Rheumatoid Arthritis

Follow-up radiographs after an initial baseline reading in patients with rheumatoid arthritis or psoriatic arthritis may still show radiographic progression despite treatment with current therapies, but it’s unclear if they will affect treatment decisions between patients and doctors that may take place regardless of the radiographic information, according to arguments made for and against their usefulness in a point-counterpoint session at the 2023 Rheumatology Winter Clinical Symposium.

Alvin Wells, MD, PhD, director of the department of rheumatology at Advocate Aurora Health in Franklin, Wisc., said that x-rays “reflect the history of joint pathology” and can get worse over time, correlating with disease activity and severity.

BSIP/UIG/GettyImages

While RA does not yet have the “holy grail” of complete or true remission, Dr. Wells argued, the combination of clinical remission, laboratory remission, and imaging remission gets patients with RA close to the ideal when measured over time. “You need to continue to monitor these patients as you follow them along,” he said.

The BARFOT study, which evaluated 1,938 patients with early RA in two cohorts during 1992-1999 and again between 2000 and 2006, showed that more active treatments in the 2000s did not result in improvements in Health Assessment Questionnaire (HAQ) and pain scores, compared with patients treated in the 1990s. “You can see in some of those patients those scores do increase, and that even despite aggressive therapies that we had in 2006, you can still see some of those patients still have progression of the disease,” Dr. Wells explained. “How did they know? Because they looked.”

He also cited a study from researchers at the Mayo Clinic who examined 586 patients with RA that showed a higher prevalence of functional disability in patients with RA who also had radiographic changes, compared with patients without RA. “Radiographic changes correlate with disease severity and functional disability as well,” Dr. Wells said.

Just as prostate-specific antigen levels are used in prostate cancer screening and hemoglobin A1c is measured in diabetes management, radiographs should be used to track progression of disease in RA and PsA, Dr. Wells argued. “[I]f you don’t know, you can’t treat,” he said.

Some patients near remission may have radiographic progression even though disease activity measurements such as C-reactive protein (CRP) values do not show presence of active disease. In a study analyzing 1,184 patients with RA in the ASPIRE, ERA, Leflunomide, PREMIER and TEMPO trials, swollen joint count (SJC) was a better predictor of radiographic progression than CRP in patients near remission.

“[E]ven where you don’t see smoke, there still could be fire,” Dr. Wells said. “Some of these patients still progress and these are outliers, and the way they saw that [was] because they followed those patients along. If you don’t look, you don’t know.”

Radiographic progression can also be seen among nonswollen joints in patients with RA and PsA. In a study of 1,207 joints in 55 patients with RA and 352 joints in 18 patients with PsA, researchers in Austria found tenderness in nonswollen joints was associated with radiographic progression.

Despite having effective treatments in RA and PsA, “none of our therapies show that they’re able to prevent progression,” Dr. Wells said.

When it comes to hitting the treatment target in RA, some rheumatologists may think they can accomplish it without use of repeated radiographs. “I have a different perspective on that – that you really do indeed need to do the x-rays today and follow those x-rays along, especially if it’s going to change your treatment paradigm and what your treatment decision would be for the patient,” he said.
 

Counterpoint: Repeat radiographs aren’t helpful

Almost all rheumatologists would likely order an initial radiograph for their patients with RA or PsA, Roy M. Fleischmann, MD, clinical professor of medicine at the University of Texas and codirector of the Metroplex Clinical Research Center, both in Dallas, said in his presentation.

“If you see erosions when you start, chances are you’re going to be much more aggressive,” Dr. Fleischmann said. “So it is justification for early, more aggressive treatment of disease.”

In recent decades, radiographic progression in RA has decreased as more effective antirheumatic treatments have come into use, Dr. Fleischmann argued.

“We had x-ray progression in virtually everybody, and it was consistent no matter what we treated with, which was gold or penicillamine or any of the NSAIDs or sulfasalazine,” he said. “With methotrexate ... about 60% of patients actually have no x-ray progression, and that was a major change, and that’s one of the reasons why methotrexate has become the keystone of therapy. But even with methotrexate, [we] still had many patients who progressed.”

