Rheumatoid Arthritis

Multiple studies have emphasized the potential for severe COVID-19 outcomes in patients with rheumatic disease, including patients with rheumatoid arthritis (RA). Because these studies often group together patients with different diseases, medications, and manifestations, differences in outcomes between patients with these conditions may be difficult to tease out.

Figueroa-Parra and colleagues performed a retrospective cohort study comparing people with RA who developed COVID-19 to those who did not have RA to examine the effect of RA characteristics, such as interstitial lung disease (ILD), serostatus, and bone erosions, on COVID-19 outcomes. Patients with RA, particularly those with seropositive RA, bone erosions, and RA-associated ILD, had approximately twofold (or higher) risk for severe COVID-19 outcomes, such as mortality or mechanical ventilation, than did those without RA. However, there was no difference in outcomes seen between patients with RA who were seropositive compared with those who were seronegative, with or without bone erosions, or with or without ILD. The mechanism by which RA phenotypes and their treatment affect this risk remains unclear.

Li and colleagues also looked at COVID-19 outcomes in patients with RA according to vaccination status using a UK primary care database. Among unvaccinated patients, the risk for SARS-CoV-2 infection and hospitalization or mortality because of COVID-19 were modestly higher in people with RA. Among vaccinated patients, there was no increased risk for breakthrough infection, COVID-19 hospitalization, or mortality observed in patients with RA over 3 or 6 months of follow-up, with a slight increase over 9 months of follow-up. Overall, both studies support prior research suggesting a higher risk for more severe COVID-19 in patients with RA, as well as potential mitigation with vaccination.

Predictors of RA course and severity are of great interest in determining the optimal therapy to reduce joint damage and prevent RA progression while also minimizing the adverse effects of treatment. Early disease course has been shown to be important in several studies. Giollo and colleagues compared patients with "difficult-to-treat RA," ie, RA that is resistant to multiple biologic disease-modifying antirheumatic drugs (bDMARD) or targeted synthetic DMARD (tsDMARD), with those without in an inception cohort study and found that early difficult management as well as delay of methotrexate initiation was associated with persistent inflammatory symptoms. This finding does not show a causative relationship between methotrexate and protection from the development of refractory RA but does lend support for early aggressive treatment in patients with a high inflammatory burden.

Conversely, Parisi and colleagues performed a subanalysis of the STARTER study of patients with RA in clinical remission to evaluate the impact of different therapies. The STARTER study had shown an association between ultrasound detection of tenosynovitis and RA flares. Of the more than 250 patients completing the study, ultrasound evidence of tenosynovitis was better controlled in patients on combination bDMARD and conventional synthetic DMARD (csDMARD) therapy than in those on csDMARDs monotherapy, with a trend toward reduction in flares in patients on combination therapy. Given the relatively small effect, it is not clear that combination therapy is associated with deeper remission, but, as suggested in prior studies, ultrasound evidence of tenosynovitis may be worthwhile considering prior to tapering therapy.

Multiple studies have emphasized the potential for severe COVID-19 outcomes in patients with rheumatic disease, including patients with rheumatoid arthritis (RA). Because these studies often group together patients with different diseases, medications, and manifestations, differences in outcomes between patients with these conditions may be difficult to tease out.

Figueroa-Parra and colleagues performed a retrospective cohort study comparing people with RA who developed COVID-19 to those who did not have RA to examine the effect of RA characteristics, such as interstitial lung disease (ILD), serostatus, and bone erosions, on COVID-19 outcomes. Patients with RA, particularly those with seropositive RA, bone erosions, and RA-associated ILD, had approximately twofold (or higher) risk for severe COVID-19 outcomes, such as mortality or mechanical ventilation, than did those without RA. However, there was no difference in outcomes seen between patients with RA who were seropositive compared with those who were seronegative, with or without bone erosions, or with or without ILD. The mechanism by which RA phenotypes and their treatment affect this risk remains unclear.

