (adjusted odds ratio [aOR] 2.2; 95% CI 1.3-4.0) and 9.5-fold (aOR 9.5; 95% CI 3.9-22.7) higher with current use of ≤7.5 and >7.5 mg/day prednisolone-equivalent oral glucocorticoids, respectively. The number needed to harm was approximately 10 times higher with the current use of bDMARD vs >7.5 mg/day oral glucocorticoids (1172 vs 110).

Study details: This nested case-control study included 180 patients with first-time SAB who received glucocorticoids or bDMARD and 720 age- and sex-matched control individuals from a cohort of 30,479 patients with RA.

Disclosures: This study was supported by The Danish Rheumatism Association (TDRA) and Beckett-Fonden. Several authors reported ties with various sources, including TDRA and Beckett-Fonden.

Source: Dieperink SS et al. Antirheumatic treatment, disease activity and risk of Staphylococcus aureus bacteraemia in rheumatoid arthritis: A nationwide nested case-control study. RMD Open. 2022;8(2):e002636 (Dec 14). Doi: 10.1136/rmdopen-2022-002636

Key clinical point: Current use of oral glucocorticoids significantly increased the risk for Staphylococcus aureus bacteremia (SAB) in a dose-dependent manner in patients with rheumatoid arthritis (RA), but the absolute risk was low with biological disease-modifying antirheumatic drug (bDMARD) use.

Major finding: Relative risk for SAB was 2.2-fold (adjusted odds ratio [aOR] 2.2; 95% CI 1.3-4.0) and 9.5-fold (aOR 9.5; 95% CI 3.9-22.7) higher with current use of ≤7.5 and >7.5 mg/day prednisolone-equivalent oral glucocorticoids, respectively. The number needed to harm was approximately 10 times higher with the current use of bDMARD vs >7.5 mg/day oral glucocorticoids (1172 vs 110).

Study details: This nested case-control study included 180 patients with first-time SAB who received glucocorticoids or bDMARD and 720 age- and sex-matched control individuals from a cohort of 30,479 patients with RA.

Disclosures: This study was supported by The Danish Rheumatism Association (TDRA) and Beckett-Fonden. Several authors reported ties with various sources, including TDRA and Beckett-Fonden.

Source: Dieperink SS et al. Antirheumatic treatment, disease activity and risk of Staphylococcus aureus bacteraemia in rheumatoid arthritis: A nationwide nested case-control study. RMD Open. 2022;8(2):e002636 (Dec 14). Doi: 10.1136/rmdopen-2022-002636

Key clinical point: The probability of continued use of glucocorticoids after bridging was low among patients with rheumatoid arthritis (RA), with a shorter oral bridging schedule and lower initial dose being associated with fewer patients taking glucocorticoids at 18 months after bridging.

Major finding: The probability of using or restarting glucocorticoids decreased from 0.18 at 1 month to 0.07 at 6, 12, and 18 months of ending glucocorticoid bridging therapy. A longer duration of bridging schedule (odds ratio [OR] 1.14; 95% CI 1.05-1.24) and higher initial glucocorticoid dose (OR 1.04; 95% CI 1.01-1.06) were associated with more patients taking glucocorticoids at 18 months after bridging.

Study details: This individual patient data meta-analysis of seven clinical trials included 1653 patients with newly diagnosed RA, undifferentiated arthritis, or a high-risk profile for persistent arthritis who received glucocorticoids bridging therapy as initial treatment.

Disclosures: This study did not receive any specific funding. Several authors reported ties with various sources.

Source: van Ouwerkerk L et al. Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis. Ann Rheum Dis. 2022 (Dec 16). Doi: 10.1136/ard-2022-223443

Key clinical point: The probability of continued use of glucocorticoids after bridging was low among patients with rheumatoid arthritis (RA), with a shorter oral bridging schedule and lower initial dose being associated with fewer patients taking glucocorticoids at 18 months after bridging.