After the introduction of tumor necrosis factor inhibitors and other mechanisms in the late 1990s, “all of a sudden, you don’t see x-ray progression – mean x-ray progression – in a group of patients,” he noted.

Many rheumatologists now use a treat-to-target strategy, and if the patient achieves true clinical remission or sustained very low disease activity as measured by Boolean remission, Simple Disease Activity Index, or Clinical Disease Activity Index, they have “very little chance of radiographic progression and functional decline,” he said.

“If a patient doesn’t achieve remission or very low disease activity, obtaining a radiograph doesn’t change what you do because the patient’s not where they want to be, where you want them to be; you’re going to make a change anyway,” Dr. Fleischmann explained. “The radiograph isn’t going to help you do that.”

If a patient is in sustained remission but a radiograph is ordered and shows disease progression, he questioned what the rheumatologist would do in that situation.

“Now the patient’s in, let’s say, a Boolean remission. They have no tender joints. They have no swollen joints ... their pain assessment is zero, their CRP is zero, and they do have some x-ray progression. Where are you going to change?” Dr. Fleischmann asked. “There’s no data that anything else would work. I don’t know what you would do. So, in conclusion, I would say you really don’t need to repeat an x-ray.”
 

AI reading x-rays?

Commenting on the point-counterpoint session, Arthur Kavanaugh, MD, professor of medicine at the University of California, San Diego, and director of RWCS, asked Dr. Fleischmann and Dr. Wells how they address the issue of how many radiologists seem to be unfamiliar with reading hand radiographs and RA progression.

Dr. Fleischmann said he was trained in how to read hand radiographs in medical school, but that training no longer appears to be occurring. “If you have a good bone radiologist, of which there are not a lot, you’re great. But if you don’t have a really good bone radiologist, it’s difficult,” he said.

Dr. Kavanaugh alluded to the advancement of artificial intelligence (AI) in radiology and posed the question of how both rheumatologists felt about AI reading and interpreting their radiographs. “If you could reliably submit x-rays and they would say what the Sharp score was and where the differences were, would that change anything?” he asked.

“I think having artificial intelligence read the x-ray or an MRI is really, really good. It’ll be better than the radiologists,” Dr. Fleischmann responded. “But I don’t think that you really need to repeat the x-ray. I mean, I really don’t think you need to repeat it. You need to treat the patient.”

Dr. Wells reported having financial relationships with numerous pharmaceutical companies. Dr. Fleischmann reported no relevant financial relationships.

Follow-up radiographs after an initial baseline reading in patients with rheumatoid arthritis or psoriatic arthritis may still show radiographic progression despite treatment with current therapies, but it’s unclear if they will affect treatment decisions between patients and doctors that may take place regardless of the radiographic information, according to arguments made for and against their usefulness in a point-counterpoint session at the 2023 Rheumatology Winter Clinical Symposium.

Alvin Wells, MD, PhD, director of the department of rheumatology at Advocate Aurora Health in Franklin, Wisc., said that x-rays “reflect the history of joint pathology” and can get worse over time, correlating with disease activity and severity.

BSIP/UIG/GettyImages

While RA does not yet have the “holy grail” of complete or true remission, Dr. Wells argued, the combination of clinical remission, laboratory remission, and imaging remission gets patients with RA close to the ideal when measured over time. “You need to continue to monitor these patients as you follow them along,” he said.

The BARFOT study, which evaluated 1,938 patients with early RA in two cohorts during 1992-1999 and again between 2000 and 2006, showed that more active treatments in the 2000s did not result in improvements in Health Assessment Questionnaire (HAQ) and pain scores, compared with patients treated in the 1990s. “You can see in some of those patients those scores do increase, and that even despite aggressive therapies that we had in 2006, you can still see some of those patients still have progression of the disease,” Dr. Wells explained. “How did they know? Because they looked.”