Li and colleagues also looked at COVID-19 outcomes in patients with RA according to vaccination status using a UK primary care database. Among unvaccinated patients, the risk for SARS-CoV-2 infection and hospitalization or mortality because of COVID-19 were modestly higher in people with RA. Among vaccinated patients, there was no increased risk for breakthrough infection, COVID-19 hospitalization, or mortality observed in patients with RA over 3 or 6 months of follow-up, with a slight increase over 9 months of follow-up. Overall, both studies support prior research suggesting a higher risk for more severe COVID-19 in patients with RA, as well as potential mitigation with vaccination.

Predictors of RA course and severity are of great interest in determining the optimal therapy to reduce joint damage and prevent RA progression while also minimizing the adverse effects of treatment. Early disease course has been shown to be important in several studies. Giollo and colleagues compared patients with "difficult-to-treat RA," ie, RA that is resistant to multiple biologic disease-modifying antirheumatic drugs (bDMARD) or targeted synthetic DMARD (tsDMARD), with those without in an inception cohort study and found that early difficult management as well as delay of methotrexate initiation was associated with persistent inflammatory symptoms. This finding does not show a causative relationship between methotrexate and protection from the development of refractory RA but does lend support for early aggressive treatment in patients with a high inflammatory burden.

Conversely, Parisi and colleagues performed a subanalysis of the STARTER study of patients with RA in clinical remission to evaluate the impact of different therapies. The STARTER study had shown an association between ultrasound detection of tenosynovitis and RA flares. Of the more than 250 patients completing the study, ultrasound evidence of tenosynovitis was better controlled in patients on combination bDMARD and conventional synthetic DMARD (csDMARD) therapy than in those on csDMARDs monotherapy, with a trend toward reduction in flares in patients on combination therapy. Given the relatively small effect, it is not clear that combination therapy is associated with deeper remission, but, as suggested in prior studies, ultrasound evidence of tenosynovitis may be worthwhile considering prior to tapering therapy.

Multiple studies have emphasized the potential for severe COVID-19 outcomes in patients with rheumatic disease, including patients with rheumatoid arthritis (RA). Because these studies often group together patients with different diseases, medications, and manifestations, differences in outcomes between patients with these conditions may be difficult to tease out.

Figueroa-Parra and colleagues performed a retrospective cohort study comparing people with RA who developed COVID-19 to those who did not have RA to examine the effect of RA characteristics, such as interstitial lung disease (ILD), serostatus, and bone erosions, on COVID-19 outcomes. Patients with RA, particularly those with seropositive RA, bone erosions, and RA-associated ILD, had approximately twofold (or higher) risk for severe COVID-19 outcomes, such as mortality or mechanical ventilation, than did those without RA. However, there was no difference in outcomes seen between patients with RA who were seropositive compared with those who were seronegative, with or without bone erosions, or with or without ILD. The mechanism by which RA phenotypes and their treatment affect this risk remains unclear.

Li and colleagues also looked at COVID-19 outcomes in patients with RA according to vaccination status using a UK primary care database. Among unvaccinated patients, the risk for SARS-CoV-2 infection and hospitalization or mortality because of COVID-19 were modestly higher in people with RA. Among vaccinated patients, there was no increased risk for breakthrough infection, COVID-19 hospitalization, or mortality observed in patients with RA over 3 or 6 months of follow-up, with a slight increase over 9 months of follow-up. Overall, both studies support prior research suggesting a higher risk for more severe COVID-19 in patients with RA, as well as potential mitigation with vaccination.

Predictors of RA course and severity are of great interest in determining the optimal therapy to reduce joint damage and prevent RA progression while also minimizing the adverse effects of treatment. Early disease course has been shown to be important in several studies. Giollo and colleagues compared patients with "difficult-to-treat RA," ie, RA that is resistant to multiple biologic disease-modifying antirheumatic drugs (bDMARD) or targeted synthetic DMARD (tsDMARD), with those without in an inception cohort study and found that early difficult management as well as delay of methotrexate initiation was associated with persistent inflammatory symptoms. This finding does not show a causative relationship between methotrexate and protection from the development of refractory RA but does lend support for early aggressive treatment in patients with a high inflammatory burden.