Major finding: The probability of using or restarting glucocorticoids decreased from 0.18 at 1 month to 0.07 at 6, 12, and 18 months of ending glucocorticoid bridging therapy. A longer duration of bridging schedule (odds ratio [OR] 1.14; 95% CI 1.05-1.24) and higher initial glucocorticoid dose (OR 1.04; 95% CI 1.01-1.06) were associated with more patients taking glucocorticoids at 18 months after bridging.

Study details: This individual patient data meta-analysis of seven clinical trials included 1653 patients with newly diagnosed RA, undifferentiated arthritis, or a high-risk profile for persistent arthritis who received glucocorticoids bridging therapy as initial treatment.

Disclosures: This study did not receive any specific funding. Several authors reported ties with various sources.

Source: van Ouwerkerk L et al. Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis. Ann Rheum Dis. 2022 (Dec 16). Doi: 10.1136/ard-2022-223443

Key clinical point: The probability of continued use of glucocorticoids after bridging was low among patients with rheumatoid arthritis (RA), with a shorter oral bridging schedule and lower initial dose being associated with fewer patients taking glucocorticoids at 18 months after bridging.

Major finding: The probability of using or restarting glucocorticoids decreased from 0.18 at 1 month to 0.07 at 6, 12, and 18 months of ending glucocorticoid bridging therapy. A longer duration of bridging schedule (odds ratio [OR] 1.14; 95% CI 1.05-1.24) and higher initial glucocorticoid dose (OR 1.04; 95% CI 1.01-1.06) were associated with more patients taking glucocorticoids at 18 months after bridging.

Study details: This individual patient data meta-analysis of seven clinical trials included 1653 patients with newly diagnosed RA, undifferentiated arthritis, or a high-risk profile for persistent arthritis who received glucocorticoids bridging therapy as initial treatment.

Disclosures: This study did not receive any specific funding. Several authors reported ties with various sources.

Source: van Ouwerkerk L et al. Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis. Ann Rheum Dis. 2022 (Dec 16). Doi: 10.1136/ard-2022-223443

Key clinical point: Methotrexate use before conception increased the risk for pregnancy losses and abortion in childbearing-age women with rheumatoid arthritis (RA), with the risk for elective termination of pregnancy (ETOP) being significantly higher with methotrexate use in the period close to conception.

Major finding: Methotrexate use any time before conception was significantly associated with a higher risk for pregnancy losses (adjusted odds ratio [aOR] 2.22; P < .001) and abortion (aOR 1.76; P < .01) in women with vs without RA, with the risk for ETOP being almost 4-fold higher with methotrexate use in the 3-month window before conception (aOR 4.77; P < .05).

Study details: Findings are from a retrospective cohort study including childbearing-age women with RA who did (n = 223) and did not (n = 323) receive methotrexate and those without RA who did not receive methotrexate (n = 1690).

Disclosures: This study was supported by the Italian Society for Rheumatology. This authors did not declare any conflicts of interest.

Source: Zanetti A et al. Impact of rheumatoid arthritis and methotrexate on pregnancy outcomes: Retrospective cohort study of the Italian Society for Rheumatology. RMD Open. 2022;8(2):e002412 (Dec 12). Doi: 10.1136/rmdopen-2022-002412

Key clinical point: Methotrexate use before conception increased the risk for pregnancy losses and abortion in childbearing-age women with rheumatoid arthritis (RA), with the risk for elective termination of pregnancy (ETOP) being significantly higher with methotrexate use in the period close to conception.

Major finding: Methotrexate use any time before conception was significantly associated with a higher risk for pregnancy losses (adjusted odds ratio [aOR] 2.22; P < .001) and abortion (aOR 1.76; P < .01) in women with vs without RA, with the risk for ETOP being almost 4-fold higher with methotrexate use in the 3-month window before conception (aOR 4.77; P < .05).

Study details: Findings are from a retrospective cohort study including childbearing-age women with RA who did (n = 223) and did not (n = 323) receive methotrexate and those without RA who did not receive methotrexate (n = 1690).

Disclosures: This study was supported by the Italian Society for Rheumatology. This authors did not declare any conflicts of interest.