He also cited a study from researchers at the Mayo Clinic who examined 586 patients with RA that showed a higher prevalence of functional disability in patients with RA who also had radiographic changes, compared with patients without RA. “Radiographic changes correlate with disease severity and functional disability as well,” Dr. Wells said.

Just as prostate-specific antigen levels are used in prostate cancer screening and hemoglobin A1c is measured in diabetes management, radiographs should be used to track progression of disease in RA and PsA, Dr. Wells argued. “[I]f you don’t know, you can’t treat,” he said.

Some patients near remission may have radiographic progression even though disease activity measurements such as C-reactive protein (CRP) values do not show presence of active disease. In a study analyzing 1,184 patients with RA in the ASPIRE, ERA, Leflunomide, PREMIER and TEMPO trials, swollen joint count (SJC) was a better predictor of radiographic progression than CRP in patients near remission.

“[E]ven where you don’t see smoke, there still could be fire,” Dr. Wells said. “Some of these patients still progress and these are outliers, and the way they saw that [was] because they followed those patients along. If you don’t look, you don’t know.”

Radiographic progression can also be seen among nonswollen joints in patients with RA and PsA. In a study of 1,207 joints in 55 patients with RA and 352 joints in 18 patients with PsA, researchers in Austria found tenderness in nonswollen joints was associated with radiographic progression.

Despite having effective treatments in RA and PsA, “none of our therapies show that they’re able to prevent progression,” Dr. Wells said.

When it comes to hitting the treatment target in RA, some rheumatologists may think they can accomplish it without use of repeated radiographs. “I have a different perspective on that – that you really do indeed need to do the x-rays today and follow those x-rays along, especially if it’s going to change your treatment paradigm and what your treatment decision would be for the patient,” he said.
 

Counterpoint: Repeat radiographs aren’t helpful

Almost all rheumatologists would likely order an initial radiograph for their patients with RA or PsA, Roy M. Fleischmann, MD, clinical professor of medicine at the University of Texas and codirector of the Metroplex Clinical Research Center, both in Dallas, said in his presentation.

“If you see erosions when you start, chances are you’re going to be much more aggressive,” Dr. Fleischmann said. “So it is justification for early, more aggressive treatment of disease.”

In recent decades, radiographic progression in RA has decreased as more effective antirheumatic treatments have come into use, Dr. Fleischmann argued.

“We had x-ray progression in virtually everybody, and it was consistent no matter what we treated with, which was gold or penicillamine or any of the NSAIDs or sulfasalazine,” he said. “With methotrexate ... about 60% of patients actually have no x-ray progression, and that was a major change, and that’s one of the reasons why methotrexate has become the keystone of therapy. But even with methotrexate, [we] still had many patients who progressed.”

After the introduction of tumor necrosis factor inhibitors and other mechanisms in the late 1990s, “all of a sudden, you don’t see x-ray progression – mean x-ray progression – in a group of patients,” he noted.

Many rheumatologists now use a treat-to-target strategy, and if the patient achieves true clinical remission or sustained very low disease activity as measured by Boolean remission, Simple Disease Activity Index, or Clinical Disease Activity Index, they have “very little chance of radiographic progression and functional decline,” he said.

“If a patient doesn’t achieve remission or very low disease activity, obtaining a radiograph doesn’t change what you do because the patient’s not where they want to be, where you want them to be; you’re going to make a change anyway,” Dr. Fleischmann explained. “The radiograph isn’t going to help you do that.”

If a patient is in sustained remission but a radiograph is ordered and shows disease progression, he questioned what the rheumatologist would do in that situation.

“Now the patient’s in, let’s say, a Boolean remission. They have no tender joints. They have no swollen joints ... their pain assessment is zero, their CRP is zero, and they do have some x-ray progression. Where are you going to change?” Dr. Fleischmann asked. “There’s no data that anything else would work. I don’t know what you would do. So, in conclusion, I would say you really don’t need to repeat an x-ray.”
 

