MDedge Rheumatology

Key clinical point: The prevalence for osteoporosis continues to remain high in patients with rheumatoid arthritis (RA) despite significant advances in diagnostic methods, prevention, and treatment.

Major finding: Overall, osteoporosis was highly prevalent in patients with RA (prevalence, 27.6%; 95% CI, 23.9%-31.3%), with the prevalence being the highest in studies during 2011-2015 (36.2%; 95% CI, 24.5%-47.8%), followed by 2016-2021 (27.1%; 95% CI, 20.7%-33.4%), and before 2010 (21.6%; 95% CI, 15.8%-27.4%).

Study details: Findings are from a systematic review and meta-analysis of 57 studies including 227,812 patients with RA, of which 64,290 reported osteoporosis.

Disclosures: This study was funded by Arak University of Medical Sciences. The authors declared no conflicts of interest.

Source: Moshayedi S et al. The prevalence of osteoporosis in rheumatoid arthritis patient: A systematic review and meta-analysis. Sci Rep. 2022;12(1):15844 (Sep 23). Doi: 10.1038/s41598-022-20016-x.

Key clinical point: The prevalence for osteoporosis continues to remain high in patients with rheumatoid arthritis (RA) despite significant advances in diagnostic methods, prevention, and treatment.

Major finding: Overall, osteoporosis was highly prevalent in patients with RA (prevalence, 27.6%; 95% CI, 23.9%-31.3%), with the prevalence being the highest in studies during 2011-2015 (36.2%; 95% CI, 24.5%-47.8%), followed by 2016-2021 (27.1%; 95% CI, 20.7%-33.4%), and before 2010 (21.6%; 95% CI, 15.8%-27.4%).

Study details: Findings are from a systematic review and meta-analysis of 57 studies including 227,812 patients with RA, of which 64,290 reported osteoporosis.

Disclosures: This study was funded by Arak University of Medical Sciences. The authors declared no conflicts of interest.

Source: Moshayedi S et al. The prevalence of osteoporosis in rheumatoid arthritis patient: A systematic review and meta-analysis. Sci Rep. 2022;12(1):15844 (Sep 23). Doi: 10.1038/s41598-022-20016-x.

Key clinical point: The prevalence for osteoporosis continues to remain high in patients with rheumatoid arthritis (RA) despite significant advances in diagnostic methods, prevention, and treatment.

Major finding: Overall, osteoporosis was highly prevalent in patients with RA (prevalence, 27.6%; 95% CI, 23.9%-31.3%), with the prevalence being the highest in studies during 2011-2015 (36.2%; 95% CI, 24.5%-47.8%), followed by 2016-2021 (27.1%; 95% CI, 20.7%-33.4%), and before 2010 (21.6%; 95% CI, 15.8%-27.4%).

Study details: Findings are from a systematic review and meta-analysis of 57 studies including 227,812 patients with RA, of which 64,290 reported osteoporosis.

Disclosures: This study was funded by Arak University of Medical Sciences. The authors declared no conflicts of interest.

Source: Moshayedi S et al. The prevalence of osteoporosis in rheumatoid arthritis patient: A systematic review and meta-analysis. Sci Rep. 2022;12(1):15844 (Sep 23). Doi: 10.1038/s41598-022-20016-x.

Key clinical point: Serum levels of interferon beta (IFNβ) may distinguish early from late relapse after biologic disease-modifying antirheumatic drug (bDMARD) withdrawal in patients with rheumatoid arthritis (RA).

Major finding: Patients with serum IFNβ levels of 3.38 vs. <3.38 in log₂ had a significantly lower probability of sustained remission during the first 6 months of bDMARD withdrawal (log-rank test, P = .0177). Serum IFNβ levels of 3.38 in log₂ at the time of bDMARD withdrawal predicted early vs. late relapse in patients with highly probable relapses (area under the curve, 0.833) and patients with lower IFNβ levels (<3.38 in log₂) were able to safely discontinue bDMARD.

Study details: This prospective study included 40 patients with RA who maintained clinical remission with bDMARDs for >12 months, of which 26 relapsed at some point after bDMARD withdrawal.

Disclosures: This study was partially supported by unlimited research fund from Chugai Pharm, Eisai, and Mitsubishi-Tanabe provided to S Minota. The authors declared no conflicts of interest.

Source: Sakashita E et al. Serum level of IFNβ distinguishes early from late relapses after biologics withdrawal in rheumatoid arthritis. Sci Rep. 2022;12(1):16547 (Oct 3). Doi: 10.1038/s41598-022-21160-0.

Key clinical point: Serum levels of interferon beta (IFNβ) may distinguish early from late relapse after biologic disease-modifying antirheumatic drug (bDMARD) withdrawal in patients with rheumatoid arthritis (RA).

Major finding: Patients with serum IFNβ levels of 3.38 vs. <3.38 in log₂ had a significantly lower probability of sustained remission during the first 6 months of bDMARD withdrawal (log-rank test, P = .0177). Serum IFNβ levels of 3.38 in log₂ at the time of bDMARD withdrawal predicted early vs. late relapse in patients with highly probable relapses (area under the curve, 0.833) and patients with lower IFNβ levels (<3.38 in log₂) were able to safely discontinue bDMARD.

Study details: This prospective study included 40 patients with RA who maintained clinical remission with bDMARDs for >12 months, of which 26 relapsed at some point after bDMARD withdrawal.