Source: Zanetti A et al. Impact of rheumatoid arthritis and methotrexate on pregnancy outcomes: Retrospective cohort study of the Italian Society for Rheumatology. RMD Open. 2022;8(2):e002412 (Dec 12). Doi: 10.1136/rmdopen-2022-002412

Key clinical point: Methotrexate use before conception increased the risk for pregnancy losses and abortion in childbearing-age women with rheumatoid arthritis (RA), with the risk for elective termination of pregnancy (ETOP) being significantly higher with methotrexate use in the period close to conception.

Major finding: Methotrexate use any time before conception was significantly associated with a higher risk for pregnancy losses (adjusted odds ratio [aOR] 2.22; P < .001) and abortion (aOR 1.76; P < .01) in women with vs without RA, with the risk for ETOP being almost 4-fold higher with methotrexate use in the 3-month window before conception (aOR 4.77; P < .05).

Study details: Findings are from a retrospective cohort study including childbearing-age women with RA who did (n = 223) and did not (n = 323) receive methotrexate and those without RA who did not receive methotrexate (n = 1690).

Disclosures: This study was supported by the Italian Society for Rheumatology. This authors did not declare any conflicts of interest.

Source: Zanetti A et al. Impact of rheumatoid arthritis and methotrexate on pregnancy outcomes: Retrospective cohort study of the Italian Society for Rheumatology. RMD Open. 2022;8(2):e002412 (Dec 12). Doi: 10.1136/rmdopen-2022-002412

A recently discovered inflammatory disease known as VEXAS syndrome is more common, variable, and dangerous than previously understood, according to results of a retrospective observational study of a large health care system database. The findings, published in JAMA, found that it struck 1 in 4,269 men over the age of 50 in a largely White population and caused a wide variety of symptoms.

“The disease is quite severe,” study lead author David Beck, MD, PhD, of the department of medicine at NYU Langone Health, said in an interview. Patients with the condition “have a variety of clinical symptoms affecting different parts of the body and are being managed by different medical specialties.”

Dr. Beck and colleagues first described VEXAS (vacuoles, E1-ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic) syndrome in 2020. They linked it to mutations in the UBA1 (ubiquitin-like modifier activating enzyme 1) gene. The enzyme initiates a process that identifies misfolded proteins as targets for degradation.

“VEXAS syndrome is characterized by anemia and inflammation in the skin, lungs, cartilage, and joints,” Dr. Beck said. “These symptoms are frequently mistaken for other rheumatic or hematologic diseases. However, this syndrome has a different cause, is treated differently, requires additional monitoring, and can be far more severe.”

According to him, hundreds of people have been diagnosed with the disease in the short time since it was defined. The disease is believed to be fatal in some cases. A previous report found that the median survival was 9 years among patients with a certain variant; that was significantly less than patients with two other variants.

For the new study, researchers searched for UBA1 variants in genetic data from 163,096 subjects (mean age, 52.8 years; 94% White, 61% women) who took part in the Geisinger MyCode Community Health Initiative. The 1996-2022 data comes from patients at 10 Pennsylvania hospitals.

Eleven people (9 males, 2 females) had likely UBA1 variants, and all had anemia. The cases accounted for 1 in 13,591 unrelated people (95% confidence interval, 1:7,775-1:23,758), 1 in 4,269 men older than 50 years (95% CI, 1:2,319-1:7,859), and 1 in 26,238 women older than 50 years (95% CI, 1:7,196-1:147,669).

Other common findings included macrocytosis (91%), skin problems (73%), and pulmonary disease (91%). Ten patients (91%) required transfusions.

Five of the 11 subjects didn’t meet the previously defined criteria for VEXAS syndrome. None had been diagnosed with the condition, which is not surprising considering that it hadn’t been discovered and described until recently.