AI reading x-rays?

Commenting on the point-counterpoint session, Arthur Kavanaugh, MD, professor of medicine at the University of California, San Diego, and director of RWCS, asked Dr. Fleischmann and Dr. Wells how they address the issue of how many radiologists seem to be unfamiliar with reading hand radiographs and RA progression.

Dr. Fleischmann said he was trained in how to read hand radiographs in medical school, but that training no longer appears to be occurring. “If you have a good bone radiologist, of which there are not a lot, you’re great. But if you don’t have a really good bone radiologist, it’s difficult,” he said.

Dr. Kavanaugh alluded to the advancement of artificial intelligence (AI) in radiology and posed the question of how both rheumatologists felt about AI reading and interpreting their radiographs. “If you could reliably submit x-rays and they would say what the Sharp score was and where the differences were, would that change anything?” he asked.

“I think having artificial intelligence read the x-ray or an MRI is really, really good. It’ll be better than the radiologists,” Dr. Fleischmann responded. “But I don’t think that you really need to repeat the x-ray. I mean, I really don’t think you need to repeat it. You need to treat the patient.”

Dr. Wells reported having financial relationships with numerous pharmaceutical companies. Dr. Fleischmann reported no relevant financial relationships.

Follow-up radiographs after an initial baseline reading in patients with rheumatoid arthritis or psoriatic arthritis may still show radiographic progression despite treatment with current therapies, but it’s unclear if they will affect treatment decisions between patients and doctors that may take place regardless of the radiographic information, according to arguments made for and against their usefulness in a point-counterpoint session at the 2023 Rheumatology Winter Clinical Symposium.

Alvin Wells, MD, PhD, director of the department of rheumatology at Advocate Aurora Health in Franklin, Wisc., said that x-rays “reflect the history of joint pathology” and can get worse over time, correlating with disease activity and severity.

BSIP/UIG/GettyImages

While RA does not yet have the “holy grail” of complete or true remission, Dr. Wells argued, the combination of clinical remission, laboratory remission, and imaging remission gets patients with RA close to the ideal when measured over time. “You need to continue to monitor these patients as you follow them along,” he said.

The BARFOT study, which evaluated 1,938 patients with early RA in two cohorts during 1992-1999 and again between 2000 and 2006, showed that more active treatments in the 2000s did not result in improvements in Health Assessment Questionnaire (HAQ) and pain scores, compared with patients treated in the 1990s. “You can see in some of those patients those scores do increase, and that even despite aggressive therapies that we had in 2006, you can still see some of those patients still have progression of the disease,” Dr. Wells explained. “How did they know? Because they looked.”

He also cited a study from researchers at the Mayo Clinic who examined 586 patients with RA that showed a higher prevalence of functional disability in patients with RA who also had radiographic changes, compared with patients without RA. “Radiographic changes correlate with disease severity and functional disability as well,” Dr. Wells said.

Just as prostate-specific antigen levels are used in prostate cancer screening and hemoglobin A1c is measured in diabetes management, radiographs should be used to track progression of disease in RA and PsA, Dr. Wells argued. “[I]f you don’t know, you can’t treat,” he said.

Some patients near remission may have radiographic progression even though disease activity measurements such as C-reactive protein (CRP) values do not show presence of active disease. In a study analyzing 1,184 patients with RA in the ASPIRE, ERA, Leflunomide, PREMIER and TEMPO trials, swollen joint count (SJC) was a better predictor of radiographic progression than CRP in patients near remission.

“[E]ven where you don’t see smoke, there still could be fire,” Dr. Wells said. “Some of these patients still progress and these are outliers, and the way they saw that [was] because they followed those patients along. If you don’t look, you don’t know.”

Radiographic progression can also be seen among nonswollen joints in patients with RA and PsA. In a study of 1,207 joints in 55 patients with RA and 352 joints in 18 patients with PsA, researchers in Austria found tenderness in nonswollen joints was associated with radiographic progression.