Disclosures: This study was partially supported by unlimited research fund from Chugai Pharm, Eisai, and Mitsubishi-Tanabe provided to S Minota. The authors declared no conflicts of interest.

Source: Sakashita E et al. Serum level of IFNβ distinguishes early from late relapses after biologics withdrawal in rheumatoid arthritis. Sci Rep. 2022;12(1):16547 (Oct 3). Doi: 10.1038/s41598-022-21160-0.

Key clinical point: Serum levels of interferon beta (IFNβ) may distinguish early from late relapse after biologic disease-modifying antirheumatic drug (bDMARD) withdrawal in patients with rheumatoid arthritis (RA).

Major finding: Patients with serum IFNβ levels of 3.38 vs. <3.38 in log₂ had a significantly lower probability of sustained remission during the first 6 months of bDMARD withdrawal (log-rank test, P = .0177). Serum IFNβ levels of 3.38 in log₂ at the time of bDMARD withdrawal predicted early vs. late relapse in patients with highly probable relapses (area under the curve, 0.833) and patients with lower IFNβ levels (<3.38 in log₂) were able to safely discontinue bDMARD.

Study details: This prospective study included 40 patients with RA who maintained clinical remission with bDMARDs for >12 months, of which 26 relapsed at some point after bDMARD withdrawal.

Disclosures: This study was partially supported by unlimited research fund from Chugai Pharm, Eisai, and Mitsubishi-Tanabe provided to S Minota. The authors declared no conflicts of interest.

Source: Sakashita E et al. Serum level of IFNβ distinguishes early from late relapses after biologics withdrawal in rheumatoid arthritis. Sci Rep. 2022;12(1):16547 (Oct 3). Doi: 10.1038/s41598-022-21160-0.

Key clinical point: Patients with rheumatoid arthritis (RA) vs. general population remain at a higher risk for SARS-CoV-2 infection and its severe outcomes; although COVID-19 vaccination has reduced severe outcomes, the risk for breakthrough infections is higher among patients with RA, supporting recent recommendations for booster COVID-19 vaccination.

Major finding: Unvaccinated patients with RA vs. general population were at an increased risk for SARS-CoV-2 infection (adjusted hazard ratio [aHR] 1.11; 95% CI 1.00-1.24), COVID-19 hospitalization (aHR 1.62; 95% CI 1.34-1.96), and COVID-19 death (aHR 1.88; 95% CI 1.37-2.60). COVID-19 vaccination reduced disease severity but not the risk for breakthrough infection in patients with RA vs. general population over 9 months of follow-up (aHR1.10; 95% CI, 1.00-1.20).

Study details: Findings are from 2 cohort studies including patients with RA (unvaccinated n = 15,901; vaccinated n = 14,330) and non-RA individuals from general population (unvaccinated n = 1,558,423; vaccinated n = 1,208,659).

Disclosures: This study was supported by the National Institutes of Health and other sources. ZS Wallace declared receiving research support and consulting fees from various sources unrelated to this work.

Source: Li H et al. Risk of COVID-19 among unvaccinated and vaccinated patients with rheumatoid arthritis: A general population study. Arthritis Care Res (Hoboken). 2022 (Sep 26). Doi: 10.1002/acr.25028

Key clinical point: Patients with rheumatoid arthritis (RA) vs. general population remain at a higher risk for SARS-CoV-2 infection and its severe outcomes; although COVID-19 vaccination has reduced severe outcomes, the risk for breakthrough infections is higher among patients with RA, supporting recent recommendations for booster COVID-19 vaccination.

Major finding: Unvaccinated patients with RA vs. general population were at an increased risk for SARS-CoV-2 infection (adjusted hazard ratio [aHR] 1.11; 95% CI 1.00-1.24), COVID-19 hospitalization (aHR 1.62; 95% CI 1.34-1.96), and COVID-19 death (aHR 1.88; 95% CI 1.37-2.60). COVID-19 vaccination reduced disease severity but not the risk for breakthrough infection in patients with RA vs. general population over 9 months of follow-up (aHR1.10; 95% CI, 1.00-1.20).

Study details: Findings are from 2 cohort studies including patients with RA (unvaccinated n = 15,901; vaccinated n = 14,330) and non-RA individuals from general population (unvaccinated n = 1,558,423; vaccinated n = 1,208,659).

Disclosures: This study was supported by the National Institutes of Health and other sources. ZS Wallace declared receiving research support and consulting fees from various sources unrelated to this work.

Source: Li H et al. Risk of COVID-19 among unvaccinated and vaccinated patients with rheumatoid arthritis: A general population study. Arthritis Care Res (Hoboken). 2022 (Sep 26). Doi: 10.1002/acr.25028

Key clinical point: Patients with rheumatoid arthritis (RA) vs. general population remain at a higher risk for SARS-CoV-2 infection and its severe outcomes; although COVID-19 vaccination has reduced severe outcomes, the risk for breakthrough infections is higher among patients with RA, supporting recent recommendations for booster COVID-19 vaccination.