Just over half of the patients – 55% – had a clinical diagnosis that was previously linked to VEXAS syndrome. “This means that slightly less than half of the patients with VEXAS syndrome had no clear associated clinical diagnosis,” Dr. Beck said. “The lack of associated clinical diagnoses may be due to the variety of nonspecific clinical characteristics that span different subspecialities in VEXAS syndrome. VEXAS syndrome represents an example of a multisystem disease where patients and their symptoms may get lost in the shuffle.”

In the future, “professionals should look out for patients with unexplained inflammation – and some combination of hematologic, rheumatologic, pulmonary, and dermatologic clinical manifestations – that either don’t carry a clinical diagnosis or don’t respond to first-line therapies,” Dr. Beck said. “These patients will also frequently be anemic, have low platelet counts, elevated markers of inflammation in the blood, and be dependent on corticosteroids.”

Diagnosis can be made via genetic testing, but the study authors note that it “is not routinely offered on standard workup for myeloid neoplasms or immune dysregulation diagnostic panels.”

As for treatment, Dr. Beck said the disease “can be partially controlled by multiple different anticytokine therapies or biologics. However, in most cases, patients still need additional steroids and/or disease-modifying antirheumatic agents [DMARDs]. In addition, bone marrow transplantation has shown signs of being a highly effective therapy.”

The study authors say more research is needed to understand the disease’s prevalence in more diverse populations.

In an interview, Matthew J. Koster, MD, a rheumatologist at Mayo Clinic in Rochester, Minn., who’s studied the disease but didn’t take part in this research project, said the findings are valid and “highly important.

“The findings of this study highlight what many academic and quaternary referral centers were wondering: Is VEXAS really more common than we think, with patients hiding in plain sight? The answer is yes,” he said. “Currently, there are less than 400 cases reported in the literature of VEXAS, but large centers are diagnosing this condition with some frequency. For example, at Mayo Clinic in Rochester, we diagnose on average one new patient with VEXAS every 7-14 days and have diagnosed 60 in the past 18 months. A national collaborative group in France has diagnosed approximately 250 patients over that same time frame when pooling patients nationwide.”

The prevalence is high enough, he said, that “clinicians should consider that some of the patients with diseases that are not responding to treatment may in fact have VEXAS rather than ‘refractory’ relapsing polychondritis or ‘recalcitrant’ rheumatoid arthritis, etc.”

The National Institute of Health funded the study. Dr. Beck, the other authors, and Dr. Koster report no disclosures.

A recently discovered inflammatory disease known as VEXAS syndrome is more common, variable, and dangerous than previously understood, according to results of a retrospective observational study of a large health care system database. The findings, published in JAMA, found that it struck 1 in 4,269 men over the age of 50 in a largely White population and caused a wide variety of symptoms.

“The disease is quite severe,” study lead author David Beck, MD, PhD, of the department of medicine at NYU Langone Health, said in an interview. Patients with the condition “have a variety of clinical symptoms affecting different parts of the body and are being managed by different medical specialties.”

Dr. Beck and colleagues first described VEXAS (vacuoles, E1-ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic) syndrome in 2020. They linked it to mutations in the UBA1 (ubiquitin-like modifier activating enzyme 1) gene. The enzyme initiates a process that identifies misfolded proteins as targets for degradation.

“VEXAS syndrome is characterized by anemia and inflammation in the skin, lungs, cartilage, and joints,” Dr. Beck said. “These symptoms are frequently mistaken for other rheumatic or hematologic diseases. However, this syndrome has a different cause, is treated differently, requires additional monitoring, and can be far more severe.”

According to him, hundreds of people have been diagnosed with the disease in the short time since it was defined. The disease is believed to be fatal in some cases. A previous report found that the median survival was 9 years among patients with a certain variant; that was significantly less than patients with two other variants.

For the new study, researchers searched for UBA1 variants in genetic data from 163,096 subjects (mean age, 52.8 years; 94% White, 61% women) who took part in the Geisinger MyCode Community Health Initiative. The 1996-2022 data comes from patients at 10 Pennsylvania hospitals.