Despite having effective treatments in RA and PsA, “none of our therapies show that they’re able to prevent progression,” Dr. Wells said.

When it comes to hitting the treatment target in RA, some rheumatologists may think they can accomplish it without use of repeated radiographs. “I have a different perspective on that – that you really do indeed need to do the x-rays today and follow those x-rays along, especially if it’s going to change your treatment paradigm and what your treatment decision would be for the patient,” he said.
 

Counterpoint: Repeat radiographs aren’t helpful

Almost all rheumatologists would likely order an initial radiograph for their patients with RA or PsA, Roy M. Fleischmann, MD, clinical professor of medicine at the University of Texas and codirector of the Metroplex Clinical Research Center, both in Dallas, said in his presentation.

“If you see erosions when you start, chances are you’re going to be much more aggressive,” Dr. Fleischmann said. “So it is justification for early, more aggressive treatment of disease.”

In recent decades, radiographic progression in RA has decreased as more effective antirheumatic treatments have come into use, Dr. Fleischmann argued.

“We had x-ray progression in virtually everybody, and it was consistent no matter what we treated with, which was gold or penicillamine or any of the NSAIDs or sulfasalazine,” he said. “With methotrexate ... about 60% of patients actually have no x-ray progression, and that was a major change, and that’s one of the reasons why methotrexate has become the keystone of therapy. But even with methotrexate, [we] still had many patients who progressed.”

After the introduction of tumor necrosis factor inhibitors and other mechanisms in the late 1990s, “all of a sudden, you don’t see x-ray progression – mean x-ray progression – in a group of patients,” he noted.

Many rheumatologists now use a treat-to-target strategy, and if the patient achieves true clinical remission or sustained very low disease activity as measured by Boolean remission, Simple Disease Activity Index, or Clinical Disease Activity Index, they have “very little chance of radiographic progression and functional decline,” he said.

“If a patient doesn’t achieve remission or very low disease activity, obtaining a radiograph doesn’t change what you do because the patient’s not where they want to be, where you want them to be; you’re going to make a change anyway,” Dr. Fleischmann explained. “The radiograph isn’t going to help you do that.”

If a patient is in sustained remission but a radiograph is ordered and shows disease progression, he questioned what the rheumatologist would do in that situation.

“Now the patient’s in, let’s say, a Boolean remission. They have no tender joints. They have no swollen joints ... their pain assessment is zero, their CRP is zero, and they do have some x-ray progression. Where are you going to change?” Dr. Fleischmann asked. “There’s no data that anything else would work. I don’t know what you would do. So, in conclusion, I would say you really don’t need to repeat an x-ray.”
 

AI reading x-rays?

Commenting on the point-counterpoint session, Arthur Kavanaugh, MD, professor of medicine at the University of California, San Diego, and director of RWCS, asked Dr. Fleischmann and Dr. Wells how they address the issue of how many radiologists seem to be unfamiliar with reading hand radiographs and RA progression.

Dr. Fleischmann said he was trained in how to read hand radiographs in medical school, but that training no longer appears to be occurring. “If you have a good bone radiologist, of which there are not a lot, you’re great. But if you don’t have a really good bone radiologist, it’s difficult,” he said.

Dr. Kavanaugh alluded to the advancement of artificial intelligence (AI) in radiology and posed the question of how both rheumatologists felt about AI reading and interpreting their radiographs. “If you could reliably submit x-rays and they would say what the Sharp score was and where the differences were, would that change anything?” he asked.

“I think having artificial intelligence read the x-ray or an MRI is really, really good. It’ll be better than the radiologists,” Dr. Fleischmann responded. “But I don’t think that you really need to repeat the x-ray. I mean, I really don’t think you need to repeat it. You need to treat the patient.”

Dr. Wells reported having financial relationships with numerous pharmaceutical companies. Dr. Fleischmann reported no relevant financial relationships.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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