Conversely, Parisi and colleagues performed a subanalysis of the STARTER study of patients with RA in clinical remission to evaluate the impact of different therapies. The STARTER study had shown an association between ultrasound detection of tenosynovitis and RA flares. Of the more than 250 patients completing the study, ultrasound evidence of tenosynovitis was better controlled in patients on combination bDMARD and conventional synthetic DMARD (csDMARD) therapy than in those on csDMARDs monotherapy, with a trend toward reduction in flares in patients on combination therapy. Given the relatively small effect, it is not clear that combination therapy is associated with deeper remission, but, as suggested in prior studies, ultrasound evidence of tenosynovitis may be worthwhile considering prior to tapering therapy.

Key clinical point: Higher rehabilitation dose (>8 physical/occupational therapy visits) improved physical function in adults with rheumatoid arthritis (RA) who reported new rehabilitation visits after at least 1 year without rehabilitation visits.

Major finding: Worse physical function at baseline was associated with a higher rehabilitation dose (adjusted odds ratio [aOR] 1.29; 95% CI 1.04-1.60). Higher vs. lower rehabilitation dose was also associated with clinically favorable changes in physical function (aOR 1.41; 95% CI 1.03-1.92).

Study details: This prospective cohort analysis evaluated the data of 1,381 adults with RA from the FORWARD registry who reported new rehabilitation visits of low/medium/high dose over 6 months after no rehabilitation visits for past ≥1 year.

Disclosures: This study did not receive any specific funding. LM Thoma and E Wellsandt reported receiving support from the Rheumatology Research Foundation and/or National Institutes of Health.

Source: Thoma LM et al. Examining rehabilitation dose in adults with rheumatoid arthritis: Association with baseline factors and change in clinical outcomes. Arthritis Care Res (Hoboken). 2022 (Sep 12). Doi: 10.1002/acr.25019

Key clinical point: Higher rehabilitation dose (>8 physical/occupational therapy visits) improved physical function in adults with rheumatoid arthritis (RA) who reported new rehabilitation visits after at least 1 year without rehabilitation visits.

Major finding: Worse physical function at baseline was associated with a higher rehabilitation dose (adjusted odds ratio [aOR] 1.29; 95% CI 1.04-1.60). Higher vs. lower rehabilitation dose was also associated with clinically favorable changes in physical function (aOR 1.41; 95% CI 1.03-1.92).

Study details: This prospective cohort analysis evaluated the data of 1,381 adults with RA from the FORWARD registry who reported new rehabilitation visits of low/medium/high dose over 6 months after no rehabilitation visits for past ≥1 year.

Disclosures: This study did not receive any specific funding. LM Thoma and E Wellsandt reported receiving support from the Rheumatology Research Foundation and/or National Institutes of Health.

Source: Thoma LM et al. Examining rehabilitation dose in adults with rheumatoid arthritis: Association with baseline factors and change in clinical outcomes. Arthritis Care Res (Hoboken). 2022 (Sep 12). Doi: 10.1002/acr.25019

Key clinical point: Higher rehabilitation dose (>8 physical/occupational therapy visits) improved physical function in adults with rheumatoid arthritis (RA) who reported new rehabilitation visits after at least 1 year without rehabilitation visits.

Major finding: Worse physical function at baseline was associated with a higher rehabilitation dose (adjusted odds ratio [aOR] 1.29; 95% CI 1.04-1.60). Higher vs. lower rehabilitation dose was also associated with clinically favorable changes in physical function (aOR 1.41; 95% CI 1.03-1.92).

Study details: This prospective cohort analysis evaluated the data of 1,381 adults with RA from the FORWARD registry who reported new rehabilitation visits of low/medium/high dose over 6 months after no rehabilitation visits for past ≥1 year.

Disclosures: This study did not receive any specific funding. LM Thoma and E Wellsandt reported receiving support from the Rheumatology Research Foundation and/or National Institutes of Health.

Source: Thoma LM et al. Examining rehabilitation dose in adults with rheumatoid arthritis: Association with baseline factors and change in clinical outcomes. Arthritis Care Res (Hoboken). 2022 (Sep 12). Doi: 10.1002/acr.25019

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