Eleven people (9 males, 2 females) had likely UBA1 variants, and all had anemia. The cases accounted for 1 in 13,591 unrelated people (95% confidence interval, 1:7,775-1:23,758), 1 in 4,269 men older than 50 years (95% CI, 1:2,319-1:7,859), and 1 in 26,238 women older than 50 years (95% CI, 1:7,196-1:147,669).

Other common findings included macrocytosis (91%), skin problems (73%), and pulmonary disease (91%). Ten patients (91%) required transfusions.

Five of the 11 subjects didn’t meet the previously defined criteria for VEXAS syndrome. None had been diagnosed with the condition, which is not surprising considering that it hadn’t been discovered and described until recently.

Just over half of the patients – 55% – had a clinical diagnosis that was previously linked to VEXAS syndrome. “This means that slightly less than half of the patients with VEXAS syndrome had no clear associated clinical diagnosis,” Dr. Beck said. “The lack of associated clinical diagnoses may be due to the variety of nonspecific clinical characteristics that span different subspecialities in VEXAS syndrome. VEXAS syndrome represents an example of a multisystem disease where patients and their symptoms may get lost in the shuffle.”

In the future, “professionals should look out for patients with unexplained inflammation – and some combination of hematologic, rheumatologic, pulmonary, and dermatologic clinical manifestations – that either don’t carry a clinical diagnosis or don’t respond to first-line therapies,” Dr. Beck said. “These patients will also frequently be anemic, have low platelet counts, elevated markers of inflammation in the blood, and be dependent on corticosteroids.”

Diagnosis can be made via genetic testing, but the study authors note that it “is not routinely offered on standard workup for myeloid neoplasms or immune dysregulation diagnostic panels.”

As for treatment, Dr. Beck said the disease “can be partially controlled by multiple different anticytokine therapies or biologics. However, in most cases, patients still need additional steroids and/or disease-modifying antirheumatic agents [DMARDs]. In addition, bone marrow transplantation has shown signs of being a highly effective therapy.”

The study authors say more research is needed to understand the disease’s prevalence in more diverse populations.

In an interview, Matthew J. Koster, MD, a rheumatologist at Mayo Clinic in Rochester, Minn., who’s studied the disease but didn’t take part in this research project, said the findings are valid and “highly important.

“The findings of this study highlight what many academic and quaternary referral centers were wondering: Is VEXAS really more common than we think, with patients hiding in plain sight? The answer is yes,” he said. “Currently, there are less than 400 cases reported in the literature of VEXAS, but large centers are diagnosing this condition with some frequency. For example, at Mayo Clinic in Rochester, we diagnose on average one new patient with VEXAS every 7-14 days and have diagnosed 60 in the past 18 months. A national collaborative group in France has diagnosed approximately 250 patients over that same time frame when pooling patients nationwide.”

The prevalence is high enough, he said, that “clinicians should consider that some of the patients with diseases that are not responding to treatment may in fact have VEXAS rather than ‘refractory’ relapsing polychondritis or ‘recalcitrant’ rheumatoid arthritis, etc.”

The National Institute of Health funded the study. Dr. Beck, the other authors, and Dr. Koster report no disclosures.

A recently discovered inflammatory disease known as VEXAS syndrome is more common, variable, and dangerous than previously understood, according to results of a retrospective observational study of a large health care system database. The findings, published in JAMA, found that it struck 1 in 4,269 men over the age of 50 in a largely White population and caused a wide variety of symptoms.

“The disease is quite severe,” study lead author David Beck, MD, PhD, of the department of medicine at NYU Langone Health, said in an interview. Patients with the condition “have a variety of clinical symptoms affecting different parts of the body and are being managed by different medical specialties.”

Dr. Beck and colleagues first described VEXAS (vacuoles, E1-ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic) syndrome in 2020. They linked it to mutations in the UBA1 (ubiquitin-like modifier activating enzyme 1) gene. The enzyme initiates a process that identifies misfolded proteins as targets for degradation.