Major finding: Unvaccinated patients with RA vs. general population were at an increased risk for SARS-CoV-2 infection (adjusted hazard ratio [aHR] 1.11; 95% CI 1.00-1.24), COVID-19 hospitalization (aHR 1.62; 95% CI 1.34-1.96), and COVID-19 death (aHR 1.88; 95% CI 1.37-2.60). COVID-19 vaccination reduced disease severity but not the risk for breakthrough infection in patients with RA vs. general population over 9 months of follow-up (aHR1.10; 95% CI, 1.00-1.20).

Study details: Findings are from 2 cohort studies including patients with RA (unvaccinated n = 15,901; vaccinated n = 14,330) and non-RA individuals from general population (unvaccinated n = 1,558,423; vaccinated n = 1,208,659).

Disclosures: This study was supported by the National Institutes of Health and other sources. ZS Wallace declared receiving research support and consulting fees from various sources unrelated to this work.

Source: Li H et al. Risk of COVID-19 among unvaccinated and vaccinated patients with rheumatoid arthritis: A general population study. Arthritis Care Res (Hoboken). 2022 (Sep 26). Doi: 10.1002/acr.25028

Key clinical point: Smoking worsened disease activity and health-related quality of life at 1 year in patients with rheumatoid arthritis (RA), with effects being persistent at 3 years and early smoking cessation vs. continued smoking being associated with improved disease activity.

Major finding: At 1 year, current smokers vs. non-smokers were at a higher risk for a swollen joint number above the median (odds ratio [OR] 1.7; P = .001) and 36-Item Short-Form Health Survey physical (OR 1.5; P = .006) and mental (OR 1.4; P = .03) scores below the median, with effects being persistent at 3 years. Patients who stopped vs. continued smoking within 1 year reported a lower swollen joint number (P = .002).

Study details: Findings are from a population-based case-control study including 1531 patients with newly diagnosed RA who were followed-up for 3 years, of which 376 patients were current smokers.

Disclosures: This study was supported by grants from the Swedish Medical Research Council and other sources. The authors declared no conflicts of interest.

Source: Alfredsson L et al. Influence of smoking on disease activity and quality of life in patients with rheumatoid arthritis: Results from a Swedish case-control study with longitudinal follow-up. Arthritis Care Res (Hoboken). 2022 (Sep 23). Doi: 10.1002/acr.25026

Key clinical point: Smoking worsened disease activity and health-related quality of life at 1 year in patients with rheumatoid arthritis (RA), with effects being persistent at 3 years and early smoking cessation vs. continued smoking being associated with improved disease activity.

Major finding: At 1 year, current smokers vs. non-smokers were at a higher risk for a swollen joint number above the median (odds ratio [OR] 1.7; P = .001) and 36-Item Short-Form Health Survey physical (OR 1.5; P = .006) and mental (OR 1.4; P = .03) scores below the median, with effects being persistent at 3 years. Patients who stopped vs. continued smoking within 1 year reported a lower swollen joint number (P = .002).

Study details: Findings are from a population-based case-control study including 1531 patients with newly diagnosed RA who were followed-up for 3 years, of which 376 patients were current smokers.

Disclosures: This study was supported by grants from the Swedish Medical Research Council and other sources. The authors declared no conflicts of interest.

Source: Alfredsson L et al. Influence of smoking on disease activity and quality of life in patients with rheumatoid arthritis: Results from a Swedish case-control study with longitudinal follow-up. Arthritis Care Res (Hoboken). 2022 (Sep 23). Doi: 10.1002/acr.25026

Key clinical point: Smoking worsened disease activity and health-related quality of life at 1 year in patients with rheumatoid arthritis (RA), with effects being persistent at 3 years and early smoking cessation vs. continued smoking being associated with improved disease activity.

Major finding: At 1 year, current smokers vs. non-smokers were at a higher risk for a swollen joint number above the median (odds ratio [OR] 1.7; P = .001) and 36-Item Short-Form Health Survey physical (OR 1.5; P = .006) and mental (OR 1.4; P = .03) scores below the median, with effects being persistent at 3 years. Patients who stopped vs. continued smoking within 1 year reported a lower swollen joint number (P = .002).

Study details: Findings are from a population-based case-control study including 1531 patients with newly diagnosed RA who were followed-up for 3 years, of which 376 patients were current smokers.

Disclosures: This study was supported by grants from the Swedish Medical Research Council and other sources. The authors declared no conflicts of interest.

Source: Alfredsson L et al. Influence of smoking on disease activity and quality of life in patients with rheumatoid arthritis: Results from a Swedish case-control study with longitudinal follow-up. Arthritis Care Res (Hoboken). 2022 (Sep 23). Doi: 10.1002/acr.25026

Key clinical point: Failure to initiate methotrexate within 3 months and discontinue glucocorticoids within 6 months during early disease management were associated with difficult-to-treat rheumatoid arthritis (D2T-RA).

Major finding: A significantly lower proportion of patients with D2T-RA had adequate methotrexate treatment duration vs. those with non-D2T-RA (70.8% v. 85.5%; P = .022). Additionally, a significantly higher proportion of patients with D2T-RA vs non-D2T-RA continued glucocorticoids beyond 6 months (70.8% vs 33.8%; P < .001), with a delay of <3 months vs >12 months in methotrexate treatment (odds ratio [OR] 0.3; P = .031) and failure to discontinue glucocorticoids (OR 4.6; P < .001) being significantly associated with D2T-RA.

Study details: Findings are from a retrospective cohort study including 48 patients with D2T-RA and 145 patients with non-D2T-RA.