“VEXAS syndrome is characterized by anemia and inflammation in the skin, lungs, cartilage, and joints,” Dr. Beck said. “These symptoms are frequently mistaken for other rheumatic or hematologic diseases. However, this syndrome has a different cause, is treated differently, requires additional monitoring, and can be far more severe.”

According to him, hundreds of people have been diagnosed with the disease in the short time since it was defined. The disease is believed to be fatal in some cases. A previous report found that the median survival was 9 years among patients with a certain variant; that was significantly less than patients with two other variants.

For the new study, researchers searched for UBA1 variants in genetic data from 163,096 subjects (mean age, 52.8 years; 94% White, 61% women) who took part in the Geisinger MyCode Community Health Initiative. The 1996-2022 data comes from patients at 10 Pennsylvania hospitals.

Eleven people (9 males, 2 females) had likely UBA1 variants, and all had anemia. The cases accounted for 1 in 13,591 unrelated people (95% confidence interval, 1:7,775-1:23,758), 1 in 4,269 men older than 50 years (95% CI, 1:2,319-1:7,859), and 1 in 26,238 women older than 50 years (95% CI, 1:7,196-1:147,669).

Other common findings included macrocytosis (91%), skin problems (73%), and pulmonary disease (91%). Ten patients (91%) required transfusions.

Five of the 11 subjects didn’t meet the previously defined criteria for VEXAS syndrome. None had been diagnosed with the condition, which is not surprising considering that it hadn’t been discovered and described until recently.

Just over half of the patients – 55% – had a clinical diagnosis that was previously linked to VEXAS syndrome. “This means that slightly less than half of the patients with VEXAS syndrome had no clear associated clinical diagnosis,” Dr. Beck said. “The lack of associated clinical diagnoses may be due to the variety of nonspecific clinical characteristics that span different subspecialities in VEXAS syndrome. VEXAS syndrome represents an example of a multisystem disease where patients and their symptoms may get lost in the shuffle.”

In the future, “professionals should look out for patients with unexplained inflammation – and some combination of hematologic, rheumatologic, pulmonary, and dermatologic clinical manifestations – that either don’t carry a clinical diagnosis or don’t respond to first-line therapies,” Dr. Beck said. “These patients will also frequently be anemic, have low platelet counts, elevated markers of inflammation in the blood, and be dependent on corticosteroids.”

Diagnosis can be made via genetic testing, but the study authors note that it “is not routinely offered on standard workup for myeloid neoplasms or immune dysregulation diagnostic panels.”

As for treatment, Dr. Beck said the disease “can be partially controlled by multiple different anticytokine therapies or biologics. However, in most cases, patients still need additional steroids and/or disease-modifying antirheumatic agents [DMARDs]. In addition, bone marrow transplantation has shown signs of being a highly effective therapy.”

The study authors say more research is needed to understand the disease’s prevalence in more diverse populations.

In an interview, Matthew J. Koster, MD, a rheumatologist at Mayo Clinic in Rochester, Minn., who’s studied the disease but didn’t take part in this research project, said the findings are valid and “highly important.

“The findings of this study highlight what many academic and quaternary referral centers were wondering: Is VEXAS really more common than we think, with patients hiding in plain sight? The answer is yes,” he said. “Currently, there are less than 400 cases reported in the literature of VEXAS, but large centers are diagnosing this condition with some frequency. For example, at Mayo Clinic in Rochester, we diagnose on average one new patient with VEXAS every 7-14 days and have diagnosed 60 in the past 18 months. A national collaborative group in France has diagnosed approximately 250 patients over that same time frame when pooling patients nationwide.”

The prevalence is high enough, he said, that “clinicians should consider that some of the patients with diseases that are not responding to treatment may in fact have VEXAS rather than ‘refractory’ relapsing polychondritis or ‘recalcitrant’ rheumatoid arthritis, etc.”

The National Institute of Health funded the study. Dr. Beck, the other authors, and Dr. Koster report no disclosures.

Exercise helps patients with knee osteoarthritis, but more isn’t necessarily better, new research shows.

A low-dose exercise regimen helped patients with knee OA about as much as a more intense workout plan, according to trial results published online in Annals of Internal Medicine.

kali9/Getty Images

Both high and low doses of exercise reduced pain and improved function and quality of life.

The improvements with the lower-dose plan and its 98% adherence rate are encouraging, said Nick Trasolini, MD, assistant professor of orthopedic surgery at Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C.

“This is a very doable amount of medical exercise therapy for patients with knee osteoarthritis, and one that makes a big difference in patient-reported symptoms,” Dr. Trasolini, who was not involved in the study, said in an interview.
 

What’s the right dose?

Exercise is a go-to treatment for knee OA, but the precise dose to recommend has been unclear. To study this question, Tom Arild Torstensen, MSc, RPT, with Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, and colleagues conducted a trial at four centers in Sweden and Norway.

The study included 189 men and women with knee OA. Participants were randomly assigned to low- or high-dose exercise plans, which they performed three times per week for 12 weeks under the supervision of a physiotherapist.

Participants in the high-dose group performed 11 exercises during each session, which lasted 70-90 minutes.

The low-dose regimen consisted of five exercises – cycling, squats, step-ups, step-downs, and knee extensions – performed for 20–30 minutes.

The researchers measured outcomes using the Knee Injury and Osteoarthritis Outcome Score, which assesses pain, other symptoms, function in daily living, function in sports and recreation, and knee-related quality of life.

“Patients in both groups improved significantly over time, but high-dose exercise was not superior to low-dose exercise in most comparisons,” the study investigators reported

High-dose exercise was associated with better function in sports and recreational activity and knee-related quality of life at 6 months. Those differences did not persist at 1 year, however. The researchers reported no safety concerns with either intervention.

Adherence was “nearly perfect” in the low-dose group. It was slightly lower in the high-dose group, the researchers said.

“Interestingly, it seems that high-dose treatment could be preferable to low-dose treatment in the long run for people who lead active lives,” they wrote. “This should be the subject of future studies.”

All clinical practice guidelines for knee OA recommend exercise, but “we do not know the optimal dose,” Kim Bennell, PhD, a research physiotherapist at the University of Melbourne, said in an interview.

Dose has components, including number of times per week, number of exercises, sets and repetitions, intensity, and duration of exercise sessions, Dr. Bennell said.

“These results suggest that an exercise program that involves less time and fewer exercises can still offer benefits and may be easier for patients to undertake and stick at than one that involves greater time and effort,” she said.

The study was supported by the Swedish Rheumatic Fund. Dr. Trasolini and Dr. Bennell have disclosed no relevant financial relationships.

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

Exercise helps patients with knee osteoarthritis, but more isn’t necessarily better, new research shows.

A low-dose exercise regimen helped patients with knee OA about as much as a more intense workout plan, according to trial results published online in Annals of Internal Medicine.

kali9/Getty Images

Both high and low doses of exercise reduced pain and improved function and quality of life.

The improvements with the lower-dose plan and its 98% adherence rate are encouraging, said Nick Trasolini, MD, assistant professor of orthopedic surgery at Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C.

“This is a very doable amount of medical exercise therapy for patients with knee osteoarthritis, and one that makes a big difference in patient-reported symptoms,” Dr. Trasolini, who was not involved in the study, said in an interview.
 

What’s the right dose?

Exercise is a go-to treatment for knee OA, but the precise dose to recommend has been unclear. To study this question, Tom Arild Torstensen, MSc, RPT, with Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, and colleagues conducted a trial at four centers in Sweden and Norway.

The study included 189 men and women with knee OA. Participants were randomly assigned to low- or high-dose exercise plans, which they performed three times per week for 12 weeks under the supervision of a physiotherapist.

Participants in the high-dose group performed 11 exercises during each session, which lasted 70-90 minutes.

The low-dose regimen consisted of five exercises – cycling, squats, step-ups, step-downs, and knee extensions – performed for 20–30 minutes.

The researchers measured outcomes using the Knee Injury and Osteoarthritis Outcome Score, which assesses pain, other symptoms, function in daily living, function in sports and recreation, and knee-related quality of life.