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

Source: Giollo A et al. Early characterisation of difficult-to-treat rheumatoid arthritis by suboptimal initial management A multicentre cohort study. Rheumatology (Oxford). 2022 (Oct 3). Doi: 10.1093/rheumatology/keac563

Key clinical point: Failure to initiate methotrexate within 3 months and discontinue glucocorticoids within 6 months during early disease management were associated with difficult-to-treat rheumatoid arthritis (D2T-RA).

Major finding: A significantly lower proportion of patients with D2T-RA had adequate methotrexate treatment duration vs. those with non-D2T-RA (70.8% v. 85.5%; P = .022). Additionally, a significantly higher proportion of patients with D2T-RA vs non-D2T-RA continued glucocorticoids beyond 6 months (70.8% vs 33.8%; P < .001), with a delay of <3 months vs >12 months in methotrexate treatment (odds ratio [OR] 0.3; P = .031) and failure to discontinue glucocorticoids (OR 4.6; P < .001) being significantly associated with D2T-RA.

Study details: Findings are from a retrospective cohort study including 48 patients with D2T-RA and 145 patients with non-D2T-RA.

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

Source: Giollo A et al. Early characterisation of difficult-to-treat rheumatoid arthritis by suboptimal initial management A multicentre cohort study. Rheumatology (Oxford). 2022 (Oct 3). Doi: 10.1093/rheumatology/keac563

Key clinical point: Failure to initiate methotrexate within 3 months and discontinue glucocorticoids within 6 months during early disease management were associated with difficult-to-treat rheumatoid arthritis (D2T-RA).

Major finding: A significantly lower proportion of patients with D2T-RA had adequate methotrexate treatment duration vs. those with non-D2T-RA (70.8% v. 85.5%; P = .022). Additionally, a significantly higher proportion of patients with D2T-RA vs non-D2T-RA continued glucocorticoids beyond 6 months (70.8% vs 33.8%; P < .001), with a delay of <3 months vs >12 months in methotrexate treatment (odds ratio [OR] 0.3; P = .031) and failure to discontinue glucocorticoids (OR 4.6; P < .001) being significantly associated with D2T-RA.

Study details: Findings are from a retrospective cohort study including 48 patients with D2T-RA and 145 patients with non-D2T-RA.

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

Source: Giollo A et al. Early characterisation of difficult-to-treat rheumatoid arthritis by suboptimal initial management A multicentre cohort study. Rheumatology (Oxford). 2022 (Oct 3). Doi: 10.1093/rheumatology/keac563

Key clinical point: Patients with rheumatoid arthritis (RA) treated with Janus kinase (JAK) vs tumor necrosis factor (TNF) inhibitors were at a higher risk for venous thromboembolism (VTE), particularly pulmonary embolism.

Major finding: Patients treated with JAK vs TNF inhibitors were at a 73% higher risk for VTE (adjusted hazard ratio [aHR] 1.73; 95% CI 1.24-2.42), with the higher risk appearing to be confined to pulmonary embolism (aHR 3.21; 95% CI 2.11-4.88) rather than deep vein thrombosis.

Study details: Findings are from a prospective, register-based, active comparator study including 85,722 patients with RA, of which 27,610 patients initiated biologic/targeted synthetic disease-modifying antirheumatic drugs and were matched with 91,207 healthy controls.

Disclosures: This study was funded by Swedish Research Council, the Swedish Heart Lung Foundation, and other sources. Karolinska Institutet has or has had research agreements with various sources for safety monitoring of biologics through ARTIS/Swedish Biologics Register.

Source: Molander V et al. Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: A Swedish comparative safety study among patients with rheumatoid arthritis. Ann Rheum Dis. 2022 (Sep 23). Doi: 10.1136/ard-2022-223050

Key clinical point: Patients with rheumatoid arthritis (RA) treated with Janus kinase (JAK) vs tumor necrosis factor (TNF) inhibitors were at a higher risk for venous thromboembolism (VTE), particularly pulmonary embolism.

Major finding: Patients treated with JAK vs TNF inhibitors were at a 73% higher risk for VTE (adjusted hazard ratio [aHR] 1.73; 95% CI 1.24-2.42), with the higher risk appearing to be confined to pulmonary embolism (aHR 3.21; 95% CI 2.11-4.88) rather than deep vein thrombosis.

Study details: Findings are from a prospective, register-based, active comparator study including 85,722 patients with RA, of which 27,610 patients initiated biologic/targeted synthetic disease-modifying antirheumatic drugs and were matched with 91,207 healthy controls.

Disclosures: This study was funded by Swedish Research Council, the Swedish Heart Lung Foundation, and other sources. Karolinska Institutet has or has had research agreements with various sources for safety monitoring of biologics through ARTIS/Swedish Biologics Register.

Source: Molander V et al. Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: A Swedish comparative safety study among patients with rheumatoid arthritis. Ann Rheum Dis. 2022 (Sep 23). Doi: 10.1136/ard-2022-223050

Key clinical point: Patients with rheumatoid arthritis (RA) treated with Janus kinase (JAK) vs tumor necrosis factor (TNF) inhibitors were at a higher risk for venous thromboembolism (VTE), particularly pulmonary embolism.

Major finding: Patients treated with JAK vs TNF inhibitors were at a 73% higher risk for VTE (adjusted hazard ratio [aHR] 1.73; 95% CI 1.24-2.42), with the higher risk appearing to be confined to pulmonary embolism (aHR 3.21; 95% CI 2.11-4.88) rather than deep vein thrombosis.

Study details: Findings are from a prospective, register-based, active comparator study including 85,722 patients with RA, of which 27,610 patients initiated biologic/targeted synthetic disease-modifying antirheumatic drugs and were matched with 91,207 healthy controls.

Disclosures: This study was funded by Swedish Research Council, the Swedish Heart Lung Foundation, and other sources. Karolinska Institutet has or has had research agreements with various sources for safety monitoring of biologics through ARTIS/Swedish Biologics Register.

Source: Molander V et al. Venous thromboembolism with JAK inhibitors and other immune-modulatory drugs: A Swedish comparative safety study among patients with rheumatoid arthritis. Ann Rheum Dis. 2022 (Sep 23). Doi: 10.1136/ard-2022-223050

Key clinical point: Withdrawal of methotrexate slightly worsened disease activity without affecting remission rates in patients with rheumatoid arthritis (RA) at target who were treated with the combination of biologic disease-modifying antirheumatic drugs (bDMARD)/targeted synthetic DMARD (tsDMARD) and methotrexate.

Major finding: Withdrawing methotrexate vs maintaining combination therapy increased the disease activity score of 28-joints by 0.20 (95% CI 0.09-0.32) and decreased the proportion of patients achieving low disease activity (risk ratio [RR] 0.88; 95% CI 0.80-0.97); however, the remission rates remained unaffected (RR 0.90; 95% CI 0.81-1.01).

Study details: Findings are from a systematic review and meta-analysis of six randomized controlled trials including 1430 patients with RA at target who were treated with bDMARD or tsDMARD+methotrexate combination therapy, of which 734 withdrew and 696 continued methotrexate.

Disclosures: This study was supported by West China Hospital, Sichuan University. The authors declared no conflicts of interest.

Source: Wang X et al. Withdrawal of MTX in rheumatoid arthritis patients on bDMARD/tsDMARD plus methotrexate at target: A systematic review and meta-analysis. Rheumatology (Oxford). 2022 (Sep 20). Doi: 10.1093/rheumatology/keac515

Key clinical point: Withdrawal of methotrexate slightly worsened disease activity without affecting remission rates in patients with rheumatoid arthritis (RA) at target who were treated with the combination of biologic disease-modifying antirheumatic drugs (bDMARD)/targeted synthetic DMARD (tsDMARD) and methotrexate.

Major finding: Withdrawing methotrexate vs maintaining combination therapy increased the disease activity score of 28-joints by 0.20 (95% CI 0.09-0.32) and decreased the proportion of patients achieving low disease activity (risk ratio [RR] 0.88; 95% CI 0.80-0.97); however, the remission rates remained unaffected (RR 0.90; 95% CI 0.81-1.01).

Study details: Findings are from a systematic review and meta-analysis of six randomized controlled trials including 1430 patients with RA at target who were treated with bDMARD or tsDMARD+methotrexate combination therapy, of which 734 withdrew and 696 continued methotrexate.

Disclosures: This study was supported by West China Hospital, Sichuan University. The authors declared no conflicts of interest.

Source: Wang X et al. Withdrawal of MTX in rheumatoid arthritis patients on bDMARD/tsDMARD plus methotrexate at target: A systematic review and meta-analysis. Rheumatology (Oxford). 2022 (Sep 20). Doi: 10.1093/rheumatology/keac515

Key clinical point: Withdrawal of methotrexate slightly worsened disease activity without affecting remission rates in patients with rheumatoid arthritis (RA) at target who were treated with the combination of biologic disease-modifying antirheumatic drugs (bDMARD)/targeted synthetic DMARD (tsDMARD) and methotrexate.

Major finding: Withdrawing methotrexate vs maintaining combination therapy increased the disease activity score of 28-joints by 0.20 (95% CI 0.09-0.32) and decreased the proportion of patients achieving low disease activity (risk ratio [RR] 0.88; 95% CI 0.80-0.97); however, the remission rates remained unaffected (RR 0.90; 95% CI 0.81-1.01).

Study details: Findings are from a systematic review and meta-analysis of six randomized controlled trials including 1430 patients with RA at target who were treated with bDMARD or tsDMARD+methotrexate combination therapy, of which 734 withdrew and 696 continued methotrexate.

Disclosures: This study was supported by West China Hospital, Sichuan University. The authors declared no conflicts of interest.

Source: Wang X et al. Withdrawal of MTX in rheumatoid arthritis patients on bDMARD/tsDMARD plus methotrexate at target: A systematic review and meta-analysis. Rheumatology (Oxford). 2022 (Sep 20). Doi: 10.1093/rheumatology/keac515

Key clinical point: Ultrasound-detected subclinical inflammation of tendons and joints was better controlled in patients with rheumatoid arthritis (RA) in clinical remission who received the combination therapy of conventional synthetic and biologic disease-modifying antirheumatic drugs (csDMARD+bDMARD) vs csDMARD or bDMARD monotherapy.

Major finding: Grey-scale tenosynovitis (P = .025) and power Doppler (PD) tenosynovitis (P = .047) were better controlled with csDMARD+bDMARD than with csDMARD alone. csDMARD+bDMARD was also associated with better treatment results for PD synovitis vs csDMARD (P = .01) or bDMARD (P = .02) alone.