“Patients in both groups improved significantly over time, but high-dose exercise was not superior to low-dose exercise in most comparisons,” the study investigators reported

High-dose exercise was associated with better function in sports and recreational activity and knee-related quality of life at 6 months. Those differences did not persist at 1 year, however. The researchers reported no safety concerns with either intervention.

Adherence was “nearly perfect” in the low-dose group. It was slightly lower in the high-dose group, the researchers said.

“Interestingly, it seems that high-dose treatment could be preferable to low-dose treatment in the long run for people who lead active lives,” they wrote. “This should be the subject of future studies.”

All clinical practice guidelines for knee OA recommend exercise, but “we do not know the optimal dose,” Kim Bennell, PhD, a research physiotherapist at the University of Melbourne, said in an interview.

Dose has components, including number of times per week, number of exercises, sets and repetitions, intensity, and duration of exercise sessions, Dr. Bennell said.

“These results suggest that an exercise program that involves less time and fewer exercises can still offer benefits and may be easier for patients to undertake and stick at than one that involves greater time and effort,” she said.

The study was supported by the Swedish Rheumatic Fund. Dr. Trasolini and Dr. Bennell have disclosed no relevant financial relationships.

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

Exercise helps patients with knee osteoarthritis, but more isn’t necessarily better, new research shows.

A low-dose exercise regimen helped patients with knee OA about as much as a more intense workout plan, according to trial results published online in Annals of Internal Medicine.

kali9/Getty Images

Both high and low doses of exercise reduced pain and improved function and quality of life.

The improvements with the lower-dose plan and its 98% adherence rate are encouraging, said Nick Trasolini, MD, assistant professor of orthopedic surgery at Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C.

“This is a very doable amount of medical exercise therapy for patients with knee osteoarthritis, and one that makes a big difference in patient-reported symptoms,” Dr. Trasolini, who was not involved in the study, said in an interview.
 

What’s the right dose?

Exercise is a go-to treatment for knee OA, but the precise dose to recommend has been unclear. To study this question, Tom Arild Torstensen, MSc, RPT, with Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, and colleagues conducted a trial at four centers in Sweden and Norway.

The study included 189 men and women with knee OA. Participants were randomly assigned to low- or high-dose exercise plans, which they performed three times per week for 12 weeks under the supervision of a physiotherapist.

Participants in the high-dose group performed 11 exercises during each session, which lasted 70-90 minutes.

The low-dose regimen consisted of five exercises – cycling, squats, step-ups, step-downs, and knee extensions – performed for 20–30 minutes.

The researchers measured outcomes using the Knee Injury and Osteoarthritis Outcome Score, which assesses pain, other symptoms, function in daily living, function in sports and recreation, and knee-related quality of life.

“Patients in both groups improved significantly over time, but high-dose exercise was not superior to low-dose exercise in most comparisons,” the study investigators reported

High-dose exercise was associated with better function in sports and recreational activity and knee-related quality of life at 6 months. Those differences did not persist at 1 year, however. The researchers reported no safety concerns with either intervention.

Adherence was “nearly perfect” in the low-dose group. It was slightly lower in the high-dose group, the researchers said.

“Interestingly, it seems that high-dose treatment could be preferable to low-dose treatment in the long run for people who lead active lives,” they wrote. “This should be the subject of future studies.”

All clinical practice guidelines for knee OA recommend exercise, but “we do not know the optimal dose,” Kim Bennell, PhD, a research physiotherapist at the University of Melbourne, said in an interview.

Dose has components, including number of times per week, number of exercises, sets and repetitions, intensity, and duration of exercise sessions, Dr. Bennell said.

“These results suggest that an exercise program that involves less time and fewer exercises can still offer benefits and may be easier for patients to undertake and stick at than one that involves greater time and effort,” she said.

The study was supported by the Swedish Rheumatic Fund. Dr. Trasolini and Dr. Bennell have disclosed no relevant financial relationships.

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