Study details: Findings are from a longitudinal analysis of the STARTER study including 256 patients with RA in clinical remission who received csDMARD alone, bDMARD alone, or csDMARD+bDMARD.

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

Source: Parisi S et al. Relationship between the prevalence of subclinical tenosynovitis and treatment in patients with RA in clinical remission: STARTER study. Rheumatology (Oxford). 2022 (Sep 6). Doi: 10.1093/rheumatology/keac518

Key clinical point: Ultrasound-detected subclinical inflammation of tendons and joints was better controlled in patients with rheumatoid arthritis (RA) in clinical remission who received the combination therapy of conventional synthetic and biologic disease-modifying antirheumatic drugs (csDMARD+bDMARD) vs csDMARD or bDMARD monotherapy.

Major finding: Grey-scale tenosynovitis (P = .025) and power Doppler (PD) tenosynovitis (P = .047) were better controlled with csDMARD+bDMARD than with csDMARD alone. csDMARD+bDMARD was also associated with better treatment results for PD synovitis vs csDMARD (P = .01) or bDMARD (P = .02) alone.

Study details: Findings are from a longitudinal analysis of the STARTER study including 256 patients with RA in clinical remission who received csDMARD alone, bDMARD alone, or csDMARD+bDMARD.

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

Source: Parisi S et al. Relationship between the prevalence of subclinical tenosynovitis and treatment in patients with RA in clinical remission: STARTER study. Rheumatology (Oxford). 2022 (Sep 6). Doi: 10.1093/rheumatology/keac518

Key clinical point: Ultrasound-detected subclinical inflammation of tendons and joints was better controlled in patients with rheumatoid arthritis (RA) in clinical remission who received the combination therapy of conventional synthetic and biologic disease-modifying antirheumatic drugs (csDMARD+bDMARD) vs csDMARD or bDMARD monotherapy.

Major finding: Grey-scale tenosynovitis (P = .025) and power Doppler (PD) tenosynovitis (P = .047) were better controlled with csDMARD+bDMARD than with csDMARD alone. csDMARD+bDMARD was also associated with better treatment results for PD synovitis vs csDMARD (P = .01) or bDMARD (P = .02) alone.

Study details: Findings are from a longitudinal analysis of the STARTER study including 256 patients with RA in clinical remission who received csDMARD alone, bDMARD alone, or csDMARD+bDMARD.

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

Source: Parisi S et al. Relationship between the prevalence of subclinical tenosynovitis and treatment in patients with RA in clinical remission: STARTER study. Rheumatology (Oxford). 2022 (Sep 6). Doi: 10.1093/rheumatology/keac518

Key clinical point: Patients with rheumatoid arthritis (RA), including those across different phenotypic subgroups, were at an increased risk for severe COVID-19 compared with patients without RA, with a pronounced association being observed in patients with RA-associated interstitial lung disease (RA-ILD).

Major finding: Risk for severe COVID-19 was significantly higher in patients with RA vs. those without RA (adjusted hazard ratio [aHR], 1.75; P < .0001). Risk was persistent among the sub-group of patients who were seropositive (aHR, 1.97; P < .0001) or had erosive disease (aHR, 1.93; P < .0001) and most prominent among patients with RA-ILD (aHR, 2.50; P < .0001).

Study details: Findings are from a retrospective study of 582 patients with RA and 2,875 matched comparators without RA, all of whom had COVID-19.

Disclosures: This study did not receive any funding. Some authors reported receiving research support, consulting fees, and/or grants unrelated to this study from various sources.

Source: Figueroa-Parra G et al. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: A retrospective, comparative, multicentre cohort study. Lancet Rheumatol. 2022 (Sep 13). Doi: 10.1016/S2665-9913(22)00227-2.

Key clinical point: Patients with rheumatoid arthritis (RA), including those across different phenotypic subgroups, were at an increased risk for severe COVID-19 compared with patients without RA, with a pronounced association being observed in patients with RA-associated interstitial lung disease (RA-ILD).

Major finding: Risk for severe COVID-19 was significantly higher in patients with RA vs. those without RA (adjusted hazard ratio [aHR], 1.75; P < .0001). Risk was persistent among the sub-group of patients who were seropositive (aHR, 1.97; P < .0001) or had erosive disease (aHR, 1.93; P < .0001) and most prominent among patients with RA-ILD (aHR, 2.50; P < .0001).

Study details: Findings are from a retrospective study of 582 patients with RA and 2,875 matched comparators without RA, all of whom had COVID-19.

Disclosures: This study did not receive any funding. Some authors reported receiving research support, consulting fees, and/or grants unrelated to this study from various sources.

Source: Figueroa-Parra G et al. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: A retrospective, comparative, multicentre cohort study. Lancet Rheumatol. 2022 (Sep 13). Doi: 10.1016/S2665-9913(22)00227-2.

Key clinical point: Patients with rheumatoid arthritis (RA), including those across different phenotypic subgroups, were at an increased risk for severe COVID-19 compared with patients without RA, with a pronounced association being observed in patients with RA-associated interstitial lung disease (RA-ILD).

Major finding: Risk for severe COVID-19 was significantly higher in patients with RA vs. those without RA (adjusted hazard ratio [aHR], 1.75; P < .0001). Risk was persistent among the sub-group of patients who were seropositive (aHR, 1.97; P < .0001) or had erosive disease (aHR, 1.93; P < .0001) and most prominent among patients with RA-ILD (aHR, 2.50; P < .0001).

Study details: Findings are from a retrospective study of 582 patients with RA and 2,875 matched comparators without RA, all of whom had COVID-19.

Disclosures: This study did not receive any funding. Some authors reported receiving research support, consulting fees, and/or grants unrelated to this study from various sources.

Source: Figueroa-Parra G et al. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: A retrospective, comparative, multicentre cohort study. Lancet Rheumatol. 2022 (Sep 13). Doi: 10.1016/S2665-9913(22)00227-2.

What you really don’t want to do, if you want to improve diversity, equity, and inclusion (DEI) at your academic institution, is to recruit diverse people to your program and then have them come and feel not included, said Vivian Asare, MD. “That can work against your efforts,” she stated in an oral presentation at the annual meeting of the American College of Chest Physicians (CHEST). Dr. Asare is assistant professor and vice chief of DEI for Yale Pulmonary, Critical Care, and Sleep Medicine, and associate medical director of Yale Centers for Sleep Medicine, New Haven, Conn.

In offering a path to successful DEI, Dr. Asare said: “The first step is to build a team and discuss your mission. Invite everyone to participate and include your leadership because they’re the ones who set the stage, ensure sustainability, and can be a liaison with faculty.” Then a DEI leader should be elected, she added.

The next and very important step is to survey the current institutional climate. “You need to tap into how people feel about DEI in your program.” That entails speaking directly with the stakeholders (faculty, staff, trainees) and identifying their specific concerns and what they think is lacking. Retreats, serious group discussions, and self-reflecting (asking “what initiatives would be good for us?”), and meeting one-on-one with individuals for a truly personalized approach are among potentially productive strategies for identifying the priorities and DEI-related topics specific to a particular academic sleep program.

Dr. Asare offered up a sample DEI survey (Am J Obstet Gynecol. 2020 Nov;223[5]:715.e1-715.e7), that made direct statements inviting the respondent to check off one of the following responses: Yes, No, Somewhat, Do not know, and Not applicable. Among sample statements:

• Our department is actively committed to issues of diversity, equity, and inclusion.
• Faculty searches in the department regularly attract a diverse pool of highly qualified candidates and/or attract a pool that represents the availability of MDs in this field.
• Our outreach and recruitment processes employ targeted practices for attracting diverse populations.

Dr. Asare said that a survey can be a simple approach for garnering information that can be useful for prioritizing DEI topics of concern and igniting interest in them. Engagement requires regular DEI committee meetings with minutes or a newsletter and with updates and topics brought to faculty meetings.
 

Key DEI areas of focus

Dr. Asare listed several key DEI areas: Recruitment/retention, mentorship, scholarship, and inclusion and community engagement. Under scholarship, for example, she cited topics for potential inclusion in a DEI curriculum: Unconscious bias and anti-racism training, racism, discrimination and microaggression education (bystander/deescalation training), cultural competency and awareness, workplace civility, and health disparities. “We all know that implicit bias in providers is a reality, unfortunately,” Dr. Asare said. Being aware of these implicit biases is a start, but instruction on how to actively overcome them has to be provided. Tools may include perspective-taking, exploring common identity, and self-reflection.

To create an inclusive environment for all faculty, trainees, and staff may involve establishing a “welcome committee” for new faculty, perhaps with designating a “peer buddy,” creating social events and other opportunities for all opinions and ideas to be heard and valued. Particularly for underserved and disadvantaged patient populations, patient advocacy and community service need to be fostered through support groups and provision of resources.

Summarizing, Dr. Asare reiterated several key elements for a successful DEI program: Build a team and discuss the mission, survey the current climate allowing open communication and dialogue, plan and engage, organize, and form areas of DEI focus. Find out where you are and where you want to be with respect to DEI, she concluded.

Dr. Asare declared that she had no conflicts of interest.

What you really don’t want to do, if you want to improve diversity, equity, and inclusion (DEI) at your academic institution, is to recruit diverse people to your program and then have them come and feel not included, said Vivian Asare, MD. “That can work against your efforts,” she stated in an oral presentation at the annual meeting of the American College of Chest Physicians (CHEST). Dr. Asare is assistant professor and vice chief of DEI for Yale Pulmonary, Critical Care, and Sleep Medicine, and associate medical director of Yale Centers for Sleep Medicine, New Haven, Conn.

In offering a path to successful DEI, Dr. Asare said: “The first step is to build a team and discuss your mission. Invite everyone to participate and include your leadership because they’re the ones who set the stage, ensure sustainability, and can be a liaison with faculty.” Then a DEI leader should be elected, she added.

The next and very important step is to survey the current institutional climate. “You need to tap into how people feel about DEI in your program.” That entails speaking directly with the stakeholders (faculty, staff, trainees) and identifying their specific concerns and what they think is lacking. Retreats, serious group discussions, and self-reflecting (asking “what initiatives would be good for us?”), and meeting one-on-one with individuals for a truly personalized approach are among potentially productive strategies for identifying the priorities and DEI-related topics specific to a particular academic sleep program.

Dr. Asare offered up a sample DEI survey (Am J Obstet Gynecol. 2020 Nov;223[5]:715.e1-715.e7), that made direct statements inviting the respondent to check off one of the following responses: Yes, No, Somewhat, Do not know, and Not applicable. Among sample statements:

• Our department is actively committed to issues of diversity, equity, and inclusion.
• Faculty searches in the department regularly attract a diverse pool of highly qualified candidates and/or attract a pool that represents the availability of MDs in this field.
• Our outreach and recruitment processes employ targeted practices for attracting diverse populations.

Dr. Asare said that a survey can be a simple approach for garnering information that can be useful for prioritizing DEI topics of concern and igniting interest in them. Engagement requires regular DEI committee meetings with minutes or a newsletter and with updates and topics brought to faculty meetings.
 

Key DEI areas of focus

Dr. Asare listed several key DEI areas: Recruitment/retention, mentorship, scholarship, and inclusion and community engagement. Under scholarship, for example, she cited topics for potential inclusion in a DEI curriculum: Unconscious bias and anti-racism training, racism, discrimination and microaggression education (bystander/deescalation training), cultural competency and awareness, workplace civility, and health disparities. “We all know that implicit bias in providers is a reality, unfortunately,” Dr. Asare said. Being aware of these implicit biases is a start, but instruction on how to actively overcome them has to be provided. Tools may include perspective-taking, exploring common identity, and self-reflection.

To create an inclusive environment for all faculty, trainees, and staff may involve establishing a “welcome committee” for new faculty, perhaps with designating a “peer buddy,” creating social events and other opportunities for all opinions and ideas to be heard and valued. Particularly for underserved and disadvantaged patient populations, patient advocacy and community service need to be fostered through support groups and provision of resources.

Summarizing, Dr. Asare reiterated several key elements for a successful DEI program: Build a team and discuss the mission, survey the current climate allowing open communication and dialogue, plan and engage, organize, and form areas of DEI focus. Find out where you are and where you want to be with respect to DEI, she concluded.

Dr. Asare declared that she had no conflicts of interest.

What you really don’t want to do, if you want to improve diversity, equity, and inclusion (DEI) at your academic institution, is to recruit diverse people to your program and then have them come and feel not included, said Vivian Asare, MD. “That can work against your efforts,” she stated in an oral presentation at the annual meeting of the American College of Chest Physicians (CHEST). Dr. Asare is assistant professor and vice chief of DEI for Yale Pulmonary, Critical Care, and Sleep Medicine, and associate medical director of Yale Centers for Sleep Medicine, New Haven, Conn.

In offering a path to successful DEI, Dr. Asare said: “The first step is to build a team and discuss your mission. Invite everyone to participate and include your leadership because they’re the ones who set the stage, ensure sustainability, and can be a liaison with faculty.” Then a DEI leader should be elected, she added.

The next and very important step is to survey the current institutional climate. “You need to tap into how people feel about DEI in your program.” That entails speaking directly with the stakeholders (faculty, staff, trainees) and identifying their specific concerns and what they think is lacking. Retreats, serious group discussions, and self-reflecting (asking “what initiatives would be good for us?”), and meeting one-on-one with individuals for a truly personalized approach are among potentially productive strategies for identifying the priorities and DEI-related topics specific to a particular academic sleep program.

Dr. Asare offered up a sample DEI survey (Am J Obstet Gynecol. 2020 Nov;223[5]:715.e1-715.e7), that made direct statements inviting the respondent to check off one of the following responses: Yes, No, Somewhat, Do not know, and Not applicable. Among sample statements:

• Our department is actively committed to issues of diversity, equity, and inclusion.
• Faculty searches in the department regularly attract a diverse pool of highly qualified candidates and/or attract a pool that represents the availability of MDs in this field.
• Our outreach and recruitment processes employ targeted practices for attracting diverse populations.

Dr. Asare said that a survey can be a simple approach for garnering information that can be useful for prioritizing DEI topics of concern and igniting interest in them. Engagement requires regular DEI committee meetings with minutes or a newsletter and with updates and topics brought to faculty meetings.
 

Key DEI areas of focus

Dr. Asare listed several key DEI areas: Recruitment/retention, mentorship, scholarship, and inclusion and community engagement. Under scholarship, for example, she cited topics for potential inclusion in a DEI curriculum: Unconscious bias and anti-racism training, racism, discrimination and microaggression education (bystander/deescalation training), cultural competency and awareness, workplace civility, and health disparities. “We all know that implicit bias in providers is a reality, unfortunately,” Dr. Asare said. Being aware of these implicit biases is a start, but instruction on how to actively overcome them has to be provided. Tools may include perspective-taking, exploring common identity, and self-reflection.

To create an inclusive environment for all faculty, trainees, and staff may involve establishing a “welcome committee” for new faculty, perhaps with designating a “peer buddy,” creating social events and other opportunities for all opinions and ideas to be heard and valued. Particularly for underserved and disadvantaged patient populations, patient advocacy and community service need to be fostered through support groups and provision of resources.

Summarizing, Dr. Asare reiterated several key elements for a successful DEI program: Build a team and discuss the mission, survey the current climate allowing open communication and dialogue, plan and engage, organize, and form areas of DEI focus. Find out where you are and where you want to be with respect to DEI, she concluded.

Dr. Asare declared that she had no conflicts of interest.